heatwave main plan accessible

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Heatwave Plan forEngland 2014

Protecting health and reducing harm fromsevere heat and heatwaves

May 2014


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Contents

Foreword 3

Executive Summary 4

1. Why this plan is needed 6

2. The Heat-Health Alert service 12

3. Summary of Heatwave Plan levels and actions 17

4. Anticipated Impacts for other Sectors during a level 4 heatwave 31

5. Monitoring and surveillance 35

6. Recommended next steps for the NHS and Local Authorities 37

Annex 1: Key trigger temperatures 38

Annex 2: Public Health Core messages 40Annex 3: Heatwave Advice and Mass Gatherings 41

Acknowledgements 43


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2 Heatwave Plan for England Protecting health and reducing harm from severe heat and heatwaves

Glossary of abbreviations

CCGs Clinical Commissioning Groups

CCS Civil Contingencies Secretariat

CO Cabinet Office

DCLG Department for Communities and Local Government

DH Department of Health

EH Environmental Health

EPRR Emergency Preparedness, Resilience and Response

HHSRS Housing Health and Safety Rating System

HWB Health and Wellbeing Boards

HWS Health and Wellbeing StrategyJSNA Joint Strategic Needs Assessment

LA Local Authority

LHRP Local Health Resilience Partnership

LRF Local Resilience Forum

OGD Other Government Department

PHE Public Health England

RED Resilience and Emergencies Division, DCLG


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Heatwave Plan for England Protecting health and reducing harm from severe heat and heatwaves 3

Foreword

Professor Dame Sally C DaviesChief Medical OfficerChief Scientific AdviserDepartment of Health

Although many of us enjoy the sunshine, as aresult of climate change we are increasinglylikely to experience extreme summertemperatures that may be harmful to health.For example the temperatures reached in2003 are likely to be a normal summer by2040, and indeed globally, countries havealready experienced record temperatures.We do not know whether or not there will besevere heat over the course of this summer,but we do want to make sure that everyone

takes simple precautions to stay healthyduring periods of hot weather and when inthe sun.

The Heatwave Plan for England remains acentral part of the Department of Healthssupport to the NHS, social care and localauthorities, providing guidance on how toprepare for and respond to a heatwavewhich can affect everybodys health, butparticularly the most vulnerable people in

society.

The purpose of this Heatwave Plan is toreduce summer deaths and illness by raisingpublic awareness and triggering actions inthe NHS, public health, social care and othercommunity and voluntary organisations tosupport people who have health, housing oreconomic circumstances that increase theirvulnerability to heat. Communities and civilsociety can also help their neighbours,friends and relatives to protect againstavoidable harm to health this summer.

This plan builds on many years ofexperience of developing and improving theability of the health sector and its partners todeal with significant periods of hot weather. Itis up to each locality to consider the actionsin this plan and to adapt and incorporatethem in local plans as appropriate to the localsituation.

We know that the Heatwave Plan for Englandhas successfully helped individuals,

communities and authorities better prepareand plan for severe summer temperatures.We want people to enjoy the summer and toreduce the harm from heatwaves to thosemost at risk, for now and in the future.

Professor Dame Sally C DaviesChief Medical OfficerChief Scientific AdviserDepartment of Health


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Executive Summary

The Heatwave Plan for England is a planintended to protect the population fromheat-related harm to health. It aims toprepare for, alert people to, and prevent,the major avoidable effects on health duringperiods of severe heat in England.

It recommends a series of steps to reducethe risks to health from prolonged exposureto severe heat for:

The NHS, local authorities, social care,

and other public agencies

Professionals working with people at risk

Individuals, local communities andvoluntary groups

The Heatwave Plan has been publishedannually since 2004, following thedevastating pan-European heatwave in2003. This years plan builds on many yearsof experience of developing and improvingthe ability of the health sector and itspartners to deal with significant periods ofhot weather.

The Heatwave Plan was significantlyre-shaped in 2012 from previous years.

There have since been changes to reflect thechanges in the health care and public healthlandscape, to align the Heatwave plan moreclosely with its sister Cold Weather Plan and

to link planning for severe heat with thePublic Health Outcomes Framework.

The plan continues to be underpinned by asystem of heatwave alerts, developed withthe Met Office. The Heatwave Plan describestheHeat-Health Watch systemwhichoperates in England from 1 June to15 September each year. During this period,the Met Office may forecast heatwaves, asdefined by forecasts of day and night-timetemperatures and their duration.

The Heat-Health Watch system now

comprises five main levels (Levels 0-4), fromlong-term planning for severe heat, throughsummer and heatwave preparedness, to amajor national emergency. Each alert levelshould trigger a series of appropriate actionswhich are detailed in the Heatwave Plan.

The plan is a good practice guide and theactions denoted within it are illustrative.It is a collaborative plan supported by NHSEngland to protect and promote the health

of the population. There are three keymessages we recommend to all local areas,particularly in view of recent structuralchanges:

1. All local organisations should consider thisdocument and satisfy themselves that thesuggested actions and Heat-Health Watch

Alerts are understood across the system,and that local plans are adapted asappropriateto the local context.


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2. NHS and local authority commissioners,together with multi-agency LocalResilience Forums and Local HealthResilience Partnerships, should satisfythemselves that the distribution of Heat-Health Watch Alerts will reach thosethat need to take action, especially inlight of recent structural changes.

3. NHS and local authority commissioners,together with multi-agency LocalResilience Forums, should satisfythemselves that providers andstakeholders take appropriate actionaccording to the Heat-Health Watch Alertlevel in place and their professional

judgements.


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CHAPTER 1

Why this plan is needed

Bright, hot summer days are what many ofus look forward to for the rest of the year especially in cold, wet England!

However, while were enjoying the balmydays of summer, we should not forget thatthe temperature can get too high, that it canbecome uncomfortably hot, and for some, itcan become dangerously hot.

The evidence about the risks to health from

heatwaves is extensive and consistent fromaround the world. Excessive exposure tohigh temperatures can kill. During thesummer heatwave in Northern France in

August 2003, unprecedentedly high day- andnight-time temperatures for a period of threeweeks resulted in 15,000 excess deaths. Thevast majority of these were among olderpeople.

In England that year, there were over 2,000

excess deaths over the 10 day heatwaveperiod which lasted from 4 13 August2003, compared to the previous five yearsover the same period.

The first Heatwave Plan for England waspublished in 2004 in response to this event.Since that time we have had a significantheatwave in 2006 (when it was estimatedthat there were about 680 excess deathscompared to similar periods in previousyears). In 2009 there were approximately 300excess summer deaths during a heatwavecompared to similar periods in previousyears.

Excess deaths are not just deaths of thosewho would have died anyway in the next fewweeks or months due to illness or old age.

There is strong evidence that these summerdeaths are indeed extra and are the resultof heat-related conditions.

In contrast to deaths associated with coldsnaps in winter, the rise in mortality as aresult of very warm weather follows verysharply within one or two days of the

temperature rising.

This means that:

by the time a heatwave starts, the windowof opportunity for effective action is veryshort indeed; and therefore

advanced planning and preparedness isessential.

We know that effective action, taken early,

can reduce the health impacts of exposure toexcessive heat. Most of these are simplepreventive measures which to be effective,need to be planned in advance of aheatwave.

The aim of this plan is to raise publicawareness of the dangers of excessive heatto health and to ensure that health, socialcare and other voluntary and communityorganisations and wider civic society isprepared and able to deal with a heatwavewhen it comes so as to protect the mostvulnerable.


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The plan focuses on the effects of severe hotweather on health and wellbeing. However,severe and extended heatwaves can alsocause severe disruption to general services.For this reason, multi-agency Local HealthResilience Partnerships and LocalResilience Forums will have a critical role inpreparing and responding to heatwaves at alocal level, working closely with Health and

Wellbeing Boardson longer term strategicplanning.

1.3 The Heatwave Plan and newarrangements

The implementation of the Health and SocialCare Act 2012 has seen the abolition ofPrimary Care Trusts and Strategic Health

Authorities and the creation of a number ofnew bodies including Public Health England(PHE), NHS England and ClinicalCommissioning Groups (CCGs). At a locallevel, responsibility for public health hastransferred to local authorities.

The Department of Health (DH) isresponsible for strategic leadership of bothhealth and social care systems, but no longerhas direct management of most NHSsystems. NHS Englandprovides national

leadership for improving health careoutcomes, directly commissions generalpractice services, some specialist services,and oversees Clinical CommissioningGroups. CCGs now commission plannedhospital care, rehabilitative care, urgent andemergency care, most community healthservices and mental health and learningdisability services. Directors of PublicHealthin Local Authorities are responsiblefor population health outcomes, supported

by Public Health England (PHE), whichprovides national leadership and expertservices to support public health.

