Inclement Weather Plan CATEGORY: CLASSIFICATION: Plan Emergency planning CONTROLLED DOCUMENT PURPOSE Controlled Document Number: This plan is designed to provide actions for the Trust to undertake to ensure that it can continue to carry out its business in the event of inclement weather. 647 Version Number: 004 Controlled Document Sponsor: Controlled Document Lead: Approved By: On: October 2017 Review Date: October 2019 Distribution: Essential Reading for: Information for: Executive Director of Strategic Operations Head of Emergency preparedness and resilience Emergency preparedness steering group All staff All staff Page 1 of 10
Contents Paragraph Page 1 Introduction 3 2 Definition of inclement weather 3 3 National cold weather alert levels and actions 4 4 Potential implications for health 4 5 The aim and objectives of the plan 5 6 Notification of inclement weather 5 7 Staff attendance at work 5 8 Capacity 7 9 Catering Services 7 10 Safety of site 7 11 Communications 7 12 Patient and staff comfort 8 13 Discharge of vulnerable patients to home 9 14 Business Continuity 9 15 Visitors 10 16 Volunteers 10 17 References 10 18 Associated Policy and Procedural Documentation 10 Page 2 of 10
1. Introduction 1.1 This plan is designed to give assurance that University Hospitals Birmingham NHS Foundation Trust (the Trust ) can continue to exercise its function in the event of inclement weather. 1.2 On average there are around 25,000 excess winter deaths each year in England. Excess winter deaths are the observed total number of deaths in winter (December to March) compared to the average number of deaths over the rest of the year. 1.3 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 some of these winter deaths are extra and are related to cold temperatures and living in cold homes as well as infectious diseases such as influenza. 1.4 Cold temperatures predominantly affect older age groups, children and those with chronic illness. It is thought that about 40% of cold related deaths are due to cardiovascular disease and 33% to respiratory disease. 1.5 Heavy snow and ice have a smaller, but still important direct effect on health, predominantly resulting in falls and injury. However, snow and ice may cause significant disruption to the delivery of healthcare and other services. 2. The aim and objectives of this Plan 2.1 The aim of the plan is: To help maintain an appropriate level of service to users of QEHB, to minimise disruption when inclement weather significantly interrupts normal business. To ensure care of the vulnerable patient both in hospital and when discharged. 2.2 The objectives are:- To ensure QEHB can continue to exercise its function in the event of inclement weather To reduce exposure to low indoor temperatures within the Trust To work with partner agencies to ensure when patients are to be discharged home they are discharged to a warm, safe environment. Page 3 of 10
3. Definition of inclement weather 3.1 Inclement weather covers conditions such as snow, ice, fog, floods and severe wind, which render extremely hazardous journeys by road, by both public and private transport. 3.2 The following table shows the national alert levels and actions that are expected by provider organisations. 4. National cold weather alert levels and actions Level 0 Level 1 Level 2 Level 3 Level 4 Year round planning Ensure organisation can identify and support most vulnerable Plan for joined up support with partner organisations Work with partners and staff on risk reduction awareness (e.g. signposting for winter warmth initiatives, flu vaccination Winter preparedness and action 1 November to 31 March Ensure cold weather alerts are going to right staff and actions agreed and implemented Ensure staff in all areas are considering room temperature Ensure data sharing and referral arrangements in place Severe winter weather forecast Alert and readiness Mean temperatures of 2 C and/or widespread ice and heavy snow predicted with 60% confidence Continue level 1 actions Activate Business continuity plans as required Severe weather action Mean temperatures of 2 C and/or widespread ice and heavy snow Continue level 2 actions Implement emergency and business continuity plans: expect surge in near future Major Incident Emergency response Level 4 alert issued at national level in light of cross government assessment of the weather conditions, coordinated by the Civil Contingencies Secretariat based in the cabinet office. All level 3 responsibilities to be maintained unless advised to the contrary 4.1 These actions need to be contained within Business continuity plans. 4.2 During times of adverse weather alerts will be put out by the Communications department. Page 4 of 10
