Guidance

Warm spaces in England: an evidence review and toolkit for local organisations

Published 23 November 2023

Applies to England

Executive summary

This toolkit provides a framework for organisations seeking to develop or evaluate a warm space for their local population during the winter. Based on a systematic literature review, a small survey of local authorities across England and guidance from an expert network of providers of such spaces, this toolkit has been developed to help increase the effectiveness of warm spaces being set up to provide support to local populations through the winter months. The toolkit includes case studies sharing examples of best and promising practice as well as signposting to resources to support organisations in developing their warm space offer.

Evaluating warm spaces is one of the ways in which the evidence base for these services could be strengthened. This toolkit represents a first step towards supporting organisations to generate evidence of the health and wellbeing effectiveness of their warm space service.

Background

There is a significant body of evidence demonstrating the health risks of exposure to cold weather (1). In countries that routinely experience extreme cold weather, such as Canada and the USA, so-called ‘warming centres’ have been a longstanding approach to sheltering some of the most vulnerable members of society including rough sleepers in particular (2 to 4).

In England, concerns around the increasing costs of living and heating during winter 2022 to 2023 saw the emergence of local interventions to establish warm spaces (5 to 7). Typically, these were established and run by local authorities, communities, and voluntary, community and social enterprise sector organisations to offer a warm space, often with additional resources, for example hot drinks, internet access and support services.

A systematic review of the literature carried out by the UK Health Security Agency (UKHSA) (Appendix A) identified some of the features contributing to the use (or otherwise) of warm spaces, including ease of access, the provision of advice and support, and access to food and drink (Figure 1). The review also showed that the evidence base underpinning the effectiveness of these types of interventions, particularly from a health and wellbeing perspective, is underdeveloped. As such, the contribution that warm spaces can make in addressing societal inequalities is unclear.

Figure 1. Factors contributing to the use (or otherwise) of warm spaces

Facilitators:

• provision of food or drink
• offering social activities and interaction
• welcoming atmosphere
• advice and support services for cold weather
• easy access via public transport
• flexible opening hours

Barriers:

• security concerns
• travel or access issues
• caring or work commitments
• lack of knowledge or understanding about warm spaces

This toolkit provides a framework for organisations to consider when running or developing a warm space and provides an evaluation framework to increase understanding of what does and does not work when setting up and running such services. It is based on evidence from the systematic literature review and a survey of local providers of warm spaces in England (Appendix B), The toolkit includes case studies sharing examples of best and promising practice as well as signposting to resources to support organisations in developing their warm space offer.

Toolkit aim and objectives

This toolkit provides evidence, resources, and a framework of principles to assist organisations in the local delivery and evaluation of warm spaces in England. It should be tailored to the local context.

The objectives of the toolkit are to:

• help build engagement and collaboration between organisations setting up warm spaces, including sharing of evidence, case studies, and examples of what does and does not work, based on local experience in England
• provide practical assistance and knowledge to help organisations undertake high quality evaluations of warm spaces and link to main resources currently available
• help organisations consider the merits of creating warm spaces as an intervention to support their populations during adverse cold weather in line with UKHSA’s Adverse Weather and Health Plan

Toolkit development

To develop this toolkit, several different methods were employed:

1. A systematic review of the literature on the public health effectiveness of warm spaces was undertaken. This review identified the paucity of evidence related to the effectiveness of warm spaces but also provided some evidence of barriers and facilitators for the set-up and running of warm spaces. This is described in more detail in Appendix A.

2. A network of organisations from across England with experience of running warm spaces in winter 2022 to 2023 was convened. Participants were identified through grey literature searches undertaken as part of the systematic literature review. The network met 3 times during summer 2023 to share learning and case studies covering the setting up, running and evaluation of warm spaces, examples of which are included in this toolkit.

3. Commissioners and providers of warm spaces were invited to participate in an online survey in July 2023 via the healthy places knowledge hub and regional networks. This is described in more detail in Appendix B.

The above evidence has been synthesised to provide the basis for the framework of principles within this toolkit.