Responsibility for preparing and publishingthe Heatwave Plan for England has passedto PHE. PHE will seek to ensure that theHeatwave Plan is widely communicatedusing a variety of channels to ensuremaximum publicity.

PHE will make advice available to the publicand health and social care professionals in

affected regions, in preparation for animminent heatwave, via NHS Choices, andthe websites of the Met Office, PHE andthe DH.

NHS Choices (www.nhs.uk) continues toprovide reliable advice and guidancethroughout the year on how to keep fit andwell. It includes information on how to staywell in hot weather (www.nhs.uk/summerhealth).

The Heatwave Plan builds on existingmeasures taken by the DH, the NHS andlocal authorities to protect individuals andcommunities from the effects of severeheatwaves and encourage communityresilience. It outlines the key areas wherepublic, independent and voluntary sectorhealth and social care organisations shouldwork together to maintain and improveintegrated arrangements for planning andresponse in order to deliver the bestoutcomes possible during a heatwave duringthe summer. It is the responsibility of eachlocal area to ensure that preparedness andresponse plans are drawn up and tested.

At local level emergency planningarrangements run by local government andthe NHS are brought together in the LocalResilience Forum(LRF), which has many

years of experience of the Heatwave Planand Heat-Health Watch alert system. LocalHealth Resilience Partnerships(LHRPs)have been established to bring together local
http://www.nhs.uk/http://www.nhs.uk/summerhealthhttp://www.nhs.uk/summerhealthhttp://www.nhs.uk/summerhealthhttp://www.nhs.uk/summerhealthhttp://www.nhs.uk/


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health sector organisations to supportstrategic planning.

Health and Wellbeing Boardsact asforums for commissioners across the NHS,social care and public health systems andare responsible for Joint Strategic Needs

Assessments and Health and WellbeingStrategies to inform commissioning.

Engagement of these Boards in thelong-term strategic preparation forheatwaves and other aspects related toclimate change adaptation is critical in orderto reduce the risks and harness opportunitiesto improve health. Councillors, especiallythose with portfolio responsibility for health,have important strategic overview andscrutiny functions, as well as communityengagement and decision-making roles.

1.4 The core elements of the plan

The Heatwave Plan depends on having wellco-ordinated plans in place for how to dealwith severe hot weather before it strikes.It builds on our own experience in Englandand on expert advice from the WHO and theEuroHEAT project (Section 4 of companiondocument Making the Case) in developingother national heatwave plans. The core

elements of the plan are:

1.4.1 Strategic Planning

The climate is changing and current analysisin the first national UK Climate Change Risk

Assessmentsuggests that summers aregoing to get hotter in the future (see Making

the Case). Long term planning now isessential to support:

co-ordinated long-term planning betweenagencies to protect people andinfrastructure from the effects of severehot weather and thus reduce excesssummer illness and death;

long-term multi-agency planning to adapt

to and reduce the impact of climatechange, including greening the builtenvironment, building design (e.g.increasing shading around and insulationof buildings), increasing energy efficiency(e.g. reducing carbon emissions); andtransport policies.

We strongly recommend that this isconsidered by Health and Wellbeing Boardsand included in Joint Strategic Needs

Assessments (JSNAs) and Joint Health andWellbeing Strategies (JHWSs), in order toinform commissioning.

1.4.2 Alert System (Advance warning andadvice over the summer)

A Heat-Health Watch alert systemoperates from 1 June to 15 September,based on Met Office forecasts and data.

This will trigger levels of response from theNHS, government and public healthsystem, and communicate risks.

Advice and information for the public andfor health and social care professionals,particularly those working with at-riskgroups. This includes both generalpreparation for hot weather and morespecific advice when a severe heatwave isforecast.
https://www.gov.uk/government/policies/adapting-to-climate-changehttps://www.gov.uk/government/policies/adapting-to-climate-changehttps://www.gov.uk/government/policies/adapting-to-climate-changehttps://www.gov.uk/government/policies/adapting-to-climate-change


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1.4.3 Heatwave and Summer Preparedness

Agreement on a lead body at local orsub-national level is required to coordinatemulti-agency collaboration and to directthe response. This may be for example,NHS-England whose role, in collaborationwith CCGs, will be to ensure that localproviders of NHS commissioned carehave the capacity and capability to deliver

their functions as laid out in this plan. NHSEngland will hold the providers of NHScommissioned care to account forimplementation, in co-ordination withCCGs as appropriate.

Other elements which local NHS, publichealth and social care organisations willoversee:

action to reduce indoor heat exposure(medium and short term);

particular care for vulnerable populationgroups; and

preparedness of the health and socialcare system staff training andplanning, appropriate healthcare andthe physical environment.

1.4.4 Communicating with the public

Working with the media to get advice topeople quickly, both before and during aheatwave.

The Civil Contingencies Act 2004 providesa duty on category 1 responders to warnand inform the public before, during andafter an emergency.

There should be a local heat-related healthinformation plan specifying what iscommunicated, to whom, when and why.

This should raise awareness of howexcessive exposure to severe heat affectshealth and what preventive action peoplecan take, both throughout the year andduring heatwaves to stay cool.

Attention should especially be given toensuring that key public health messages(box 1, section 3.2) reach vulnerablegroups and those who care for them

(e.g. caregivers of the chronically ill,parents of infants) in a suitable andtimely way.

1.4.5 Working with service providers

Advising hospitals and care, residentialand nursing homes to provide cool areasand monitor indoor temperatures toreduce the risk of heat-related illness and

death in the most vulnerable populations. Helping GPs and district nurses and social

workers to identify vulnerable patients andclients on their practice lists by providingthem with heatwave information and goodpractice.

Ensuring that health and social careorganisations and voluntary groupsimplement measures to protect people intheir care and reduce heat-related illness

and death in those most at risk.

Recommending health visitors and schoolnurses provide advice to parents andchildcare providers and schools andyoung people respectively regardingbehaviours to protect health during hotweather (e.g. fluid intake, reducingexcessive sun exposure, avoiding divinginto cold water).


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Working with Registered Providers ofhousing to encourage wardens/caretakersto keep an eye out for vulnerable tenantsduring heatwaves, and to considermeasures to promote environmentalcooling such as tree planting on theirestates and building design.

Supporting staff to remain fit and wellduring spells of hot weather.

1.4.6 Engaging the community

Providing extra help, where possible,to care for those most at risk, includingisolated older people and those with aserious illness or disability. This couldcome from local authorities, health andsocial care services, the voluntary sector,communities and faith groups, families

and others. This is determined locally aspart of the persons individual care planand will be based on existing relationshipsbetween statutory and voluntary bodies.

Additional help to ensure that people areclaiming their entitlements to benefitsshould be signposted.

1.4.7 Monitoring/Evaluation

Real-time surveillance and evaluation,such as that provided by PHE (seeChapter 5).


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on these outputs in line with the Heat HealthLevels can be found in Chapter 5.

Level 0: Long-term planning to reduce riskfrom Heatwaves

Long-term planning includes year-round jointworking to reduce the impact of climatechange and ensure maximum adaptation to

reduce harm from heatwaves. This involvesinfluencing urban planning to keep housing,workplaces, transport systems and the builtenvironment cool and energy efficient.Long-term heatwave planning is a keyconsideration highlighted in the National

Adaptation Programme(NAP), which setsout actions to address the risks identified inthe UK Climate Change Risk Assessment.

Level 1: Heatwave and Summerpreparedness

Summer preparedness runs from 1 June to15 September when a Level 1 alert will beissued. The Heatwave Plan will remain atLevel 1 unless a higher alert is triggered.During the summer months, social andhealthcare services need to ensure thatawareness and background preparednessare maintained by implementing the

measures set out in the Heatwave Plan.

Level 2: Alert and readiness

This is triggered as soon as the Met Officeforecasts that there is a 60 per cent chanceof temperatures being high enough on atleast two consecutive days to havesignificant effects on health. This will normallyoccur 23 days before the event is expected.

As death rates rise soon after temperatureincreases, with many deaths occurring in thefirst two days, this is an important stage to

ensure readiness and swift action to reduceharm from a potential heatwave.

Level 3: Heatwave action

This is triggered as soon as the Met Officeconfirms that threshold temperatures havebeen reached in any one region or more.

This stage requires specific actions targeted

at high-risk groups.

