Brighton & Hove
Protecting Health and Reducing Harm During Winter
(To be read in conjunction with the Cold Weather Plan for England & supporting guidance)
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Document Control
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Version |
V1.0 Final draft |
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Drafted by: |
Becky Woodiwiss Public Health Principal and Barbara Hardcastle Public Health Specialist Public Health, Health & Adult Social Care Directorate, Brighton and Hove City Council and Brighton & Hove Clinical Commissioning Group |
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Reviewed by: Approved by:
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Health and Adult Social Care Directorate Management Team October 2021 B&H Health Protection & Screening Forum, September 2021 |
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Date Issued: |
September 2021 |
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Review Date: |
September 2022 |
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Target Audience: |
Brighton & Hove City Council Health & Adult Social Care, other Directorates, partner agencies and Local Health Economy. Including The Health Protection & Screening Forum, NHS secondary and community providers, Clinical Commissioning Group (CCG), Primary care, Out of Hours (OOHs) Provider, & Brighton & Hove City Council, Community and Voluntary sector |
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Mandatory / Statutory guidance Requirements
Winter guidance and advice
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Civil Contingencies Act 2004 http://www.legislation.gov.uk/ukpga/2004/36/contents NHS EPRR Framework & associated guidance http://www.england.nhs.uk/ourwork/gov/eprr/ Public Health England Cold Weather Plan for England http://www.gov.uk/phe/cold-weather-plan BHCC Covid19 Local Outbreak Plan https://new.brighton-hove.gov.uk/local-covid-19-outbreak-plan NHS Community Health guidance https://www.england.nhs.uk/coronavirus/ Annual seasonal influenza (flu) vaccination programme https://www.gov.uk/government/publications/national-flu-immunisation-programme-plan Keep Warm Keep Well - NHS Choices (www.nhs.uk) Met Office Weather Ready pages ‘Are you ready for winter ? https://www.metoffice.gov.uk/weather/warnings-and-advice/weatherready Excess winter deaths and morbidity and the health risks associated with cold homes https://www.nice.org.uk/guidance/ng6 Preventing excess winter deaths and illness associated with cold homes Quality standard [QS117] Published date: March 2016 https://www.nice.org.uk/guidance/qs117/chapter/Related-NICE-quality-standards Cutting the cost of keeping warm https://www.gov.uk/government/publications/cutting-the-cost-of-keeping-warm |
Version Control
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Plan Version |
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1.0 |
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Final draft |
01/09/2020 |
B Woodiwiss |
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2.0 |
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Updated draft |
14/09/2021 |
B Woodiwiss |
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4. ‘Level 0’ planning implications and needs for B&H
6. Risk of Cold Weather (governance and assurance) at B&H
7. Cascading Cold Weather Level Alerts
8. Local cascade arrangements within B&H
10. Level 0 Planning And Action Card Implementation
11. Consolidation of previous work
14. Key public health messages
15. Awareness, Training and Exercising
1. Introduction
1.1 Planning for winter 2021/2022
Planning for the Winter of 2021/22 is in the context of the COVID-19 pandemic, its health and socio-economic impacts, resulting services changes, and an expanded Seasonal Influenza Vaccination Programme.
The COVID-19 pandemic started in January 2020 and waves of infection have continued to occur since, however the vaccination programme has had an impact on reducing the number of deaths and hospital admissions[1]. A Local Outbreak Control Plan is in place to prevent and manage any further outbreaks.
Throughout the response phase many service changes have been made to ensure service users and staff are safe. These changes have embedded over the spring and summer, so services are COVID-19 prepared for the winter demands.
The enhanced Flu Programme has expanded the eligible groups and targets to vaccinate and it is hoped will reduce impact of seasonal flu during winter.
Nationally, the impact of the EU exit is starting to be felt with disruption linked to the ending of free movement of people, goods and services between the UK and EU on 1st January 2021. Strategic and practical work has been ongoing across Sussex to mitigate against potential issues to do with access to supplies, equipment, staffing and medicines and moving forwards, consideration of Brighton & Hove’s identified Brexit risks will be incorporated into both Winter planning and the COVID-19 response and recovery planning.
1.2 Impact of cold weather
In recent previous years there have been significant periods of severe and sustained cold weather. This has highlighted the need to have effective plans in place to mitigate the effects of cold weather on health.
On average, there are around 25,000 excess winter deaths each year in England. Excess winter deaths (EWDs) are the observed total number of deaths in winter (December to March) compared to the average of the number of deaths over the rest of the year. Excess deaths are not just deaths of those who would have died anyway in the next few weeks or months due to illness or old age. There is strong evidence that many of these winter deaths are indeed ‘extra’ and are related to cold temperatures and living in cold homes, respiratory illnesses, and cardiovascular conditions as well as infectious diseases such as influenza are the main causes of excess mortality in preceding years. This is predominantly in the older age groups, those with chronic illnesses and children, Heavy snow and ice has a small direct effect on health, predominantly as a result of falls and injuries. Additionally it causes disruption to the delivery of health, social care and other services. In the recent past, the rate of winter deaths in England was twice the rate observed in some northern European countries, such as Finland.
Although there are several factors contributing to winter illness and death, in many cases simple preventative action could avoid many of the deaths, illnesses and injuries associated with the cold. Many of these measures need to be planned and undertaken in advance of cold weather.
Living in a cold home has significant and demonstrable direct and indirect health impacts. There is strong evidence that shows it is associated with poor health outcomes and an increased risk of morbidity and mortality for all age groups. People live in cold homes often due to fuel poverty [2]. A household is considered to be fuel poor if it has higher than typical energy costs and would be left with a disposable income below the poverty line. Fuel poverty is driven by 3 main factors: household income, high or unmanageable energy costs and the energy efficiency of a home.
1.3 COVID19 and the cold
Those at high risk of COVID19 infection, morbidity or mortality are similar population groups as those at greater risk from the ill health effects of cold weather (Fig 2.6). For COVID19, these are the over 70s, those with chronic health conditions especially respiratory and CVD, those clinically extremely vulnerable, pregnant women and people living in areas of higher deprivation and experiencing ongoing health and/ or socio-economic inequalities.
A combination of factors are likely to exacerbate the situation further over the colder months, the continued vulnerability of the population, and poorer weather, may mean that people spend more time in their homes, where transmission may be more likely. The socio-economic impacts will cause greater fuel poverty, should public spaces be closed again due to another lockdown it will reduce the warm places people can visit. If services continue to work from home fewer people will be visiting people homes, so there will be less opportunities to notice a home is cold, damp or hard to heat.
There are also small but relevant direct effects of the environmental conditions on the virus which persists for longer at lower temperatures either outdoors or in a cold and poorly ventilated home, and with lower UV levels.[3] Changes in delivery of health, social care and other support services may also impact on health seeking behaviours adding to the risk for the very vulnerable. As part of the ongoing management of the COVID19 pandemic people will need to self-isolate in their homes for periods of time if they contract the infection or are a primary contact. Additional support will be needed for those with cold homes or who are living in fuel poverty.[4]
All services delivered in preparation for or in response to the cold weather will follow the COVID19 infection prevention and control guidance relevant for their service and appropriate for the recipient and community context.
