Guidance

Cold-Health Alert action card for health and social care providers

Updated 20 October 2023

Who this action card is for

This Cold-Health Alert (CHA) action card summarises the suggested actions that providers of health or social care should consider to prepare for and respond to each CHA type. It is intended primarily for managers and staff working in the following settings:

• hospitals
• adult or children’s social care providers in care homes and other residential settings
• health and/or social care providers in the community operating from fixed sites such as GP surgeries
• services delivering care to people in their homes

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. Providers should work with organisations including 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.

In a clinical or care setting with a patient or client, staff should exercise professional judgement and respond appropriately to the patient’s needs. Staff should be aware of the effects of cold weather on health, and when they notice a client or patient at risk of cold, for example from living in a home that is too cold, should know what immediate actions to take to ensure the patient’s safety. There should be clear guidelines for them to make other necessary arrangements (for example addressing housing issues) in the immediate and longer term.

Not all actions recommended in this action card will apply to managers working in all of the settings listed above: sections below disaggregate actions by setting where relevant. Managers and staff should carefully consider those actions that apply to the settings in which they work, for the health and wellbeing of their clients or patients and staff, and read this action card alongside guidance for social care, for healthcare settings, for people who sleep rough and others as appropriate.

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

Managers and staff should consider the following:

Identify those at risk

If you work for a service delivering care to people in their homes, establish methods to identify, alert and monitor individuals most vulnerable to cold-related illnesses on your caseload. Methods for identifying vulnerable people should include reference to clinical advice if staff are unsure whether someone is at risk. These considerations should also extend to carers – considering their needs and what care they may be able to give in the event of adverse cold weather.

Work to identify those at risk may include developing and maintaining a register of the most vulnerable individuals.

Ensure that organisations and staff are prompted to signpost vulnerable people to relevant sources of support to help protect them from cold (for example for energy efficiency measures, benefits or related advice).

Business continuity plans (BCPs) and/or cold weather plans

In all settings:

• ensure that you are engaged with local Emergency Preparedness, Response and Recovery (EPRR) and other strategic arrangements for winter planning
• ensure that the organisational BCP includes adverse cold weather as a potential risk and that plans are in place for possible surges in demand for services during the winter
• consider how best to mobilise and engage community organisations and support the development of community emergency plans.

Work with partners

In all settings, work with commissioners, other providers, businesses and other partners as appropriate to coordinate BCPs and/or cold weather plans, ensuring vulnerable and marginalised groups are appropriately supported and are involved in the planning process.

Training plans

If you work in a community setting, develop a training plan to ensure that staff are aware of the local cold weather plans and are engaged in preparing for adverse cold weather. The plan should also help staff to identify those most likely to be at risk from cold weather and advise on how to raise concerns where necessary, drawing on established resources such as UKHSA’s Helping People Living in Cold Homes e-learning module.

Data sharing agreements

In all settings, 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.

Environmental improvements

In all settings, consider environmental improvements that need to be made to your premises to provide a safe environment during cold weather. For example:

• draught-proof windows, doors and other points of energy loss
• ensure heating systems are maintained and in good working order

Cold weather preparedness (green)

Figure 2. Impact and likelihood risk matrix: green

Suggested areas you can support preparedness are:

Alerts

In all settings:

• test out and ensure that organisational systems for distributing CHAs are fully operational and effective, and that staff can access advice, and understand what actions to take depending on the alert level
• review and update relevant distribution lists for information and weather alert cascades

Audit

In all settings, 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

In all settings:

• ensure staff are familiar with this action card, any relevant guidance and your local plans before 1 November each year
• ensure that the most important public health messages around preparedness for cold weather exposure are communicated using channels that maximise accessibility (for example posters)
• take advantage of clinical contacts to reinforce public health messages about cold weather and cold homes on health
• develop proactive messages aimed at the people using your services, especially to vulnerable groups and underserved populations, to communicate during weather alerts on simple actions they can take to guard against health risks from cold – these can draw on 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)

Protecting people at risk

In all settings:

• promote vaccination for COVID-19 and/or flu among service users who are eligible, to help reduce risks from respiratory infections during the winter – this should also apply to staff as a preventive measure to reduce the risk of respiratory infections during winter, depending on their eligibility
• ensure staff members are taking other actions as set out in UKHSA cold weather guidance for vulnerable groups, including those in healthcare settings, in adult social care settings, and for people who are sleeping rough – as appropriate to your setting

If you work in a care home or other residential setting, a hospital or a fixed site in the community, such as a GP surgery:

• ensure that plans are in place to be able to monitor room temperature, body temperature, pulse rate and blood pressure to protect residents
• identify points of higher risk of injury on their premises in the event of ice and/or snow, such as at entrances and exits and playground areas, and prioritise these for clearance or gritting when snow and/or ice occur – this would include ensuring adequate supplies of relevant equipment (for example shovels and gloves)

If you deliver care to people in their homes, ensure that organisations and staff are prompted to signpost those vulnerable to cold weather to:

• sources of support for keeping their home warm and with cost of living support, including help to manage energy bills, as needed
• advice on simple measures to improve home energy efficiency and safety to reduce risks that may increase in cold weather (for example from carbon monoxide exposure) as outlined in UKHSA’s Keeping warm and well: staying safe in cold weather guidance
• advice on things that can be done to find out what’s causing damp and/or mould at home and how to address it, where relevant – new guidance from the Office for Health Improvement and Disparities (OHID) outlines what private and social rented landlords should do to respond to damp and mould and take preventative action

Training

In all settings, ensure relevant staff members are aware of and understand BCPs and/or cold weather plans, including ensuring relevant staff have received training on appropriate actions to take under these plans where applicable.

