Avon and Somerset Local Health Resilience Partnership Page: i of 53
CONTENT 1. INTRODUCTION... 1 Aim... 1 Objectives... 1 Scope... 2 Links to other plans... 2 2. COMMON SEVERE WEATHER DEFINITIONS... 2 Heatwave... 2 Cold Weather... 2 Flooding... 3 Storms and Gales... 3 3. RASCI FRAMEWORK... 3 4. TRIGGERS, ACTIVATION & ESCALATION... 8 Triggers... 8 Activation... 8 Escalation... 8 5. SITREP REPORTING... 8 6. LHRP Communication and Coordination... 9 Arranging a teleconference... 9 Warning and Informing... 9 Media... 9 7. ACTION LOG... 9 8. MUTUAL AID... 10 9. SEVERE WEATHER LHRP RESPONSE ACTION CARDS... 10 ANNEX'S A. SITREP REPORT TEMPLATE... 11 B. SEVERE WEATHER - CONFERENCE CALL AGENDA... 13 C. SEVERE WEATHER LHRP RESPONSE ACTION CARDS... 14 Heatwave Action Cards... 14 Cold Weather Action Cards... 24 Flooding Action Cards... 34 Storms and Gales Action Card... 40 D. POTENTIAL HEALTH IMPACTS... 46 Heatwave... 46 Cold Weather... 46 Flooding... 47 Page: ii of 53
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VERSION CONTROL DOCUMENT CHANGE HISTORY Version Date Comments 1.0 15 November 2013 1 st Issue 1.1 28 May 2014 Reviewed and updated post the publications of the Heatwave Plan for England 2014 Draft circulated for comment and sign off to LHRP Tactical Planning Group. 2.0 18 June 2014 2 nd Issue following review and endorsement by the LHRP Strategic Group Sponsoring Directors: Author(s): LHRP Strategic Group Andrew Sinclair / Sharon Wilson Document Reference: Page: iv of 53
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1. INTRODUCTION 1.1 The purpose of this plan is to ensure health commissioners and NHS-funded providers across Avon and Somerset are able to provide a robust and resilient response during severe weather affecting communities and health services. 1.2 It reflects the planning assumptions detailed within the National Resilience Planning Assumptions (Cabinet Office, 2011) and the Avon and Somerset Local Resilience Forum (LRF) Community Risk Register 1. 1.3 The plan is an operational framework for a local health response based on, but not replicating national strategy and guidance for severe weather, namely the; Heatwave Plan for England 2014 2 : Cold Weather Plan for England 2013 3 Keep warm keep well Booklet- HM Government Publications 4 Met Office Get Ready for Winter 5 National Flood Emergency Framework for England 6 1.4 The severe weather categories covered by the plan are: Heatwave Cold Weather Flooding Gales/Storms 1.5 All references in the plan to the area team means; a. The Bristol, North Somerset, Somerset and South Gloucestershire Area Team for all providers and commissioners operating within these geographical areas b. The Bath, Swindon, Wiltshire and Gloucester Area Team for all providers and commissioners operating within these geographical areas Aim 1.6 To provide an operational framework for responding to incidents where severe weather threatens health and wellbeing and which may disrupt health service provision. Objectives Outline the actions taken in response to severe weather Detail the receipt and distribution of weather warnings across the Local Health Resilience Partnership 1 Avon and Somerset LRF Risk Register 2 Heatwave Plan for England 2014 3 Cold Weather Plan for England 2013 4 Keep Warm, Keep Well Booklet 5 Met Office Get Ready for Winter 6 The National Flood Emergency Framework for England Page: 1 of 53
Ensure a coordinated response within and between LHRP partners Provide an overview of response phases and key actions Identify methods to provide an integrated response Illustrate the process for communication and risk assessment Detail the response for individual members of the LHRP Scope 1.7 The scope of the plan covers the operational processes for mobilising health resources to respond to severe weather and with the potential to significantly impact on routine services and / or may require additional resources to implement effective control measures. 1.8 This plan does not provide a process for day-to-day management of severe weather within individual organisations. All agencies will hold their own incident response / major incident and business continuity plans to manage internal organisational pressures. Wider roles and responsibilities, including the common response framework can be found in the Avon and Somerset LHRP Incident Response Concept of Operations. In addition, Avon and Somerset Local Resilience Forum Major Incident Response Guide will be used to inform multi-agency response arrangements. Links to other plans 1.9 This document should be read in conjunction with the Avon and Somerset; LHRP Incident Response Concept of Operations LHRP Standard Operating Procedure for Access to 4 x 4 Transport Support (including the Wessex 4 x 4 Memorandum of Understanding) LRF Multi Agency Flood Response Framework LRF Individual Organisation s Business Continuity Plans 2. COMMON SEVERE WEATHER DEFINITIONS Heatwave 2.1 Heatwave is defined by forecasts of day and night time temperatures and their duration by the Met Office; for example in the South West England a forecast of daytime temperatures exceeding 30 o C and night time temperatures above 15 o C for 2-3 days or more. 2.2 The Heat-Health alert planning system based on the forecasting of Heatwaves by the Met Office who provide a level of alert with actions to be taken for each level for all, including the health community. Cold Weather 2.3 Cold weather requiring NHS organisations to consider/ take preparatory actions is defined as mean temperatures of 2 o C and / or widespread ice or heavy snow. Page: 2 of 53