1.4 The national Cold Weather Plan[5]
The Cold Weather Plan for England (CWP), published annually since 2011 aims to prevent avoidable harm to health, by alerting people to the negative health effects of cold weather and enabling them to prepare and respond appropriately.
The CWP also aims to reduce pressure on the health and social care system during winter through improved anticipatory actions with vulnerable people. This year these pressures may include seasonal surge pressures, the impact of Flu, Covid-19 or other wider circumstances such as the ongoing impacts of the end of the Brexit Transition Period from 1st January 2021.
Concerns have been raised over the safety and health of patients and citizens being overlooked during the negotiations on the future UK-EU relationship.[6] There are local plans in place to mitigate potential implications for access to essential winter supplies, equipment and medicines. [7]
The EWD Index is excess winter deaths as a percentage increase of the expected deaths based on non-winter deaths.[8] Local and national excess winter mortality is highly variable year on year and shows no clear trend. However, in the 2018 to 2019 winter period (December to March), there were an estimated 23,200 EWD in England and Wales and this was substantially lower than in most previous years.[9] Excess winter deaths index for Brighton & Hove also showed a fall in 2018-19. There were 51 EWDs (7.4%) lower than England (15.1%) and the South East (14.3%). This was the third lowest EWD figure in the South East.
The Cold Weather Plan for England is at https://www.gov.uk/government/collections/cold-weather-plan-for-england this page contains links to the national plan, health risks of cold homes, a supporting ‘making the case’ document, and an easy-read summary document, action cards for all groups involved, ‘Keep Warm Keep Well’ leaflet and supporting guidance.
The National CWP acknowledges the roles of Local Authorities, Directors of Public Health, NHS England Regional Office, Clinical Commissioning Groups, Health and Wellbeing Boards (HWB’s), NHS Trusts, GP’s, Emergency Planning Officers, and others. The Department of Health commissioned an independent evaluation of the CWP from the Policy Innovation Research Unit (PIRU) in 2012. The findings indicate that negative health effects start at relatively moderate outdoor temperatures of around 4-8°C. Although the risk of death increases as temperatures fall, the higher frequency of days at moderate temperatures mean that the greatest health burden in absolute numbers of deaths, occurs at these moderate temperatures. This means that action to prevent excess winter morbidity and mortality should not be restricted to the very cold days, but should be carried out throughout the year tailoring solutions to protect the most vulnerable.
The Fuel Poverty Strategy for England (currently under review) emphasises the role the health and social care sector can play in tackling fuel poverty and sets targets up to 2030.[10].
1.5 Key messages for action
This Brighton and Hove Cold Weather Plan is a good practice guide and the actions denoted within it are illustrative. There are five key messages recommended to all local areas:
1. All local organisations should consider the Cold Weather Plan for England and satisfy themselves that the suggested actions and Cold Weather Alerts are understood across the system, and that local plans are adapted as appropriate to the local context.
3. City Council and NHS commissioners should satisfy themselves that providers and stakeholders will take appropriate action according to the Cold Weather Alert level in place, their professional judgements and remain COVID-19 safe.
4. Opportunities should be taken for closer partnership working with the voluntary and community sector to help reduce vulnerability and to support the planning and response to cold weather.
5. Long-term planning and commissioning to reduce cold-related harm both within and outside the home is considered core business by health and wellbeing boards and should be included in joint strategic needs assessments and joint health and wellbeing strategies.
2. Aim
2.1 The aim of this plan is to set out the procedures and work-streams to be implemented within Brighton and Hove City Council, the local health economy (LHE) and with key city partners in support of the National Cold Weather Plan for England.
3. Objectives
3.1 The objectives of this plan are to:
· To define the partners engaged with the implementation of this Plan
· To ensure the requirements of the National Plan are complied with locally, by clearly stating the work-streams agreed to be relevant and those partners engaged in their delivery.
· To set out the coordination and oversight / assurance arrangements in support of the plan.
· To understand and mitigate, as far as possible, the impact of cold weather on the community and those most vulnerable to cold weather.
· To safely deliver this Plan in the context of COVID19 guidance.
· To support those self-isolating as a result of COVID-19 illness or Test and Trace Service instructions to keep well and warm at home.
· To review any implications for this Plan of the EU exit and access to relevant supplies.
4. ‘Level 0’ planning implications and needs for B&H
4.1 The planning implications for the National Plan and other known circumstances are:
· Strong local leadership and partnership working at all levels across sectors continues to be vital to tackle the range of causes and reduce the number of “excess” deaths that are observed each winter.
· B&H planning arrangements are supporting the importance recognised in the Plan of long-term and strategic planning and commissioning to reduce cold-related harm. This is considered core business by Health and Wellbeing Boards (HWBs) and joint strategic needs assessments (JSNAs), as evidenced by the linking of these arrangements to the Public Health led Health Protection & Screening Forum and HWB.
· The need to ensure that the action cards are disseminated widely to all City stakeholders as appropriate for:
ü Frontline Health & Social Care staff in community & care facilities
ü Commissioners in the Local Authority and the CCG
ü GP’s & Practice Staff and pharmacies
ü Community & Voluntary Sector organisations
ü Provider Organisations
ü Other relevant organisations in the city
ü Individuals.
· To ensure there is a link to the City’s Vulnerable People Plan and other Emergency Planning Resilience and Response plans.
· The Public Health Outcomes Framework includes indicators to reduce excess winter deaths[11] and address fuel poverty[12]
· Working with partners to ensure that a strategic approach to the reduction of EWDs and fuel poverty is taken across the local health and social care economy. In particular:
ü To develop a shared understanding of EWD’s and what partners can do to reduce them.
ü To identify those most at risk from seasonal variations.
ü To improve winter resilience of those at risk via a locally annually agreed programme.
ü To ensure a local, joined-up programme is in place to support improved housing, heating and insulation, including uptake of energy-efficient, low-carbon solutions.
ü To achieve a reduction in carbon emissions and assess the implications of climate change.
ü To consider how winter plans can help to reduce health inequalities, how they might target high-risk groups and address the wider determinants of health.
ü To ensure that organisations and staff are prompted to signpost vulnerable clients onwards (e.g. for energy efficiency measures, benefits or related advice).
ü To work with partners and staff on risk reduction awareness, information and education including vaccinations.
ü To engage with local CVS organisations for planning and implementation of all stages of the Plan.
5. Cold Weather Alerts
5.1 The Plan is implemented via a system of cold weather alerts – linked to the existing winter weather warning system developed by the Met Office ‘National Severe Weather Warning Service’ (NSWWS) – which will trigger appropriate actions up to a major incident. A Cold weather health watch system operates in England from the 1 November to 31 March every year, in association with Public Health England. However, should thresholds for an alert be reached outside of this period, an extraordinary heat-health alert will be issued and stakeholders are advised to take the usual public health actions. The alerts take account of temperature along with other winter weather threats such as ice and snow.
5.2 Recommended indoor temperatures
Fig 2.1 Indoor room temperatures.
5.3 The Cold Weather Plan sets out actions at five Cold Weather Alert Levels
The 5 alert levels are shown in Fig. 2.2 below as being:
Fig. 2.2 Cold Weather Plan alert levels
5.4 Definitions (See the National Plan for full details).
Cold Weather Alert – to provide early warning of low temperatures and/or snow and ice will be issued when there is a high likelihood (more than 60%) that there will be a mean temperature at or below 20C for a period of 48 hours in one or more regions in the next five days. A level 2 will be issued when this weather is forecast, and a level 3 when the snow and ice is occurring. An NSWWS warning is highly likely to have been issued as well.
