Item 28
Although a formal committee of Brighton & Hove City Council, the Health & Wellbeing Board has a remit which includes matters relating to the Clinical Commissioning Group (CCG), the Local Safeguarding Board for Children and Adults and Healthwatch.
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Title: Brighton and Hove City Council Winter Cold Weather Plan 2022/23
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Date of Meeting:08 November 2022
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Report of: The Executive Director, Health & Adult Social Care
Becky Woodiwiss - Public Health Principal, Public Health, Health & ASC
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Contact: |
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Email: becky.woodiwiss@brighton-hove.gov.uk
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Wards Affected: All
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FOR GENERAL RELEASE
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Executive Summary
The BHCC winter cold weather plan is updated annually. This year, planning for the winter of 2022/23 is in the context of the economic downturn, cost of living increases, political changes, ongoing challenges to the health and social care sector, continuing demands of COVID-19 and its health and socio-economic impacts, and seasonal Influenza.
The BHCC plan localises the Cold Weather Plan for England and both aim to prevent avoidable harm to health, by alerting services and people to the negative health effects of cold weather and enabling all 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 will include cost of living, increasing fuel cost with associated fuel poverty, and possible seasonal surge pressures, and the impacts of Flu, Covid-19 and other seasonal viruses.
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Glossary of Terms
CWP = Cold Weather Plan EWD = Excess winter deaths COVID-19 = coronavirus illness in humans caused by SARS-COV-2 infection. CVD = Cardio-vascular disease SWEP = Severe Weather Emergency Protocol VCS = voluntary and community sector ICB = Integrated Care Board ICP = Integrated Care Partnership
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1. Decisions, recommendations and any options
1.1 That the Board notes the content of the report and the actions to be taken by the Council services and partner organisations.
1.2 The City Council, NHS commissioners and partner organisations are assured that plans are in place and action identified to respond to Cold Weather Alerts and that service providers and stakeholders will take appropriate action according to the Cold Weather Alert level in place, their professional judgements, and remain COVID-19 safe.
2. Relevant information
2.1 The Cold Weather plan helps prevent the major avoidable effects on health during periods of cold weather. It is compiled by public health with input from all BHCC Directorates. It describes the key issues for the city, cold weather alert system, related work-streams and governance arrangements.
2.2 An estimated 28,300 excess winter deaths (excluding COVID) occurred in England and Wales in 2019/20. 19.6% higher than 2018/19. 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. The usual peak in excess winter deaths is usually seen in January/February.
The EWD Index is as a percentage increase of the expected deaths based on non-winter deaths. Local and national excess winter mortality is highly variable year on year, so five year rolling averages are used, and shows no clear trend. For winters 2014/15 to 2018/19 the EWD Index in Brighton & Hove was 21.4% equating to 144 extra deaths each year. This is the same as England (21.4%) and similar to the South East (21.3%). For one year 2019/20 the EWD for 85+ at 19% is more similar to England (20.8%) and SE (20.7%) [1]
2.3 There is strong evidence that many of these winter deaths are related to cold temperatures, living in cold homes, respiratory illnesses, and cardiovascular conditions as well as infectious diseases such as influenza.
2.4 Those at greater risk from the ill health effects of cold weather are the over 70s, those with chronic health conditions especially respiratory and Cardiovascular disease, those clinically extremely vulnerable, pregnant people and people living in areas of higher deprivation, experiencing ongoing health and/or socio-economic inequalities and those living in cold and/or damp homes. Specifically, the cold weather affects thermoregulation and with ageing there is reduced thermoregulatory control and thermal perception, this is magnified in certain conditions e.g. dementia.
2.5 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.
2.6 The effects of cold weather start at outdoor temps below 8°C and indoor temperatures below 18°C. Living in cold environment increases blood pressure and the risk of blood clotting (cholesterol and fibrinogen). Negative respiratory effects are seen from 180C increasing as temperatures lower.
2.7 People live in cold homes often due to fuel poverty [2]. The Government released a new national Fuel Poverty strategy in February 2021, which included a new definition for Fuel Poverty measurement. The Low Income Low Energy Efficiency (LILEE) measure finds a household to be fuel poor if it:
· Has a residual income below the poverty line (after accounting for required fuel costs); and,
· Lives in a home that has an energy efficiency rating below Band C.
2.8 The latest available figures released in May 2022 using this new definition, estimate that in 2020 (there is a standard two-year lag in the data), 12% of households in Brighton & Hove were in fuel poverty. This equates to 15,814 households in the city. This is fifth highest of all South East authorities, but 15th of the 16 CIPFA comparators of which 9 are midlands or northern authorities. [3]
2.9 Although the new definition of fuel poverty does not take account of energy costs directly, it can be assumed that the number of households in the city struggling to pay their energy bills has increased significantly over recent months due to the significant increases in energy tariffs and the general costs of living.