Toolkit

Setting up and running warm spaces

There are several resources available to support organisations in setting up and running warm spaces. For example, the Chartered Institute of Library and Information Professionals published ‘A Warm Welcome: setting up a warm space in your community’ (5), which is a guide providing practical suggestions for warm spaces to consider, including planning an accessible warm space, training and safeguarding considerations for volunteers and staff. The Warm Welcome Campaign provides support to warm spaces by hosting a community of practice, sharing resources, providing branding and communications as well as offering funding collaborations.

Sections below outline suggested approaches, based on the evidence gathered through the 3 methods described above, for local organisations to consider when setting up and running warm spaces to enable them to begin to evaluate the impact and effectiveness of their warm spaces.

Understand the needs of your local population

Your local population is likely to have unique needs and vulnerabilities to cold weather. It is important to understand the demographic profile of your population, social vulnerabilities, as well as identifying community assets; collectively these will inform how you might design an appropriate warm space service for your population.

Demographic factors to consider in your area could include the number of people over 65 years old, young children (particularly those aged under 5 years), and those from Gypsy, Roma or Traveller communities. You could use the Core20PLUS framework to help you to identify specific populations.

Social factors to consider include people sleeping rough, those who are homeless or at risk of homelessness, areas of deprivation, housing quality (such as homes which are hard to heat, or which rely on traditional heating methods) and new arrivals (such as refugees, asylum seekers and other immigrants).

Consider the findings and recommendations in the Marmot Review 10 Years On report to support the identification of priority areas and populations (8).

Understand your local assets

Assets are things like skills, knowledge, capacity, resources or buildings which communities have. This could include venues, local businesses, places of worship, local people and groups, faith leaders, and parish or town councils.

Your local authority may hold relevant data for you to consider when planning your warm space offer. This information is often published publicly within the local joint strategic needs assessment for your community.

Your warm space should seek to reduce health inequalities; an equality impact assessment may be helpful to identify access needs and potential barriers for people with protected characteristics, in addition to any vulnerable groups you have identified locally.

It is good practice to involve your local community and community organisations in decision-making about their community assets, people at risk, and the services within it as this can improve the effectiveness and the reach of your service to your local population. See A guide to community-centred approaches for health and wellbeing for more detail. This was published by Public Health England (PHE), which has now become UKHSA.

Define your priority groups

Carefully define the groups who would benefit from your warm space service, as this is likely to influence the location, type of service, and activities or support offered. For example, a warm space service tailored to people sleeping rough would be very different to one aimed at older people living in their own homes.

The National Institute for Health and Care Excellence (NICE) guidelines on excess winter deaths and illness and the health risks associated with cold homes may provide useful background evidence to help identify populations that may benefit most from your warm space.

It may be that your service is ‘open to all’ but think carefully about how you can tailor the service to support those most at risk in your community.

Understand what has been tried before, locally, and elsewhere, as relevant to the groups you are looking to support. The case studies in this toolkit may provide some useful suggestions.

Warm space locations

The location and accessibility of your warm space services will be critical to its success. Consider how your audience will reach the service, for example, if it is accessible by foot or public transport, whether secure bicycle or mobility scooter parking is available, and whether it is in an area that may be attractive for other reasons, such as near shops or other services, such as a GP practice.

Aim to narrow health inequalities rather than widen them, for example prioritise locations in more deprived areas with fewer community assets, rather than those that are more affluent and well served by other services.

Our evidence shows that building on existing services and assets, such as a library, is more effective than setting up a bespoke service or emergency shelter, as the community may already know and trust the service, staff, and area.

Consider links to other local organisations such as voluntary, community or social enterprise organisations, food partnerships, libraries, or family hubs. Using established services should also reduce capital and set-up costs.

Consider collaboration with local businesses, such as cafés, that may have good relationships with the audience, and combining spaces as this may also help to minimise costs by capitalising on existing facilities and subsiding running expenses.

Consider the security and accessibility considerations of your chosen site.

Make the offer attractive

Evidence shows that warm spaces providing entertainment and services see a much higher footfall than those solely designed as a place for people to go to be warm. Services could consider providing wifi, books, games, and social interaction.

Provide hot drinks and snacks. Warm or hot food is best as this would help attendees to stay warm.

Consider what timings attendees would benefit from. For instance, warm spaces for those rough sleeping may be needed overnight, whereas older people may prefer a daytime service.

