Guidance

Cold-Health Alert action card for commissioners

Updated 20 October 2023

Who this action card is for

This Cold-Health Alert (CHA) action card summarises the suggested actions that commissioners of health and social care should take to prepare for and respond to each CHA type, including:

• commissioners of health and social care services
• local authorities
• directors of public health
• Integrated Care Systems

These include actions to consider:

• all year round to support winter preparedness
• for pre-winter readiness and winter preparedness
• for a yellow alert
• for an amber alert
• for a red alert

The actions are illustrative. Commissioners should work with organisations such as NHS England, local authorities, Local Health Resilience Partnerships (LHRPs) and Local Resilience Forums (LRFs) to ensure that local plans are developed and in place for the coming winter as part of wider preparedness and response to adverse cold weather events.

About cold weather and health: who is at risk

Whilst exposure to cold can affect anyone, some people are particularly at risk. These include:

• older people (aged 65 and above)
• people with cardiovascular (heart and circulation) 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

There are many reasons for the increased risk of ill health in cold weather. These include:

• poor quality housing and particularly cold homes
• the higher frequency of circulating infectious diseases, such as flu and norovirus during the winter months
• physical hazards such as snow and ice

During cold weather, people may also use malfunctioning or inappropriate appliances to heat their homes. This can increase the risk of carbon monoxide poisoning. When a house is damp as well as cold, mould is more likely to occur. This can increase the risk of illness, especially from asthma.

Further information on who is at risk from cold and why can be found in the AWHP supporting evidence document.

About the Cold-Health Alert action cards

The Cold-Health Alert (CHA) action cards have been updated to reflect the new ‘impact-based’ CHA warning systems, which have been developed in tandem with the Adverse Weather and Health Plan (AWHP). The AWHP, CHA action cards and associated documents provide a broad framework for action, and local areas and organisations should tailor these good-practice suggestions to their local needs and ensure that these fit with wider local arrangements.

A CHA should trigger a series of actions by different organisations and professionals as well as the public, building upon year-round planning activities to ensure cold-weather preparedness. The action cards emphasise the importance of joint working across agencies including the voluntary and community sectors and highlight one aim of the AWHP: to ensure that there is an integrated response to severe weather events across sectors. Local areas will need to consider those actions indicated in the relevant section which will need to be taken jointly across organisations and sectors.

Using the Cold-Health Alert action cards

In line with other weather-warning systems in operation within England (and the UK), CHAs will be issued 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 (Figure 1). 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 at-risk groups, such as rough sleepers or people using adult social care services, through to wider impacts on the general population) as well as 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, the combination of impact and likelihood will be displayed within a risk matrix as illustrated below.

Once a CHA is issued, it will be cascaded to everyone registered to receive the alerts as well as being made available on the dedicated web platform. CHAs will be issued with as much lead time to the cold weather event as possible to allow users time to make local assessments and to initiate all appropriate actions to reduce harm to health. Users should review every CHA when issued to ensure they fully understand the potential impacts and how likely they are to occur.

The following sections explain the alert levels in more detail.

Figure 1. Impact and likelihood risk matrix

Green (winter preparedness)

No alert will be issued as the conditions are likely to have minimal impact on health. However, during periods when the risk is minimal, it is important that organisations ensure that they have plans in place and are prepared to respond should an alert (yellow, amber or red) be issued.

Yellow (response)

Yellow alerts cover a range of situations in which action is required within the health and social care sector. Yellow CHAs may be issued during periods of cold weather which would be unlikely to impact most people. However, those who are particularly vulnerable (for example older people with multiple health conditions and on multiple medications, or those who are sleeping rough and at greater risk of cold exposure) are likely to struggle to cope in these conditions. A yellow alert may also be issued if the confidence in the weather forecast is low, but there could be more significant impacts if the worst-case scenario is realised. In this situation the alert may be upgraded as the confidence in both the weather forecast and the likelihood of observing those impacts increases.

Amber (enhanced response)

An amber CHA represents a situation in which the expected impacts are likely to be felt across the health and social care sectors, with potential for the whole population to be at risk. Other sectors, apart from health and social care (for example transport) may also start to observe impacts, indicating that a coordinated response is required. In addition, in some circumstances a National Severe Weather Warning Service (NSWWS) warning may be issued for snow, ice or wind in conjunction with and aligned to the CHA. This situation would indicate that significant impacts are expected across multiple sectors.