Heavy snow is defined as snow falling at a rate of at least 2 cm. per hour or more, expected 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 in the bulletin the areas that are affected. 2.4 Widespread ice is defined as when rain falls on to surfaces with temperatures at or below zero; or condensation occurs 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. It usually forms in sheets. Warnings are issued when any depth of ice is expected over a widespread area. Warnings will also be issued after snowfall when compacted snow is expected to cause an ice risk. 2.5 The term widespread indicates icy surfaces will be found extensively over the area defined in the Met Office bulletin. Flooding 2.6 Flooding is a constant hazard to life and property. We know from the Environment Agency s national assessment of flood risk (published June 2009) that: one in six homes in England is at risk of flooding; over 2.4 million properties are at risk of flooding from rivers or the sea in England, of which nearly half a million are at significant risk; and one million of these are also vulnerable to surface water flooding, with a further 2.8 million properties susceptible to surface water flooding alone. 2.7 As well as flooding from rivers, the sea and surface water, there are significant risks for some communities from groundwater flooding and water from failed or overflowing reservoirs. The scope of the National Flood Emergency Framework extends to these risks too. Storms and Gales 2.8 Wind speeds exceeding 60 mph resulting in localised / widespread damage to infrastructure and transportation 3. RESPONSIBLE, ACCOUNTABLE, SUPPORTING, CONSULTED, INFORMED (RASCI) FRAMEWORK 3.1 A RACSI framework provides a structure to identify organisational responsibilities. The completed RASCI framework in Table 1 below provides an agreed structure for health response activities in terms of identifying key stakeholders, roles and responsibilities as well as resources required to support the response. Page: 3 of 53
Table 1 RASCI Framework Page: 4 of 53 Responsible For Accountable For Supporting on Consulted on Informed About Met Office Providing forecast of Heatwave /cold weather/flooding/storm s and Gales and publishing Alert levels. Area Team Represent NHS providers at the Avon and Somerset LRF Strategic and Tactical Co-ordination Group meetings / teleconferences Participating in Multi Agency FASTCON teleconferences activated by the Environment Agency Moving the local community between levels of alert. Coordinating the position statement Implementing own organisational Business Continuity Plans. Implementing own organisational recovery Effective, coordinated health community response. Moving the local community between levels of alert. Ensuring commissioned services have the capability and capacity to fulfil their responsibilities. Facilitating mutual aid provision Coordination of Business Continuity service changes. Coordination of recovery plans Communications campaigns and Command, control and coordination activities on behalf of LHRP Information regarding impacts across LHRP and neighbouring areas
Public Health England Clinical Commissioning Group plans. Communications campaigns and patient information Seeking assurance on health system preparedness Implementing own organisational Business Continuity Plans Implementing own organisational recovery plans Communications campaigns and patient information Managing the assurance process with health providers Work with partner agencies on risk reduction awareness Coordinating the health response within their commissioning area Implementing own organisational Business Continuity Plans. Implementing own organisational recovery plans. patient information. Long term health monitoring Ensuring commissioned services have the capability and capacity to fulfil their responsibilities Supporting coordination, identification and provision of mutual aid for commissioned providers Moving the local community between alerts Providing additional information about impacts on health Page: 5 of 53
Communications campaigns and patient information. Providers Work with commissioner to develop long term response plans Make appropriate environmental adjustments Providing a position statement to the Area Team from the declaration of level 2 alert levels. Implementing own organisational Business Continuity Plans Implementing own organisational recovery plans Communications campaigns and patient information Local Authorities Implementing own organisational Business Continuity Plans. Implementing own organisational recovery plans. Long term health monitoring Ensuring that services are provided as normal Keeping commissioners informed where severe weather has impact on ability to maintain business as usual Responding to or making request for mutual aid Effective, coordinated social care community response Ensuring commissioned services have the capability and Mutual aid Communication campaigns Mutual aid Communication campaigns Providing impact assessment feedback Moving the local community between alert levels Moving the local community between alert levels Page: 6 of 53
Communications campaigns and patient information. capacity to fulfil their responsibilities LRF Partners Communications campaigns and patient information (warning and informing) Moving the local community between alert levels Voluntary and Community Groups Developing a community emergency plan to identify and support vulnerable neighbours Communications campaigns and patient information Moving the local community between alert levels Page: 7 of 53
4. TRIGGERS, ACTIVATION & ESCALATION Triggers 4.1 This plan can be triggered on receipt of a level 2 weather alert warnings from the Met Office or a Severe Flood Warning from the Environment Agency. Activation 4.2 LHRP members, through their commissioners, when weather impacts require special arrangements to be implemented or by the Area Team when National Alert Levels are reached or a multi-agency Local Resilience Forum Tactical or Strategic Co-ordination Group is formed. Escalation 4.3 From level 3 activation of arrangements will be agreed via an initial teleconference between LHRP partners and co-ordinated via further teleconferences or face-to-face meetings as required. 5. SITREP REPORTING 5.1 The SITREP report template attached at Annex A will be completed by each LHRP member in preparation for the severe weather teleconferences and / or meetings. The process for managing SITREPs is detailed below in Table 2. Table 2 SITREP Process LEVEL OF ALERT Level 0/1 Level 2 Level 3 No SITREPs required SITREP Process Anticipate and Preparedness Exceptional Reporting Only SITREP completed by each LHRP member and emailed to the area team by 10:00 hours on Thursday mornings. Area Team will collate and distribute whole system SITREP to LHRP partners by 14:00 hours to ensure potential impacts to the wider system are understood in preparation for the weekend. No further required. SITREP completed by each LHRP member and forwarded to area team in preparation for a wide system teleconference. Weekly teleconferences will take place at 10:00 hours on Thursday mornings; however if the event warrants Page: 8 of 53