Heavy snow – Snow that is expected to fall for at least two hours. Geographic extent is not considered, and sometimes the event can be quite localised.
Widespread ice – Ice forms when rain falls on surfaces at or below zero; or already wet surfaces fall to or below zero. The ice is usually clear and difficult to distinguish from a wet surface. The term “widespread” indicates that icy surfaces will be found extensively over the area defined by the Met Office in the alert.
Cold Weather Plan levels.
Level 0: Year round planning to reduce harm from cold weather
This emphasises that year-round planning is required to build resilience and reduce the impact of cold weather. This level of alert relates to those longer-term actions that reduce the harm to health of cold weather (e.g. housing and energy efficiency measures, and long-term sustainable approaches to influence behaviour change across health and social care professionals, communities and individuals.)
Level 1: Winter preparedness and action
Level 1 is in force throughout the winter from 1 November to 31 March and covers the moderate temperatures where the greatest total burden of excess winter death and disease occur. This is because the negative health effects of cold weather start to occur at relatively moderate mean temperatures (4-8°C depending on region) and there are normally many more days at these temperatures each winter.
Level 2: Alert and readiness
Level 2 is triggered when the Met Office forecasts a 60% chance of severe winter weather, in one or more defined geographical areas within 48 hours. Severe winter weather is defined as a mean temperature of 2°C or less and/or heavy snow and widespread ice.
Level 3: Severe weather action
This is triggered as soon as the weather described in Level 2 actually happens. It indicates that severe winter weather is now happening and an impact on health services is expected.
Level 4: National emergency
This is reached when cold weather is so severe and/or prolonged that its effects extend outside health and social care, and may include for example power or transport problems, or water shortages, and/or where the integrity of health and social care systems is threatened. At this level, multi-sector response at national and regional levels will be required.
The decision to go to a Level 4 is made at national level and will be taken in light of a cross-government assessment of the weather conditions, co-ordinated by the Civil Contingencies Secretariat (Cabinet Office).
Fig. 2.3 Cold Weather Plan alert levels and
actions
5.5 Detailed Arrangements.
Detailed arrangements are set out in the National Plan for the key groups; commissioners of health and social care, provider organisations, frontline health and social care facilities and community, GPs and their staff, community and voluntary sector, national level organisations, individuals
5.6 Modelling for winter pressures on hospital admissions
The public health department provides weekly modelling on the expected impact of cold weather on hospital admissions. This is sent to HASC, USH and CCG colleagues.
6. Risk of Cold Weather (governance and assurance) at B&H
6.1 The health, social, economic and environmental risks associated with a Severe Cold Weather spell have been assessed by the Sussex Local Resilience Forum (SRF) (Ref H18) and included on the Sussex Community Risk Register. Information regarding the risk of severe weather can be found on the Sussex Local Resilience Forum website https://www.sussex.police.uk/SysSiteAssets/media/downloads/sussex/about-us/sussex-resilience-forum/srf-community-information-on-risks-in-sussex.pdf
6.2 It is the responsibility of the NHS England South (South-East) and for Sussex DsPH to engage with providers and multi-agency partners via the Local Health Resilience Partnership, (LHRP), a body linked to the SRF to assess risks and to ensure plans are in place to protect the communities of Sussex from health-related vulnerabilities.
6.3 The Director of Public Health for Brighton and Hove ensures that local plans are in place within B&H, and will ensure that coordination arrangements are in place with City Council and health and Social Care organisations & NHS funded providers, and other stakeholders, to ensure that all partners understand their responsibilities and have organisational plans in place in line with the information set out in Appendix 1. Oversight of these arrangements will be provided by the Brighton and Hove Health Protection & Screening Forum, which reports to the Health & Wellbeing Board, in line with the National Cold Weather plan.
6.4 Partners include:
Ø BHCC (Public Health & Adult Social Care, Families, Children and Learning , Highways, Communications, Housing, Parks, Sea Front, City Clean and Emergency Planning & Resilience Team)
Ø Brighton & Hove CCG (Commissioning Teams / Winter Pressures, Communications )
Ø NHS England / Improvement (South-East)
Ø University Hospitals Sussex NHS Foundation Trust (secondary care provider)
Ø Sussex Community Foundation Trust (community services provider)
Ø Sussex Partnership Foundation Trust (mental health services provider)
Ø South East Coast Ambulance (is also the NHS 111 provider).
Ø IC24 (Out of Hours –Provider).
Ø Community Works - Community and voluntary groups and services (CW)
Ø British Red Cross (BRC).
6.5 Planning meetings (coordinated by the BHCC Public Health and the Emergency Planning and Resilience Team, on behalf of the Health Protection Forum), will identify local work-streams which support these arrangements. These are detailed below.
7. Cascading Cold Weather Level Alerts
7.1 The Level will be publicly displayed on the Metrological office website at http://www.metoffice.gov.uk/health/professionals/cold-weather-alerts
7.2 Other typical arrangements for alerting via email etc. are detailed in the diagram below at Fig.2.5
8. Local cascade arrangements within B&H
8.1 Local cascade arrangements are as per the national model (shown below), with the following additional actions:
· All category 1 providers (including SCFT / hospital trusts / SECAmb etc) also receive alerts direct from the Met Office.
· The BHCC Emergency Planning & Resilience Team forward alerts to all internal BHCC departments (including Adult Social Care) and external partners locally including the Community and Voluntary sector and ‘Community Resilience’ contacts that request the service.
· BHCC ASC have provided assurance that they will inform ALL B&H care & residential homes and home care providers
· Brighton and Hove CCG (having delegated authority for Primary Care Commissioning), inform city GP Surgeries via a process agreed with the primary care team.
· The CCG Resilience lead disseminates alerts to CCG staff (on-call managers, agreed primary care staff and Communications), and to IC24 (Out Of Hour’s provider), and to Sussex Partnership Foundation Trust, (SPFT) and to the British Red Cross.
It is therefore confirmed that systems are in place to ensure that all who need to receive cold weather alerts are doing so within the city.
Local cascading within the B&H is as per the diagram above, and local updates are that:
9. At-risk groups
9.1 These include examples of sub-categories, as well as living conditions and health conditions which may place people at risk to the potential of their vulnerability in relation to the cold weather. (See figure 2.6 below).
9.2 Brighton & Hove has an old housing stock with 66% of houses built before 1945 (compared with 43% across England) and many private sector properties labelled ‘hard to treat’ (for example those with solid walls) in relation to energy efficiency measures. Brighton and Hove has an estimated 11.3% of households living in fuel poverty, equating to 14,575 households. This is higher than both the South East (7.9%) and England (10.3%)[13].
9.3 Groups at greater risk of harm from cold weather (as defined by the national CWP) are detailed in fig 2.6 below. (It is recognised that the NICE guidance refers to 65+).