Some warm spaces offer additional support services, (such as debt advice, or social services), which may be helpful to attendees. However, consider carefully if this could be potentially off-putting to people.

Case study: ‘Warm items’ project – Kirklees council

Kirklees Council Public Health team procured a range of warm items that were handed out to identified residents in need via warm spaces based in libraries.

Warm items procured included warm clothing (including base layers, hats, scarves, gloves, socks and fleece jackets), hot water bottles, heated blankets, microwave wheat packs and electric hand warmers.

As a result of this scheme, 234 households received one or more warm item(s) as a result of this scheme, with most receiving more than one item. This included:

• 26 households with children (11%)
• 145 households with pensioners (62%)
• 29 households with a disabled person (12%)

Avoid stigma

Consider how to brand the service. Although commonly called ‘warm spaces’ some evidence suggests that this is potentially stigmatising.

Branding may focus on other benefits or services offered, with a place providing warmth being one of many benefits of using the service. For example, some services have opted for terms like ‘welcoming spaces’ instead of ‘warm spaces’ to focus on the social benefits of the interventions.

Promote the offer

Consider the messaging and choice of communication channels for the service. It is recommended to co-produce communications, where possible. For example, community contributions can ensure messages about service benefits are understood and that communications are culturally appropriate.

Consider how your message will reach your audience. Many services have used social media. However, it is important to note that a digital communications strategy may not be appropriate for all.

Consider aligning your service alongside other health promoting opportunities such as seasonal vaccinations campaigns like flu or COVID-19.

Many areas and organisations have created maps or repositories of warm spaces in their area, in order to make it easy for people to find their local warm spaces. An example is Leeds City Council. The Warm Welcome campaign and Warm Spaces host online directories of warm spaces through which you can register your warm space locations and people can use to search for warm spaces near them.

Evaluating the impact of warm spaces

Evaluation is an essential part of improving the quality of services, informing decision making and building an evidence base. A well-thought-out evaluation can be useful for future commissioning of services and sharing findings can help other providers improve their services.

There is not a strong evidence base for warm spaces, so even a simple evaluation will be useful. While not all the suggested approaches will be appropriate for every warm space, when evaluating your warm space please consider the following steps.

Planning your evaluation

It’s important to consider:

• who will conduct the evaluation
• who will be asked to participate in an evaluation
• what questions will be asked
• who will collect and analyse the data
• how the findings will be used

Anyone can undertake an evaluation; however, you may wish to consider collaborating with your local authority public health team, local academic institutions such as universities for additional advice or support, particularly with regards to conducting your evaluation and analysing your data.

Have clear aims for your service (for example to protect health or alleviate loneliness) and plan to evaluate from the outset of the intervention.

To evaluate your service, it is important to collect information that helps you to assess whether your service has delivered against its objectives. The information you collect should be considered at the beginning.

Consider ways to ensure data collection is simple and straightforward (such as by collecting data at the point attendees register for or arrive at the warm space).

If you decide to conduct a survey, using the same set of questions before and after attendance at a warm space can help you to capture outcomes in a systematic way. Using standardised and validated health and wellbeing measures, such as the Office for National Statistics Personal Wellbeing Indicator (ONS4), which is free, may be useful. The Wellbeing Measures Bank has several suggested measures you could consider.

Consider capturing the inputs for the service, including financial, staffing, and other resources that could be used to help you track the cost effectiveness of the warm space.

Identify the service objectives, which are the impact or changes you hope the service will deliver. These objectives should be specific, measurable, achievable, realistic and time bound (SMART). 

Consider how you can bring the community together to reflect on the warm space, for example holding an evaluation workshop or focus group.

Considering the social value of your warm space may be a helpful way to capture outcomes of your service. Social value is defined by the Local Government Association as the wider financial and non-financial value created by an organisation through its day-to-day activities in terms of the wellbeing of individuals and communities, social capital created and the environment. If you have the resources to do so, a social return on investment evaluation is an approach you may want to consider to evaluate your warm space.

You may need to consider seeking consent to allow you to collect and use certain information. Speak to your Data Protection Officer for more information, if your organisation has one. The Information Commissioner’s Office provides helpful advice for small organisations on a range of uses relating to data protection. 