5. Potential implications for health 5.1 Increase demand on Emergency Departments and hospital admissions due to injury secondary to ice such as road traffic accidents, Slips and falls leading to fractures, hypothermia in the elderly and deterioration of chronic respiratory illness. 5.2 Increase demand on hospital beds and longer hospital admissions. 5.3 Disruption of staff journey to work, which in turn will have the potential to impact on delivery of patient care due to a reduction in staff available to work. 5.4 The disruption and interruption by external providers of essential services to the Trust such as the presence of ice on electrical power line poses a threat to continued electrical power and burst water mains. 5.5 Increased demand on Mortuary and Bereavement services due to excess deaths. 5.6 Injuries and infectious diseases as a result of increased flooding a Foresight report predicted that by 2080 over three million people in the UK could be at risk from flooding. Whilst QEHB is not on a flood plain there are potential staff who travel into work may well live in such an area. 5.7 Anxiety and depression linked to physical and economic insecurity flooding increases the risk of depression fourfold. 6. Notification of inclement weather 6.1 A cold weather alert service operates from 1 November to 31 March, based on Met office forecasts and data, 24 hours a day via email from metoffice@service.govdelivery.com to NHS Trust Chief Executives and Emergency Planning Co-ordinators. 6.2 This will trigger levels of response from the NHS, local government and public health system, and communication risks to the public. 7. Staff attendance at work 7.1 Refer to the associated Workforce Availability Procedure. http://uhbpolicies/assets/workforceavailabilityprocedure.pdf 7.2 In the situation where staff have been unable to attend work: The Nurse in charge of the ward / department must inform within hours their divisional Matron, out of hours the Clinical Site Manager. Page 5 of 10
Concerns regarding Medical staffing issues/levels must be taken to the bed meeting by the Divisional Capacity team with an indication of the plan to address shortfall. Allied Health Professionals staffing issues/levels mustbe taken to the bed meeting by their management team with an indication of work load that can be achieved and how work load will be prioritised. Capacity Nurses to be allocated according to demand caused by absence of staff and dependency of patients. All divisions departments to take staffing levels to each bed meeting for the forthcoming 24 hours. Nursing staffing dash board must be updated to reflect staffing levels each day In order to prepare for the potential reduction in the Trust s workforce, each department / division needs to determine the minimum staffing levels for the safe operation of services. Following bed meetings, QEHB+ to be contacted to discuss availability of staff to support the Trust during this period of time. Divisional Clinical Nurse Specialist to be made available to support inpatient essential clinical areas, staff to be allocated to areas as and when demand required. If demand indicates, Corporate and Education Nursing also to provide support to inpatient essential clinical areas. Study leave to be cancelled following discussion with Chief Nurse and Deputy Chief Nurse, Nursing staff to be allocated back into the clinical areas. Cancellation of study leave for Medical staff will be determined by the Medical Director. In the event of extreme weather, Allied Health Professionals managers should be represented at the bed meetings to discuss staffing issues and their service demands. Focus must be on keeping essential acute clinical areas working at a functional level. In the event of extreme inclement weather, where services have been identified as non-essential, employees may be redeployed within reason to support core emergency and inpatient services. Page 6 of 10
8. Capacity In extreme cases where staff are unable to travel home from work, accommodation will be available at QEHB and this can be accessed via the Clinical Site Manager/on call manager. 8.1 Bed meetings to take place as planned at 9.00am, 12.00pm, and 4.30p.m. Further bed meetings will be at the discretion of the Head of Ops within hours and the Clinical Site Manager out of hours. 8.2 Decisions to cancel TCIs will be made at divisional level, taking into consideration staffing levels, skill mix & bed availability. 8.3 Priority will be given to inpatients workload; there may be a need to cancel outpatient clinics to enable this to happen. 9. Catering Services The Trust will ensure catering services are available to patients and employees during the episodes of inclement weather. The Trust currently holds sufficient stocks in the Catering department of frozen and nonperishable foods to last three days. In the event where inclement weather is prolonged the catering Business continuity plan will be implemented to ensure that both patients and staff are catered for. 10. Safety of site 10.1 The Trust has a duty to ensure access to the site is maintained at all times, for public, staff and emergency vehicles. 