Fig. 2.5 At risk groups
Fig. 2.6 Groups at greater risk of harm from cold weather
9.4 COVID19 related risks
It is important that all services across all sectors identify those at greatest risk this winter, taking into account intersecting risks. Ask about living in a cold home, and support vulnerable individuals to access existing resources to keep warm. for example, people with COVID19 or those who have been asked to self-isolate by the NHS Test & Trace service will be isolating in their own homes. If they have cold homes or are fuel poor and cannot heat their homes adequately, they may be at increased risk of the negative health effects of the cold weather. This may exacerbate their illness especially if the home is damp. It may also reduce compliance with self-isolation guidance from the Test & Trace service.
The Local Outbreak Plan identifies the Community Hub as route by which people who are self isolating can get practical support if it is needed.
People being discharged from hospital or in-patient care may be at increased risk of the cold if their home was left empty and / or unheated. All discharge, rehabilitation and reablement plans consider home circumstances. People are only discharged if they are considered to be well enough for self-care. Cold homes and fuel poverty may not be an obvious consideration however from this year most services include questions about ability to heat the home . Further links and contact details should be made explicit for support with cold homes and fuel poverty given the impact on health and recuperation especially for older people and those with respiratory or CVD conditions.
9.5. Covid 19 Cold weather and Care Home settings
Care settings managers should remind staff about the following:
· To follow hand hygiene guidance Letterhead with fold lines (england.nhs.uk)
· Type IIR masks are still recommended for the delivery of social care (in the absence of Type II) in line with local NHS recommendations
· Staff should follow the PPE guidance for mask changing Personal protective equipment: resource for care workers working in care homes during sustained COVID-19 transmission in England - GOV.UK (www.gov.uk)
· For winter the minimum acceptable living environment temperature is 18c – the HSE advice is to maintain a warm temperature at same time as keeping rooms ventilated e.g. adjusting indoor heating if windows are open to ventilate spaces; opening windows at higher level to reduce draught effect.
· Ventilation is even more important in absence of natural sunlight as the virus will survive longer.
· Air conditioning units can be used, but they must bring air in from the outside, not recirculate the room air. They need to be maintained following manufactures guidance, ensuring they are cleaned regularly including emptying the capture tray/tank if present.
· Flu vaccination for all staff and residents should be strongly encouraged; there is growing evidence of poorer outcomes for those with Influenza and Covid-19 co-infection
· COVID-19 PCR and LFT tests and reagents need be stored in accordance with the manufacturer’s instructions.
- PCR tests use various types of transport medium, however if there is prolonged exposure to elevated temperatures outside the range they should be stored at, it could reduce their shelf life, packaging integrity, discolouration, pH shift and degradation of physical characteristic, which affects the efficacies of the test
- for Innova Lateral Flow Devices the test cartridge and extraction solution must be stored at ambient temperature (2-30°C). The reagents and devices must be at room temperature 15-30°C when used for testing
- the tube and cap can behave differently, leading to leakage of the medium, and the torque (screw part) on the tube decreases
- if the kits have been stored at elevated temperature, there is a risk of inaccurate results
Risk assessment must be undertaken to identify the hazards and risks associated with elevated storage temperature, consider regular temperature monitoring and control will be necessary to ensure this and frequency of monitoring should be based on a local risk assessment
10. Level 0 Planning And Action Card Implementation
10.1 Action cards for all partner groups are contained at Appendix 1.
10.2 All provider Trusts have provided assurance to the CCG and to the DPH that winter planning arrangements have been updated in line with the National Plan, and latest guidance.
10.3 The public health team draft this Plan is to be reviewed at the Health and Adult Social Care Directorate Management Team meeting and approved by the Brighton & Hove Health Protection & Screening Forum, which is linked to the Health & Wellbeing Board with specific responsibility for health protection, via the DPH.
11. Consolidation of previous work
11.1 The following work has been consolidated into winter planning in B&H over recent years:
· An annual Public Health winter programme to reduce the impact of cold homes and fuel poverty on the health of the local population.
· Liaison with Communities Equalities and Third sector Team at BHCC to widen reach to vulnerable communities and population groups in the city
· Information shared onward by the CCG to GP surgery Patient Participation Groups
· Agreement that B&H communications and media messages will be jointly coordinated by BHCC and CCG comms teams. A B&H Vulnerable People Plan has been agreed, which defines what may make people vulnerable, and contains a system for contact those considered vulnerable to that context and how to contact them as guided by an information sharing protocol.
· Annual flu campaign to support the vaccination uptake across all eligible groups and to the wider population.
12. Winter Planning
A winter planning groups meet as required. This Plan acknowledges the findings of the 2012-2013 Evaluation of the Cold Weather Plan, in that the majority of the burden of cold-related ill-health occurs at moderate outdoor winter temperatures (from 4-8ºC), and the required ‘increased emphasis on year-round (Level 0) and winter preparedness and action (Level 1) to protect ‘at-risk’ population groups. It is also in line with the NICE Guidance on excess winter deaths and morbidity, acknowledging ‘the need for strategic approaches, single point of contact services offering tailored solutions to which all who come into contact with vulnerable people can refer’.
The Government’s Covid Winter Plan [14]
The Government released their Covid Winter Plan which recognises that winter is always a challenging time for the NHS and all sector care services. This winter could be particularly difficult due to the impacts of COVID-19 on top of the usual increase in emergency demand and seasonal respiratory diseases such as influenza (flu). It is a realistic possibility that the impact of flu (and other seasonal viruses) may be greater this winter than in a normal winter due to very low levels of flu over winter 2020-21[15]. There is considerable uncertainty over how these pressures will interact with the impact of COVID-19. Contingency planning will be ongoing with close monitoring and review of the data, epidemiology and the science.
The Plan includes two scenarios depending on the levels of Covid in circulation, numbers in hospital, in critical care and consider wider social impacts .
There will be ongoing work with the Local Contain Frameworks
additional support to areas with high number of cases and numbers
in hospital; continuing health protection regulations; advising
people on how to protect themselves and others with clear guidance
and communication. Further developments in treatment and care with
advances in antivirals and therapeutics for those with Covid,
including long covid will also be supported
centrally.
Plan A
· Vaccination: Ongoing offer to un(der)-vaccinated; booster for Groups 1-9; single dose for 12-15 year olds (See detail at 12.15)
· Test, Trace, Isolate and Support to limit transmission: Local Authorities continuing to support enhanced Community Testing; local case tracing; managing self isolation support payments
· Support for health and care: Build Back Better Plan with funding to support managing pressures and recovering services; flu vaccination (see detail at 12.14); Long Covid NHS services; mandatory care staff vaccination (CQC settings)
· Advice: Get vaccinated; let air in; use masks; test and isolate; stay at home if unwell; wash hands; use the app.
· Businesses: Working Safely / H&S approach; consider using NHS Covid pass
· International: Vaccinate the world and manage risk at the borders
Plan B (based on NHS pressures)
· Enhanced communications to the public reflecting increased risk
· Vaccine passport using NHS App: mandatory for nightclubs, crowded venues 500+, crowded outside events 4,000+, all events 10,000+.
· Masks mandated (settings tbc)
· Work from home advice
· Further stringent restrictions, although considered unlikely, may follow pending severity of the situation.
This Cold Weather Plan has been provided to the partners listed for consultation, amendment and agreement. An update on issues linked to winter preparedness for 2021/22 as follows below.