it ad hoc teleconference will be set up. Conference call members to review and access wide system impacts and agree mitigating actions, mutual aid and the need for further conference calls leading into / over the weekend. Area team to collate and circulate notes and actions from conference calls. Level 4 As advised via the Area Team 6. LHRP COMMUNICATION AND COORDINATION 6.1 The primary method of communication will be through a LHRP teleconference although this may be replaced by face to face meetings if required. All LHRP members will be invited to participate in severe weather conference calls by the Area Team. Arranging a teleconference 6.2 Teleconference arrangements can be found in Section 4.1 of the LHRP Incident Response Concept of Operations document. A prepared agenda can be found at Annex B. Warning and Informing 6.4 Should public information messages be required, this will be co-ordinated by the LHRP Area Team working with health partners and the ASLRF Media Cell, if activated. Media 6.5 Severe weather will generate media interest. Requests for interviews may be received from a number of sources. These may be general information enquiries, requests for radio / TV interviews or requests for information from people presenting themselves at LHRP partners premises. All requests should be routed via LHRP partners Communications Team; all media briefings should be approved by their Communications Manager prior to dissemination. 6.6 The Communications Managers will liaise directly with the AT and, if appropriate, the ASLRF Media Cell to ensure media statements and press releases provide consistent and accurate information on the current situation. 7. ACTION LOG 7.1 An action log will be complete for severe weather teleconferences and / or meetings and circulated immediately to ensure agreed actions can be complete by the responsible organisation. The action log template can be found in Section 4.8 of the LHRP Incident Response Concept of Operations document. Page: 9 of 53
8. MUTUAL AID 8.1 The Avon and Somerset LHRP Memorandum of Understanding makes provision for securing mutual aid (staffing) from other NHS provider organisations in the event of having activated their Major Incident Plan or other emergency plan. A copy of the MOU can be found in Appendix B of the LHRP Incident Response Concept of Operations document. 9. SEVERE WEATHER LHRP RESPONSE ACTION CARDS 9.1 Severe weather action cards can be found in Annex C. The action cards have been developed to provide an aid memoir to commissioners and providers to ensure they are taking appropriate actions to mitigate the impacts, and just as importantly warning and informing patients, carers and staff. 9.2 To assist on call staff with their decision making, an overview of the potential health impacts of severe weather can be found at Annex D. Page: 10 of 53
SITREP REPORT TEMPLATE ANNEX A Organisation: Name (completed by): Date: Time: Telephone number: Email address: Authorised for release by (name & title): Type of Incident (Name) Organisations Name: Impact / potential impact of incident on services / critical functions and patients (See Note 1 below) Impact on other service providers Mitigating actions for the above impacts Impact of business continuity arrangements Page: 11 of 53
Media interest expected / received Mutual Aid Request Made (Y/N) and agreed with? Additional comments Other issues Note 1 1. General increase in admissions? 2. Weather specific increase in clinical presentations? (e.g. heatwave - Strokes, Signs of dehydration / cold Weather- hypothermia, falls, fractures etc.) 3. Impact on caseload (e.g. patients not attending appointments- gone out for the day as weather good. or increase in requests for appointments/visits due to heat/cold related illness. Difficulty getting to patients causing delay in receipt of treatments-diabetics in community, dialysis) 4. Impact on Staff-wellbeing (e.g. sickness levels) 5. Impact on infrastructure (e.g. keeping buildings coo l/ warm, transportation of people and goods, IT issues due to heat) 6. Social issues- (e.g. temporary relocation of patients, staff,public) Page: 12 of 53
SEVERE WEATHER - CONFERENCE CALL AGENDA ANNEX B No. Item 1 Introductions 2 Current Severe Weather Alert status 3 Situation Update - LHRP members using information provided in SITREP 4 Current Command and Control Arrangements Health Multi Agency 5 Key Issues & Risks (Acute Trusts / Community Health / Mental Health / Ambulance Service) Suspension of non-critical services & staff redeployment Maintenance of critical health services Safety of Staff and Staff Welfare 6 Agreed actions to mitigate impacts 7 Communications Reporting arrangements (NHS England SITREPS / SCG SITREPS) Public information and media strategy Internal NHS communications and staff briefings 8 Frequency of future teleconference/meetings 9 Confirm 10 Any Other Business 11 Date/Time Next Conference Call Page: 13 of 53
ANNEX C SEVERE WEATHER LHRP RESPONSE ACTION CARDS Heatwave Action Cards LEVEL 1 Summer Preparedness and Long-Term Planning During the summer months, NHS Trusts, Social Care, Public Health, Local Authorities and residential care / nursing homes will work in partnership to ensure that awareness and background preparedness is maintained against the measures set out in the national heat wave plan. Action 1 Work with partner agencies to coordinate appropriate heatwave plans. NHS England Area Team 2 Work with LA DPHs and Social Care to ensure managers of care, residential and nursing homes are aware of the heatwave plan alert system and know how to access advice. 3 Make sure staff are aware of heatwave plan for England and the associate advice. 4 Make sure emergency contacts and business continuity plans are up to date Clinical Commissioning Groups 5 Work with commissioned providers on risk reduction awareness, information and education to patients and carers. 6 Make sure staff are aware of heatwave plan for England and the associated advice. Page: 14 of 53