Figure 2 provides a simple framework which you may find useful as part of developing service objectives, considering the structure, the process, and the resulting outputs and outcomes from the service.

Figure 2: Adapted Donabedian model providing a framework for evaluating warm spaces

Step 1: Design

Has the warm space reached the priority audience?

For example, has it reached specific neighbourhoods, age groups or populations you aimed to?

Step 2: Process

Has the warm space been efficiently used?

For example, what percentage occupancy have you averaged over the time your warm space has been open?

Step 3: Output/outcome

What are the outcomes following the use of your warm space?

For example, did attendees report improvements in their health and wellbeing?

Consider using a simple questionnaire to see the impacts of attendance on health and wellbeing.

Conducting your evaluation

The following sections provide some further detail following the outline of the framework above.

Design: Has the warm space reached the priority audience?

Aim to collect relevant data to understand if the audience of the service were your intended groups. The Core20PLUS framework may be useful to refer back to here, if you used it to help identify your priority audience.

Consider if the overall number of attendees or attendees from specific groups is more important in terms of defining a successful service.

Consider whether attendees were different to your priority audience, and if so, why? For instance, did the more socially engaged and affluent attend because they had better support and travel arrangements, or were services less accessible to some vulnerable groups? You could consider using postcode data to assess neighbourhood reach and/or undertaking a demographics survey to assess age, sex and ethnicity.

Consider conducting surveys of your population in a different environment (for example outside supermarkets) to find out if they were aware of the warm space, if they used it, and if they would recommend it to their friends and family.

Capturing the views of attendees. A simple survey could ask them what they like and dislike about the service, and if they have any suggestions for improvement.

Process: How was the warm space used?

Some services struggle to attract people, and so detailed information on usage is important to understand how successful the service has been and can be more informative than simply measuring overall footfall.

Consider measuring how long people tend to stay, what times people prefer to arrive and depart, and whether the same people come back for further visits.

Aim to measure how people used the warm spaces and what activities were preferred over others.

Capture the views of stakeholders involved in the setting up or providing of warm spaces to gather information on how they felt the warm space was used.

Case study: stakeholder feedback – Kirklees Council

Kirklees Council collated feedback from organisations that provided warm spaces and associated cost-of-living support for residents during winter 2022 to 2023.

The following questions were posed to organisations:

• Did footfall increase?
• Did it reach the people who were most in need? We took a proportionate universalist approach (9) to this work; as such, while all residents were welcome in our warm spaces, priority groups included people experiencing financial hardship, older people, people with long-term conditions and people with disabilities
• What worked well?
• What would need to be different in future?
• Were there any additional benefits to the organisation or community from having a warm space?

Outcome: what are the outcomes following use of your warm space?

Consider the health and wellbeing impact that the warm space has had on attendees. This could be conducted using a simple questionnaire or validated health and wellbeing measures, described in more detail in the planning your evaluation section.

Consider using financial metrics, for example cost per visit, to demonstrate how effectively resources have been allocated.

Consider measuring secondary effects, for example if the funding allowed another service or community provision to continue running during a period of financial strain.

Case study: Evaluation methods – Sandwell Metropolitan Borough Council and the University of Birmingham

The evaluation of Sandwell Metropolitan Borough Council (SMBC) warm space programme was conducted to assess the effectiveness of their warm spaces in meeting the needs of the community and to identify any areas of improvement. It aimed to understand:

• how people perceive warm spaces
• how to most effectively reach people who would benefit from using warm spaces
• how to maximise use of warm spaces
• the barriers and facilitators to using warm spaces

A mixed-method approach was employed for this evaluation involving a quantitative survey of warm-space users and providers and in-depth qualitative interviews with warm-space users (group 1), providers (group 2), and community leaders (group 3). The evaluation tools can be accessed at Evaluation of Sandwell Metropolitan Borough Council warm space programme – methods and tools or Find a welcoming space in Sandwell and include an example provider survey and interview topic guides.

Following this evaluation, important recommendations were made for the future of warm spaces in Sandwell:

• increase the number of warm spaces available in the borough
• improve accessibility of warm spaces, particularly for people with disabilities
• provide more activities and resources at warm spaces
• work with community partners to promote the warm spaces and to raise awareness of their importance

Studying and acting on your evaluation

An important element of evaluation is to share its findings.