Red (emergency response)

A red CHA would indicate significant risk to life for everyone, including the healthy population. Severe impacts would be expected across all sectors, and a coordinated response is essential. The UK government will declare an emergency if there is severe or prolonged cold weather affecting sectors other than health and social care, and if the conditions require a coordinated multi-agency response.

Actions to consider all year round to support cold weather preparedness

Long-term, strategic actions

Consideration should be given to the following:

Identify those at risk

Develop an understanding of the local population and groups who may be vulnerable to the impacts of cold weather on health through Integrated Care Partnerships, Joint Strategic Needs Assessments (JSNAs) and other interagency arrangements. Consider how your winter plans can help to protect those groups most likely to be affected, and how they might target high-risk groups and address the wider determinants of health.

Develop local strategic plans

Ensure Integrated Care Partnership strategies and Joint Local Health and Wellbeing Strategies (JHWSs) address longer-term resilience-building for the population and infrastructure. Working with partner agencies, incorporate arrangements to prepare for and mitigate against the impact of cold weather into long-term health improvement and organisational plans. These should include identifying and improving the resilience of those individuals and communities most at risk and ensuring that a local, joined-up programme is in place. Such plans should include working with partner agencies, planning and infrastructure providers, and communities.

Work with partners

Work with partner agencies, providers, businesses and voluntary and community sector organisations to coordinate business continuity plans (BCPs) and/or cold weather plans, ensuring vulnerable and marginalised groups are appropriately supported. Commissioners should work with partners to ensure that cold weather planning features within wider winter resilience planning, and that a strategic approach to the reduction of excess winter deaths and fuel poverty is taken across the local health and social care economy.

Commissioners should also work with partners on ways to reduce risk for staff, for example through flu vaccination in September and October, and providing information and education to help them manage and reduce health risks arising from cold exposure.

Work with planning and other infrastructure providers

Commissioners should ensure that a local, joined-up programme is in place to support improved housing, heating and insulation, including uptake of energy-efficient, low-carbon solutions and other measures to reduce internal energy use and help better retain heat.

Work with communities

Engage the community and voluntary sector to support development of local community emergency plans for adverse cold weather, and to ensure that BCPs are fit for purpose. Working with local communities (and especially representatives from vulnerable groups) can help to ensure that plans are co-produced in a way that maximises the potential uptake of recommended actions.

Data-sharing agreements

Ensure appropriate 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.

Surveillance and monitoring

Ensure surveillance and monitoring systems are in place to enable evaluation of the effectiveness of any locally established cold weather interventions, drawing on sources such as relevant Public Health Outcomes Framework indicators and metrics and UKHSA’s syndromic surveillance systems as appropriate.

Cold weather preparedness

Figure 2. Impact and likelihood risk matrix: green

While the risk matrix remains green (or similar), there are still areas of preparedness which you can support:

Alerts

The AWHP (figure 3) outlines how CHAs should be cascaded across the health and social care system (and more broadly). You should:

• test out and ensure that these systems for distributing CHAs are fully operational and effective locally
• ensure that key partners, including all managers of care homes and other residential settings are aware of the alert system, can access advice and can understand what actions to take
• review and update relevant distribution lists for information and weather-alert cascades

Audit

Complete an audit of organisational BCPs and/or cold weather plans to ensure that these are up to date, including reviewing AWHP and CHA action cards to adapt suggestions for local circumstances.

Communication

Ensure that the most important public health messages around preparedness for cold weather exposure are communicated using a variety of channels (for example online or using posters) to ensure accessibility for different audiences. Engage representatives from the relevant communities and/or groups to ensure that the appropriate communications channels and communicators are used.

Ensure care homes, GPs, primary and community care services, hospitals and other health and care providers are aware of the AWHP and any local cold weather plans and are engaged in preparing for cold weather.

Liaise with other institutional establishments (for example prisons and schools) to promote awareness of cold-weather guidance and local cold-weather plans.

Develop proactive messages aimed at the public, especially to vulnerable groups and underserved populations, to communicate during weather alerts. These messages should accurately communicate the nature of risks to health from cold, and concrete, actionable steps that can be taken to manage these risks. They may draw on existing materials such as UKHSA’s ‘keeping warm and well’ guidance. These messages (and the channels through which they are communicated) should be co-developed with representatives from the relevant populations.

