Guidance

Heat-Health Alert action card for national government

Updated 21 March 2024

Applies to England

Who this action card is for

This Heat-Health Alert (HHA) action card summarises the suggested actions that national government, for example NHS England, UK Health Security Agency (UKHSA), Department of Health and Social Care (DHSC), Met Office, Cabinet Office, Local Government Association (LGA), other government departments should consider to prepare for and respond to each HHA alert type:

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

The actions are illustrative and organisations including the NHS, local authorities, Local Health Resilience Partnerships (LHRPs) and Local Resilience Forums (LRFs) should ensure that local plans are developed and in place for the coming summer as part of wider preparedness and response to extreme heat events.

Other resources

Sector specific and more detailed guidance can be found on GOV.UK:

• Hot weather and health: supporting vulnerable people
• Hot weather advice: planning events and mass gatherings
• Beat the heat guidance
• Weather-Health Alerting System: user guide

About HHA action cards

The HHA action cards have been updated to reflect the new impact-based HHA warning systems, which have been developed in tandem with the Adverse Weather and Health Plan (AWHP). The AWHP, HHA action cards and associated documents provide a broad framework for action, and local areas and organisations need to tailor these good practice suggestions to their local needs and ensure that these fit with wider local arrangements. HHAs should trigger a series of actions by different organisations and professionals as well as the public, building upon year-round planning activities to ensure hot weather preparedness.

The action cards emphasise the importance of joint working across agencies including the voluntary and community sector, and highlight one of the aims of the plan, which is 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.

The action cards cover the core elements of heat-health action plans recommended by the World Health Organization (WHO) heat-health action plans guidance:

• longer-term development and planning
• preparation before the summer
• prevention during the summer
• specific responses to hot weather
• monitoring and evaluation

Using the HHA action cards

In line with other weather warning systems in operation within England (and the UK) warnings 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. 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) as well as the likelihood (low to high) of those impacts occurring.  This additional information should aid 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 as illustrated below.

Once the decision is made to issue an alert (yellow, amber, or red), 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 is 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. 

Figure 1. Impact and likelihood risk matrix

Green (summer preparedness)

No alert will be issued as the conditions are likely to have minimal impact and health.  However, during periods where 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)

These alerts cover a range of situations.  Yellow alerts may be issued during periods of heat in which would be unlikely to impact most people, but those who are particularly vulnerable (for example the elderly with multiple health conditions and on multiple medications) are likely to struggle to cope and where action is required within the health and social care sector specifically.

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 improves.

Amber (enhanced response)

An amber alert would represent a situation in which the expected impacts are likely to be felt across the whole health service, with potential for the whole population to be at risk and where other sectors apart from health 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) Extreme Heat warning may be issued in conjunction and aligned with the UKHSA HHA. This situation would indicate that significant impacts are expected across multiple sectors.

Red (emergency response)

A red alert would indicate significant risk to life for even the healthy population.  A red warning would be issued in conjunction with and aligned to a red NSWWS Extreme Heat warning. Severe impacts would be expected across all sectors with a coordinated response essential.

Suggested actions to consider all year round to support summer preparedness

Long-term, strategic actions would seek to address the 9 areas of action outlined in the Adverse Weather and Health Plan (AWHP), as appropriate locally, including:

• service delivery
• capacity building
• organisational arrangements
• communication
• risk management
• early warning systems
• research and data analysis
• quality assurance
• policy development and accountability

Within these 9 areas of action, consideration should be given to:

Longer term strategies

Work with partner agencies on longer term strategies to include consideration of plans to prepare for and mitigate the impact of hot weather including housing, infrastructure, and environmental action.

Business Continuity Plans (BCPs) and/or hot weather plans

Work with partner agencies, providers, and businesses to coordinate BCPs and/or hot weather plans, ensuring vulnerable and marginalised groups are appropriately supported. This may include developing and maintaining a register of the most vulnerable individuals to ensure they can be offered appropriate support where required.

Ensure relevant stakeholders are aware of the BCP and hot weather plans and are engaged in preparing for hot weather.

