Guidance

Supporting vulnerable people before and during cold weather: healthcare professionals

Published 11 September 2023

Applies to England

© Crown copyright 2023

This publication is licensed under the terms of the Open Government Licence v3.0 except where otherwise stated. To view this licence, visit nationalarchives.gov.uk/doc/open-government-licence/version/3 or write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: psi@nationalarchives.gov.uk.

Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned.

This publication is available at https://www.gov.uk/government/publications/cold-weather-and-health-supporting-vulnerable-people/supporting-vulnerable-people-before-and-during-cold-weather-healthcare-professionals

Who is this guidance for

This guidance is for healthcare professionals working in community, care home or hospital environments, including those working in managerial and in patient-facing roles.

This guidance offers advice for caring for people most at risk during cold weather. Healthcare professionals should also consult the Cold-Health Alert action card for healthcare providers. This summarises the suggested actions that healthcare providers should consider when preparing for and responding to each Cold-Health Alert (CHA) type (yellow, amber or red). Additionally, it identifies some of the main long-term strategic actions which will help minimise the burden on health arising from cold weather. Find more information within (about the Cold-Health Alert system) about the CHAs.

Main messages

Adverse cold weather can put people at greater risk of ill-health and even death, primarily because it increases the probability of complications from existing disease, and of injury due to falls.

You can reduce the risks associated with exposure to adverse cold weather for those you care for by:

  • knowing who is at risk
  • being alert to increased cardiovascular, respiratory and other complications from cold exposure
  • adapting individual care plans to respond to adverse cold weather
  • promoting vaccination for those eligible to reduce risks from COVID-19 and flu
  • having action plans in place for your organisation and/or place of work tailored to the local context
  • signposting people to sources of support for housing, energy bills and other needs as appropriate, including specific support for those on low incomes

About cold weather and health

Deaths and illnesses during the winter months are significantly higher than at other times of the year. Cold weather can cause people to become unwell in various ways. Direct cold exposure can result in death or severe illness due to hypothermia, although deaths where hypothermia is the primary cause are relatively rare. Exposure to cold can lead to direct effects including:

  • increase the risk of blood clots forming in the body, in turn increasing the risk of heart attacks and strokes
  • increase susceptibility to chest infections
  • worsen breathing problems
  • increase the risk of falls

Cold exposure can also result in indirect effects such as increased risk from mental health conditions such as depression and anxiety. Cases of carbon monoxide poisoning typically increase during the winter months. This is because people are more likely to use cooking or heating systems at home that worsen indoor air quality and are less likely to ventilate their homes as they would during warmer weather.

Other factors also contribute to increased risks to health during cold weather. These include fuel poverty, poor-quality housing and particularly cold homes. The risk of exposure to an underheated home is greater among those on low incomes, and those who are housebound.

Who is at risk

Many people are vulnerable to the effects of cold weather. These include:

  • people who have chronic medical conditions
  • those living with learning and/or physical disabilities that may prevent them being able to keep warm (for example because they are unable to move around) or leave them at greater risk of developing chest infections
  • those who cannot afford to keep warm enough during the winter months

Those at risk include:

  • older people (aged 65 and over)
  • people with cardiovascular conditions
  • people with respiratory conditions (in particular, chronic obstructive pulmonary disease and childhood asthma)
  • people with mental health conditions
  • people with learning and/or physical disabilities
  • young children (particularly those aged under 5)
  • pregnant women
  • people on a low income

People who are sleeping rough are also at greater risk from cold exposure. Further guidance is available for those working with people sleeping rough.

Hypothermia is defined as a core body temperature less than 35°C. However, best practice clinical guidance is available on how to recognise and manage those suffering from hypothermia, for whom signs and symptoms may include:

  • shivering
  • cognitive impairment
  • changes in pulse and respiratory rates
  • changes in blood pressure levels
  • frostbite

The National Institute for Health and Care Excellence (NICE) offers advice on early recognition of, and action on, complications of cold exposure including strokes, heart attacks and pneumonia.

Older people are at greater risk of falls during periods of adverse cold weather, especially when these are accompanied by snowfall and/or ice. The Office for Health Improvement and Disparities (OHID) has produced guidance for health and care professionals on measures to reduce the risk of falls and fractures in older people in the community.

How to prepare for cold weather

Preparation for cold weather should occur year-round, and plans for managing adverse cold weather events should be agreed and distributed before 1 November each year. The UK Health Security Agency’s (UKHSA) Adverse Weather and Health Plan outlines 9 important areas for action that healthcare organisations and their partners can consider when developing local cold weather plans.

Make as much use as possible of existing care plans to assess which individuals are at particular risk, and to identify what extra help they might need. Where possible, involve their family and any informal carers in these arrangements.

An action card for healthcare providers can be found on GOV.UK . This card covers recommended actions under different CHA levels, spanning preparedness and response.

If you are advising, visiting, supporting, or caring for someone in the community, the following steps should be taken before adverse cold weather happens to reduce health risks to the public.

Actions to take all year round

In preparation for winter, there are actions that you can take depending on the role in which you work.

Managerial role

If you are working in a managerial role, you should establish methods to identify, alert and monitor individuals most vulnerable to cold-related illnesses on your caseload. Consider seeking specialist advice from clinical teams if you are unsure how to determine whether someone is at risk.

You should ensure data sharing agreements or protocols are in place to allow organisations to share data or intelligence, including details of the most vulnerable people where appropriate.

Patient-facing role

If you are working in a patient-facing role, you should consider the needs of carers, the support they can continue to give during periods of adverse cold weather, and what additional support they may need to fulfil their roles during periods of adverse cold weather.