Level 4: National Emergency

This is reached when a heatwave is sosevere and/or prolonged that its effectsextend outside health and social care, suchas power or water shortages, and/or wherethe integrity of health and social caresystems is threatened. At this level, illness

and death may occur among the fit andhealthy, and not just in high-risk groups andwill require a multi-sector response atnational and regional levels.

The decision to go to a Level 4 is made atnational level and will be taken in light of across-government assessment of theweather conditions, co-ordinated by the CivilContingencies Secretariat (Cabinet Office).

2.1 Met Office heatwave warnings

Heatwave Warnings will:

Be colour-coded to indicate more easilythe National Severe Weather WarningService (NSWWS) regions affected by achange from one Heatwave Warning levelto another (e.g. from Level 2 to Level 3).

This will help responders to clarify whatactions in turn need to be taken.

Published and sent by the Met Office at09:00 rather than 10:00 to aid planners
https://www.gov.uk/government/publications/adapting-to-climate-change-national-adaptation-programmehttps://www.gov.uk/government/publications/adapting-to-climate-change-national-adaptation-programmehttps://www.gov.uk/government/policies/adapting-to-climate-changehttps://www.gov.uk/government/policies/adapting-to-climate-changehttps://www.gov.uk/government/publications/adapting-to-climate-change-national-adaptation-programmehttps://www.gov.uk/government/publications/adapting-to-climate-change-national-adaptation-programme


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Indicate which local resilience forum (LRF)is situated within the NSWWS region, inorder to help responders.

Include a link to Met Office and weatherpattern maps

Use social media (e.g. Twitter/Facebook).The alerts are already backed up bytweets, linking to the alert webpagethrough the Met Office twitter feed.

You can subscribe to this feedby following: @metoffice.(http://twitter.com/metoffice)

Figure 2.2 summarises the Met Office serviceand notifications. A dummy alert forillustration purposes is given in Figure 2.3,and Figure 2.4 illustrates how heatwave alertmessages should be cascaded by e-mailthroughout the local community andnationally as appropriate. Local ResilienceForums, Local Health ResiliencePartnerships, and health and social care

organisations will want to develop this into aspecific cascade system that is appropriatefor their local area.

Figure 2.2: Met Office service and notifications

Service Purpose Distribution Timing

Heatwave

Warning

To provide early warning of high temperatures.

The alert levels have been set with thresholds

known to cause ill health from severe hot weather.

They are to help ensure that healthcare staff and

resources are fully prepared for hot weather

periods that might impact on health and to raise

awareness for those individuals who are more

vulnerable to hot weather conditions.

E-mail Alert issued as

soon as agreed

threshold has been

reached and when

there is a change in

alert level. Issued

between 1 June

and 15 September

HeatwavePlanning Advice To provide advice throughout the summer periodrelating to high temperatures. E-mail Twice a week (9ameach Monday and

Friday from 1 June

to 15 September)

National Severe

Weather Warning

Service (NSWWS)

To provide warnings of severe or hazardous

weather that has the potential to cause danger to

life or widespread disruption. These warnings are

issued to:

The public, to prompt consideration of actions

they may need to take

Emergency responders, to trigger their plans

to protect the public from impacts in advance

of an event, and to help them recover from any

impacts after the event

Email, web,

SMS, TV,

radio

When required

General weather

forecasts

To enable the public to make informed decisions

about their day to day activities

Web, TV,

radio

Every day
mailto:%40metoffice?subject=http://twitter.com/metofficehttp://twitter.com/metofficemailto:%40metoffice?subject=


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Figure 2.3: Example of a Heat-Health Watch Alert

Page 1 of 2

Heatwave Warning

Tel: 0870 900 0100 www.metoffice.gov.uk

NHS (Ref: MO43)

Forecast Issued on Saturday, 18 August 2012 at 09:00

Heat-Health Watch

Level 2 - Alert & Readiness

http://www.metoffice.gov.uk/public/weather/heat-health/#?tab=hotWeatherAlert

The probability of heatwave conditions in part of England between 0900 on Sunday and 0800 onWednesday is 60%

An update will be issued when the alert level changes in any region. Alerts are issued once a day by0900 if required and are not subject to amendment in between standard issue times. Note that thedetails of the forecast weather are valid at the time of issue but may change over the period that an alertremains in force. These details will not be updated here unless the alert level also changes, the latest

forecast details can be obtained at the following link:http://www.metoffice.gov.uk/public/weather/forecast/#?tab=map

eg ona sk ssessments or ccurrence o eatwave ond t ons etween 0900 oca meon Sunday and 0800 Local Time on Wednesday.

he areas that are ke y to e a ected are:

Region Risk CommentsNorth East England 40 % Cooler near coasts.North West England 60 % Cooler near coasts.Yorkshire and the Humber 50 % Cooler near coasts.West Midlands 60 %East Midlands 60 % Cooler near Lincolnshire coasts.East o England 70 % ooler near coasts.Southeast England 80 % Cooler near coasts.London 90 %

out west England 60 % ooler near coasts.Wales 60 % Cooler near coasts.

General Comments:- High pressure over Scandinavia will allow very warm air to spread in from thecontinent. The warmest conditions will be across Southeast England, up into theMidlands and into eastern Wales. Maximum temperatures of between 32 and33C are likely in these areas, with minima in the order of 20C in London and 18Cin the Midlands. Sea breezes will moderate the temperatures near coasts,particularly in east as easterly flow increases.

Organisations providing health and social care should be aware of the advice and guidance set out in thePublic Health Englands Heatwave Plan, and the Heatwave Plan for Wales, as to the actions necessarybefore and during a Level 2 or Level 3 heatwave. Specific advice to be followed by health care professionals,and the managers and staff of residential and nursing homes in the event of a heatwave is available fromPublic Health Englands website https://www.gov.uk/government/publications/heatwave-plan-for-england-2013and the Welsh Government website http://wales.gov.uk.

These alerts are sent to the CE of every provider of NHS commissioned care, Local Authority and Social

Care Organisation in England, and to Health Board CEs and Local Authority Directors of Social Services inWales. If you would like to add a colleague to receive these alerts we would be grateful if you could set up aninternal cascade within your organisation. If this is not possible, or you feel you are receiving this message inerror please contact:

For England: [email protected] Wales: [email protected]

Page 2 of 2

To aid local planning, listed below are the Local resilience Forum (LRFs) matched against their regions.

NHS Region NSWWS Region Local Resilience Forum

North

North East EnglandDurham and DarlingtonNorthumbriaCleveland

Yorkshire and the HumberHum erNorth YorkshireWest YorkshireSouth Yorkshire

North West England

es ireCumbriaGreater ManchesterLancashire

Merseyside

Midlands

West Midlandsta ords i re

WarwickshireWest MerciaWest Midlands

East Midlands

DerbyshireLeicestershireLincolnshireNorthamptonshireNottinghamshire

East of England

Bedords ireCambridgeshireEssexHertfordshireNorfolkSuffolk

South

South East England

SussexKentSurreyThames ValleyHampshire and Isle of Wight

South West England

Avon & SomersetDevon, Cornwall & Isle of ScillyDorsetGloucestershireWiltshire and Swindon

London London London

Wales Wales

Dyfed PowysGwentNorth WalesSouth Wales


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Figure 2.4: Typical cascade of heatwave alerts

Met Office

Heatwave

Alert

CivilContingencies

Secretariat

Department ofHealth

OtherGovernmentDepartments

and Agencies

Schools

Residentialhomes

Nurseries andKindergarten

VoluntaryOrganisations

Social Services

Care and NursingHomes

GPs and District

Nurses

Mental healthtrusts

Ambulance trusts

Hospital trusts

Walk in centres

Pharmacies

Day CareCentres

Communityhealth service

providers

ClinicalCommissioning

Groups(CCGs)

Public, via media e.g.TV, radio,

newspapers

Notes:

NHS England Area Teams and CCGs should work collaboratively to ensure that between them they have acascade mechanism for heatwave alerts to all providers ofNHS commissioned care both in business as usualhours and the out of hours period in their area. *PHE Centres would be expected to liaise with Directors of Public Health to offer support, but formal alerting wouldbe expected through usual Local Authority channels.LHRPs and HWBs are strategic and planning bodies, but may wish to be included in local alertcascades.

NHSEngland

NHS Choices

SummerResilience

Network

Health andWellbeingBoards

CorporateTeam

(National)

RegionalTeams

Area Teams

LocalAuthority

(CE/ DASS/DCS/Emergency

Planner)

andDirectors of

PublicHealth*

Inc. LocalResilience

Forums (andLocal HealthResilience

Partnerships)

Public HealthEngland

4 Regions

15 PH Centres*


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CHAPTER 3

As noted above, the issue of a HeatwaveAlert should trigger a series of actions bydifferent organisations and professionals aswell as the general public. The tables thatfollow summarise the actions to be taken bydifferent organisations and groups from theprevious section in order to respond to thealert level, be it preparing for, or respondingto, an actual episode of severe hot weather.