2.10 Living in a cold home as a result of fuel poverty has a disproportionate impact on the health of certain groups. Exposure to cold temperatures increases blood pressure and risk of blood clotting, heart failure/attack and stroke. It also suppresses the immune system, diminishes the lungs’ capacity to fight off infection and increases constriction of the airways, increasing the risk of bronchitis and pneumonia. When a house is damp as well as cold, mould is likely to occur. This increases the risk of respiratory illness, particularly asthma.
2.12 The map below shows the distribution across the city using the Low Income Low Energy Efficiency (LILEE) fuel poverty metric.[4] This map shows the concentrations of those living in fuel poverty but this may not be those who are at highest risk the ill health effects of cold homes.
2.13 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 understand this plan within the context of climate change understand the mitigations needed to continue to work towards the commitment as a city to become carbon neutral by 2030
· To safely deliver this Plan in the context of COVID19 guidance.[5]
2.14 The BHCC CWP sits alongside the NHS trusts Winter Plans that are about increases in service demands during the cold weather. It also recognises the key role of the VCS and wider partners in winter resilience. It also sits alongside the Vulnerable People’s Pplan, which is about identifying vulnerable people during a major incident or crisis. This could be relevant this winter if there are power outages leaving residents reliant on medical equipment at risk.
2.15 The Plan is linked to a system of cold weather alerts – generated by the Cold weather health watch system developed by the Meteorological Office including the ‘National Severe Weather Warning Service’ (NSWWS). This comprises five levels of response based on cold weather thresholds. The thresholds have been developed to trigger an alert when severe cold weather is likely to significantly affect people's health and they also take account of temperature along with other winter weather threats such as ice and snow.
2.16 The national plan sets out best practice actions for each sector, services and the public at each of the five (0-4) levels based on the levels in the diagramme here. These are incorporated into the BHCC plan. Additional service specific plans are further identified as at 2.20.
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Level 0 |
Year round planning to reduce harm from cold weather
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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.)
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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.
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Level 2 |
Alert and readiness
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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
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Level 3 |
Severe weather action
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This is triggered as soon as the weather described in Level 2 actually happens. It indicates that severe winter weather is now happening, with snow and ice, and an impact on health services is expected A NSWWS warning is highly likely to have been issued as well
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Level 4 |
National emergency
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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.
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2.17 The Cold Weather Watch system operates in England from 1st November to 31th March every year, in association with UK Health Security Agency (UKHSA) and Office for Health Improvement and Disparities (OHID). 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 widespread ice [6] and heavy snow [7].
2.18 Alerts are cascaded to Council services and all wider stakeholders and local service providers. The CWP summarises the actions to be taken by different Directorates, services and partner organisations. Each council Directorate has its own assurance processes for compliance regarding actions required. Governance oversight for the Cold Weather plan is provided by the Brighton and Hove Health Protection & Screening Forum.
2.19 Of specific relevance this winter are those actions relating to those our most vulnerable residents such as rough sleepers, those living in care settings, those in fuel poverty in cold homes.
2.20 The following list outlines examples of the actions required for BHCC Directorates and programmes to mitigate risks. Some of which are triggered by changes in the alert levels (as indicated), others are ongoing good practice, preparedness and response to the context of this winter.
· Level 0- All BHCC services to include winter and cold weather actions as an ongoing part of their business continuity plans.
· Level 0 - Cascading cold weather alert levels. Also cascading alerts for storms, strong winds and flooding, more likely during Winter and even more likely due to the impacts of climate change.
· Level 1 - All services to identify their service users vulnerable to cold weather, planning for, and setting in place and monitoring necessary actions.
· An increased range of initiatives to address fuel poverty through the co-ordination of the response of the (multi-agency) Fuel Poverty & Affordable Warmth Steering Group. This includes;
o practical advice on available energy support (Help with fuel bills (brighton-hove.gov.uk) and provides a link to the Local Energy Advice Partnership.
o An increase Warmth for Wellbeing’ programme, providing money advice and small grants, and (with BHESCo) home energy checks and advice. This 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.
o The council is exploring, with the local CVS sector, the practicalities of using their buildings and public spaces to provide warm spaces for people, both to help them avoid impacts on their health, and therefore avoid greater demand on health and social care services, but also to contribute to helping them to manage energy use and costs.
