Approved & ratified at FIC Updated in line with UKHSA Cold Weather Plan
1. Introduction
This plan provides the framework for coordinating the organisations response to a sudden or prolonged period of cold weather and/or flooding. It is not a standalone document and supplements the organisation’s existing Major Incident and Business Continuity Plans by providing additional information and guidance specific to mitigating, minimising and responding to the effects of cold weather and flooding
In line with national guidance the plan is:
• Built on effective service and business continuity arrangements; and
• Responsive to local challenges and needs.
When activated this plan contains procedures that allow the organisation to:
• Receive and cascade Met office notifications and Environment Agency alerts
• Comply with any external reporting requirements and generate local situation reports;
• Reduce impact (including reducing the likelihood of excess deaths);
• Identify service users that are ‘high risk’ who might be at increased vulnerability during cold weather;
• Ensure that critical services are maintained;
• Cope with localised disruptions to services;
• Provide timely, authoritative and up-to-date information for staff; and
• Return to normal working after cold/severe weather incidents as rapidly and efficiently as possible
This plan like all Provide’s emergency plans is updated as new guidance is made available and following recommendations from internal (or external) incidents and exercises.
This plan is not a stand-alone document and should be used in conjunction with the following plans
• The Provide Business Continuity Plan and Service Business Continuity arrangements, which detail how individual services will continue to deliver their critical activities during a cold weather or flooding event.
• The Major Incident Plan that provides the response structure to manage any major or critical incident.
2. Purpose
The aim of this plan is to ensure that PROVIDE can respond to severe weather disruptions to its business in a way that ensures that statutory obligations are met, and supports its overall vision and mission.
The objectives of this plan are to ensure:
• Provide is compliant with its legal and regulatory obligations
• Critical and essential activities and services are identified, protected and ensure their continuity
• Stakeholder requirements are understood and can be delivered
• Staff, service users and the public are properly communicated with
• Staff receive adequate support and advice in the event of a severe weather disruption
3. Definitions
The following terms and definitions are included within this document
Term
Business continuity
Business Continuity Incident
Critical Incident
Civil Contingencies
Act 2004
Civil Contingencies
Secretariat (CCS)
Flood Alert
Flood warning
Definition
Capability of the organisation to continue to delivery of products or services at acceptable predefined levels following a disruptive incident
A business continuity incident is an event or occurrence that disrupts an organisation’s normal service delivery, below acceptable predefined levels, where special arrangements are required to be implanted until services can return to an acceptable level.
A critical incident is any localised incident where the level of disruption results in the organisation temporarily or permanently losing its ability to deliver critical services, patients may have been harmed or the environment is not safe requiring special measures and support from other agencies, to restore normal operating functions
The Civil Contingencies Act 2004 (CCA) delivers a single framework for the protection of civil protection in the UK.
The Act divides responder organisations into two categories; Category One and Category Two depending on the extent of their involvement in civil protection work
The Civil Contingencies Secretariat (CCS), or Cabinet Office, is to ensure the United Kingdom's resilience against disruptive challenge, and to do this by working with others to anticipate, assess, prevent, prepare, respond and recover.
Flooding is possible and you need to be prepared
Flooding is expected and you should take immediate action. Impact on the ground will include flooded homes, businesses and infrastructure
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, but the Met Office will always try to indicate which area will be affected in the alert.
Invocation Act of declaring that the business continuity arrangements need to be put into effect in order to continue delivery of key products or services
Major Incident
Severe flood warning
Widespread ice
A major incident is any occurrence that presents serious threat to the health of the community or causes such numbers or types of casualties, as to require special arrangements to be implemented.
There is severe flooding and danger to life. Impact on the ground will include deep and fast flowing water, potential collapse of structures, critical resources disabled, large towns isolated and large volumes of evacuees
Warnings are issued when any depth of ice is expected over a widespread area. Warnings will also be issued after a snowfall when compacted snow is expected to cause an ice risk
4. Duties
Chief Executive
The Chief Executive has the overall responsibility for emergency preparedness, resilience and response (EPRR) and is accountable to the Board for ensuring that systems are in place to facilitate an effective incident response including the continuity of critical/essential services
Accountable Emergency Officer (AEO)
The Provide Health Chief Executive is the nominated Accountable Emergency Officer (AEO) who is responsible for ensuring the full implementation of the organisation’s emergency preparedness resilience and response arrangements (on behalf of the Provide Group Chief Executive). The AEO may be called upon to help in the response of any incident that result in the corporate (this) plan being invoked.
The Emergency Preparedness Resilience & Response (EPRR) Manager is responsible for assisting the AEO in implementing the emergency preparedness resilience and response arrangements and where available may be asked to provide advice during the incident response.
All staff
All staff have a role to play in business continuity in raising alerts, assisting service leads/managers in keeping the service running as normal as possible, and being flexible in their working arrangements.