12.1 University Hospitals Sussex NHS Foundation Trust.
Plans are reviewed annually at UHS. The Trust participates in the NHS Operational Pressures Escalation Level (OPEL) procedures, which are centred around the Hospital Trusts geographic area and seeks to ensure that ‘capacity management’ issues are monitored effectively and where all resources in the local health care system (including those of BHCC) are managed on a daily basis by a teleconference and reported/monitored using appropriate management tools. It now includes risk and pressures in the system relating to COVID19 as C-OPEL. It is led by the CCG’s Director of Resilience. It is recognised that the Trust is often at high levels of escalation, but the issues are actively managed with the support of other organisations. The Trust is committed to raising staff flu vaccination levels and vaccinate other eligible groups as identified in the annual Flu letter. Business Continuity Plans are regularly updated. UHS operates using COVID19 infection prevention and control guidance for the safety of staff, patients and partner organisations. Plans are in place for the EU exit in light of supplies, equipment, staffing and medicines.
12.2 Sussex Community NHS Foundation Trust.
SCFT provides out-patient clinics on-site and teams of healthcare staff such as Health Visitors, who deliver frontline community health services to patients in B&H and across wider Sussex. The Immunization Team is part of this Trust and contributes to the annual flu vaccination programme. The Trust maintains service level Business Continuity Plans and has access to 4x4 vehicles to deliver its role during severe weather. The Trust has a Cold Weather Plan, Winter Plan and Escalation Plan which are available to staff on the Trust intranet. Staff and patients are provided advice on all aspects of winter health that can be found on NHS How to Stay Well This Winter and the Keep warm- keep well leaflets. SCFT operates using COVID19 infection prevention and control guidance for the safety of staff, patients and partner organisations. Plans are in place for the EU exit in light of supplies, equipment, staffing and medicines.
12.3 BHCC Health and Adult Social Care
Public Health - Reduction of excess winter deaths and fuel poverty are Public Health (PH) priorities as highlighted in the Public Health Outcomes Framework.
Public Health and Housing co-chair a cross-sector, multi-agency Fuel Poverty and Affordable Warmth Steering Group, which meets quarterly to oversee delivery of the Fuel Poverty and Affordable Warmth Strategy 2016-2020. During the COVID-19 pandemic, key partners have met virtually with increased frequency to share information and coordinate support to households struggling to pay energy bills. Public Health have ensured links between this group and the Welfare Support and Financial Assistance Group. The overarching aims of the Fuel Poverty & Affordable Warmth Steering Group are to:
· Reduce preventable excess winter death rates
· Improve health and wellbeing among vulnerable groups
· Reduce pressure on health and social care services
· Reduce fuel poverty and the risk of fuel debt or being disconnected from gas and electricity supplies
· Improve the energy efficiency of homes.
The steering group will also consider additional issues for those who are self-isolating due to COVID-19 and ensure relevant connections with the Community Hub and other local initiatives as appropriate.
Building on previous successful partnership work and in collaboration with the steering group, initiatives to support at-risk groups during the winter months and beyond will be commissioned by Public Health. The Warmth For Wellbeing programme focusses on reaching marginalised and isolated communities, to identify and engage with those who are at elevated health risk due to living in fuel poverty and/or a cold home and reduce the health impacts through;
· Information and advice
· Home visits and assessments in line with COVID-19 guidance
· Provision of small measures
· Debt & benefits advice and casework
· Small hardship grants
Citizens Advice charities across Sussex have partnered with Your Energy Sussex, the local energy supplier backed by councils from across Sussex, to offer fuel vouchers to vulnerable households struggling to pay their fuel bills. Eligible householders can apply to their local Citizens Advice for multiples (up to 3) of a £49 voucher for a family and £28 voucher for a single occupier. Funding is limited and additional sources of funding are being explored to widen and extend this support. This scheme will end on 18 October 2021 or sooner if the funds are depleted.
Adult Social Care - Both Domiciliary and bed-based services are delivered by the Directorate, which has well-rehearsed Business Continuity Plans and heightened infection prevention and control measures in response to the COVID-19 pandemic. Independence at Home have service level agreements with both the Seafront Team and City Parks at BHCC, who will assist where possible with 4x4 vehicles and drivers in bad weather i.e. snow. Services and organisations across health and social care work closely together. Each service has a process in place which identifies level of need, the number of visits required and in what time scales. This assists in identifying and prioritising community visits at times of high demand / limited resources / extreme weather conditions. All services delivered are considered in light of the COVID-19 guidance.
Flu vaccination is actively encouraged in all provider and commissioned services as staff are eligible under the National Flu Programme. All HASC front line social care delivery staff are actively encouraged to visit their general practice or local pharmacies for flu vaccinations.
The ASC team also maintains links with independent Care Homes (including Nursing Homes), and Home Care providers in the City.
A range of resources are distributed through ASC networks for example Helping to prevent winter deaths and illnesses associated with cold homes; A quick guide for home care managers [16] Advice to Care Homes Guidance on Outbreaks of Influenza in Care Homes’, promotion of the pneumococcal vaccination and norovirus prevention.
Cold weather information is routinely be shared widely across the city through these general contacts.
Access.Point@brighton-hove.gov.uk and / or Contracts Unit Admin Team ContractsUnit.AdminTeam@brighton-hove.gov.uk
Control.Carelink@brighton-hove.gov.uk carelinkplus@brighton-hove.gov.uk
The Adult social care: our COVID-19 winter plan 2020 to 2021 sets out national support available for the social care sector for winter 2020 to 2021, as well as the main actions to take for local authorities, NHS organisations, and social care providers, including in the voluntary and community sector. Examples include arrangements for safely reopening day services or respite services; support the wider PPE needs of the sector, rolling out further testing, visiting guidance and additional funding for infection prevention and control.
BHCC Health and Adult Social Care commission the ‘Severe Weather Emergency Protocol’ (SWEP). This activates when the temperature feels like 0 degrees for 1 night, (SWEP will also open where possible on an Amber weather warning). The SWEP service offers overnight shelter to rough sleepers. Community and third sector organisations working with rough sleepers within the city are involved in ensuring that rough sleepers are informed when the service is open and how to access. The service is open to all rough sleepers regardless of local connection.
This service is normally offered in shared sleep environments and we are in planning stages to look at how we deliver the service this winter to ensure the safety and wellbeing of rough sleepers whilst COVID-19 remains a real risk. We will be sharing plans as they are developed.
Am annual plan is agreed with the NHS to support the patients journey on discharge from hospital as set out here below.
12.4 BHCC Families, Children and Learning Directorate
It is important to involve services for children and families in winter preparations and health protection, particularly in order to reach the city’s schools. Schools closures have a clear impact on the city, and support to business continuity planning in educational settings is available. Key city gritting routes do not always cover all individual routes to schools. Following the mandatory school closures earlier in 2020 as part of the Covid pandemic response, schools, their pupils and their families are more set up for and experienced in home and remote learning techniques. This could help with school’s badly affected by poor weather.