· The Council continues to develop the ‘Brighton & Hove Warmer Homes’ programme, due to be launched in Spring 2023 with additional funding to support energy efficiency improvements for eligible owner occupiers and households in the private rented sector. This is in addition to ongoing energy efficiency improvements of its council housing stock. Plus further funding via the Disabled Facilities Grant funded Warm Safe Homes Grant. to improve energy efficiency.
· 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.
· Active promotion of the annual flu vaccination programme and the Covid-19 Autumn vaccination boosters.
· BHCC Highways Winter Service Plan[8]:This plan sets out gritting and monitoring arrangements relating to public roads and pavements.
· BHCC maintains an information page on the council website which provides advice and updates on winter weather: http://www.brighton-hove.gov.uk/content/parking-and-travel/roads-and-highways/winter-weather
· Ongoing falls prevention work including Standing Tall strength & balance classes, Staying Active to prevent falls training and health promotion falls risk awareness raising.
· Ageing Well programme to reduce loneliness, social isolation, increase wellbeing and independence and prevent ill health.
· Children’s Centres and Council Nurseries distribute weather related posters and leaflets, promote flu vaccine and signpost families for advice on fuel poverty.
· Family Information Service cascade information via social media (Twitter and Facebook)
· Initiatives with the VCS include support to neighbourhoods and Brighton & Hove Energy Services Co-operative working with the vulnerable in hard to heat homes.
· Proactive winter readiness information is sent out from public health through services across the city during September and October and in times of adverse weather cascade information and support to community and voluntary sector and other partners.
· Communications and campaign jointly with the NHS for the public and partners such as ‘stay well this winter’ to alert and inform city residents.
· Infection prevention and control support for care and homeless settings. This includes learning, development, communications and support.
· Response to health protection incidents as required in collaboration with UK Health Security Agency
· Development of a winter indoor activities and places directory, as part of a programme currently titled ‘weathering winter in the city' Set up in response to cost of living and fuel poverty crisis.
· At Level 2 – preparations are started, and at Level 3 the Severe Weather Emergency Protocol’ (SWEP) activates when the temperature feels like 0 degrees for 1 night, The SWEP service offers overnight shelter to rough sleepers. SWEP is manged by BHCC housing directorate. Housing have identified a provider with self-contained units to reduce transmission and risk relating to Covid19 and Flu.
· Level 3 - Emergency Planning lead and manage the BHCC Transport Hub. The Transport Hub is an agreed arrangement between partners to support BHCC in running a hub facility in periods of severe weather (Level 3) to transport patients to services or services to patients at home. This includes 4x4 vehicles and drivers in bad weather i.e. snow
2.21 There continues to be additional focus and support for the care sector with the UKHSA Winter-readiness (infection prevention) information for care homes in South East England Winter 2022/23[9]. This sets out actions relating to the increased pressure the winter may bring with the combinations of cold weather, COVID-19 and Flu and provides information for care homes on preparing for the winter season, to help try to avoid cases and outbreaks of infectious disease. Adult Social Care and public health are supporting care settings in terms of communications, infection prevention and control and assurance relating to business continuity plans.
3. Important considerations and implications
Legal:
3.1 As described in the body of this report the BHCC Cold Weather Plan is a localised version of the Cold Weather Plan for England which is a good practice guide. This report is for noting by the Board only.
Lawyer consulted: Sandra O’Brien Date: 12/10/22
Finance:
3.2 Any additional costs resulting from the Brighton and Hove Winter Plan will need to be met from within identified resources across NHS Sussex and the Council.
Winter pressures causes significant financial strain across Health & Social Care. Current budget forecasting accounts for anticipated increased demand over this period. However, budget forecasts may be subject to variation later in the year due to the unpredictable nature of the impact on services during the winter.
Finance Officer consulted: Sophie Warburton Date: 12/10/2022
3.3
Finance Officer consulted: Date:
Equalities:
3.4 We have considered equalities in the Winter Cold Weather Plan. This includes a focus on how cold weather impacts on older people, vulnerable people, and those living in fuel poverty. This forms part of a wider assessment on ‘seasonal weather impacts’ to consider the different needs and provide the relevant support to the most vulnerable communities in the city.
3.5 Sustainability:
Climate change will potentially make the winter weather more variable with milder and colder spells, increases in storms, winds and floods.
3.6 Health, social care, children’s services and public health:
Setting out the responsibilities and actions to support those most at vulnerable to the negative health impacts of the winter cold weather is the main focus of this Committee report and the Plan.
Supporting documents and information
Appendix1: BHCC Winter Cold Weather Plan 2022/23
Appendix 2: NHS Sussex Winter plan for Brighton & Hove (to follow for main committee meeting)