7 Agree plans for a surge in demand for services due to potential effects from the heat and sun 8 Make sure emergency contacts and business continuity plans are up to date General Practice 9 Ensure staff training includes a specific session on the Heatwave Plan for England 10 Consider how you can promote key public messages in surgery. i.e. take advantage of clinical contact with patients to promote public health messages about the heatwaves and keeping homes cool. 11 When making home visits, be aware of room temperatures in the household and if necessary provide advice on how to keep the home cool and staying out of the sun. 12 Make sure you are familiar with the principles and core elements of the national Heatwave Plan. 13 Ensure you are familiar with Trust and local business continuity plans Providers (Acute Trusts / Mental Health / Community Health) 14 Include heatwave risk assessments in patients clinical records and consider making necessary changes to care plans in the event of a heatwave (e.g. initiating daily visits by formal or informal care givers for those living alone) 15 Identify patients on your caseload who may be vulnerable during a heatwave and raise awareness of heat illnesses and their prevention among patients and carers 16 Ensure thermometers are available in all in-patients areas to monitor room temperature 17 Identify or create cool rooms/areas (able to be maintained below 26 C) Page: 15 of 53
18 When making home visits, be aware of room temperatures in the household and if necessary provide advice on how to keep cool and hydrated (Using the guidance Looking after yourself and other in hot weather 7 ) Looking after yourself and others during hot weather 2014 Page: 16 of 53
LEVEL 2 Alert and Readiness This is triggered as soon as the Met Office forecasts threshold temperatures for at least two to three days ahead in any one region, or forecasts that there is a 60 per cent chance of temperatures being high enough on at least two consecutive days to have significant effects on health. As most deaths occur in the first two days, this is an important stage at which to ensure readiness and swift action to reduce harm from a potential heatwave. 1 In liaison with DPH and PHE support the communication of public media messages. 2 Continue to maintain contact with LA DPHs and Social Care to ensure managers of care, residential and nursing homes are aware of the change in the heatwave alert level and know what actions to take. NHS England Area Team 3 Notify GPs of alert status and ensure appropriate action is taken 4 Continue to communicate alerts to staff and consider potential staff welfare / safety issues i.e. temperatures in work environments. 5 If required, co-ordinate receipt of health system SITREP reports and distribute a collated health service system wide report 6 Consider potential business continuity implications and take action as appropriate Page: 17 of 53
7 Seek assurance that commissioned providers are implement agreed level 2 actions. Clinical Commissioning Groups 8 Consider potential capacity issues and were necessary work with providers to implement mitigation strategies in advance of potential heatwave impacts on services 9 Consider potential business continuity implications and take action as appropriate 10 Continue to communicate alerts to staff and consider potential staff welfare / safety issues (i.e. temperatures in work environment) General Practice 11 Continue to take advantage of clinical contact with patients to reinforce public health messages. 12 When prioritising visits, consider vulnerability to heat as a factor in decision making 13 Consider potential business continuity implications and take action as appropriate 14 Send heatwave alerts to staff and make sure they are aware of their roles within heatwave plans Providers (Acute Trusts / Mental Health / Community Health) 15 Ensure there is sufficient staffing, particularly for vulnerable patients 16 Review caseloads and adjust care plans for high risk patients living on their own who have no regular contacts and consider how best to maintain daily contact i.e. through visits or phone calls 17 Give key public health messages to patients and their carers 18 When making home visits, continue to be aware of room temperatures in the household and provide Page: 18 of 53
appropriate advice 19 Check and record temperatures in-patient s areas during the hottest periods 20 Ensure cool areas in inpatient facilities are below 26 C. 21 Review and prioritise high-risk patients. 22 Ensure sufficient cold water and ice is available in inpatient facilities. 23 Consider weighing patients regularly to identify dehydration and rescheduling physiotherapy to cooler hours. Page: 19 of 53
LEVEL 3 Heatwave Action This is triggered as soon as the Met Office confirms threshold temperatures have been reached in any one region or more. This stage requires specific actions targeted at high-risk groups. 1 Continue to liaise with DPH and PHE to support the communication of public media messages. 2 Continue to maintain a close link to LA DPHs and Social Care to ensure managers of care, residential and nursing homes are aware of the change in the heatwave alert level and understand what actions to take. NHS England Area Team 3 Notify GPs of alert level 3 and ensure appropriate action is taken to mitigate impacts on service provision 4 Continue to communicate alerts to internal staff and consider potential staff welfare / safety issues 5 Activate weekly LHRP Teleconference calls and co-ordinate the health system response to deal with pressures going into the weekend 6 Implement business continuity plans and take action as appropriate 7 Seek assurance that commissioned providers are implement agreed level 3 actions. Clinical Commissioning Groups 8 Support NHS England in co-ordinating the health system response to ensure service pressures in the system are being managed effectively by providers. 9 Implement business continuity plans and take action as appropriate Page: 20 of 53