Work with partners

In all settings:

• agree plans with local partners for coping with surges in demand for services and make sure that emergency contacts are up to date
• where relevant, liaise with providers of emergency shelter for people experiencing homelessness to agree plans for adverse cold weather and ensure capacity to scale up provision

Suggested actions to consider for a yellow alert

Figure 3. Impact and likelihood risk matrix: yellow alert

Suggested actions once an alert is issued

In all settings:

• 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
• consider how to make best use of available capacity in preparation for surges in demand, for example by using community beds for at-risk patients who do not need an acute bed and enabling access to step-down care
• ensure road/pavement gritting preparations are in place to allow access to critical services and pedestrian hotspots if ice and/or snow are expected

If you work in a care home or other residential setting, a hospital or a fixed site in the community such as a GP surgery:

• monitor temperatures inside buildings especially where people spend most time and aim to keep to 18°C (for example by keeping windows and doors closed to reduce draughts)
• prioritise maintenance of heating systems to keep rooms being used warm
• ensure that clients/patients have access to other ways of keeping warm (for example blankets and warm drinks) if needed

If you work for a service delivering care to people in their homes:

• ensure that staff are prompted to signpost vulnerable people to other sources of support
• communicate proactive messages aimed at the people using your services, especially to vulnerable groups and underserved populations to help them understand health risks from cold weather and simple actions they can take to guard against these, drawing on materials such as UKHSA’s Keeping warm and well: staying safe in cold weather guidance

Suggested actions once an alert is in effect

In all settings:

• activate BCPs and emergency plans as required
• use the CHA impact matrix to inform the local risk assessment for and response to cold weather
• activate road and pavement gritting to allow access to critical services and pedestrian hotspots, if ice and/or snow occur

If you work in a hospital, a fixed site in the community such as a GP surgery or for a service delivering care to people in their homes:

• increase evidence-based advice to health and social care workers on ways of identifying those at risk from cold and ways to manage their needs, drawing on UKHSA guidance for adult social care managers and healthcare providers, and general population messages as appropriate
• increase pro-active communication aimed at the public, especially to underserved populations and vulnerable groups, to help reduce risks from cold exposure
• ensure staff are undertaking appropriate home checks when visiting clients or patients, for example room temperature, medications and food supplies, and that unpaid carers are receiving appropriate advice and support
• ensure that high-risk individuals are actively monitored during cold weather episodes, and that those most vulnerable to cold-related illnesses have visitor or phone call arrangements in place
• ensure that staff are prompted to signpost vulnerable people to other sources of support (for example for energy efficiency measures, benefits or related advice)

Suggested actions to consider for an amber alert

Figure 4. Impact and likelihood risk matrix: amber alert

Suggested actions once alert is issued

In all settings:

• activate local BCPs and/or cold weather plans, including cascading alert to relevant members of staff
• use the CHA impact matrix to inform the local risk assessment for and response to cold weather
• support staff to determine how and where to prioritise travel, especially if ice and/or snow occur
• activate road and pavement gritting to allow access to critical services and pedestrian hotspots, if ice and/or snow occur

If you work in hospital, a fixed site in the community such as a GP surgery, or for a service that delivers care to people in their homes:

• increase evidence-based advice to health and social care workers on ways of identifying those at risk from cold and ways to manage their needs, drawing on UKHSA guidance for adult social care managers and healthcare providers, and general population messages as appropriate
• increase evidence-based communication aimed at the public, especially to underserved populations and vulnerable groups, to help reduce risks from cold exposure – using resources such as UKHSA’s Keeping warm and well in cold weather poster
• ensure that high-risk individuals are actively monitored during cold weather episodes, and that those most vulnerable to cold-related illnesses have visitor or phone call arrangements in place

Suggested actions to consider for a red alert

Figure 5. Impact and likelihood risk matrix: red alert

Suggested actions once alert is issued

In all settings:

• 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
• activate road and pavement gritting to allow access to critical services and pedestrian hotspots, if ice and/or snow occur
• support staff to determine how and where to prioritise travel
• continue other actions as per amber alert above unless advised to the contrary

If you work in hospital or for a service that delivers care to people in their homes:

• increase evidence-based advice to health and social care workers on ways of identifying those at risk from cold, and ways to manage their needs, drawing on UKHSA guidance for adult social care managers and healthcare providers, and general population messages as appropriate
• increase evidence-based communication aimed at the public, especially to underserved populations and vulnerable groups, to help reduce risks from cold exposure – using resources such as UKHSA’s Keeping warm and well in cold weather poster
• ensure that high-risk individuals are actively monitored during cold weather episodes, and that those most vulnerable to cold-related illnesses have visitor or phone call arrangements in place
• mobilise community and voluntary support especially for those who are at-risk from cold, and who may not be able to readily access services via other routes

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