10.2 Engie services are responsible for ensuring the site remains safe and will invoke their winter maintenance programme. This includes ensuring that all roads and paths around the hospital are gritted and/or cleared of snow. 11. Communications 11.1 In the event of serious inclement weather affecting the Trust s service provision, the Communications Team can use internal and external communications channels to inform staff and the public. 11.2 The primary external communications channels would be radio and television. Morning bulletins achieve the greatest audiences, so decisions about service suspension or delay should be made as early as possible. 11.3 The Communications Team can also send Trust-wide emails about the impact of inclement weather, asking managers to cascade the information to their staff. Page 7 of 10
11.4 Key information required by the Communications team: Which departments are affected? Which departments remain open? Contact information for patients/visitors needing more information Information specifically for GPs wanting to make urgent referrals to CDU/ED Primary UHB contact for Communications to clear statements/website changes about the inclement weather effects. 12. Patient and Staff comfort When the temperature within the ward / department area drops below 20 C staff must contact the Engie help desk to report it. If an in-patient area has a consistent recorded temperature below 20 C then patients must be moved to an area that is more suitable. Patients must be supplied with extra blankets where required. Extra blankets for patients can be obtained by contacting ext. 12692 and delivery will be arranged. When patients leave the ward for investigations and procedures, staff must ensure the patient is dressed appropriately and covered with blankets where required. Staff should discourage patients from leaving the hospital building in cold weather as they could be at risk of hypothermia or at risk of falls. Staff must consider offering further hot drinks rounds to patients and ensuring patients are offered hot meals at least once per day. When a patient is discharged home, staff have a responsibility to ensure patients are dressed appropriately. At the discretion of the Chief Nurse or in their absence the deputy Chief Nurse, staff may wear navy cardigans; these must be removed when delivering direct patient care. Page 8 of 10
Staff are also encouraged to have warm drinks, away from the patient area. Staff restaurant facilities are open from 07.00hours through to 20.00 hours where hot meals and drinks are available. In extreme weather conditions where staff are unable to leave the Trust, between the hours of 20.00 hours and 07.00 hours a regen kitchen will be utilised to make hot food and drinks for the staff. Staff who are unable to travel home from work due to the bad weather may be provided with accommodation. 13. Discharge of vulnerable patients to home 13.1 Assess if the patient is likely to be vulnerable to the cold and if action is required to make their house warm enough for them to return to. This assessment needs to take place well before they are discharged to allow time for remedial action to take place if required. 13.2 The term Vulnerable relates to a number of different groups including: People with cardiovascular conditions People with respiratory conditions People with mental health conditions People with disabilities Older people (aged 65 and over) People on low income 13.3 As part of planned discharge, ward staff must coordinate the efforts involved to ensure the home is warm enough for the patient to be discharged too. This must include simple measure such as communicating with family, carers or friends, the planned discharge date and to ensure the heating is turned on prior to discharge. 14. Business Continuity 14.1 In the event of severe weather the Service Interruption Management Team (SIMT) will meet in the Ops Centre to discuss ongoing plans. 14.2 The SIMT will ensure that Critical departments have implemented their Business continuity plans to ensure wherever possible services are maintained. Page 9 of 10
14.3 Cancellation of out-patients and elective surgery will be discussed at the SIMT meetings. 15. Visitors 15.1 Staff must take into consideration, visitors visiting outside of visiting hours when travel is hindered by the weather, flexible visiting must be discussed with the relatives. 15.2 Visitors must be made aware of where facilities are within the Hospital to enable them to purchase hot food and drinks. 16. Volunteers Volunteers working within the Trust may be utilised to provide comfort to patients, support of clinical staff and can be contacted via The Voluntary Services Manager. 17. References Cold weather plan for England, NHS England, October 2015 Met Office Cold weather Health watch service 18. Associated Policy and Procedural Documentation Adverse Weather Procedure Workforce Availability Procedure Page 10 of 10