Please share any findings from your evaluation of warm spaces with UKHSA at SAWHP@UKHSA.gov.uk

Consider disseminating your findings and evaluations to colleagues and organisations across the country. This may be through existing networks, such as the healthy places knowledge hub (login required).

Use your evaluation to help you consider how you could improve your warm space(s) in subsequent years.

Consider integrating the evaluation process as part of a wider ‘Plan, Do, Study, Act’ (PDSA) cycle, through which you can continuously assess and improve the service.

Building evidence and best practice

As previously described, evaluation is an important process for improving the quality of services, informing decision making and building an evidence-base. The results of any evaluations can be used for the development and improvement of policy for the next cycle of service delivery. The UKHSA Adverse Weather and Health Plan is underpinned by supporting evidence, which underlines the activities and scientific evidence which support the plan. UKHSA is using best practice and best available evidence throughout to feed into the plan and the findings and evidence generated by evaluation of warm spaces will be included in future iterations. Local authorities, local resilience forums, national government organisations and agencies (such as UKHSA), and other delivery groups will also use these findings to improve the guidance on this topic. 

Useful resources

There are several resources available to support local organisations to set up and run their warm spaces:

• The Warm Welcome campaign
• A Warm Welcome: setting up a warm space in your community (5)
• Office for Health Improvement and Disparities Public health profiles
• A guide to community-centred approaches for health and wellbeing – this was published by PHE, which has now become UKHSA

There are also several resources available to support local organisations to evaluate their warm spaces:

• Warm Welcome Impact Evaluation (10)
• Local Government Association social return on investment evaluation tool (11)
• Social Value UK
• Wellbeing measures bank
• The Health Foundation – evaluation: what to consider (12)
• Evaluating community projects: a practical guide (13)

Appendix A: Public health effectiveness of warm spaces during periods of adverse cold weather – a systematic review of the literature

Introduction

In some countries, such as Canada and the USA, warming centres have been a longstanding approach to sheltering some of the most vulnerable members of society from extreme cold weather.

In England, recent cold winters, coupled with concerns around the increased costs of heating, have seen the emergence of small-scale, local interventions to establish warm spaces. However, the effectiveness of warm spaces in improving the health and wellbeing of attendees remains unclear.

The aim of this systematic literature review was to establish the evidence base for warm spaces as a public health strategy.

Methods

UKHSA undertook a systematic literature review using electronic databases (Medline, Embase and Web of Science) as well as CENTRAL and Google Scholar from 1 January 2010 to 14 February 2023. Search terms were constructed based on the keywords identified in an initial rapid review of the available literature undertaken previously by UKHSA and a pilot search undertaken in Medline to assess the application of the keywords.

Studies were screened for inclusion based on titles and abstracts and then full text by 2 reviewers independently. The primary outcomes for consideration were any physical or mental health or wellbeing outcome (including wider determinants of health). Quality assessment was conducted using the Mixed Methods Tool (MMAT) (14).

Figure A1: Flow diagram of systematic literature review process

Identification:

• Records identified from:
  • Medline – 1,458
  • Embase – 1,932
  • Web of Science – 568
  • CENTRAL – 869
  • Google Scholar – 22
• Total – 4,849
• Records removed before screening – 1,261

Screening:

• records screened by title and abstract – 3,588
• records excluded – 3,567
• full text accessed – 21
• records excluded – 17

Inclusion:

• studies included in review – 4

Results

Four studies were identified for inclusion in the final review, all of which were qualitative, using methods including surveys, observations, discussions and interviews. Studies were from 3 countries – Canada (n=2), USA (n=1), UK (n=1) – and 3 studies focused on warm space provision for rough sleepers. One study used interviews from the local community in which a warm space was located.

No studies directly assessed health and wellbeing outcomes following the use of warm spaces; studies focused on the characteristics of attendees and the barriers and facilitators to using warm spaces. Health outcomes assessed included physical and mental health and substance use, while wellbeing outcomes assessed included safety and security. Figure 1 describes the facilitators and barriers identified in the literature.