An FCL departmental representative attends the Health Protection & Screening Forum and it is hoped this will result in further opportunities to coordinate city winter planning. Services and information to support families in fuel poverty will be widely shared through FCL networks. Children’s centres and Council nurseries distribute weather related posters and leaflets, promote the flu vaccine and can sign-post families for advice on fuel poverty. Private, voluntary and private early years childcare settings can be sent information to pass on advice to families. The Family Information Service can also pass on information using their Twitter account and Facebook page. The Family Information Service and the Integrated Team for Families can provide advice for families to reduce fuel poverty. Information about the seasonal flu vaccinations generally and the schools based vaccination programme will be shared through wider FCL networks. Children under 5, pregnant women are recognised at risk groups.
All schools, early years and children’s services will be operating under strict COVID-19 guidelines over Winter 2021/2022. The NHS Flu Vaccination programme has been extended to cover all school years from Reception to year 11. There is a commitment to continue with the successful levels of vaccination uptake as seen in previous years. BHCC will be offering a reimbursed Flu vaccination to all school staff who are not eligible for the free NHS one.
The City recognises that numbers of rough-sleepers across the city have risen, and this is a particular problem for the seafront area.
It has been acknowledged that advice to traders re flood defences etc can be obtained from the YouGov website at https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/451622/LIT_4284.pdf
The Seafront Office will issue a warning email to seafront businesses if the Met Office weather warnings identify a specific risk of overtopping or coastal flooding in Brighton & Hove.
A number of products such as flood sacks etc can be locally obtained from B&Q and Travis Perkins etc.
Events such as the B&H ‘Christmas Day Swim’ are kept under review. The team put out public safety signage and press releases about the dangers of swimming in the sea at this time of year in the lead up to Christmas., The swim is not an ‘event’ which is recognised by the council as it has no formal organiser and has no safety cover (Brighton Swimming Club do not wish to be responsible). The Seafront Office are on duty on Christmas Day and will advise the public not to enter the water if they are considering it. However, the Seafront Officers are not there to provide lifeguard cover as this is not their role.
12.6 IC24 (NHS Out of Hours Provider).
IC24 provides out of hours and roving GP services to B&H and to E Sussex, as well as a GP in A&E at Royal Sussex County Hospital, a walk-in service and other facilities. The organisation may have challenges in providing some services during periods of adverse weather but may access 4x4 support via links with Adult Social Care and the CCG.
Cityclean (01273 294706/01273 292229) staff working for BHCC and trained as gritter drivers are on a rota for the winter season and operate under the direction of the BHCC ‘Winter Duty Officer’ who will advise on weather and road conditions, and on action required by the team. Road gritting routes cover main roads, all bus routes and access roads to emergency services such as ambulance stations. In sevesnowfall, additional Cityclean staff working for BHCC may work on pavement clearance for identified priority areas such as city centre and hospital entrances. There are 7 gritters (including a pavement gritter) and they will all be serviced before the start of the Winter Gritting period.
12.8 The BHCC Highways Winter Service Plan 2020-21
This plan states the Councils gritting and monitoring arrangements specifically relating to public roads and pavements. It is available on the council’s public website (see below).
The Local Authority maintains an information page on the council’s public website, which provides advice on winter weather (see http://www.brighton-hove.gov.uk/content/parking-and-travel/roads-and-highways/winter-weather) and driving and ‘what you can do’ as well as on ‘what the Council does’. The link to this page is: https://www.brighton-hove.gov.uk/content/parking-and-travel/roads-and-highways/winter-road-maintenance
The highways plan ensures that roads to NHS hospitals are gritted, as well as ambulance stations. Clearance of pavements which lead to those hospitals are also on the Priority list.
B&H Bus Company’s routes are on the City’s gritting routes. Salt is good at combating ice but the addition of the buses and other heavy transport is needed to make it as effective as possible, Salt will only melt a very thin layer of snow or ice so anything more than snow flurries will settle on gritted roads. Under such circumstances, the aim is to reclaim the network as soon as possible using a grit/salt mixture and snow ploughing. It is important to keep the buses running where possible to help break up snow but that is an operational decision for the bus company. Issues for Brexit; reduction in vehicle part access, fuels, etc will be covered by Business Continuity Plans
.
Pavement clearance will also be carried out during snow events. Grit bins are provided across the coldest, steepest areas of the city for the public to use.
The service operates from 1 November until the end of March, 24 hours a day, 7 days a week. The period may be extended on a day-to-day basis in cases of severe cold weather continuing into April or starting earlier in October.
12.9 BHCC Flood Management
The City’s focus is on groundwater and surface water (as the Environment Agency retains responsibility for other areas). The approach is to reduce (not eliminate) risk. Groundwater levels are currently higher than in recent years, but the situation is being closely monitored. Patcham residents are in contact with BHCC staff, and developments are being monitored.
12.10 BHCC Housing.
The team has responsibility for the Council’s stock of social and seniors housing. The
Housing Sustainability & Affordable Warmth Manager works closely with the Public
Health lead for fuel poverty & EWDs to plan annual winter warmth initiatives. Energy
saving advice is available for vulnerable council tenants from the Housing Inclusion
Team.
In an emergency the service is committed to stopping non-urgent work and to re-deploy housing staff to other services who need extra support. The Estates Services provide salt and equipment to residents to help clear communal pathways to blocks. The Council’s Housing Repairs and Maintenance service and heating contractor run out of hours services. They maintain winter contingency stock including heaters etc. Out of hours the duty housing officer is contactable via the Emergencies and Resilience Team or via Carelink.
12.11 BHCC Emergency Planning and Resilience team (EP&R)
Transport hub arrangements and lists of community volunteers are annually reviewed. The B&H Transport Hub results from an agreed arrangement between partners to support BHCC in running a hub facility during periods of severe weather. The Transport Hub is managed and staffed via the agreement, and by an operational document. The Hub (once setup) will:
Ø Ensure an overview is maintained on weather conditions.
Ø Liaise with the BHCC Highways department and media sources to understand the impacts of the severe weather on the cities road’s.
Ø Understand the implications of the weather falling on roads on transport providers including buses and taxis.
Ø Coordinate available 4 x 4 resources (including via the NHS MOU with Sussex 4x4 Response), from partner organisations and local community volunteers Match local prioritised requests for 4x4’s against availability.
Ø Work with community and voluntary sector groups who may be able to assist with the community response to severe weather events.
The BHCC ‘EP&R Team’ and the Public Health lead for Health Protection and resilience both engage with external partners including the Sussex Resilience Forum (SRF), and the Sussex Local Health Resilience Partnership (LHRP), and responding agencies to ensure that B&H is fully engaged in planning for a number of areas which may involve severe weather and winter-related events at the Sussex level. This has included City participation in a Sussex Pandemic Flu exercise and in a review of the SRF ‘Adverse Weather framework’ in 2017.
12.12 British Red Cross
BRC has agreed to link with BHCC and other local services and is available to support them during periods of severe winter weather. BRC have other winter provision available in B&H:
• A 24 Emergency Response Messaging service which will mobilise staff and volunteers as required, 24/7/365 to support people in crisis and depending on what the situation is, if BRC can help, they will respond.
• The basic “offer” to B&H is to provide practical and emotional support, work in Rest Centres, providing transportation during bad weather and home welfare checks on vulnerable individuals.
•BRC can also provide blankets, hot drinks etc and staff.
• If made aware of a longer term failure of infrastructure or facilities, then BRC may be able to call in our dedicated communications or catering units to provide operational support to large groups of people.