Heads of Service/Service Leads (Operational/Bronze)
Heads of Service/Service leads keep their business as usual role in a business disruption including those resulting from a severe weather incident and are responsible for the coordination of the team and functions for which they are usually responsible. All Heads of Service/service leads need to be aware of their team’s essential and critical activities
Director/Senior Manager on-call (Tactical/Silver)
The role of the Associate Director or manager on-call (Tactical/Silver if a major/critical incident has been declared) is to coordinate the business continuity measures across the organisation.
Director on-call/Strategic (Gold) commander
The Director on-call or Strategic (Gold) Commander if a major incident has been declared) sets the strategic direction for the organisations response and provides final oversight and approval for the logs, authorises external situation reports, mutual aid arrangements and communications.
5. Consultation and Communication
This plan has been reviewed by the Property Health & Safety Group and ratified by the Finance and Investment Committee (FIC).
6. Monitoring
NHS England EPRR Annual Assurance Process
All NHS organisations and providers of NHS funded care are held to account by NHS England and NHS Improvement for having effective EPRR processes and systems in place. An annual assurance process is used by NHS England to seek assurance that
organisations are prepared to respond to an emergency and have the resilience in place to continue to provide safe patient care during a major incident or business continuity event. The indicators are set against the EPRR core standards and an action plan is agreed against any standard that is assessed as requiring improvement. Progress against the action plan is monitored through Senior Leadership Team (SLT).
Business continuity or major/critical incidents will be monitored by the EPRR manager through SLT and any lessons identified will be considered for changes to EPRR practice.
7. Flood Planning
Planning information
Provide has actively participated in the development of all local Multi-Agency Flood Plans (MAFP). The plans aremaintained by local authorities/councils and are ratified by the Local Resilience Forums. All Multi-agency flood plans detail Provide’s response actions to any perceived or actual flooding incident.
In the event of a flooding incident occurring internally within a Provide site (i.e. a burst water pipe) dependant on the severity and impact upon services business continuity plans should be referred to.
Warning and informing
Under the Civil Contingencies Act (CCA) 2004 all Category 1 responders (e.g. emergency services, Local Authorities, NHS England & MSE ICB, UKHSA) have a duty to maintain arrangements to warn the public if an emergency is likely or has already occurred. In the case of a flooding incident, the lead agency for carrying out this duty will change as the incident progresses. Prior to an incident, the Environment Agency will be the lead agency. During an incident, dependant on the impacts, the local authority/council or the police will be the lead agency while in the recovery phase the local authority/council will act as the lead agency.
Provide will coordinate its warning and informing activities to ensure that residents, staff, carers and relatives receive consistent, accurate information and advice. Good coordination will prevent agencies issuing conflicting messages.
The Environment Agency is responsible for issuing warnings as detailed below.
Flood Alert - Flooding is possible and you need to be prepared
Flood Warning - Flooding is expected and you should take immediate action. Impact on the ground will include flooded homes, businesses and infrastructure
Severe Flood Warning - there is severe flooding and danger to life. Impact on the ground will include deep and fast flowing water, potential collapse of structures, critical resources disabled, large towns isolated and large volumes of evacuees
The Environment Agency also provides a telephone information line for the public to call before, during and after flooding.
The joint EA/ Met Office Flood Forecasting Centre produces a Flood Guidance Statement, which provides a daily flood risk assessment for responders to assist with tactical planning decisions. Flood Guidance Statements are issued by email and received by the emergency preparedness team.
The emergency preparedness resilience and response manager in conjunction with the communications team will ensure that staff are provided with timely and up-to-date information about the potential flooding and if required response arrangements.
8.
National Severe Weather Warning Service (NSWWS)
WARNINGS
The Met Office’s National Severe Weather Warning Service (NSWWS) warns organisations and the public about a range of high-impact weather events, including rain, snow, wind, fog and ice. This service operates year-round across the UK and can be found on the Met Office website.
A warning will be issued when snow and ice is forecast to cause an impact across a number of sectors, including health. It is issued based on a combination of the impact of the weather, and the likelihood of the weather happening. A NSWWS warning can be issued up to 5 days in advance of the expected event.
Warning levels
• Warnings are based on a combination of:
• likelihood – how likely the event is to occur
• impact – the potential impact the expected conditions may have
• Colour of warnings (impact matrix)
Warnings are given a colour depending on a combination of both the likelihood of the event happening and the impact the conditions may have:
• red
• amber
• yellow
9. Cold weather alerts and levels
Alerts
Depending on the severity, duration and geographical spread of severely cold weather conditions, a series of escalating alerts will be issued up to a national emergency (Level 4).
The Met Office will issue alerts up to Cold Weather Alert Level 3, while a Level 4 alert will be issued following cross-government consultation, in response to a particularly severe winter weather event.
This service will run in England from 1 November to 31 March.
Levels
Level 0: Long term planning – Level 0 denotes that these are actions that should be taken throughout the year, to ensure preparedness at the start of winter
Level 1: Winter preparedness – Level 1 is in force throughout the winter from 1 November to 31 March, with the seasonalflu vaccination programme starting on 1October.