3.1 Using the action tablesThe actions outlined in the tables areillustrative. Local areas should consider theseas guides when developing local heatwavepreparedness arrangements. The HeatwavePlan for England is a broad framework andlocal areas need to tailor the suggestedactions to their local situation and ensure thatthey have the best fit with wider localarrangements.

The tables emphasise the importance of jointworking across agencies including thevoluntary and community sector, andhighlight one of the aims of the plan, which isto ensure that there is an integrated responseto severe heat events across sectors. Localareas will need to consider those actionsindicated in the tables which will need to betaken jointly across organisations andsectors.

Local organisations are asked to consider

the action tables and to recast thesuggested actions in ways that are mostappropriate for them. NHS, localauthorities, Local Health ResiliencePartnerships and Local Resilience Forumsshould assure themselves that heatwaveresponse plans are in place for the comingsummer as part of wider preparedness andresponse plans to extreme climate events.Chapter 6 highlights the overarching next

steps which NHS and local authorities shouldtake to ensure that the Heatwave Alerts arebeing disseminated and acted upon locally.

It is also worth reiterating:

The actions for each alert level are notintended to be an all or none situation.We would expect staff and organisationsto develop action plans which make senseto them using these as a broad template.

We would also expect staff to exerciseprofessional judgement in a clinicalsetting with a patient or client and respondappropriately to that patients needs.

We are asking staff to be much moreaware of the effects of severe heat onhealth and when they notice a client orpatient at risk of overheating, for example,from living in a home that is too hot, thatthey know what immediate actions to taketo ensure safety and that there are clearguidelines for them to make othernecessary arrangements (e.g. addressinghousing issues) in the immediate andlonger term.

Summary of Heatwave Plan levels andactions


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We strongly support a system-wideapproach to assessing the nature of theproblem and addressing these acrossorganisations locally that makes mosteffective and efficient use of resources.Local areas may also wish to refer to anearlier DH toolkit How to reduce the risk ofseasonal excess deaths systematically invulnerable older people at population level.

This is designed to help local communitiesto take a systematic approach to reducethe risk of seasonal excess deaths in olderpeople.

Please refer to the glossary of abbreviationson page 2 and note that both NHS Englandand PHE have sub-national arrangements forliaison; communication, coordination andresponse during emergency events and howthey in turn work with local providers of NHS

commissioned care and local authorities.

In 2012, the Royal College of GeneralPractitioners published a factsheet based onthe Heatwave Plan to provide advice for GPsand their teams.
http://lpbcc.files.wordpress.com/2012/02/ref-11-seasonal-access-deaths.pdfhttp://lpbcc.files.wordpress.com/2012/02/ref-11-seasonal-access-deaths.pdfhttp://lpbcc.files.wordpress.com/2012/02/ref-11-seasonal-access-deaths.pdfhttp://lpbcc.files.wordpress.com/2012/02/ref-11-seasonal-access-deaths.pdfhttp://lpbcc.files.wordpress.com/2012/02/ref-11-seasonal-access-deaths.pdfhttp://lpbcc.files.wordpress.com/2012/02/ref-11-seasonal-access-deaths.pdf


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22 Heatwave Plan for England Protecting health and reducing harm from severe heat and heatwaves Heatwave Plan for England Protecting health and reducing harm from severe heat and heatwaves 2 3

Figure 3.2: Providers health and social care staff in all settings (community, hospitals and care homes)

Level 0 Level 1 Level 2 Level 3 Level 4

Long-term planning

All year

See accompanying document Makingthe Case for more detail

Heatwave and Summerpreparedness programme

1 June 15 September

Heatwave is forecast Alert andreadiness

60% risk of heatwave in the next 23days

Heatwave Action

Temperature reached in one or moreMet Office National Severe WeatherWarning Service regions

Major incident Emergencyresponse

Central Government will declare a Level4 alert in the event of severe orprolonged heatwave affecting sectorsother than health

Professional Staff (all settings):

Develop systems to identify andimprove resilience of high-risk

individuals Request an HHSRS assessment

from EH for clients at particular ri sk.

Encourage cycling/walking wherepossible to reduce heat levels andpoor air quality in urban areas.

Care Homes and Hospitals

Work with commissioners todevelop longer term plans toprepare for heatwaves

Make environmental improvementsto provide a safe environment forclients in the event of a heatwave

Prepare business continuity plans tocover the event of a heatwave (e.g.storage of medicines, computerresilience, etc)

Work with partners and staff to raiseawareness of the impacts of severeheat and on risk reductionawareness (key public healthmessages box 1)

Professional Staff (all settings)

Identify high-risk individuals on yourcaseload and raise awareness of

heat illnesses and their preventionamong clients and carers (see keypublic health messages box 1)

Include risk in care records andconsider whether changes might benecessary to care plans in the eventof a heatwave (e.g. initiating dailyvisits by formal or informal caregivers for those living alone)


Ensure business continuity plans arein place and implement as required;ensure appropriate contact detailsare provided to LA/NHS emergencyplanning officers to facilitate transfer

of emergency information

Identify or create cool rooms/areas(able to be maintained below 26C)

Install thermometers wherevulnerable individuals spend

substantial time

Professional staff (all settings):

Check high-risk people have visitor/phone call arrangements in place

Reconfirm key public healthmessages to clients

Check clients room temperature ifvisiting


Check indoor temperatures arerecorded regularly during the hottestperiods for all areas where patientsreside

Ensure cool areas are below 26C

Review and prioritise high-risk

people

Ensure sufficient cold water and ice

Consider weighing clients regularlyto identify dehydration andrescheduling physio to cooler hours

Communicate alerts to staff andmake sure that they are aware ofheatwave plans

Ensure sufficient staffing Implement business continuity

Professional staff (all settings):

Visit/phone high-risk people

Reconfirm key public health

messages to clients

Advise carers to contact GP ifconcerns re health


Activate plans to maintain businesscontinuity including a possiblesurge in demand

Check indoor temperatures arerecorded regularly during the hottestperiods for all areas where patientsreside

Ensure staff can help and adviseclients including access to coolrooms, close monitoring ofvulnerable individuals, reducinginternal temperatures throughshading, turning off unnecessarylights/equipment, cooling building atnight, ensuring discharge planningtakes home temperatures and

support into account

NATIONAL EMERGENCY

Continue actions as per Level 3 unlessadvised to the contrary

Central government will declare aLevel 4 alert in the event of severe orprolonged heatwave affectingsectors other than health and ifrequiring coordinated multi-agencyresponse

High-risk Groups

Community: Over 75, female, living on own and isolated, severe physical or mental illness; urban areas, south-facing top flat; alcohol and/or drug dependency, homeless, babies and young children, multiplemedications and over-exertion

Care home or hospital: over 75, female, frail, severe physical or mental illness; multiple medications; babies and young children (hospitals).

*Because Level 2 is based on a prediction, there may be jumps between levels. Following Level 3, wait until temperatures cool to Level 1 before stopping Level 3 actions.

** Level 4: Adecision to issue a Level 4 alert at national level will be taken in light of a cross-government assessment of the weather conditions, co-ordinated by the Civil Contingencies Secretariat


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Figure 3.3: Community and Voluntary Sector & Individuals


Long-term planning

All year

See accompanying document Makingthe Case for more detail


1 June 15 September



Heatwave Action




Community Groups:

Develop a community emergencyplan to identify and support

vulnerable neighbours in event of aheatwave

Assess the impact a heatwave mighthave on the provision and use ofusual community venues

Support those at-risk to make surethey are receiving the benefits theyare entitled to.