You should develop approaches to include risk in care records and consider whether changes might be necessary to care plans in the event of cold weather.

You should ensure plans are in place to be able to monitor room temperature and, in clinical settings, body temperature, pulse rate and blood pressure.

Actions to take during the winter months

To prepare for adverse cold weather, there are certain actions you can take to identify and protect those at risk, protect yourself, and support training and capacity development.

Managerial role

If you are working in a managerial role, you should support staff training and capacity development by ensuring staff are aware of and understand business continuity plans and/or cold weather plans that apply in their setting, and what actions they may need to take if they are activated.

You should be supporting staff to complete training, where available, to help identify those most likely to be at risk from adverse cold weather, for example by drawing on resources such as UKHSA’s ‘Helping People Living in Cold Homes’ e-learning module.

You can support staff by testing out systems and ensure that local dissemination systems for the CHAs are fully operational and effective and that colleagues you work with understand what actions to take when they receive them. This may include reviewing and updating relevant distribution lists for information and weather alert cascades.

Patient-facing role

If you are working in a patient-facing role, you should help to identify and protect those at risk by ensuring that you have identified all those vulnerable to cold weather on your caseload and that arrangements are in place to support and protect them appropriately. This may include developing and maintaining a register of the most vulnerable individuals to ensure they can be offered appropriate support where required.

You should ensure that you offer COVID-19 and/or flu vaccinations to all those who are eligible, as a preventive measure to reduce the risk of respiratory infections during winter.

For those working in hospital settings, ensure prompt identification of those at risk from adverse cold weather on admission, and put in place plans to enable discharge to warm accommodation.

You should ensure that appropriate home checks are being carried out when visiting clients, for example checking temperatures in rooms (such as living rooms and bedrooms) in which people spend most of their time at home and reviewing medication stocks and food supplies.

You should establish where relevant, referring those that you identify as being at risk from a cold home to local services (for example housing services), who may be able to help improve their living conditions.

You should be ensuring carers are receiving advice and support, for example on signs and symptoms to look out for suggesting that those vulnerable to cold are becoming unwell, or on sources of additional clinical or financial support where necessary.

You should advise on support measures or about how to stay warm and well during cold weather, namely by signposting to the following:

If you are working in a managerial or a patient-facing role, you can protect yourself by getting vaccinated against COVID-19 and/or flu as a preventive measure to reduce the risk of respiratory infections during winter. You can check whether you are eligible for flu vaccination and book an appointment with your employer occupational health service, your pharmacy or your GP, provided that you are eligible. For COVID-19, the NHS will contact you if your records suggest you may be eligible for vaccination.

Responding to cold weather

If a Cold-Health Alert is issued, there are certain actions you can take.

Implement general measures

If you are working in a patient-facing role, you should:

  • ensure local actions for the vulnerable are being carried out such as arranging daily contacts or visits
  • ensure that appropriate home checks are carried out when visiting clients, for example, room temperature, checking medications and food supplies and ensuring carers are receiving appropriate advice and support to help them continue providing care
  • ensure that rooms, particularly living rooms and bedrooms, are kept warm (for those in care, residential and nursing home facilities, and in the community)
  • advise carers to contact nominated clinical leads if they have concerns regarding the health of a patient or client
  • identify and actively monitor high-risk individuals during cold weather episodes, checking that individuals most vulnerable to cold-related illnesses have visitor or phone call arrangements in place

Consider extra care needs

Anyone in a high-risk category who is living alone is likely to need at least daily contact during adverse cold weather, by care workers, volunteers, or informal carers. Individuals at greater risk may need extra care and support.

If you are working in a patient-facing role, check that:

  • the person can contact the primary care team if one of their informal carers is unavailable
  • their care plan contains contact details for their GP, other care workers and informal carers
  • there are adequate arrangements for food shopping and other essentials, to reduce the need for them to go out in adverse cold weather
  • there are mechanisms for escalating the level of care and support available if there is a sudden increase in needs during a period of adverse cold weather

Protect yourself

Whether you are working in a managerial or a patient-facing role, day-to-day practice may be disrupted during adverse cold weather. You may find it difficult to commute to work, or to reach service users through street outreach work. Staff absences may also be more likely during this time due to, for example, respiratory illness. Business continuity plans may therefore need to be implemented.

You should consider:

Further resources and information

Additional documents

About the Cold-Health Alert system

Cold-Health Alerts will be issued to those who have signed up to the CHA system when the weather conditions have the potential to impact the health and wellbeing of the population. The alerts will be given a colour (yellow, amber or red) based on the combination of the impact the weather conditions could have, and the likelihood of those impacts being realised. These assessments are made in conjunction with the Met Office when adverse weather conditions are indicated within the forecast.

Yellow and amber alert assessments cover a range of potential impacts (for example impacts on specific vulnerable groups such as rough sleepers) through to wider impacts on the general population. They also cover the likelihood (low to high) of those impacts occurring. This combination of information on impacts and likelihood should help those making decisions about the appropriate level of response during an alert period. Within the alert that is issued, the combination of impact and likelihood will be displayed within a risk matrix. Red alerts indicate a national emergency with a risk to life for the general population, with wide ranging temperature impacts outside the health sector.

Once the decision is made to issue an alert, these will be cascaded to those registered to receive the alerts and made available on the new dedicated web platform. Alerts will be issued with as much lead time to the event as possible to allow users time to make their local assessments and to initiate all appropriate actions to reduce harm to health. Users should review every alert when issued to ensure they fully understand the potential impacts and how likely they are to occur.

Back to top