Level 2: Alert and readiness – Level 2 is triggered when the Met Office forecasts a 60% risk of severe winter weather in one or more defined geographical areas within 48 hours. A Level 2 alert is issued when a mean temperature of 2°C is predicted for at least 48 hours, with 60% confidence, and/or widespread ice and heavy snow is forecast, with the same confidence.
Level 3: Severe weather action – a Level 3 alert is triggered when the weather described in Level 2 above actually happens. It indicates that severe winter weather is now occurring, and an impact on people’s health and on health services is expected
Level 4: National emergency – Level 4 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 Level 4 is made at national level and will be taken in light of cross government assessment of the weather conditions, coordinated by the Civil Contingencies Secretariat (Cabinet Office).
Table 1
Cold Weather Plan levels
Level 0
Level 1
Level 2
Level 3
Level 4
Long-term planning
All year
Winter preparedness programme 1 November – 31 March
Severe winter weather is forecast – Alert and readiness
Mean temperature of 2 C and/or widespread ice and heavy snow are predicted within 48 hours, with 60% confidence
Response to severe winter weather – Severe weather action
Severe winter weather is now occurring: mean temperature of 2 C or less and/or widespread ice and heavy snow
Major incident – Emergency response
Central Government will declare a Level 4 alert in the event of prolonged cold weather affecting sectors other than health.
Cold Weather Alerts – definitions
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, but the Met Office will always try to indicate which area will be affected in the alert.
Widespread ice – Warnings are issued when any depth of ice is expected over a widespread area. Warnings will also be issued after a snowfall when compacted snow is expected to cause an ice risk.
10.Cold weather planning
Strategic planning information
Long term planning for cold weather will be included in health improvement plans agreed by local partner agencies including health, social care, local authorities and others and be owned collectively by those partners.
A key part of the planning process is to identify and address the needs of different groups and communities including marginalised and vulnerable groups. Long term planning and commissioning to reduce cold-related harm is considered core business by Health and Wellbeing Boards and included within Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies.
At risk groups
The Cold Weather Plan for England lists the following key groups to be particularly at–risk in the event of a severe cold weather event;
• Older people (over 75 years old)
• Otherwise ‘frail’ older people
• Children under the age of five
• People with pre-existing chronic medical conditions such as heart disease, stroke or transient ischaemic attack (TIA), asthma, chronic obstructive pulmonary disease or diabetes
• People with mental ill-health that reduces individuals ability to self-care (including dementia)
• People with learning difficulties
• Pregnant women (in view of potential impact of cold on foetus)
• People assessed as being at risk of, or having had, recurrent falls
• People who are housebound or otherwise limited mobility
• People living in deprived circumstances
• People living in houses with mould
• People who are fuel poor (needing to spend 10% or more of household income on heating home)
• Elderly people living on their own
• Homeless or people sleeping rough
• Other marginalised groups
Cold Weather Impacts
Health
Evidence implies that there is an increase in hospital admissions and general practice attendances from cold related illnesses, these include;
• Heart attack
• Stroke
• Influenza
• Falls & injuries
• Respiratory Disease
• Hypothermia
Indirect effects include *mental health illnesses such as depression and carbon monoxide poisoning from poorly maintained or poorly ventilated boilers.
Damp, cold housing is associated with an increase in mental health problems such as depression and anxiety. Living in these homes can affect people’s ability to go about their daily lives. Some people become socially isolated as they are reluctant to invite friends or family to a cold house while others seek refuge elsewhere as an alternative to staying in.
Cold housing can also negatively affect children’s emotional wellbeing and resilience. Studies have suggested that more than one in four adolescents living in cold housing are at risk of developing mental health problems compared with one in 20 adolescents who have always lived in warm housing.
Health impacts associated with cold homes also include:
• Increased risk of heart attack and stroke
• Respiratory illnesses – adults and children
• Low weight gain in infants
• Poor diet and nutrition as a result of ‘heat or eat’ choices
• Falls and accidents
• Worsening of existing health conditions or slow recovery from illness
COLD & Covid-19 risks and impacts COVID-19 is likely to amplify the risks of cold weather. It is critical that actions to prevent health harms from cold temperatures and winter weather continue – including identifying and supporting those at risk – with necessary adaptations in line with coronavirus guidance to keep everyone safe.
Risk factors linked with worse outcomes from COVID-19, that are also risks for cold-related harms, are:
• age (65+ for cold, 70+ for COVID-19)
• underlying health conditions – chronic respiratory and heart disease
• diabetes
• pregnancy
Factors that impact on ability to adapt to cold, such as severe mental illness, cognitive impairment, drug and alcohol dependencies and disability, may also impact on ability to reduce exposure to COVID-19 – for example, through reduced ability to maintain good respiratory and hand hygiene.