Discussion

The limited literature identified suggested that warm spaces are typically located in community venues that people visit for other purposes. In England, there are several examples of partnerships between local authorities, communities and voluntary, community and social enterprise sector organisations to offer a warm space, and resources, for example hot drinks and internet access.

In Canada and the USA, warm spaces are often provided specifically for rough sleepers and offer multiple additional services and support. Findings from warm space evaluations identified through this review may not be representative of warm spaces offered to the wider population.

There was limited evidence on the effectiveness of warm spaces on health and wellbeing due to a lack of evaluation of existing facilities. Future development of warm spaces should consider approaches to evaluate the impacts of attendance on health and wellbeing. This could include using ‘big data’ to assess the impact on health and care service use, cold-related morbidity and mortality, as well as measures of loneliness and isolation and improvements in overall wellbeing.

Appendix B: Warm space survey findings

Introduction

Commissioners and providers of warm spaces in the winter of 2022 to 2023 in England were invited to take part in a survey in July 2023 via the healthy places knowledge hub and regional networks. They were asked a series of questions about the location, aim and population of their warm spaces as well as the service being offered. In addition, respondents were asked to provide details of any evaluation undertaken and the barriers and facilitators they experienced in setting up and running their warm spaces.

Results

Responders and settings

There were 13 responses, with the majority from northern regions, (5 from the South East, 3 from the North West, 3 from the North East, one from the East Midlands, one from Yorkshire and Humber).

Ten responses were from local authority or local government organisations and 3 were from the voluntary, community and social enterprise sector.

Ten responders described their population as mainly living in a deprived area and most of these tended to be in urban settings.

One respondent specifically mentioned their area was rural, which meant transport access to the service was difficult.

Priority audience

In terms of targeted provision, 4 warm spaces specifically targeted older people, 5 targeted low-income households and one targeted people experiencing homelessness.

Six responders mentioned alleviating loneliness and social isolation as a core aim of the service.

Types of venue

There was a mix of venues used, and some providers hosted warm spaces in more than one venue.

Ten providers used libraries, 9 used community centres, 5 used cafes and 5 used faith-based venues.

Type of service

There was a mix of provision on offer. The majority (10 out of 13) mentioned that hot drinks were available, and food was available at 8 services.

Some form of entertainment or social activity was also provided at 8 services. Wifi and advice services were mentioned by some respondents (2 out of 13 and 3 out of 13 respectively).

Evaluation

Nearly all providers had conducted some form of evaluation. Several providers had measured user numbers; where user numbers were measured, attendance ranged from fewer than 100 to over 15,000. However, the offers were very different, and these numbers could include use outside of the warm space (for example typical visitors to a library).

Some providers described their services as successful as they felt they had been able to support their local populations which was evidenced in the positive feedback they received. Others reported lower uptake than expected.

Some providers used surveys and case studies to evaluate their warm space offer and assess user satisfaction, which was reported to be high.

No provider had measured health outcomes. 

Barriers

Several providers reported the issue of stigma. Some received feedback to change the name from ‘warm spaces’ to ‘welcoming spaces’ or ‘food and fun’, to avoid stigmatisation.

Transport was cited as major issue for older people, especially in more rural areas. One provider secured bespoke transport for the service.

Funding was reported to be an issue for several and impacted how long the service could run for and opening hours.

Communications and promotions of the service to priority audiences (especially those not using digital media) was reported to be a significant issue by multiple providers. Word of mouth was cited to be the main way people found out about some services.

Poor uptake was attributed by some respondents to bad weather, which is concerning, as it’s potentially during such events that warm spaces could have the greatest benefit.

Some providers cited difficulties in evaluating their services (especially when there was more than one venue) and found getting detailed data on individuals onerous and off-putting to people.

Appendix C: Acknowledgements

We would particularly like to acknowledge the input of the Warm Spaces Evidence and Evaluation Network in preparing this toolkit.

We would also like to acknowledge the many individuals and organisations who have kindly offered their advice and support in developing this toolkit. In particular, we would like to acknowledge the organisations who responded to the warm spaces survey for sharing their case studies and evidence for use in this toolkit. We would also like to acknowledge the work of Natalie Adams, Charles Dearman, and Carl Petrokofsky of UKHSA in preparing this toolkit.

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