Individuals:

Make environmental improvementsinside and outside the house whichreduce internal energy and heat

Install loft and wall insulation

Identify cool areas in the house touse in the event of a heatwave

If on medications, ensure that thesecan be stored at safe levels in aheatwave

Community Groups

Further develop communityemergency plan

Support the provision of goodinformation about health risksespecially with those vulnerablegroups and individuals (see keypublic health messages box 1)

Individuals

Find good information about healthrisks and key public healthmessages to stay healthy duringspells of severe heat (see key publichealth messages box 1)

Look out for vulnerable neighbours

Community Groups

Keep an eye on people you know tobe at risk

Stay tuned into the weather forecastand keep stocked with food andmedications

Check ambient room temperatures

Individuals

Stay tuned into the weatherforecast

Check ambient room temperatures especially those rooms wheredisabled or high risk individualsspend most of their time

Keep an eye on people you know tobe at risk ensure they have accessto plenty of cool liquids

Look out for vulnerable neighbours

Community Groups

Activate community emergency plan

Check those you know are at risk

Individuals

Follow key public health messages

Check those you know are at risk

NATIONAL EMERGENCY

Continue actions as per Level 3 unlessadvised to the contrary

Central government will declare aLevel 4 alert in the event of severe orprolonged heatwave affectingsectors other than health and ifrequiring coordinated multi-agency

response

High-risk Groups






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Figure 3.4: National Level: NHS England, PHE, DH, Met Office, Other Government Departments


Long-term planning

All year


1 June 15 September



Heatwave Action




The Cabinet Office will take the leadon coordinating and working acrossGovernment to prepare for severeheatwave and other associatedextreme climate events. Individualgovernment departments will workwith their partners on suchpreparations.

National implementation of theNational Adaptation Programme willcontinue, improving protection fromsevere weather events.

DH, PHE and NHS England will lookto improve monitoring and analysisof heat-related illness and deathsand evaluate the Heatwave Plan.

PHE and NHS England will issuegeneral advice to the public andprofessionals and work closely withthe NHS, OGDs and other nationalorganisations that produce adviceon staying healthy and ensuringservice continuity during periods ofprolonged severe heatwaves.

Preparations are the overallresponsibility of PHE in collaborationwith the Met Office, NHS England,DH and local bodies.

PHE and NHS England will makeadvice available to the public andprofessionals.

NHS England will ensure nationalguidance is cascaded to localservices, and identify organisationsmost vulnerable to heatwaves.

Heat-Health Watch alerts will besent by the Met Office to the agreed

list of organisations and Category 1responders as noted in Figure 2.4.PHE and NHS England will cascadethe alerts to sub-national units withintheir organisations.

DH will liaise with CO and OGDs toensure agreed responses aremobilised as required. DCLG will

share info with LRFs.

PHE will routinely monitor syndromicand mortality surveillance.

A Level 2 alert will be sent by theMet Office to the agreed list oforganisations and Category 1responders as noted in Figure 2.4.

Central government departments,which should then cascade theinformation through their ownstakeholder networks and front-linecommunication systems

DH will ensure OGDs, particularlyDCLG RED are aware of the changein alert level and brief Ministers asappropriate

PHE will make advice available tothe public and professionals inaffected regions via NHS Choices,NHS England, DH (GovNet), andMet Office websites

NHS England will hold healthservices to account for takingappropriate actions to prepare for a

heatwave

PHE will continue to monitorsyndromic and mortality surveillance

As per Level 2 arrangements

Met Office will continue to monitorand forecast temperatures in each

area, including the likely duration ofthe period of the heatwave, the likelytemperatures to be expected andthe probability of other regionsexceeding the Level 3 threshold

NHS England will muster mutual aidwhen requested by local services

PHE will continue to monitorsyndromic and mortality surveillanceand produce a weekly report for

inclusion within a weekly PHEheatwave output

Level 4 alert issued at national level inlight of cross-Government assessmentof the weather conditions, coordinatedby the CCS based in the CO.Implementation of national emergencyresponse arrangements by centralGovernment. Response likely toinvolve:

national government departments

executive agencies

public sector, including health sector

voluntary sector

PHE will continue to monitor syndromicand mortality surveillance and producea weekly report for inclusion within adaily PHE heatwave output

High-risk Groups






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3.2 Box 1 Key Public Health Messages1

Stay out of the heat:

Keep out of the sun between 11.00am and 3.00pm.

If you have to go out in the heat, walk in the shade, apply sunscreen and wear a hatand light scarf.

Avoid extreme physical exertion.

Wear light, loose-fitting cotton clothes.

Cool yourself down:

Have plenty of cold drinks, and avoid excess alcohol, caffeine and hot drinks.

Eat cold foods, particularly salads and fruit with a high water content.

Take a cool shower, bath or body wash.

Sprinkle water over the skin or clothing, or keep a damp cloth on the back ofyour neck.

Keep your environment cool:

Keeping your living space cool is especially important for infants, the elderly or thosewith chronic health conditions or who cant look after themselves

Place a thermometer in your main living room and bedroom to keep a check on thetemperature.

Keep windows that are exposed to the sun closed during the day, and open windowsat night when the temperature has dropped.

Close curtains that receive morning or afternoon sun. However, care should be takenwith metal blinds and dark curtains, as these can absorb heat consider replacing or

putting reflective material in-between them and the window space.

Turn off non-essential lights and electrical equipment they generate heat.

Keep indoor plants and bowls of water in the house as evaporation helps cool the air.

If possible, move into a cooler room, especially for sleeping.

Electric fans may provide some relief, if temperatures are below 35C.2

1 Adapted from: WHO Europe public health advice on preventing health effects of heat2 NOTE: Use of Fans: At temperatures above 35C fans may not prevent heat related illness. Additionally fans can cause

excess dehydration (Cochrane Review). The advice is to place the fan at a certain distance from people, not aimingit directly on the body and to have regular drinks. This is especially important in the case of sick people confined to bed.
http://www.euro.who.int/__data/assets/pdf_file/0007/147265/Heat_information_sheet.pdfhttp://www.cochrane.org/sites/default/files/uploads/Evidence_aid/Electric%20fans%20for%20reducing%20adverse%20health%20impactsin%20heatwaves.pdfhttp://www.cochrane.org/sites/default/files/uploads/Evidence_aid/Electric%20fans%20for%20reducing%20adverse%20health%20impactsin%20heatwaves.pdfhttp://www.euro.who.int/__data/assets/pdf_file/0007/147265/Heat_information_sheet.pdf


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(Longer term)

Consider putting up external shading outside windows.

Use pale, reflective external paints.

Have your loft and cavity walls insulated this keeps the heat in when it is cold andout when it is hot.

Grow trees and leafy plants near windows to act as natural air-conditioners (seeMaking the Case)

Look out for others:

Keep an eye on isolated, elderly, ill or very young people and make sure they are ableto keep cool.

Ensure that babies, children or elderly people are not left alone in stationary cars.

Check on elderly or sick neighbours, family or friends every day during a heatwave.

Be alert and call a doctor or social services if someone is unwell or further help isneeded.

If you have a health problem:

Keep medicines below 25 C or in the refrigerator (read the storage instructions on thepackaging).

Seek medical advice if you are suffering from a chronic medical condition or takingmultiple medications.

If you or others feel unwell:

Try to get help if you feel dizzy, weak, anxious or have intense thirst and headache;move to a cool place as soon as possible and measure your body temperature.

Drink some water or fruit juice to rehydrate.

Rest immediately in a cool place if you have painful muscular spasms (particularly in thelegs, arms or abdomen, in many cases after sustained exercise during very hotweather), and drink oral rehydration solutions containing electrolytes.

Medical attention is needed if heat cramps last more than one hour.

Consult your doctor if you feel unusual symptoms or if symptoms persist.


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3.3 Guidance for those looking afterschoolchildren and those in early yearssettings during heatwaves

Outdoors

On very hot days (i.e. where temperaturesare in excess of 30C) children should nottake part in vigorous physical activity.

Children playing outdoors should be

encouraged to stay in the shade as muchas possible.

Loose, light-coloured clothing should beworn to help children keep cool and hatsof a closed construction with wide brimsshould be worn to avoid sunburn.

Thin clothing or suncream should be usedto protect skin if children are playing ortaking lessons outdoors for more than 20minutes.

Children must be provided with plenty ofcool water *and encouraged to drink morethan usual when conditions are hot.*The temperature of water supplied fromthe cold tap is adequate for this purpose.

Indoors

Windows and other ventilation openingsshould be opened during the cool of earlymorning or preferably overnight to allowstored heat to escape from the building.It is important to check insuranceconditions and the need for security ifwindows are to be left open overnight.

Windows and other ventilation openingsshould not be closed, but their openingsreduced when the outdoor air becomeswarmer than the air indoors. This shouldhelp keep rooms cool whilst allowingadequate ventilation.

Use outdoor sun awnings if available, orindoor blinds, but do not let solar shadingdevices block ventilation openings orwindows.

Keep the use of electric lighting to aminimum during heatwaves.

All electrical equipment, includingcomputers, monitors and printers shouldbe switched off when not in use andshould not be left in standby mode.Electrical equipment, when left on, or instandby mode generates heat.

Which children are likely to be mostaffected by high temperatures?

Childrens susceptibility to high temperaturesvaries; those who are overweight or who aretaking medication may be at increased risk ofadverse effects. Children under four years ofage are also at increased risk.