10 Continue to communicate alerts to internal staff and consider potential staff welfare / safety General Practice 11 Be aware of a possible surge in demand for GP appointments in the days following a level 3 heatwave period 12 Ensure staff members are aware of heat related risks and are able to advise patients accordingly 13 Implement business continuity arrangements and take action as appropriate 14 Report critical service impacts to NHS England Primary Care Team 15 Activate local plans to main business continuity including a possible surge in demand for Trust Services 16 Continue to give out key public health messages to patients and carers 17 Implement local care plans for contacting and caring for vulnerable community patients Providers (Acute Trusts / Mental Health / Community Health) 18 During home visits, be aware of room temperatures and continue to provide appropriate advice 19 Advise carers to contact GP if they have concerns about patients health 20 Ward staff to ensure access to cool rooms, close monitoring of vulnerable patients, reducing internal temperatures through shading, turning off unnecessary lights/equipment, cooling building at night, ensuring discharge planning takes home temperatures and support into account 21 Ensure that room / ward temperatures are checked and recorded regularly during the hottest periods for all in patient settings 22 Activate plans to maintain business continuity including a possible surge in demand Page: 21 of 53
LEVEL 4 EMERGENCY This is reached when a heatwave 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. In the event of a major incident being declared, all existing emergency policies and procedures will apply. Refer to Avon and Somerset lincident Response Concept of Operations. NHS England Area Team 1 Upon the declaration of a Level 4 alert by Central Government assess local impacts and activate local incident response plans if appropriate 2 If Major Incident is declared, implement BNSSSG AT Incident Response Plan and the LHRP Incident Response Concept of Operations 3 Co-ordinated and manage the response of LHRP Partners. 4 Continue to implement business continuity arrangements, as appropriate. Clinical Commissioning Groups 5 All Level 3 heatwave actions to continue. 6 Support NHS England Area Team in co-ordinating wider health response. Page: 22 of 53
7 Continue to implement business continuity arrangements, as appropriate. General Practice 8 All Level 3 heatwave actions to continue. 9 Continue to implement business continuity arrangements, as appropriate. 10 Implement Incident Response Plans / Major Incident Plans Providers (Acute Trusts / Mental Health / Community Health) 11 Stand up Trust Incident Co-ordination Centre, if required 12 Establish contact with CCG, Area Team and Local Authority Co-ordination Centres 13 All Level 3 Heatwave actions to continue. 14 Continue Implementing local business continuity management plans Page: 23 of 53
Cold Weather Action Cards LEVEL 1 Winter Preparedness 1 November to 31 March This is in force throughout the winter from 1 November to 31 March and indicates that preparations should be in place to protect health and ensure service continuity in the event of severe cold and winter weather 1 Work with partner agencies to coordinate appropriate Cold Weather plans. 2 Work with LA DPHs and Social Care to ensure managers of care, residential and nursing homes are aware of the cold weather alert system and know how to access advice. NHS England Area Team 4 Work with GPs on risk reduction awareness (e.g. influenza vaccination for at risk groups / staff), information and education. 5 Make sure staff are aware of cold weather plans and advice. 6 Work with GPs and staff on risk reduction awareness (e.g. influenza vaccination for staff), information and education. 7 Make sure emergency contacts are up to date. Clinical Commissioning 9 Work with commissioned providers on risk reduction awareness (e.g. influenza vaccination for at risk in-patients / staff), information and education. Page: 24 of 53
Groups 10 Make sure staff are aware of cold weather plans and advice. 11 Agree plans for winter surge in demand for services. 12 Make sure emergency contacts are up to date. General Practice 13 Ensure staff training includes a specific session on the Cold Weather Plan for England. 14 Consider how you can promote key public messages in surgery. i.e. take advantage of clinical contact with patients to promote public health messages about cold weather and cold homes. 15 Encourage all practice staff, including GPs have a flu vaccination. 16 Test your business continuity arrangements. 17 When making home visits, be aware of room temperatures in the household and if necessary provide advice on the minimum heating levels and where patients can get assistance, if required (Use the Keep Warm, Keep Well Booklet for up to date information). Providers (Acute Trusts / Mental Health / Community Health) 18 19 Undertake internal reviews to ensure information is going to the right staff and appropriate actions are agreed and able to be implemented when received, especially to protect vulnerable patients. Ensure staff identify patients at risk on their caseload and make necessary changes to care plans for high risk groups. 20 For those with multiple agency involvement, ensure the care coordinator / key worker is clearly identified. 21 Work with partner agencies to coordinate Cold Weather Planning. Page: 25 of 53
22 Ensure there are clear arrangements for signposting those at risk patients to other services (e.g. home insulation schemes, benefits entitlements) when identified in clinical situations or consultations. 23 Ensure data-sharing and referral arrangements are in place. 24 25 26 Work with patients at risk, their families and carers to ensure they are aware of the dangers of Cold Weather and cold housing and how to keep warm. Work with partners to ensure vulnerable patients have access to fuel supplies. Link to energy supplier priority service registers as required. Work with partners and staff on risk reduction awareness (e.g. flu vaccination for staff), information and education. 27 Provide a flu vaccination programme to all front-line staff and encourage staff to be vaccinated. 28 Ensure patients are aware of influenza and other vaccination programmes. 29 Identify the resources available to you for raising awareness of the health risks associated with winter weather and cold housing (for example, pharmacists have a key role in reminding people to have sufficient medicine and can help with preventive medicines management). 30 Ensure staff are aware of business continuity plans for severe winter weather. 31 Plan for a winter surge in demand for services. Page: 26 of 53