Other groups with increased risk across the 2 hazards include:
• people who are housebound or otherwise have low mobility – they have reduced ability to self-care, greater dependence on care, suffer from social isolation
• people living in deprived circumstances
• people living in houses with mold - mold arises in poorly ventilated settings and poor ventilation is likely to be a risk factor for transmission of COVID-19 within the home
• people living in households experiencing fuel poverty – fuel poverty is linked to income and socio-economic deprivation, which is recognised as a risk factor for both cold and COVID-19
• people who are homeless or sleeping rough
• other marginalised or socially isolated individuals or groups – these may face barriers to accessing care because of, for example, language barriers or concerns about eligibility
Potential increase in exposure to cold may arise as a result of:
• Fuel poverty and cold homes
o Increased numbers of people spending more time at home than usual, with increased demand for energy and costs of heating.
o Economic drivers this winter may see an increase in the number of households and a difference in the types of households that experience fuel poverty and cold homes, not all of whom will be aware of funds or resources available to help with keeping warm.
• Reduced access to public warm spaces
• Necessary controls to limit spread of COVID-19 may limit access to warm public spaces, such as libraries.
• Discharge of vulnerable patients from hospital to a cold home This is a specific risk that has been recognised by NICE.
• Transmission of viruses is dominated by indoor pathways. People spend significantly more time indoors during the winter.
• Risk of transmission indoors is likely to be increased by housing factors:
o Poor ventilation in winter months increases the density of virus particles accumulating in a room. Barriers to ventilation include fuel poverty and other contextual factors such as noise, pollution and security concerns.
o Overcrowding
• Socio-economic factors: poor housing and deprivation are often shared risk factors for poor health that may also interact to increase the risk of transmission.
• Homelessness and rough sleeping
o There may be reduced access to shelters and other public warm spaces due to COVID-19 measures, which increases risk of exposure to cold.
o Homeless people, including the hidden homeless, may be at increased risk of exposure to COVID-19 due to overcrowding, and barriers to practicing regular hand and respiratory hygiene, as well as facing a high burden of pre-existing health problems.
o The extent of interacting risks from cold and COVID-19 faced by this vulnerable group will be influenced by decisions such as the safe provision of shelters, alternative accommodation and the activation of any severe weather emergency plans
11.Severe weather response arrangements
Management arrangements
For the response to a cold, flooding or winter weather emergency Provide will use normal management arrangements, local issues will be managed in the first instance by a line manager. In the event of a period of prolonged cold weather, it may be necessary depending on the severity and impact of the weather and disruption to invoke business continuity arrangements.
Determining the response
Cold weather and flooding alerts are received by the EPRR Manager who will review the alert and potential local impacts. Depending on the type and severity of the incident the
response may be treated as a major incident (Level 4 cold weather alert or widespread flooding) when the organisation may decide to invoke the provisions of the Provide Major Incident Plan (MIP). This will only be invoked if the incident meets the criteria for a Major Incident
Reporting
In the event of a cold weather or flooding alert being issued, the organisation may be required to submit situational reports externally to NHS England and/or our commissioners or collect information regarding service levels. The request will normally be sent via email for completion. Local commissioners may also request assurance that the organisation is aware of the alert and is undertaking the appropriate actions. Such requests will be coordinated through the EPRR Manager.
Patient care
Senior managers should also monitor the need to carry out actions required of this plan at short notice to safeguard services and protect staff and patients and should initiate service Business Continuity Plan arrangements as necessary.
Staff Attendance Issues
Staff should make every attempt to attend work; should staff be unable to attend work due to weather conditions Human Resources have provided guidance as at Appendix A.
Snow and ice
The effects of snow upon the organisations operations will vary depending upon its severity, the speed of onset and the length of time it continues snowing.
Provide commissions a contractor who provides a full gritting service to all Provide owned sites. The contractor monitors the temperatures and grit access points where low temperatures are likely to result in the formation of icy conditions. Gritting where possible is completed before the falling of snow to prevent accumulations. Where snow has accumulated on site this is cleared where possible and fresh grit applied. For all non-owned Provide sites this service is the responsibility of the landlord/owner. The primary difficulty posed by snow is its impact upon travel, both staffs travel to work, between sites, and home visiting (For Travel Guidance see Appendix B).
Local Authority Gritting routes
Most local authorities advertise their gritting routes through their websites and communicate their gritting routes via twitter.
If a credible advanced warning is received this will alert the organisation that there is the potential for flooding to occur. In this phase, local councils will monitor the risks more closely, keep multi agency partners informed of the developing situation and prepare the Council’s response.
Multiagency partners may be asked to acknowledge receipt of advanced warnings and take any preparatory actions they deem necessary. In addition the following actions may be taken
• The EPRR Manager will disseminate information to relevant teams/services and on-call teams as necessary
• Services to review business continuity arrangements and update staff.
• Site staff to check that any drains outside their premises are free of debris that could block them and result in flooding (visual check by walk around site perimeter) - should any potential blockages be identified, the maintenance contractor for the site should be notified and they will make arrangements for clearance.
• On-Call staff to familiarise themselves with the Corporate Business Continuity Plan and the health actions detailed in the relevant Multi-Agency Flood Plans.
Flood Event Occurring
Each flooding incident is different and the priorities of the response will vary; however, there are some priority tasks that are common to many flooding incidents. These are as follows;
• Affected services to consider activating their Business Continuity Plans if necessary and escalating response as appropriate.