Some children with disabilities or complexhealth needs may be more susceptible to

temperature extremes. The school nurse,community health practitioner, family healthvisitor or the childs specialist healthprofessional may be able to advise on theparticular needs of the individual child.Schools need to provide for childrensindividual needs. Support staff should bemade aware of the risks and how tomanage them.

Further information is available from theHealth Protection Agency website, pendingmigration to the PHE site: Looking afterschoolchildren and those in early yearssettings during heatwaves: Guidance forteachers and other professionals.
http://www.hpa.org.uk/Topics/EmergencyResponse/ExtremeWeatherEventsAndNaturalDisasters/Heatwaves/heatwaves_teachers/http://www.hpa.org.uk/Topics/EmergencyResponse/ExtremeWeatherEventsAndNaturalDisasters/Heatwaves/heatwaves_teachers/http://www.hpa.org.uk/Topics/EmergencyResponse/ExtremeWeatherEventsAndNaturalDisasters/Heatwaves/heatwaves_teachers/http://www.hpa.org.uk/Topics/EmergencyResponse/ExtremeWeatherEventsAndNaturalDisasters/Heatwaves/heatwaves_teachers/http://www.hpa.org.uk/Topics/EmergencyResponse/ExtremeWeatherEventsAndNaturalDisasters/Heatwaves/heatwaves_teachers/http://www.hpa.org.uk/Topics/EmergencyResponse/ExtremeWeatherEventsAndNaturalDisasters/Heatwaves/heatwaves_teachers/http://www.hpa.org.uk/Topics/EmergencyResponse/ExtremeWeatherEventsAndNaturalDisasters/Heatwaves/heatwaves_teachers/http://www.hpa.org.uk/Topics/EmergencyResponse/ExtremeWeatherEventsAndNaturalDisasters/Heatwaves/heatwaves_teachers/


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3.4 Other considerations for summerpreparedness

3.4.1 Heatwaves and Large Public Events

Summer is a time for people to get outsideand enjoy themselves. Large scale publicevents, such as music and arts festivals;sports events; and national celebrations areheld up and down the country every summerproviding enjoyment to millions of people.

Local agencies are generally well equipped toplan and deal with such events. There iswell-tried and tested guidance, especiallyfrom the Health and Safety Executive EventsSafety Guide (see Annex 3). However, theeffects of excessive heat and sun exposureare sometimes not highlighted enough.

Large public events increase exposure toheat and direct sunlight and can makeorganisational responses more difficult.Individual behaviours often change (forexample, people may be reluctant to use thetoilet facilities due to the long queues and sopurposely reduce fluid intake). At many largeevents, people get into a good position tosee the event and then reduce fluid intake

and heat avoidance behaviours so as not tolose their spot. This can lead to heat-relatedillness, dehydration and/or collapse.

3.4.2 Ramadan

Box 2 Heat Health Advice During Ramadan

Many members of the Muslim community may be fasting during the daylight hours in themonth of Ramadan. All local areas should familiarise themselves with the dates ofRamadan each year and build appropriate actions into their local plans if it falls during thesummer months. It is common to have one meal just before sunrise and an evening mealafter sunset during Ramadan. During hot weather, dehydration is a common and seriousrisk. Its important to balance food and fluid intake between fasts and especially to drink

enough water.

If you start to feel unwell, disoriented or confused, or collapse or faint, advice is to stopfasting and have a drink of water or other fluid. This is especially important for older adults,those with poorly controlled medical conditions such as low/high blood pressure, diabetesand those who are receiving dialysis treatment. The Muslim Council of Britain hasconfirmed that breaking fast in such conditions is allowable under Islamic law. Also makesure to check on others in the community who may be at greater risk and keep an eye onchildren to ensure they are having a safe and healthy Ramadan.

Guidance has been produced to help ensure that members of the Muslim communityhave a safe and healthy Ramadan Ramadan Health Guide: A guide to healthy fastingproduced in association with the NHSwith further information available on NHS Choices Healthy Ramadan.
http://www.communitiesinaction.org/Ramadan%20Health%20and%20Spirituality%20Guide.pdfhttp://www.communitiesinaction.org/Ramadan%20Health%20and%20Spirituality%20Guide.pdfhttp://www.nhs.uk/Livewell/HealthyRamadan/Pages/healthyramadanhome.aspxhttp://www.nhs.uk/Livewell/HealthyRamadan/Pages/healthyramadanhome.aspxhttp://www.nhs.uk/Livewell/HealthyRamadan/Pages/healthyramadanhome.aspxhttp://www.nhs.uk/Livewell/HealthyRamadan/Pages/healthyramadanhome.aspxhttp://www.communitiesinaction.org/Ramadan%20Health%20and%20Spirituality%20Guide.pdfhttp://www.communitiesinaction.org/Ramadan%20Health%20and%20Spirituality%20Guide.pdf


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Response arrangements will need to benecessarily flexible, in order to adapt tothe nature of the challenge and othercircumstances at the time while applyinggood practice, including lessons fromprevious emergencies.

Anticipated risks and responses during aheatwave Level 4, according to different

sectors, are summarised below.

The previous pages have highlighted therisks to public health from a heatwave. Therisks to other important areas of life from fouror more days where temperatures havereached threshold values during the day andovernight are equally important and will havean impact on health and the ability of healthservices to respond. These wider risks,which have the potential to generate

disruption at a national, regional and locallevel, include the following:

4.2 Transport infrastructure

Road surfaces are susceptible to meltingunder extreme or prolonged temperatures;however, as the surface temperature maynot be dependent on the air temperature,melting is more likely to be as a result of

direct sunlight. Traffic congestion leading to delays on

motorways or trunk roads has potentiallyserious consequences for those strandedin vehicles, particularly vulnerable peoplesuch as the elderly or young children.

The rail network will be susceptible to railswarping or buckling under extreme orprolonged temperatures and this will varyaccording to specific local factorsincluding local geography and themaintenance status of the track. As a veryapproximate guide, staged preventativemeasures begin to be applied when airtemperatures reach 22C. The most

extreme precautions would only cut in atair temperatures of 36C (which is likely togive a railhead temperature of over 50C).

Extreme temperatures on the LondonUnderground network could lead to arange of health and safety challenges.London Underground network operationsmonitor Met Office weather forecasts, andif temperatures are forecast not to fallbelow 24C for three days running theywill get ready to implement plans to deployhot weather notices and bottled watersupply, as well as measures to preventtrack buckling.

4.3 Power supplies

At a time when energy companiestraditionally maintain power stations forthe winter by standing units down overthe summer, rising temperatures increase

the demand for supply due to the use ofair-conditioning units and reduce thepower-carrying capacity of the system,as it is harder to cool conductors thiswill restrict the maintenance windowavailable and could ultimately requiregreater redundancy on the system topermit maintenance.

Rising temperatures cause coolingproblems for power stations as they are

unable to cool components. This effecthas been experienced in France, but notyet to a serious extent in the UK.


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High air temperatures are more of aproblem and nuclear reactors can trip outat above 40C, although this has never yetbeen reached at any site (38C being therecord).

Rising temperatures lower power stationefficiency. This effect is of lower concernthan the two effects above.

4.4 Environmental pollution

Air quality smogs typically accompanyheatwaves as these often occur duringperiods of limited dispersion and /oreasterly continental air masses arriving inthe UK. As a result pollutants are less wellspread or added to a higher backgroundconcentration which can lead to highconcentrations of nitrogen dioxide and

particulate matter. Heatwave conditionsoften lead to increased ozone levelsfollowing interactions of other pollutantswith sunlight. Information on the latestpollution levels and the air quality forecastcan be found on the UK-Airwebsite(Defra).

Water quality prolonged sunshine canaccelerate the growth of blue-green algae,which can cause problems for aquatic life,

including fish, as well as toxic algalblooms, causing problems for publicrecreational water activities

A prolonged heatwave may causeincreased health and environmentalproblems including odour, dust and vermininfestation, increasing public nuisance andcomplaint. Additional measures would benecessary to mitigate these problems,including more frequent refuse collectionsand enhanced pollution control measuresat landfills and other waste treatmentfacilities.

4.5 The potential for wildfires

The risks during a heatwave can be greaterbecause the vegetation will be that muchdrier than usual. The smoke and other risksfrom wildfire can cause the closure ofmotorways and contributes to local andregional air pollution. For more informationplease see the Health Protection Agencywebsite on response to wildfires, pending

migration to the new PHE website.

4.6 Animal welfare

Rising temperatures would require theincrease of ventilation requirements foranimals temporarily housed at farms,markets and slaughterhouses.