LEVEL 2 Alert and Readiness This is declared when the Met Office forecasts a 60% risk of severe winter weather in one or more defined geographical areas in the days that follow. This usually occurs two to three days ahead of the event. A Level 2 alert would be 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 are forecast, with the same confidence. 1 In liaison with DPH and PHE support the communication of public media messages. 2 Continue to maintain a close link to LA DPHs and Social Care to ensure managers of care, residential and nursing homes are aware of the change in the cold weather alert level and know what actions to take. 3 Notify GPs of alert status and ensure appropriate action is taken. NHS England Area Team 4 Continue to communicate alerts to internal staff and consider potential staff welfare / safety issues. (i.e. travel to from work / home working policy). 5 Work with LA teams to secure gritting provision to accident hotspots on the pavements or roads, advice on gritting priorities to prevent accidents in icy weather and ensure access by utilities and other essential services. 6 If required, co-ordinate receipt of health system SITREP reports and distributes a collated health service system wide report. 7 Consider potential business continuity implications and take action as appropriate. Page: 27 of 53
8 Seek assurance that commissioned providers are implement agreed level 2 actions. Clinical Commissioning Groups 9 Consider potential capacity issues and were necessary work with providers to implement mitigation strategies in advance of potential weather impacts. 10 Consider potential business continuity implications and take action as appropriate. 11 Continue to communicate alerts to internal staff and consider potential staff welfare / safety issues (i.e. travel to from work / home working policy). General Practice 12 Continue to take advantage of clinical contact with patients to reinforce public health messages. 13 When prioritising visits, consider vulnerability to cold as a factor in decision making. 14 Consider potential business continuity implications and take action as appropriate. Providers (Acute Trusts / Mental Health / Community Health) 15 16 Consider how to make best use of available capacity, for example by using community beds for patients at risk who do not need an acute bed and enabling access to step-down care and reablement. Be prepared for an influx of weather related injuries and illnesses. Communicate alerts to staff and ensure organisation level Cold Weather Plan actions are implemented, especially those to protect vulnerable patients. 17 Review caseloads and adjust care plans for high risk patients living on their own who have no regular Page: 28 of 53
contacts and consider how best to maintain daily contact i.e. through visits or phone calls 18 Ensure staff undertake appropriate home checks when visiting patients, e.g. room temperature; medications and food supplies. 19 Consider carers needs and the support they can continue to give. 20 Acute and Community Trusts to ensure rooms, particularly inpatient wards and sitting rooms, are kept warm. 21 Activate business continuity arrangements and emergency plans as required. 22 Activate plans to deal with a surge in demand for services. Page: 29 of 53
LEVEL 3 Severe Weather Action This is issued when the weather described in Level 2 actually happens. It indicates that severe winter weather is now occurring, and is expected to impact on people s health and on health services. 1 Continue to liaise with DPH and PHE to support the communication of public media messages. 2 Continue to maintain a close link to LA DPHs and Social Care to ensure managers of care, residential and nursing homes are aware of the change in the cold weather alert level and know what actions to take. 3 Notify GPs of alert level 3 and ensure appropriate action is taken to mitigate impacts on service provision. NHS England Area Team 4 Continue to communicate alerts to internal staff and consider potential staff welfare / safety issues. (i.e. travel to from work / home working policy). 5 Continue to work with LA teams to secure gritting provision to accident hotspots on the pavements or roads 6 Activate weekly LHRP Teleconference calls and co-ordinate the health system response to deal with pressures going into the weekend. 7 Implement business continuity plans and take action as appropriate. 8 Seek assurance that commissioned providers are implement agreed level 3 actions. Clinical 9 Support NHS England in co-ordinating the health system response to ensure service pressures in the system Page: 30 of 53
Commissioning Groups are being managed effectively by providers. 10 Implement business continuity plans and take action as appropriate. 11 Continue to communicate alerts to internal staff and consider potential staff welfare / safety issues (i.e. travel to from work / home working policy). General Practice 12 Be aware of a possible surge in demand for GP appointments in the days following a cold spell. 13 Ensure staff are aware of cold weather risks and are able to advise patients accordingly. 14 Implement business continuity arrangements and take action as appropriate. 15 Communicate alerts to staff and ensure locally agreed actions take place, especially those to protect vulnerable patients. Providers (Acute Trusts / Mental Health / Community Health) 16 Implement local care plans for contacting high risk patients. 17 Ensure carers are receiving appropriate advice and support. 18 During home visits, be aware of room temperatures and continue to provide appropriate advice. 19 Implement plans to deal with surge in demand. 20 Implement business continuity arrangements. Page: 31 of 53
LEVEL 4 Emergency Response This is reached when a period of cold weather is so severe and/or prolonged that its effects extend outside health and social care, and may include, for example, transport or power 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, coordinated by the Civil Contingencies Secretariat (Cabinet Office). NHS England Area Team 1 Upon the declaration of a Level 4 alert by Central Government assess local impacts and activate local incident response plans if appropriate. 2 If Major Incident is declared, implement BNSSSG AT Incident Response Plan and the LHRP Incident Response Concept of Operations. 3 Co-ordinated and manage the response of LHRP Partners. 4 Continue to implement business continuity arrangements, as appropriate. Clinical Commissioning Groups 5 All Level 3 Cold Weather actions to continue. 6 Support NHS England Area Team in co-ordinating wider health response. 7 Continue to implement business continuity arrangements, as appropriate. Page: 32 of 53