• If out of hours on-call staff to be alerted by affected services, Local Area Team or Local Authority.
• Director on-Call should consider whether to activate the Corporate Business Continuity Plan - consider redeployment of essential staff to alternative work locations.
• Should the organisation be called upon to assist in a community emergency due to the flood event, on-call senior management staff should:
o consider whether the organisations emergency response requires activation of the Incident Coordination Centre (details of how to do this are in the On-Call Pack and the Major Incident Plan)
o undertake any necessary actions outlined in the relevant Multi-Agency Flood Plan
o manage the organisation’s response in support of the community and partner responders.
o identify all vulnerable persons. The response given to vulnerable people during a flooding incident must be made a priority. When a major incident is declared the organisation may be asked to provide details of known vulnerable people in the affected areas. Further details can be found at Appendix C
o Identify the organisation sites within the affected are and consider the actions required to ensure the buildings are protected from flooding. A list of all the Provide estate is included within the on-call pack.
4x4 Response support
In times of severe weather (heavy snow, flooding etc) Essex County Council have an agreed protocol to provide 4x4 support capability to emergency services for use in emergency situations. Procedures to be followed can be found at Appendix D
Stand down
The receipt of a lower level alert from the Met Office/Environment Agency will be communicated to staff via the emergency preparedness team. If a major incident had been declared the decision to stand down will be made by the Strategic (Gold) Command; on agreeing to stand-down all managers activated or placed on stand-by must be contacted and stood down and staff should be informed as necessary.
Recovery
Should a cold weather or flooding event affect the organisation’s operations or the local community, the Strategic (Gold) Command is responsible for initiating and managing the provide recovery processes. This may involve co-ordinating the Provide response with a wider multi-agency community recovery process led by the Local Authority.
Should the impact upon the organisation be significant, the Strategic (Gold) Command may consider appointing a Recovery Manager to co-ordinate the internal recovery process as a support to their overall leadership of the incident.
12.Cold weather alert actions
Cold weather alert – level 1
COLD WEATHER ALERT – LEVEL 1 ACTIONS
Winter Preparedness Period – 1 November to 31 March
Level 1 alerts run throughout the winter and indicate that people should be preparing for the possibility of severe weather and its effects on health.
EPRR
Manager
1 Ensure that the severe weather and major incident plans are up to date and are accessible to all staff
2 Ensure that the internal alert and cascade system for the appropriate staff to receive Cold/Severe Weather Alerts is in place and activated.
On-call Staff
1 Read and understand responsibilities outlined in the plan and actions to undertake upon the receipt of Cold/Severe Weather Alerts
Community Based Services
1 Ensure staff are briefed on the severe weather plan and that staff are encouraged to receive the flu vaccination
2 Identify individuals who are at risk from cold weather taking into account both cold and covid19 intersecting risks (see sections 9 2 & 9.4)
3 Identify any changes to individual care plans for those in high-risk groups, which might be necessary in the event of a cold or severe weather incident, including initiating daily visits by formal or informal carers to check on people living on their own
4 Work with the families and informal carers of at-risk individuals, to ensure that they are aware of the dangers of cold weather and offer advice/leaflets on how to keep warm
5 Check clients room temperatures if visiting. Ensure that they have at least one room which meets recommended room temperatures. (18 ºC day and night-time, see Appendix E)
6 Signpost those at risk clients/patients to other services; use the Keep Warm Keep Well booklet for up to date patient information and advice.
7 Encourage patients in at-risk groups to seek the flu vaccination from their GP Inpatient Areas & Clinics
1 Ensure staff are briefed on the severe weather plan and that staff are encouraged to receive the flu vaccination
2 Identify patients within at-risk groups preparing for discharge and ensure they get advice/ leaflets on how to keep warm
3 Encourage patients in at-risk groups to seek flu vaccination from their GP
Communications Team
1 Use ‘Week in Summary’ to inform staff to familiarise themselves with the severe weather plan and that the level one actions are currently in place
Cold weather alert – level 2
COLD WEATHER ALERT – LEVEL 2 ACTIONS
A Level 2 alert is triggered when mean temperatures of 2C and/or widespread ice or heavy snow is predicted within 48 hours and for at least 48 hours, with 60% confidence
The Met Office will inform the organisation and the will broadcast public warning messages via the internet, television and radio broadcasts.