12.13 Seasonal Vaccination Programmes
Flu is a respiratory illness and COVID-19 is primarily a respiratory illness. There are strong similarities between the two - those at higher risk of acquiring it, side effects and subsequent complications, and mortality.
12.14 Influenza vaccination programme 2021/22
This year the national Flu programme has extended uptake targets, expanded groups eligible for the vaccination and widened delivery routes in response to the additional infection prevention measures needed for COVID-19.[17]
There are imminent plans to establish for winter 2021/22 a joint Flu and Covid-19 NHS Sussex Programme Board with a range of Task and Finish groups focussing on key aspects such as; health & social care staff, primary care, outbreak arrangements, vaccine supply, data, communications, health promotion and prevention. Locally, the city’s multi-sector Flu Planning meeting co-ordinates implementation across organisations in support of the Flu prevention plan.
Due to the Covid prevention measures of mask wearing, social distancing and lockdowns, the amount of flu circulating in 2020 was very low. It is thought that as society has opened-up again there is a high likelihood that the 2021-22 flu season could be up to 50% larger than typically seen. It could also coincide with Covid 19 outbreaks, placing additional pressure on the NHS.[18]
Traditionally uptake of the flu vaccine has been consistently lower than the SE and England average for all eligible groups with the exception of the schools programme which achieves 67% uptake. [19]
This is supported by a major new public facing marketing campaign to encourage take up amongst eligible groups for the free flu vaccine, and a targeted campaign for front-line health and social care workers. Resources will be available to from the PHE Campaign Resource Centre at: https://campaignresources.phe.gov.uk/resources/
Vaccinations are available to those not in the target groups through pharmacies at a low cost (£8-£15)
Free flu vaccinations are available for:
· all children aged 2 to 15 (but not 16 years or older) on 31 August 2021
· those aged 6 months to under 50 years in clinical risk groups
· pregnant women
· those aged 50 years and over
· those in long-stay residential care homes
· carers
· close contacts of immunocompromised individuals
· frontline health and social care staff including:
· a registered residential care or nursing home
· registered domiciliary care provider
· a voluntary managed hospice provider
· Direct Payment (personal budgets) and/or Personal Health Budgets, such as Personal Assistants.
· Learning from the Covid19 vaccination programme as revealed a range of workforce who are day-to-day directly delivering health and social care to vulnerable residents and these groups will be considering as within this Flu programme. Examples include special school staff giving PEG feeds[20] to children; social care workers in supported living hostels.
§ At the Brighton and Hove level additional groups are being considered as clinically vulnerable such as homeless and rough sleepers, regular services users of the Alcohol and Substance misuse services.
§ BHCC have an annual scheme with pharmacies for its staff to have the Flu vaccinations for those that are not eligible for the free NHS vaccinations.
Uptake ambitions - at least 75% for all group this year with 100% for all groups of health and social care workers.
The vaccinations need to be delivered in line with infection prevention COVID-19 guidance.
Flu immunisation of frontline health and social care staff
As set out above, the main care providers are expected to deliver a significant improvement in staff vaccination rates this year moving towards a compliance rate of 100%. Having staff vaccinated reduces their own vulnerability, increases the resilience of the provider, and reduces the threat of transmission to patients. Staff vaccination programmes are in place across local provider organisations. Although uptake will be monitored by NHS England and NIHP, local providers’ coverage will be monitored via the Flu Planning Group, Sussex Programme Board, A&E Delivery Board, at Quality Review Group meetings with providers and by the CCG’s Executive Management Team.
BHCC and the CCG are actively encouraging all front line health, social care, [21] residential and Care Homes to vaccinate their residents and these are free of charge
Community pharmacies will be able to vaccinate all residents and staff in care settings as part of the NHS programme.
12.15 Covid-19 Vaccination programme
At the time of writing some of the delivery details for the Covid-19 vaccination programme are being finalised.[22] [23]
It covers;
· Mandatory covid19 vaccinations for all those working in care home
· continuing roll out the first and second doses for those 16+ who have not yet been vaccinated with enhanced efforts to improve uptake in those areas and populations with lowest uptake
· vaccinating 12-15 year school children, prioritising the clinically extremely vulnerable
· delivering a third dose (booster) in a phased approach to those in cohorts 1-9
starting in October with
o those living in residential care homes for older adults
o frontline health and social care workers
o all those aged 16 to 49 years with underlying health conditions that put them at higher risk of severe COVID-19, and adult carers
o adult household contacts of immunosuppressed individuals
and from November to all adults aged 50 years or over
12.16 Clinical Commissioning Group
Local plans are in place to respond to escalations in pressure in the local health system. The level of pressure is gauged using the Operational Pressures Escalation Level Framework (OPEL) and the local response to the escalation levels identifies a set of actions to be taken by all partners within the BUSH health system to manage the increased levels of pressure. This now includes COVID-19 assessments, impacts and mitigations as C-OPEL. As the CCGs in Sussex are working in close alignment, the plans for the UHS East System are now closely aligned with the plans of support neighbouring trusts.
The aim of using the C-OPEL Framework is to ensure planned or elective as well as urgent care services operate as effectively as possibly in delivering year round services for patients.
The key objectives are to ensure sustainable delivery of the two national NHS service standards i.e. the 4 hour A&E standard and 18 weeks for referral to treatment for planned care. These are achieved by a system-led process known as ‘SHREWD’ which provides real-time monitoring of hospital flow and capacity and is able to report information nationally. Locally the system is overseen by senior management at UHS EAST and the CCG.
12.17 Community and Voluntary sector
The CVS is increasingly involved in supporting the planning for winter resilience. This is both through their networks across the city into neighbourhoods and groups working with those more vulnerable to cold.
There are services provided by a wide variety of organisations to help those in fuel and food poverty. These include Age UK, NEA, Brighton & Hove Citizens Advice Bureau , Brighton and Hove Energy Services Co-operative (BHESCO), the British Red Cross, The Fed Lions, Club and others.
The strength of the partnership approach taken during the COVID-19 response has established a shared approach to supporting those most vulnerable in the city and this will be especially important in addressing the demand of the cold weather, Flu, self-isolation for COVID-19, its socio-economic impacts.
The CVS are represented at the BHCC Flu Planning meetings and the Sussex Programme board.
Groups are becoming increasingly involved in various parts of the City prone to weather and cold-related risks. Examples include ‘Time To talk befriending’, ‘One Church Brighton’, Neighbourhood Watch and the Woodingdean Residents Association.
12.18 Brighton & Hove Energy Services Co-operative
BHESCoaims to improve resident’s thermal comfort targeting vulnerable people in hard to heat homes, thereby reducing EWD's, and provide advice to consumers including action on tariffs, switching energy supplier and take up of energy efficiency offers. They have some funding to pay for simple measures like weather stripping, secondary glazing film, energy meters and radiator reflectors. Other areas of housing-related concern include the elderly, vulnerable and socially isolated. There are good links to other BHCC housing teams and other stakeholders.
13 Communication
13.1 There are three areas of communication: Awareness, Warning & informing and Advising the public.
13.2 Awareness – pre 1st November each year. This will be done through the national and local campaigns , by informing and educating the public about the risks of cold weather, and how people in the identified vulnerable groups can prepare themselves.