Workplace champions

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

Training plans

Develop a training plan to ensure that staff are aware of BCPs and are engaged in preparing for hot 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 vulnerable people where appropriate.

Escalation protocols

Review and update escalation protocols to ensure all departments know and understand their role.

Surveillance and monitoring

Ensure surveillance and monitoring systems are in place to enable evaluation of the effectiveness of any hot weather interventions that are established nationally or within relevant sectors. Consider monitoring relevant indicators such as Public Health Outcomes Framework and Adult Social Care Outcome Framework.

Pre-summer readiness and summer preparedness

Figure 2. Impact and likelihood risk matrix: green

Suggested areas you can support preparedness are:

Alerts

Test out and ensure that national and organisational dissemination systems for heat health alerts 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 BCPs and/or hot weather plans to ensure that these are up to date, including reviewing AWHP and HHA action cards to adapt suggestions for local circumstances and ensuring escalation protocols are up to date.

Communication

Work with partner agencies to ensure BCP and/or hot weather plans are coordinated across national organisations. Ensure staff are familiar with this action card, any relevant guidance, and your local plans before 1 June each year.

Training

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

Suggested actions to consider for a yellow alert

Figure 3. Impact and likelihood risk matrix: yellow alert

Suggested actions once alert is issued:

• a yellow alert will be sent by UKHSA to those registered to receive the alerts and via other information cascades
• preparations are the overall responsibility of UKHSA; in collaboration with the Met Office, NHS England, DHSC and local bodies, UKHSA and NHS England will make advice available to the public and professionals
• UKHSA and Met Office will continue to monitor the weather forecast and undertake dynamic risk assessment considering the likely temperatures and expected impacts and adjust the alert accordingly
• organisations will monitor their own information and intelligence

Suggested actions once alert is in effect:

• central government departments should cascade the alert and other relevant information through their own stakeholder networks and front-line communication systems
• UKHSA and Met Office will continue to monitor the weather forecast and undertake dynamic risk assessment considering the likely temperatures and expected impacts and adjust the alert accordingly
• DHSC will ensure other government departments are aware of the change in alert level and can brief ministers as appropriate
• UKHSA will make advice available to the public and professionals in affected regions via the NHS, DHSC (GovNet), and Met Office websites
• NHS England will hold health services to account for taking appropriate actions to prepare for hot weather
• organisations will monitor their own information and intelligence

Suggested actions to consider for an amber alert

Figure 4. Impact and likelihood risk matrix: amber alert

Suggested actions once alert is issued:

• an amber alert will be sent by the UKHSA to those registered to receive the alerts and via other information cascades
• central government departments should cascade the alert and other relevant information through their own stakeholder networks and front-line communication systems
• DHSC will ensure other government departments are aware of the change in alert level and can brief ministers as appropriate
• NHS England will hold health services to account for taking appropriate actions to prepare for hot weather
• organisations to monitor own information and intelligence
• UKHSA and Met Office will continue to monitor the weather forecast and undertake dynamic risk assessment considering the likely temperatures and expected impacts and adjust the alert accordingly
• NHS England will muster mutual aid when requested by local services
• following agreed escalation procedures, the Met Office may issue an amber National Severe Weather Warning (NSWWS) in alignment with an amber HHA for regions is England

Suggested actions to consider for a red alert

Figure 5. Impact and likelihood risk matrix: red alert

Suggested actions once alert is issued:

• emergency response alert issued at national level in light of cross-government assessment of the weather conditions, coordinated by COBR Unit based in the Cabinet Office
• following agreed escalation procedures, a red HHA and red NSWWS will be issued for regions in England
• Cabinet Office COBR Unit to consider coordinating asummer resilience network meeting
• all departments and agencies to be prepared to feed into situational awareness as appropriate and coordinated by Cabinet Office
• implementation of national emergency response arrangements by central government

Central government response is likely to involve:

• national government departments
• executive agencies
• public sector, including health sector
• voluntary sector
• UKHSA and Met Office will continue to monitor the weather forecast and undertake dynamic risk assessment considering the likely temperatures and expected impacts and adjust the alert accordingly
• Extreme Heat response to consider compounding hazards and how these may hamper the response (for example wildfires and drought)