Community Based Services
1 Ensure that list of patients at risk are up-to-date
2 Put in place additional care arrangements if considered necessary
3 When visiting patients, ensure that they are warm and have at least one room that meets the recommended room temperatures (18 ºC day and night-time, see Appendix E)
4 Check that patients have supplies of food and medication
5 Remind patients of actions they may take to protect themselves from the effects of severe cold
6 Prepare actions to be taken to increase capacity to meet increased pressures
7 Consider how forecast weather conditions may affect your ability to make your visits/ do your work
Inpatient Areas
1 Check that the temperatures in patient areas meet the recommended room temperatures (18 ºC)
2 Identify patients within at-risk groups preparing for discharge and ensure they get advice/ leaflets on how to keep warm
3 Prepare actions to be taken to increase staff capacity to meet increased pressures
Clinics
1 Ensure that preparations have been made for a potential influx of weather-related injuries and illnesses
2 Ensure that the temperatures in patient areas meet the recommended room temperatures (18ºC)
Communications Team
1 Inform staff of alert level increase via the front page of intranet, via the staff briefing and social media.
2 Inform the public using supplied DHSC guidance regarding staying warm in the winter
3 Feature alert level change on front page of the Provide website and link to the Met Office Severe Weather Alert page
All Services
1 Consider how forecast weather conditions may affect your service/teams ability to continue service delivery
2 Consider implementing business continuity arrangements as appropriate.
Cold weather alert – level 3
COLD WEATHER ALERT – LEVEL 3 ACTIONS
Response to actual severe weather occurring
The Met Office will inform the organisation via email and the will broadcast public warning messages via internet, television and radio broadcasts.
Community Based Services
1 Continue all level two actions
2 Prepare to support increased discharge from Acute Trusts and implement actions to increase capacity to meet increased pressures as required
3 Consider whether it is necessary to maintain daily telephone contact with vulnerable patients
4 Consider how forecast weather conditions may affect your ability to make your visits/ do your work (i.e. ice, snow)
Inpatient Areas
1 Continue all level two actions
2 Prepare to support increased discharge from Acute Trusts and implement actions to increase capacity to meet increased pressures as required
Clinics
1 Continue all level two actions
2 Implement any pre-prepared actions necessary to deal with an influx of weather-related injuries and illnesses
Communications Team
1 Inform staff of alert level increase via the front page of intranet, through an all staff email, via the staff briefing and social media
2 Inform the public using supplied DHSC guidance regarding staying warm in the winter
3 Feature alert level change on front page of the Provide website and link to the Met Office Severe Weather Alert page
On-call Staff
1 Monitor disruption to services and consider the implementation of service business continuity plans or surge management plans. If either are activated inform the Director on-call who will monitor the situation and if required consider activating the Corporate Business Continuity Plan.
All Services
1 Consider how forecast weather conditions may affect your service/teams ability to continue service delivery
2 Consider implementing business continuity arrangements as appropriate.
Cold weather alert – level 4
COLD WEATHER ALERT – LEVEL 4 ACTIONS
Major Incident Emergency response - severe or prolonged cold weather affecting sectors other than health
Level 4 is issued when the cold weather is so severe and/or prolonged that its effects extend outside health and social care, such as power or water shortages, and/or where the integrity of health and social care systems is threatened. At this level, illness and death may occur among the fit and healthy and not just in high-risk groups. All actions as described within the previous cold weather alerts will remain in place alongside any other actions required to provide safe patient care and staffing. Level 4 may be declared locally, regionally or nationally, according to established operating doctrines.
13.Communications
During the winter periodand in anyflooding event communications will be key in reassuring staff and providing advice to patients and the local community ensuring that they receive appropriate advice and guidance issued by the Met Office and government departments.
On receipt of a cold weather or flooding alert the EPRR Manager will ensure that it is disseminated to the appropriate areas and will agree in liaison with the communications team what staff and/or media messages are required.
In the event of actual cold weather or flooding, the Provide Communications team will ensure that staff are aware of cold weather and flood response procedures and receive alert level updates as appropriate. The Provide website, intranet and social media accounts will also be used to provide information to staff and services users
Where cold weather related communications to the public are released the message(s) should include or as a minimum how to access the winter warm benefits advice and clear self-care guidelines as to prevent cold weather related illness or injury. The key public health messages are attached as at Appendix F.
Communicating service status, changes to services and other response activities of the organisation will be necessary during any winter weather or flooding event. This communication will occur during the event rather than before the event resulting in reactive communications. These messages will be posted by the most appropriate and accessible method.
External communications relating to closures and health advice will be updated using any guidance issued by the Department of Health & Social Care, UK Health Security Agency (UKHSA) or NHS England & NHS Improvement messages. All messages will be updated by the communications team and copied to our partners and providers as to ensure consistency of messages.
Appendix A – HR GUIDANCE on Staff attendance issues
ADVERSE WEATHER CONDITIONS
It is expected that all staff make every reasonable effort to attend work when their normal transport arrangements has been disrupted due to extreme weather conditions.
Managers should take the following action for anyone who was unable to get into work. If staff were unable to attend work, the following options apply:
• Annual Leave
This will be the normal situation where no other option applies and is subject to agreement by the Line Manager.
• Carers Leave
If the member of staff is the main carer and had to organise childcare they are entitled to 1 day carers leave. Any additional days should be followed by annual leave, or unpaid leave if annual leave has been exhausted.
• Work from Home
If staff can work effectively from home this should be agreed in advance with their Manager.
• Disability
Although infrequent, this may apply where an existing disability or impairment is the sole reason for the absence. This disability needs to be known by the Manager prior to absence.