'Help Us, Help You' Stay Well This Winter
The Public Health England and NHS England marketing campaign, Help Us, Help You - Stay Well this Winter’, will run starting in September. This phased campaign aims to help those with long-term health conditions (particularly respiratory conditions), older people, school children, pregnant women and parents of under-5s stay well and keep their loved ones well this winter. This includes messages about flu vaccination, contacting NHS 111, seeking advice at the first signs of a winter illness, accessing evening and weekend GP appointments and the advantages of consulting with community pharmacists. It will include COVID-19 messages also.
Further information is available from: https://campaignresources.phe.gov.uk/resources/campaigns/34-stay-well-this-winter/overview which also provides a link to sign up for email updates.
‘Top Tips for Keeping Warm and Well’, in collaboration with Age UK. The leaflet is targeted at pensioners in receipt of pension credit in England, Scotland and Wales. It will sit alongside an updated ‘Keep Warm Keep Well’ booklet, found at:
The CCG runs a winter communications campaign titled ‘#HelpMyNHS’. This is run across Sussex . The campaign encourages people to use A&E and GP services appropriately and highlight the other services available. There is a strong focus on self-care and prevention, which links into the NHS England campaign as described above. The local campaign will starts during November and includes communications materials, marketing and a media campaign.
13.3 Warning – at each change of cold weather level. The Met Office will communicate to the public any change in levels and what the changes means, taking into specific account the local weather warnings.
13.4 Local Warning and Informing – Immediately when Level 2 and above is reached. Public health staff and the LA Emergency Planning & Resilience Team will liaise with CCG and BHCC Communications staff to agree a local interpretation of public messages, based on then Public Health messages as taken from the national plan.
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Key public health messages |
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Take up your Covid-19 vaccination when it is offered/available
Contact your GP or pharmacist if you think you, or someone you care for, might qualify for a free flu jab.
Free flu vaccinations are available for those who are at risk. For a full list see the annual flu plan, available at: www.gov.uk/government/collections/annual-flu-programme
Keep your home warm, efficiently and safely: · heating your home to at least 18°C in winter poses minimal risk to your health when you are wearing suitable clothing (see page 40 for full advice). · get your heating system and cooking appliances checked and keep your home well ventilated · use your electric blanket as instructed and get it tested every 3 years · never use a hot water bottle with an electric blanket · do not use a gas cooker or oven to heat your home; it is inefficient and there is a risk of carbon monoxide poisoning and this can kill · make sure you have a supply of heating oil or LPG or sold fuel if you are not on mains gas or electricity – to make sure you do not run out in winter
Keep in the warmth by: · fitting draught proofing to seal any gaps around windows and doors · making sure you have loft insulation. And if you have cavity walls, make sure they are insulated too · insulate your hot water cylinder and pipes · draw your curtains at dusk to help keep heat generated inside your rooms · make sure your radiators are not obstructed by furniture or curtains
Look after yourself: · food is a vital source of energy and helps to keep your body warm so have plenty of hot food and drinks · aim to include 5 daily portions of fruit and vegetables. Tinned and frozen vegetables count toward your 5 a day · stock up on tinned and frozen foods so you don’t have to go out too much when it’s cold or icy · exercise is good for you all year round and it can keep you warm in winter · if possible, try to move around at least once an hour. But remember to speak to your GP before starting any exercise plans · wear lots of thin layers – clothes made from cotton, wool or fleecy fibres are particularly good and maintain body heat · wear good-fitting slippers with a good grip indoors and shoes with a good grip outside to prevent trips, slips and falls · make sure you have spare medication in case you are unable to go out · check if you are eligible for inclusion on the priority services register operated by your water and power supplier
Look after others: · check on older neighbours or relatives, especially those living alone or who have serious illnesses to make sure they are safe, warm and well
Get financial support: there are grants, benefits and sources of advice to make your home more energy efficient, improve your heating or help with bills. It’s worthwhile claiming all the benefits you are entitled to before winter sets in. |
13.5 Staff information.
All partner agencies will ensure that suitable messages are also passed to staff, detailing warnings where appropriate, actions to be taken, and measures in line with their Business Continuity Plans, which must be kept up to date. This may include the need to re-deploy staff during severe weather, arrangements for home-working where appropriate, support to access Covid-19 and flu vaccinations, and proactive information on how to stay safe and keep well during the winter months
13.6 De-Briefing & Support.
Post incident, a de-briefing should be held to ensure lessons are identified and learnt, and also partners should ensure that support is offered to staff in appropriate cases.
14. Key public health messages
14.1 These are the core messages to be broadcast as official weather warnings alongside national and regional weather forecasts. They may be expanded or otherwise refined in discussion with broadcasters and weather presenters.
14.2 Level 1: Winter preparedness and action
This is in force from 1 November to 31 March and indicates that actions should be taking place to protect health from cold weather, and that preparations should be in place to ensure service continuity in the event of severe winter weather. No warning is required, unless the situation worsens to warrant a level 2 alert. A spell of chilly weather might warrant a message along the lines of:
“If this does turn out to be a spell of severe cold weather, we’ll try to give you as much warning as possible. But in the meantime, if you want advice about protecting your health from the cold go to the winter health pages at www.nhs.uk. If you are worried about your health or that of somebody you know, ring NHS 111.”
14.3 Level 2: Alert and readiness
The Met Office, in conjunction with PHE, is issuing the following cold weather warning for [regions identified]:
“Severe cold weather can be dangerous, especially for the very young or very old or those with chronic disease. Advice on how to reduce the risk either for yourself or somebody you know can be obtained from the winter health pages at www.nhs.uk or from your local chemist. If you are worried about your health or that of somebody you know, ring NHS 111.”
14.4 Level 3 and 4: Severe cold weather action/emergency
The Met Office, in conjunction with PHE, is issuing the following severe cold weather advice for [regions identified]:
“Make sure that you stay warm. If going outside make sure you dress appropriately. If indoors, make sure that you keep your heating to the right temperature; heating your home to at least 18°C in winter poses minimal risk to your health when you are wearing suitable clothing. If there is anyone you know who might be at special risk, for example, an older person living on their own, make sure they know what to do to stay warm and are well stocked with food and medications. If you are worried about your health or that of somebody you know, ring NHS 111”
15. Awareness, Training and Exercising
15.1 Staff that has an active part to play in the cold weather response will require awareness training in this plan, its requirements and implementation. All partners will ensure that this is made available.
15.2 Opportunities for testing and exercising this plan and associated arrangements will be considered by executives from partners as listed to validate the plan and any subsequent major alterations required.
Appendix 1 – Cold Weather Plan Action Cards
Action Cards for the implementation of the Cold Weather Plan for England are available for the following:
· Commissioners (Health & Social Care) & other Local Authority directorates ’
· GP’s & Practice Staff,
· Frontline Health & Social Care Staff in Community and Care facilities,
· Individuals
· Community and Voluntary sector
The Cold Weather Plan for England ‘landing page’ is located at:
https://www.gov.uk/government/collections/cold-weather-plan-for-england
Further details as to the roles each sector should plan are outlined at:
Appendix 1
NHS Winter Plan 2021 – Brighton & Hove CCG PLACEHOLDER