General Practice 8 All Level 3 Cold Weather actions to continue. 9 Continue to implement business continuity arrangements, as appropriate. Providers (Acute Trusts / Mental Health / Community Health) 10 All Level 3 Cold Weather actions to continue. 11 Implement Incident Response Plans / Major Incident Plans 12 Continue to implement business continuity arrangements Page: 33 of 53
Flooding Action Cards Flooding is possible. Be prepared. (Issued between two hours to two days in advance of flooding) Action Commissioners, General Practice and Providers 1 Maintain a Watching Brief - Daily check of Met Office forecast and Environment Agency Flood Alerts for South West region and ensure an appropriate level of response Action 2 Start to identify vulnerable patients that may require additional support during flooding. Providers (Acute Trusts / Mental Health / Community Health) 3 Start to review surge capacity and the need for, and availability of, staff support in the event of a prolonged flood incident. 4 Facilities Management / Estates to identify level of resilience to utilities and services. 5 Estates to confirm operation status of generators to ensure continuity of power to support equipment, heating / lighting of air conditioning units that may be at risk from flooding. 6 Inpatient wards to identify level of resilience to utilities and services. 7 Trust services to prepare to implement local resilience plans if required. Page: 34 of 53
Flooding is expected. Immediate action required. (Issued half an hour to 1 day in advance of flooding) Commissioners, General Practice and Providers 1 Maintain a Watching Brief - Daily check of Met Office forecast and Environment Agency Flood Alerts for South West region and ensure an appropriate level of response 2 If required, co-ordinate receipt of health system SITREP reports and distribute a collated health service system wide report and assess need for a system wide teleconference. NHS England Area Team 3 If required, represent LHRP partners on the EA FASTCON teleconferences. 4 If activated, represent LHRP partners at the Avon and Somerset LRF Silver Planning Teleconferences / Meetings. 5 Implement Business Continuity Plans, as required. Clinical Commissioning 6 Consider potential capacity issues and were necessary work with providers to implement mitigation strategies in advance of potential weather impacts. Page: 35 of 53
Groups 7 Implement Business Continuity Plans, as required 8 Continue to review surge capacity and the need for, and availability of, staff support in the event of flooding. 9 Consider, where appropriate, daily visits / phone calls for vulnerable patients living on their own who have no regular daily contacts. This may involve informal carers, volunteers and care workers and will be targeted at defined risk groups. 10 Work with families and informal carers to highlight dangers of flooding and promote ways to keep safe. 11 Use all available resources to maximise frontline district nurse / health visitor capacity. Providers (Acute Trusts / Mental Health / Community Health) 12 Make daily contact with vulnerable, community-based patients. 13 Discharge planning should reflect local and individual circumstances so that people at risk are not discharged to accommodation that may be at risk from flooding. 14 Identify what non essential activities could cease. 15 Review service levels to ensure staffing levels will be sufficient to cover the anticipated flooding period. 16 Re-enforce messages on risk and protective measures to be taken by staff. 17 Maintain community based services. 18 Use all available resources to maximise frontline inpatient/ community capacity. Page: 36 of 53
19 Implement Business Continuity Plans, as required. Page: 37 of 53
SEVERE FLOODING. DANGER TO LIFE. (ISSUED WHEN FLOODING POSES SIGNIFICANT THREAT TO LIFE) (NHS England Area Team) 1 Upon receipt of a Severe Flood Warning activate a LHRP Teleconference to assess local impacts and activate local incident response plans and the LHRP Incident Response Concept of Operations, if appropriate. 2 Continue to represent NHS partners on the EA FASTCON teleconferences. 3 Continue to represent NHS Partners at the Avon and Somerset LRF at Tactical Control and the Strategic Coordination Centre if set up. 4 Co-ordinated and manage the response of LHRP Partners. 5 Continue to implement business continuity arrangements. Clinical Commissioning Groups 6 Support NHS England Area Team in co-ordinating the wider health response. 7 Continue to implement business continuity arrangements. Page: 38 of 53
Providers (Acute Trusts / Mental Health / Community Health) 8 Continue with Flood Warning above. 9 Implement Incident Response Plans / Major Incident Plans. 10 Continue to implement business continuity arrangements. Page: 39 of 53
Storms and Gales Action Card Damage from storms and gales is the most common cause of weather related disruption in the UK. LEVEL 1 BE AWARE General Impacts Severe weather warning for strong winds 60-70mph localised disruption to transportation /infrastructure Health Impacts Disruption to service provision leading to minor health impact. Slight increase in A&E/minor injury attendance Action Commissioners, General Practice and Providers 1 Maintain a Watching Brief - Daily check of Met Office forecast for South West region and ensure an appropriate level of response. Page: 40 of 53
LEVEL 2 BE PREPARED General Impacts Winds speeds 70-80mph Widespread structural damage and resulting disruption. Disruption to Infrastructure and transportation Health Impacts Disruption to service provision leading to minor health impacts Increase in A&E / minor injury attendance. Commissioning, General Practice and Providers 1 Maintain a Watching Brief - Daily check of Met Office forecast and Environment Agency Flood Alerts for South West region and ensure an appropriate level of response. (NHS England Area Team) 2 If required, co-ordinate receipt of health system SITREP reports and distribute a collated health service system wide report and assess need for a system wide teleconference. 3 If activated, represent NHS Partners at the Avon and Somerset LRF Silver Planning Teleconferences / Meetings. 4 Consider implementing Business Continuity Plans. Commissioning and Providers 5 Consider potential capacity issues and were necessary work with providers to implement mitigation strategies in advance of potential weather impacts. 6 Consider implementing Business Continuity Plans. Page: 41 of 53