• Unauthorised unpaid absence
Applies where no contact has been made by the member of staff to the service.
As part of the organisation’s business continuity procedures all managers should ensure that they have up to date contact details for their staff and that staff are able to make contact with them or their normal place of work
Appendix B – Highways ENGLAND Guidance
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In severe and wintry weather it's even more important to plan your journey. We provide up to the minute traffic reports for our network of 4,300 miles of motorways and major A roads across England.
Just a few minutes checking our website before you set off can make all the difference to your journey.
Before you set off
Our website includes the latest traffic reports, maps showing how the traffic is flowing on England's motorways and major A roads, views from CCTV cameras, average speeds and the displays on motorway message signs. This can be access from http://www.trafficengland.com/
If you are away from your computer or have already set out on your journey, there are still lots of ways to get Highways England live traffic information.
Updates on the move
On overhead message sign - our control centres will flash up important travel messages, including warning you of delays and advising of alternative routes. We also have automatic signs telling you how long it will take traffic to reach certain destinations at that time.
When you take a break
We have a free app for your iPhone or if you have another type of smart phone that is web enabled, you can visit our website to access a mobile friendly version. This will allow you to select live updates by road, region or motorway. Remember: Never stop on the hard shoulder to do this and never use your mobile phone while driving
We also have information points with screens displaying our live traffic updates at many motorway service areas.
Your route
Highways England look after England’s motorways and major ‘A’ roads, our colleagues in local authorities look after all the other roads, and we work as hard as we can to keep our networks clear during severe weather.
Stick to the main roads where you can and avoid exposed routes
You should drive with care and respect the road conditions wherever you drive, but not every road can be treated. You need to take even more care driving on minor roads.
Even if the time and location of snowfall is perfectly forecast, it will still take us time to clear the snow after it has fallen and to treat the road with salt to reduce the risk of ice. It's not just the salt treatment that helps cut through snow and ice; it's the steady flow of traffic too.
Remember though, snow ploughs can't get through if the road or motorway is full of stationary traffic, so give our vehicles and crew the space they need to do their job and help you on your journey!
Check weather updates Take weather conditions into account when planning your route by visiting the Met Office website or listening to local radio broadcasts.
Timing
Always allow extra time in severe weather. Listen to warnings or advice and consider whether or not your journey is essential. If severe weather is forecast, can you plan your journey to travel before the worst of the weather? Or wait until it has passed? Or at least allow time after the snowfall for our crews to start clearing and treating the roads? It all helps. Remember, in severe weather you will need to allow more time for your journey. If severe weather is forecast are you able to change your travel plans?
Twitter
Our Twitter channel @HighwaysEngland will help you prepare for your winter journey with timely reminders and traffic updates. There are also regional feeds for live traffic information
Appendix C – Vulnerable persons
People who are vulnerable are ‘less able to help themselves in the circumstances of an emergency’. Emergency responders have a responsibility ‘to plan for and meet the needs of those who may be vulnerable in emergencies’*.
The statutory guidance ‘Emergency Preparedness’ states that it is not easy to define in advance and for planning purposes who are the vulnerable people to whom special consideration should be given in plans.
Those who are vulnerable will vary depending on the nature of the emergency. It then states that for planning purposes there are broadly three categories that should be considered:
• those who, for whatever reason, have mobility difficulties, including people with physical disabilities or a medical condition and pregnant women
• those with mental health difficulties
• others who are dependent, such as children†
Others who should also be considered are as follows;
• those who have mobility limitations or are supporting someone with mobility limitations (disabled, the ill & parents nursing infants)
• those that have limited ability to comprehend a risk / hazard or cannot understand a situation because of language issues.
• those in unfamiliar surroundings without friends and family or support nearby
If required, Local Councils, local health services, voluntary groups and utility companies can search their databases for service users who may need extra help. The results of these searches can then be shared with other agencies in the context of the response and recovery to the incident
Appendix D – Essex 4x4 support protocol
Essex Health 4x4 Response Procedure
1. Introduction
In times of severe weather (heavy snow, flooding etc) Essex County Council have an agreed protocol with the Essex Rover Rescue Club to provide 4x4 support capability to emergency services for use in emergency situations.
There may be times when ‘health’ may require support to undertake their duties and it would be appropriate for contact to be made to ECC requesting support through the Essex Rover Rescue Club.
2. Procedure
If you as a health provider within Essex require support to carry out your duties in an emergency, the following procedure must be followed.
Please note the following clear criteria for considering appropriate requests for support, which are:
1. A life threatening situation?
Will the patient come to significant harm if care is not provided to him/her?
(In most cases this would be an Ambulance service response or urgent community care provision)
2. Urgent delivery / collection of drugs?
Will the patient come to significant harm if they do not receive their medication?
3. Urgent collection of personnel?
Will patients be significantly harmed if this member of staff is not collected?
