Guidance

Cold-Health Alert action card for the voluntary and community sector

Updated 20 October 2023

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This publication is available at https://www.gov.uk/government/publications/cold-weather-plan-action-cards-for-cold-weather-alert-service/cold-health-alert-action-card-for-the-voluntary-and-community-sector

Who this action card is for

This Cold-Health Alert (CHA) action card summarises the suggested actions that voluntary and community sector (VCS) organisations should consider to prepare for and respond to each CHA type.

The VCS covers a wide variety of organisations ranging from broad-based providers, emergency response organisations and campaigning organisations through to representative groups, community centres, parish councils and neighbourhood forums among many others. It includes organisations focusing on:

  • particular conditions
  • particular types of service provision
  • specific client groups or communities

Actions outlined in this card include those 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. Organisations including NHS England, local authorities, Local Health Resilience Partnerships (LHRPs) and Local Resilience Forums (LRFs) should develop frameworks and plans for how voluntary, community and third-sector organisations are involved in the development of local plans in place for the coming winter as part of wider preparedness and response to adverse cold weather.

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

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.

Suggested actions to consider all year round to support cold weather preparedness

Long-term, strategic actions

Identifying those at risk

Establish methods to identify, alert and monitor people most vulnerable to cold-related illnesses on your caseload.

Community Emergency Plans (CEPs) and/or cold weather plans

Ensure that there is a CEP for adverse cold weather to ensure that support can continue to be given to people at risk under these conditions. Work with partner agencies, providers and businesses to coordinate CEPs and/or cold weather plans, ensuring people in vulnerable situations and marginalised groups are appropriately supported. This may include developing and maintaining a register of the most at-risk people and ensuring that organisations and staff are prompted to signpost these individuals to other sources of support (for example for energy efficiency measures, benefits or related advice).

Workplace champions

Consider identifying individuals to be workplace champions to increase awareness among staff and volunteers of the potential risks of adverse weather and climate change. These champions may also encourage staff and volunteers to embed best practice mitigation against, planning for and responding to adverse weather.

Training plans

Develop a training plan to ensure that staff and volunteers are aware of the local cold weather plans and are engaged in preparing for adverse cold weather.

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 at-risk people where appropriate.

Monitoring

Consider ways to monitor interventions to manage the risk of adverse cold weather to enable evaluation of the effectiveness of any cold weather interventions that are established locally.

Built environment improvements

Identify the local and national support available to make improvements in your community. Help individuals you care for to access such support.

Cold weather preparedness

Figure 2. Impact and likelihood risk matrix: green

Suggested areas you can support preparedness are:

Alerts

Test out and ensure that local dissemination systems for CHAs are fully operational and effective, and that staff understand what actions to take. Review and update relevant distribution lists for information and weather alert cascades.

Audit

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

Capacity planning

Assess the impact that cold weather might have on provision of, and access to, usual community venues. Set up rotas of willing volunteers to keep the community safe during cold weather and to check on people at risk. Consider how to deliver support to people who may not be able to access services during cold weather (for example due to location or because of physical or financial constraints).

Communication

Ensure staff, volunteers and stakeholders are aware of cold weather guidance and are engaged in preparing for cold weather. Ensure staff and volunteers are familiar with this action card, any relevant guidance and your local plans before 1 November each year.

Where relevant, help those vulnerable to adverse cold weather by:

Liaise with providers of emergency shelters for people experiencing homelessness to agree plans for adverse cold weather and ensure capacity to scale up provision, drawing on UKHSA guidance for people sleeping rough and SWEP guidance as appropriate.

Protecting those at risk

Promote vaccination for COVID-19 and flu among beneficiaries who are eligible, to help reduce risks from respiratory infections during the winter. This should also apply to staff and volunteers working for VCS organisations who are more vulnerable to cold as a preventive measure to reduce the risk of respiratory infections during winter, depending on their eligibility. Further details of who is vulnerable to cold exposure is available in the AWHP supporting evidence document.

Training

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

Work with partners

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 staff and volunteers are prompted to signpost vulnerable clients onwards or provide relevant advice, using the links above. 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 CEPs.

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 and volunteers are aware of and understand CEP and/or cold weather plans, including cascading plans to relevant members of staff and volunteers
  • use the CHA impact matrix to inform local risk assessments for, and response to, cold weather
  • activate CEPs
  • support the provision of information about health risks from reliable sources such as UKHSA’s ‘keeping warm and well’ guidance – especially to vulnerable groups and underserved populations

Additional considerations for staff working with vulnerable individuals:

  • monitor temperature in places where vulnerable individuals spend substantial time
  • ensure relevant staff know how to check, record and follow internal procedures if a cause for concern is identified

Suggested actions when an alert is in effect:

  • use the CHA impact matrix to inform the local risk assessment for and response to cold weather
  • check individuals most vulnerable to cold-related illnesses have appropriate arrangements in place
  • reaffirm key evidence-based public health messages to the public, especially to vulnerable groups and underserved populations using accessible approaches (for example leaflets, posters and so on)
  • continue to actively engage people known to be at risk and check on welfare regularly and support them to seek help if necessary

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 CEPs and/or cold weather plans, including cascading alert to relevant members of staff, and work with providers and other partners to mobilise these plans
  • use the CHA impact matrix to inform the local risk assessment for and response to cold weather
  • 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
  • ensure staff are undertaking appropriate home checks when visiting clients, for example room temperature, medications and food supplies
  • ensure carers and volunteers are receiving appropriate advice and support to enable them to identify and support staff and volunteers to reduce unnecessary travel
  • discuss within LRF structure how local VCS organisations can be involved as
    • providers of resources, such as equipment (blankets, sleeping bags, stoves), facilities (emergency accommodation) or people (volunteers, signposting)
    • sources of insight and advice on how to best work with and support different communities
    • a means to share information

Suggested actions to consider for a red alert

Figure 5. Impact and likelihood risk matrix: red alert

The UK government will declare an emergency in the event of severe or prolonged cold weather affecting sectors other than health and if requiring coordinated multi-agency response.

Suggested actions once alert is issued:

  • activate local CEPs 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
  • actively monitor high-risk individuals during cold weather episodes, considering daily visits or phone calls to those vulnerable to cold-related illnesses
  • ensure staff are undertaking appropriate home checks when visiting clients, for example room temperature, medications and food supplies
  • ensure carers and volunteers are receiving appropriate advice and support
  • increase communication of key evidence-based public health messages, especially to underserved populations and vulnerable groups
  • 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:

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