Providers (Acute Trusts / Mental Health / Community Health) 7 Ensure building/facility managers are aware of the impending weather warning and consider potential impacts to buildings and surrounding areas, as appropriate. 8 Consider identification of vulnerable, community-based patients and review patient lists. 8 Consideration potential service disruption implications as a result of either staffing or infrastructure problems. 10 Raise staff awareness and provide situation updates. Page: 42 of 53
LEVEL 3 TAKE ACTION General Impacts Winds above 80mph Widespread severe structural damage and resulting disruption. Disruption to-infrastructure and transportation Large scale damage Health Impacts major disruption to service provision leading to major health impact s Large increase injuries requiring in A&E / minor injury attendance Increase in death Displacement of people impacting health e.g.medications required. Commissioning, General Practice and Providers 1 Continue to maintain a Watching Brief - Daily check of Met Office forecast and Environment Agency Flood Alerts for South West region and ensure an appropriate level of response. (NHS England Area Team) 2 Set up LHRP Teleconference and establish impacts on health services and infrastructure. 3 If activated, represent NHS Partners at the Avon and Somerset LRF Silver Planning Teleconferences / Meetings. Clinical Commissioning Groups 4 Support NHS England Area Team in co-ordinating wider health response. 5 Continue to implement business continuity arrangements. Page: 43 of 53
6 Review surge capacity and the need for, and availability of staff. 7 Work with patients families and informal carers to highlight dangers from storms / severe gales and promote ways to keep safe. 8 Use all available resources to maintain critical community services. 9 Make daily contact with vulnerable, community-based patients. 10 Discharge planning should reflect local and individual circumstances so that patients and staff are not put at risk Providers (Acute Trusts / Mental Health / Community Health) 11 Identify what non essential activities could cease. 12 Review service levels to ensure staffing levels will be sufficient to maintain critical hospital-based services. 13 Reinforce messages on risk and protective measures to be taken by staff. 14 15 16 Produce vulnerable patient lists and be prepared to work in partnership with other multiagency groups to identify vulnerable people /areas which may be affected during the storm. Staff should be advised on what actions to take, dependent upon the prevailing conditions, in order to maintain a safe working environment and working practices. All staff should be kept informed of the on-going situation and given advice, if appropriate, via the staff website and via email. Page: 44 of 53
LEVEL 4 EMERGENCY Action (NHS England Area Team) 1 2 If a major incident is declared, activate the area teams Incident Response Plan and the LHRP Incident Response Concept of Operations. Continue to represent NHS Partners at the Avon and Somerset LRF at Tactical Control and the Strategic Coordination Centre if set up. 3 Co-ordinated and manage the response of LHRP Partners. Action Clinical Commissioning Groups 4 Continue all actions in Level 3 above. Continue to support NHS England Area Team in co-ordinating wider health response. Action Providers (Acute Trusts / Mental Health / Community Health) 5 Continue all actions in Level 3 above. 6 Implement Incident Response Plans / Major Incident Plans. 7 Continue to implement business continuity arrangements. Page: 45 of 53
POTENTIAL HEALTH IMPACTS Heatwave 1.1 The main causes of illness and death during a heatwave are respiratory and cardiovascular diseases. Additionally, there are specific heat related illnesses including: Annex D Heat cramps caused by dehydration and loss of electrolytes, often following exercise. Heat rash small, red, itchy papules. Heat oedema mainly in the ankles, due to vasodilation and retention of fluid. Heat syncope dizziness and fainting, due to dehydration, vasodilation, cardiovascular disease and certain medications. Heat exhaustion is more common. It occurs as a result of water or sodium depletion, with nonspecific features of malaise, vomiting and circulatory collapse, and is present when the core temperature is between 37ºC and 40ºC. Left untreated, heat exhaustion may evolve into heatstroke. Heatstroke can become a point of no return whereby the body s thermoregulation mechanism fails. This leads to a medical emergency, with symptoms of confusion; disorientation; convulsions; unconsciousness; hot dry skin; and core body temperature exceeding 40ºC for between 45 minutes and eight hours. It can result in cell death, organ failure, brain damage or death. Heatstroke can be either classical or exertional (e.g. in athletes). 1.2 There are certain factors that increase an individual s risk during a heatwave. These include: Older age: especially women over 75 years old, or those living on their own who are socially isolated, or in a care home. Chronic and severe illness: including heart conditions, diabetes, respiratory or renal insufficiency, Parkinson s disease or severe mental illness. Medications that potentially affect renal function, the body s ability to sweat, thermoregulation or electrolyte balance can make this group more vulnerable to the effects of heat. Inability to adapt behaviour to keep cool: having Alzheimer s, a disability, being bed bound too much alcohol, babies and the very young. Environmental factors and overexposure: living in urban areas and south facing top floor flats, being homeless, activities or jobs that are in hot places or outdoors and include high levels of physical exertion. 1.3 In a moderate heatwave, it is mainly the high risk groups mentioned above who are affected. However, during an extreme heatwave such as the one affecting France in 2003, normally fit and healthy people can also be affected. Cold Weather 1.4 The impact of cold weather on health is predictable and mostly preventable. Direct effects of winter weather include an increase in incidence of: Page: 46 of 53