Rising temperatures lead to changesin transport, markets and temporarily

housed animal stocking densities.

Delays on transport have the potential tolead to increased distress and suffering ofanimals and increase the number ofdeaths of animals in transit.

Slaughterhouses killing throughput maybe affected due to reduced working hoursat slaughterhouses and the transport of alower number of animals.

There is the potential for an increase in thenumber of pet fatalities due toirresponsible owners leaving them inrestricted enclosures with poor ventilation(e.g. dogs in cars).

4.7 Water shortages

Water companies have plans in place todeal with failure in the supply of mains

water or sewerage services. These plansare regularly reviewed and tested by thewater companies and are independentlycertified every year.
http://uk-air.defra.gov.uk/http://www.hpa.org.uk/Topics/EmergencyResponse/ExtremeWeatherEventsAndNaturalDisasters/Wildfires/http://www.hpa.org.uk/Topics/EmergencyResponse/ExtremeWeatherEventsAndNaturalDisasters/Wildfires/http://uk-air.defra.gov.uk/


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In the event of a reduced mains supply,water companies would introduce watersaving measures such as reducing waterpressure or limiting 24/7 supply. In theevent of a loss of mains supply, watercompanies are required to supply waterby alternative means, such as in statictanks or bottled water. There is arequirement to provide not less than 10

litres per person per day, with specialattention given to the needs of vulnerablepeople, hospitals and schools.

Where an interruption to the piped watersupply exceeds five days, the minimumrequirement rises to 20 litres per personper day.

Strong demand during a heatwave has thepotential to jeopardise the availability ofwater supplies, particularly in southern

and some other parts of the UK, andcould lead to local hose-pipe restrictions ifhigh temperatures persist.

4.8 Childrens sector

Some schools have had to close classroomswhere conditions are too hot. Please refer toPHE guidance: Looking after schoolchildrenand those in early years settings during

heatwaves: Guidance for teachers and otherprofessionals.

4.9 Crops

Horticulture is very sensitive to risingtemperatures, as crops start to experiencestress due to heat and water shortage,and will die if prolonged.

Crops may not be harvested at

appropriate times and may be lost orquality and nutritional value may bereduced.

High temperatures may mean cropscannot be sown at appropriate times orneed more water.

Flowering and pollination may be affected,reducing fruit and grains.

It may become difficult to store crops suchas potatoes at the appropriatetemperature as machinery has to workharder.
http://www.hpa.org.uk/Topics/EmergencyResponse/ExtremeWeatherEventsAndNaturalDisasters/Heatwaves/heatwaves_teachers/http://www.hpa.org.uk/Topics/EmergencyResponse/ExtremeWeatherEventsAndNaturalDisasters/Heatwaves/heatwaves_teachers/http://www.hpa.org.uk/Topics/EmergencyResponse/ExtremeWeatherEventsAndNaturalDisasters/Heatwaves/heatwaves_teachers/http://www.hpa.org.uk/Topics/EmergencyResponse/ExtremeWeatherEventsAndNaturalDisasters/Heatwaves/heatwaves_teachers/http://www.hpa.org.uk/Topics/EmergencyResponse/ExtremeWeatherEventsAndNaturalDisasters/Heatwaves/heatwaves_teachers/http://www.hpa.org.uk/Topics/EmergencyResponse/ExtremeWeatherEventsAndNaturalDisasters/Heatwaves/heatwaves_teachers/http://www.hpa.org.uk/Topics/EmergencyResponse/ExtremeWeatherEventsAndNaturalDisasters/Heatwaves/heatwaves_teachers/http://www.hpa.org.uk/Topics/EmergencyResponse/ExtremeWeatherEventsAndNaturalDisasters/Heatwaves/heatwaves_teachers/


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5.1 The Public Health OutcomesFramework: Level 0

The Public Health Outcomes Framework setsout desired outcomes and indicators to helpus understand how well public health isbeing improved and protected. A number ofOutcome Framework indicators can belinked to long-term planning for severe heatand heatwaves (see companion documentMaking the Case). PHE will publish data in anonline toolthat allows Local Authorities to

compare themselves with other authorities inthe region and benchmark themselvesagainst the England average.

5.2 Real Time Monitoring and Surveillance:Levels 1-4

PHE, in collaboration with other agenciesprovides both information on excess mortalityand morbidity due to heatwaves. Much of

this is recorded in as near real-time aspossible to provide agencies with a sourceof intelligence on how health is affected bya spell of hot weather. The frequency ofoutputs at each heatwave level are givenbelow.

Level 1: Heatwave and SummerPreparedness: PHE will routinely monitoroutputs from real-time syndromic surveillancesystems including calls to NHS 111, GP in

hours and out of hours consultations andemergency department attendances (on adaily basis, week days only), for the impact ofheat-related morbidity using a range of

syndromic health indicators. Information onheat-related illness will be included in routineweekly surveillance reportspublished on thePHE website; these will provide a source ofintelligence on how severe the effects areand how well services are responding.

PHE will continue to provide heatwavemortality surveillance, producing weeklyexcess all-cause mortality estimates basedon ONS weekly data during the summer and

publish outputs once a fortnight on the PHEwebsite in the PHE mortality report.

Level 2: Alert and readiness: PHE willcontinue to monitor routine syndromicsurveillance systems for any increases inheat-related illness including calls to NHS111, GP in hours and out of hoursconsultations and emergency departmentattendances (on a daily basis, week daysonly). It will continue to provide information

on heat-related illness in routine weeklysurveillance reports.

PHE will continue to produce weekly excessall-cause mortality estimates based onweekly ONS data during the summer andpublish outputs once a fortnight on the PHEwebsite in the PHE mortality report. Inaddition, PHE will request release of dailydeaths data and monitor daily any increase inexcess summer deaths based on availabledata. Daily monitoring will continue up untilone week after return to level 1.

Monitoring and surveillance

CHAPTER 5
http://www.phoutcomes.info/http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/RealtimeSyndromicSurveillance/http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/RealtimeSyndromicSurveillance/http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/Mortality/EpidemiologicalData/mortweeklyreportsarchive201213/http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/Mortality/EpidemiologicalData/mortweeklyreportsarchive201213/http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/RealtimeSyndromicSurveillance/http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/RealtimeSyndromicSurveillance/http://www.phoutcomes.info/


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Level 3: Heatwave action: PHE willcontinue to monitor any increases in heat-related illness reported in calls to NHS 111,GP in hours and out of hours consultationsand emergency department attendances(on a daily basis, week days only) and willproduce an additional single weekly heatwave syndromic surveillance report, inaddition to the routine weekly surveillance

outputs, for incorporation into a weekly PHEheatwave output. This additional report willprovide a source of intelligence on howsevere the reported effects are includingfurther information on the impact on existingregions and age groups.

PHE will continue to monitor any increasein mortality based on available daily andweekly data.

Level 4: Emergency: PHE will continue tomonitor any increases in heat-related illnessreported in calls to NHS 111, GP in hoursand out of hours consultations andemergency department attendances (on adaily basis, week days only), providing a daily(weekday only) syndromic surveillance reporton heat-related illness in the community, forincorporation into a daily PHE output.

Mortality will be monitored as per level 3.

5.3 Evaluation

PHE will work together with the DH toprepare an annual review of the HeatwavePlan which takes place each spring.


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CHAPTER 6

Recommended next steps for the NHS andLocal Authorities

We have stressed that the Heatwave Plan forEnglandis a good-practice document andthe actions denoted are illustrative. It is up toeach Local Authority and their NHS partnersto consider the actions in this plan; adaptthem and incorporate them as appropriate tothe local situation, as a component of widerheatwave planning and other climate changeadaptation arrangements. Local teams fromNHS England and PHE are there to support,to advise, and to coordinate these

arrangements as required.

In light of the guidance and good practicerecommendations made in the HeatwavePlan for England, there are three keymessages we would like to recommend toall local areas:

1. All Local Authorities, NHS commissionersand their partner organisations shouldconsider the Heatwave Plan for England

and satisfy themselves that the suggestedactions and the Heatwave Alert service areunderstood across their locality. Localheatwave and climate change adaptationplans should be reviewed in light of thisPlan.

2. NHS and Local Authority commissioners,together with Local Resilience Forums,should review or audit the distribution ofthe Heatwave Alerts across the localhealth and social care systems to satisfythemselves that the alerts reach those thatneed to take appropriate actions,immediately after issue. Figure 2.4 is an

illustrative diagram showing a cascade ofa Heatwave Alert message. Local areasneed to adapt these to their particularsituations and ensure themselves that thecascades are working appropriately.We would ask that particular care is takento ensure independent care homes andhospitals and healthcare providers aremade aware of the Plan, and for carehomes, of the specific risks associatedwith residents of homes and of the

specific advice directed at Care HomeManagers and Staff.