(please note getting members of staff to work is a business continuity issue and this procedure is not to be used for general staff, this criteria is specifically for an urgent transfer (for example a key surgeon needed for urgent care of a patient)
4. Urgent assistance to access a location?
Will the patient be significantly harmed if access is not gained by the emergency services?
Please note this criteria has been designed for life threatening situations, if this system is abused or misused those needing urgent support may be placed at greater harm, in all circumstances please consider all other capabilities prior to requesting support.
Please ensure that all requests are forwarded to your emergency lead and AEO’s within your lead CCG after the event to review the procedure and identify any lessons learnt.
For your information the process which the ECC Duty Officer will go through and the information that will be required is attached in Appendix 1.
3. Multi-Agency Support
If there are any issues with any requests that are received by Essex County Council Duty Officer or East of England Ambulance Control Centre then contact should be made with the Lead CCG to resolve these issues.
Please page the Director on Call for the ICB who will in turn liaise with the requester: Page: 07623 972256.
Appendix E
Call out requirements for Essex Rover Rescue (Used by ECC Duty Officer)
A number of organisations have passed the Essex County Council Duty Officer number down the line with the recommendation that we be called if assistance is required by Essex Rover Rescue. Unfortunately, there has not been a strong enough emphasis on the need for it to be an emergency.
Consequently, the Duty Officer has received calls for assistance which do not constitute an immediate emergency, e.g. to collect staff unable to get to work or to deliver nonessential drugs. There have also been a number of calls trying to reserve 4 x 4 assistance the following day or to put them on standby on a ‘just in case’ basis. Clearly, any of these problems should be considered by organisations within their Business Continuity Plans rather than relying on what is, to all intent and purposes, an emergency response capability.
To assist you in your decision making please consider the following matrix before deciding whether or not to contact Essex Rover Rescue.
Date Time of Call Duty Officer Log Sheet Reference
Officer
Name of caller Organisation
Reason for request
Is the request:
(a) A life threatening situation?
(b) Urgent delivery / collection of drugs?
(c) Urgent collection of personnel?
(d) Urgent recovery of a vehicle or vehicles?
(e) Urgent assistance to access a location?
(f) Recovery of stranded people to a place of safety?
Approved Declined
If the request does not fit any of the criteria, it should be politely declined with an explanation that we require to hold the 4 x 4 response for emergency use only.
Each request must be considered on a case specific basis. Emphasis is on the life threatening element and general movement of staff should be a Business Continuity issue
The first day of a severe weather event may require the above criteria to be slightly watered down depending on the circumstances. However, in a prolonged event we need to be more clear-cut when making these decisions in order that our emergency capability is not diminished.
Under no circumstances will we permit Rover Rescue to be put on standby for any particular organisation. It should be explained that they are on standby for all partners and will be deployed to a specific incident.
The following are a few examples where assistance can be provided:
• Collect a surgeon for a lifesaving procedure
• Convey medical assistance to a seriously ill patient
• Convey lifesaving drugs to a seriously ill patient
• Assist vehicle recovery during a large traffic jam in serious inclement weather
• Access vehicles caught in large traffic jams
• Assist utility companies to access locations for urgent repairs to critical equipment
• Recover / assist immobilised ambulance vehicles
The following are a few examples where assistance may be declined when the severe weather incident is prolonged and reasonable Business Continuity Plans would have made allowances for these eventualities. A certain amount of leeway should be permitted on the first days of the severe weather.
• Delivery of meals on wheels
• Conveying care workers to vulnerable persons when not life threatening
• Reserving 4 x 4 vehicle
• Collect staff unable to travel due to severe weather
• Delivery of drugs for a non-life threatening situation e.g. antibiotics
These examples are not exhaustive and your discretion is still paramount. They are however, given to ensure that we are seen to be consistent in our decision making.
Appendix G – Key public health messages
Get you flu jab if you:
• Are aged 65 or older
• Are aged two, three or four years old
• Are pregnant
• Have a serious medical condition such as chronic heart, lung, neurological, liver or kidney disease or diabetes
• Have a weakened immune system due to HIV or treatments that supress the immune system such as chemotherapy
• Have had a stroke or transient ischaemic attack (TIA) or post-polio syndrome
• Are living in a long stay residential care home or other long stay care facility (not prison or uni halls)
• Are the main carer for an elderly or disabled person whose welfare may be at risk if you fall ill
Keep your home warm, efficiently and safely:
• Heat your home to the right temperature; your living room and your bedroom and the rest of the house heated to 18ºC (65ºF). Above this and you may waste your money; below this you may risk your health. This will keep your home warm and may lower your bills.
• If you can’t heat all the rooms you use, heat the living room during the day and your bedroom just before you go to bed
• 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 three 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 solid fuel if you are not on mains gas or electricity – to make sure you do not run out in winter
Keep the warmth in by:
• Fitting draught proofing to seal any gaps around windows and doors
• Making sure you have loft insulation. And if you have any 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 & drinks
• Aim to include five daily portions of fruit and vegetables. Tinned & frozen vegetables count toward this
• Stock up on tinned and frozen foods so you don’t have to go out too much when its 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/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.