Integrated Care Boards and Health and Wellbeing Boards may wish to consider monitoring the preparedness of local providers via their Integrated Care Partnership Strategies and Joint Local Health and Wellbeing Strategies. They may also wish to test the robustness of local dissemination and communication strategies for alerts.

Training

Ensure relevant staff members are aware of and understand BCPs and/or cold weather plans, including ensuring relevant staff have received training where applicable.

Work with partners

Identify which local health, social care and voluntary and community sector organisations are most vulnerable to the effects of cold weather.

With local partners, agree plans for coping with surges in demand for services during winter and make sure that emergency contacts are up to date. Ensure that organisations and staff are prompted to signpost vulnerable clients onwards, for example for energy efficiency measures, benefits or related advice.

Where relevant, liaise with providers of emergency shelters for people experiencing rough sleeping to agree plans for adverse cold weather and ensure capacity to scale up provision.

Support communities to help those at risk, for example through development of community emergency plans.

Suggested actions to consider for a yellow alert

Figure 3. Impact and likelihood risk matrix: yellow alert

Suggested actions once an alert is issued:

• ensure relevant staff members are aware of and understand BCPs and/or cold weather plans, including cascading plans to relevant members of staff
• use the CHA impact matrix to inform the local risk assessment for and response to cold weather
• ensure key partners, including healthcare professionals and all managers of care, residential and nursing homes are aware of the alerts and can access relevant advice
• communicate proactive public health messages aimed at the public, especially to vulnerable groups and underserved populations to help them identify risks of cold exposure and understand how to manage them
• work with partner agencies (for example transport) to ensure arrangements for road and/or pavement gritting are in place to allow access to critical services and pedestrian hotspots if ice and/or snow are expected

Suggested actions once an alert is in effect:

• activate BCPs and emergency plans as required
• use the CHA impact matrix to inform the local risk assessment for and response to cold weather
• increase pro-active communications aimed at the public, especially to underserved populations and vulnerable groups, to help them identify risks of cold exposure and understand how to manage them
• continue to ensure that organisations and staff are prompted to signpost vulnerable people to other sources of support (for example for energy efficiency measures, benefits or related advice)
• activate road/pavement gritting to allow access to critical services and pedestrian hotspots, if ice and/or snow occur

Suggested actions to consider for an amber alert

Figure 4. Impact and likelihood risk matrix: amber alert

Suggested actions once alert is issued:

• activate local BCPs and/or cold weather plans, including cascading alert to relevant members of staff
• support local community organisations to mobilise community emergency plans
• use the CHA impact matrix to inform the local risk assessment for and response to cold weather
• increase the volume and frequency of proactive communication aimed at the public, especially to underserved populations and vulnerable groups, to help them identify risks of cold exposure and understand how to manage them
• support partner organisations to prioritise essential travel especially if ice and/or snow are expected
• engage the community and voluntary sector to mobilise additional support (for example equipment and facilities) to help those most at risk, where necessary
• work with partner agencies (for example transport) to ensure road and pavement gritting arrangements are in effect to allow access to critical services and pedestrian hotspots

Suggested actions to consider for a red alert

Figure 5. Impact and likelihood risk matrix: red alert

Suggested actions once alert is issued:

• follow all local emergency response plans and feed into local (and, where appropriate, national) coordination and response
• use the CHA impact matrix to inform the local risk assessment for and response to cold weather
• increase evidence-based advice to health and social care workers working in the community, health and social care settings, and to the wider workforce
• increase evidence-based communication messages aimed at the public, especially to underserved populations and vulnerable groups, to help them identify risks of cold exposure and understand how to manage them
• issue media alerts about keeping warm and well in adverse cold weather
• support partner organisations to prioritise essential travel especially if ice and/or snow are expected
• mobilise support from the voluntary and community sector to ensure sufficient resources are available to safeguard people who are at-risk during cold weather episodes
• work with partner agencies (for example transport) to ensure road and pavement gritting arrangements are in effect to allow access to critical services and pedestrian hotspots
• continue other actions as per amber alert above unless advised to the contrary

Other resources

Sector-specific and more detailed guidance can be found for:

• Keeping warm and well: staying safe in cold weather
• Supporting vulnerable people before and during cold weather: for adult social care managers
• Supporting vulnerable people before and during cold weather: for healthcare professionals
• Supporting vulnerable people before and during cold weather: people homeless and sleeping rough
• Top tips for keeping warm and well in winter – leaflet
• Keeping warm and well: staying safe in cold weather – poster
• Weather-Health Alerting System: user guide