3. NHS and Local Authority commissioners,together with Local Resilience Forums,should seek assurance that organisationsand key stakeholders are takingappropriate actions in light of theHeatwave Alert messages. The actionsidentified in Chapter 3 are based on thebest evidence and practice available,

but are illustrative. It is for local areas toamend and adapt this guidance and toclarify procedures for staff andorganisations in a way which isappropriate for the local situation.

As ever, it is for professionals to use theirjudgement in any individual situation toensure that they are doing the best theycan for their patient or client.


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ANNEX1

Key trigger temperatures

Figure 4summarises the key triggertemperatures during a heatwave. Althoughexcess seasonal deaths start to occur atapproximately 25C, for practical reasons theHealth Heatwave alert system is based upontemperature thresholds where the odds ratiois above 1.151.2 (a 1520% increased risk).

The different trigger temperatures for localareas are summarised below with regional

variations due to relative adaptation to heat.However, a significant proportion of excesssummer deaths occur before the HealthHeatwave alert is triggered, whichemphasises the importance of long-termplanning actions by local authorities andthe health sector.

33C Tarmac Roads maybegin to melt.

24.5C Temperatureat which any excessdeaths may firstbecome apparent

38.5C Highest daytimetemperature recorded inthe UK

41.5C and 36.2CTemperatures recorded on thetube and on the platformduring 2003 heatwave.

52C and 48C when trainrails reach these temperaturesa Temporary Speed Restriction(TSR) is introduced. Trainspeeds are reduced by 50%and 30% respectively

36C Network Rail would beexperiencing railheadtemperatures of 50+C whenair temperatures of 36C arereached. Extremeprecautions would then beintroduced.

24C (for 3 days running) London Undergrounddeploy hot weather noticesand supply bottled water.

Maintenance workersbegin work to stop railsbuckling. Network rail alsobegin additionalprecautions to their tracks.

Figure 4. Trigger temperatures


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ANNEX2

Public Health Core messages

These are the core messages to be broadcast as official PHE warnings alongside nationaland regional weather forecasts. They may be expanded or otherwise refined in discussionwith broadcasters and weather presenters.

Level 1: Summer preparedness and long-term planning

No warning required unless there is a 60 per cent probability of the situation reaching Level 2somewhere in the UK within the next three days, then something along the lines of:

If this does turn out to be a heatwave, well try to give you as much warning aspossible. But in the meantime, if you are worried about what to do, either foryourself or somebody you know who you think might be at risk, for advice go to

NHS Choices at www.nhs.uk/summerhealth . Alternatively ring NHS 111.

Level 2: Alert and readiness

The Met Office, in conjunction with PHE, is issuing the following heatwave warning for[regions identified]:

Heatwaves can be dangerous, especially for the very young or very old or thosewith chronic disease. Advice on how to reduce the risk either for yourself orsomebody you know can be obtained from NHS Choices at

www.nhs.uk/summerhealth , NHS 111 or from your local chemist.

Level 3 and 4: Heatwave action/Emergency

The Met Office, in conjunction with PHE, is issuing the following heatwave advice for [regionsidentified]:

Stay out of the sun. Keep your home as cool as possible shading windows andshutting them during the day may help. Open them when it is cooler at night. Keepdrinking fluids. If theres anybody you know, for example an older person living ontheir own, who might be at special risk, make sure they know what to do.
http://www.nhs.uk/summerhealthhttp://www.nhs.uk/summerhealthhttp://www.nhs.uk/summerhealthhttp://www.nhs.uk/summerhealth


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ANNEX3

Heatwave Advice and Mass Gatherings

The attached list provides a quick heat-health checklist that can be used when planning largescale public events (mass gatherings). This should be used in conjunction with other moredetailed planning advice (e.g. Health and Safety Executives Events Safety Guide).

Heat-health risk Actions to consider

Increased exposure toheat

Provide temporary shaded areas at event locations(umbrellas, tents)

Reduce the need to queue (efficient check in, additionalstaffing, or staggered ticket entry)

Provide a water spray/mist area/spraying (showers, gardenhose)

Make available a map of local public air-conditioned spaceswhere people can have respite from the heat (considerextending opening hours of these venues)

Divert strenuous activities for cooler days or cooler periods ofthe day and provide an alternative, less strenuous programfor hot days

Communicationbarriers

Prepare advice for tourists and distribute around hotels,money exchanges and transport hubs

Produce and distribute heat-health advice printed onto freefans or caps (can be used to fan/protect against sun whilstcontaining information on protecting against and recognisingheat-related illnesses, and provide emergency phonenumber in case of identified heat related illness)

Inform your audience and/or your members about the healthrisks and possible preventive measures through digitalscreens/speakers/announcements

Reduced access to

water

Distribute water bottles or temporary water dispensers

Ensure an adequate supply of drinking water. On hot days itis advisable to provide free drinking water
http://www.qub.ac.uk/safety-reps/sr_webpages/safety_downloads/event_safety_guide.pdfhttp://www.qub.ac.uk/safety-reps/sr_webpages/safety_downloads/event_safety_guide.pdf


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Heat-health risk Actions to consider

Severe heat emergency Consider moving date, location or cancel event in extremeheat alert (especially at a Level 4 alert)

Ensure adequate immediate relief for people in emergencyand ensure their transport to the first aid/health unit

Medical needs Remember that people with asthma, heart disease and/orother additional chronic conditions are additionally healthsensitive to ozone and/or heat

Keep in mind that alcohol and some (prescription) drugs canworsen effect of heat

Ensure adequately trained personnel who notify authoritiesas soon as there are incidences of heat illness observed

Food needs Provide water-rich foods such as salads, yogurt and ensurethat food is kept cool to prevent contamination

Adapted using best practice advice from:

1. Lowe D, Ebi K, Forsberg B Heatwave Early

Warning Systems and Adaptation Advice to

Reduce Human Health Consequences of

Heatwaves. Int. J. Environ. Res. Public Health

2011, 8, 4623-4648

2. Plan Nacional de Actuaciones Preventivas de los

Efectos del Exceso de temperaturas Sobre la

Salud (Spain). Available online:

http://www.msps.es/ciudadanos/saludAmbLaboral/planAltasTemp/2011/

docs/planNacionalExcesoTemperaturas.pdf

3. Plano De Contingncia Para Ondas De Calor

(Portugal). Available online:

http://www.dgs.pt/upload/membro.id/ficheiros/i010993.pdf

4. Dianne Lowe (Personal Communication)

5. Outputs from Discussions at Heatwave

Seminar 2012
http://www.msps.es/ciudadanos/saludAmbLaboral/planAltasTemp/2011/docs/planNacionalExcesoTemperaturas.pdfhttp://www.msps.es/ciudadanos/saludAmbLaboral/planAltasTemp/2011/docs/planNacionalExcesoTemperaturas.pdfhttp://www.msps.es/ciudadanos/saludAmbLaboral/planAltasTemp/2011/docs/planNacionalExcesoTemperaturas.pdfhttp://www.msps.es/ciudadanos/saludAmbLaboral/planAltasTemp/2011/docs/planNacionalExcesoTemperaturas.pdfhttp://www.dgs.pt/upload/membro.id/ficheiros/i010993.pdfhttp://www.dgs.pt/upload/membro.id/ficheiros/i010993.pdfhttp://www.dgs.pt/upload/membro.id/ficheiros/i010993.pdfhttp://www.dgs.pt/upload/membro.id/ficheiros/i010993.pdfhttp://www.msps.es/ciudadanos/saludAmbLaboral/planAltasTemp/2011/docs/planNacionalExcesoTemperaturas.pdfhttp://www.msps.es/ciudadanos/saludAmbLaboral/planAltasTemp/2011/docs/planNacionalExcesoTemperaturas.pdfhttp://www.msps.es/ciudadanos/saludAmbLaboral/planAltasTemp/2011/docs/planNacionalExcesoTemperaturas.pdfhttp://www.msps.es/ciudadanos/saludAmbLaboral/planAltasTemp/2011/docs/planNacionalExcesoTemperaturas.pdf


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Acknowledgements

We particularly wish to acknowledge thework of the Steering Group* and advice of awider Reference Group in helping us preparethe Heatwave Plan:

Angie Bone, PHE*

Yvonne Doyle, PHE*

Carl Petrokof

heatwave main plan accessible

Documents