Fighting the cold: working to reduce excess winter deaths

Image from Flickr user FranTaylor under Creative Commons License

Image from Flickr user FranTaylor under Creative Commons License

We may have all breathed a sigh of relief when last week’s cold snap finally eased, but for those working in public health the consequences of the cold weather are still playing out.

Cold weather poses a significant risk to health. There is a notable rise in deaths, and also illnesses and injuries, during the winter period. Indeed, in England and Wales there were 11.6% (18,200) more deaths in 2013/14 during the winter period (December to March) compared with the non-winter period (known as “excess winter deaths”).

Older people, particularly those aged over 75 years old, are most vulnerable to cold weather-related illness. The majority of excess winter deaths occur within this age group and those living on their own or who are socially isolated are most at risk. Other groups at risk include those experiencing chronic or severe illnesses, particularly heart conditions or circulatory disease, children under the age of five, and homeless people /street sleepers.

The reasons why cold weather has such a negative impact on health are complex and interlinked with fuel poverty, poor housing and health inequalities. There can be an increase in circulating infectious diseases, particularly flu and norovirus, and snow and ice can cause falls. Cold weather has also been linked to increased cases of hypothermia, carbon monoxide poisoning (from faulty heating appliances), and mental health problems such as depression and anxiety.

However, there is evidence to suggest that many of these ill effects are preventable. In some northern European countries, such as Finland, the rate of winter deaths is far lower than that in England, despite experiencing much lower temperatures.

To help address this, the Government has published an annual ‘Cold Weather Plan’ (CWP) since 2011 aimed at local authorities, health and social care staff and any professionals working with vulnerable people. The plan operates a system of cold weather alerts, comprising five levels (Levels 0-4), from year-round planning for cold weather, through winter and severe cold weather action, to a major national emergency. Each alert level aims to trigger a series of appropriate actions, which are detailed in the plan. The latest CWP was published in October 2014.

It stresses the importance of year round planning and all-winter action for reducing excess winter deaths and relieving the additional pressures on the NHS and social care which occur during the winter months. Recommended all-year actions include:

  • addressing fuel poverty
  • improving housing and energy efficiency measures
  • raising awareness of preventative actions among staff.

All-winter actions (November to March) include:

  • communicating with the public about what they can do to reduce the risk of cold weather to their health
  • identifying vulnerable clients
  • supporting vulnerable clients to seek appropriate help.

There are also key public health messages which should be communicated with residents/patients, relating to flu vaccinations, keeping homes adequately heated and ventilated, available financial support, and looking after vulnerable older neighbours and relatives.

A guide to communicating effectively with the public during periods of extreme weather was published recently by the Local Government Association (LGA). The LGA have also provided guidance for local authorities on how they can help to reduce the negative effect of cold weather on health. It highlights examples of innovative schemes, including the installation of free temperature sensors and a volunteer ‘winter squad’ to care for vulnerable residents.

Investing in cold weather planning is important – although the media focuses on travel disruption during cold weather, for many of the most vulnerable in our society it can be a death sentence.


Further reading

The Information Service has a number of resources on cold weather planning – a selection are listed below.

Cold weather plan for England 2014: making the case – why long-term strategic planning for cold weather is essential to health and wellbeing

A turn for the better (Liverpool’s Healthy Homes Programme), IN Property Journal, Jul/Aug 2014, pp42-44 (Ref No. A51407)

Staying in touch (social media), IN Local Government News, Vol 36 No 2 Mar/Apr 2014, pp44-45 (Ref No. A49753)

Behind cold doors: the chilling reality for children in poverty

Reducing harm from cold weather: local government’s new public health role

N.B. Abstracts and access to journal articles are only available to members.

Can the Care Act really provide the transformation in adult social care needed for modern society?

pregnant carer giving pills and medication to her patientBy Heather Cameron

The legislative framework for adult social care in England has been described as out-dated by the Department of Health (DH) as it is focused on crisis intervention rather than prevention and early intervention, and on the provision of services, rather than enabling the system to be centred around the health and wellbeing of people and carers. The DH has therefore highlighted the need for government intervention to reform the legal framework so it better fits the purpose of modern care and support.

The government’s objectives for adult social care are to improve people’s quality of life, delay and reduce the need for care, ensure positive care experiences and safeguard adults from harm. The Care Act 2014 was passed into law on 14th May 2014 with the aim of transforming adult social care in England to meet these objectives.  Although the Act is generally concerned with care and support matters in England, some provisions extend to the devolved nations.  The main focus of the Act is on promoting individual wellbeing and preventing the need for care and support. In particular, it makes provision:

  • to reform the law relating to care and support for adults and the law relating to support for carers;
  • about safeguarding adults from abuse or neglect;
  • about care standards;
  • about Health Education England;
  • about the Health Research Authority;
  • about integrating care and support with health services; and
  • for connected purposes.

According to Care and Support Minister, Norman Lamb: “the Care Act represents the most significant reform of care and support in more than 60 years, putting people and their carers in control of their care and support. For the first time, the Act will put a limit on the amount anyone will have to pay towards the costs of their care.”

Due to come into force in April 2015, with its provisions related to funding reform to be implemented a year later, the success, or otherwise, of the Care Act’s implementation is as yet unknown.

Nevertheless, there has been much discussion over the potential issues and challenges with regard to implementation. The College of Social Work (TCSW) argues that the implementation of the legislative reforms “will be challenging and demand significant cultural and attitudinal changes, both strategically and in professional practice”.

The Act presents significant changes for local authorities which will be challenging to implement in the proposed timescale. Concerns have been raised by both local authorities and charities over the funding of the Act’s provisions and the sustainability of adult social care services. A recent article published in Community Care highlights such concerns among councils, noting that nine out of 10 councils believe key parts of the Act will be jeopardised if the government fails to provide local authorities with adequate funding for implementing the reforms.

According to London Councils, London is facing double the shortfall in funding to prepare for the Care Act than previously thought with proposed new funding arrangements unveiled by the government to leave the capital with a £36 million gap.

Moreover, a subsequent article in Community Care suggests that local authorities need to consider the training challenge now in order to negotiate the issues raised by the new funding reforms.

The main costs of the Act relate to improved legal rights for carers (rising to £175 million per annum). However, there may be additional costs, for example where local authorities face increased demand for services due to improved information. Greater clarification on the support available to carers could potentially increase the workload for social care professionals as the number of carers’ assessments could also increase.

The additional requirements of providing support to self-funders as well as carers could also take its toll on councils. Caroline May, business partner in finance at Havering LBC noted at a recent roundtable that:

“There are a lot of unknowns out there that will present us with financial challenges. I think culture shift is going to be huge across the board.”

The Association of Directors of Adult Social Care (ADASS), which represents local authorities, is unconvinced that local authorities can implement the changes required in the proposed timescale. In a joint report with the Local Government Association, they highlight the financial challenges local authorities face, particularly at a time of budget cuts and increasing demand for services. A recent inquiry into adult social care in England has highlighted that there was an 8% real terms cut in spending between 2010/11 and 2012/13; and demand for care provided by adults is projected to rise by over 50% between 2007 and 2032, while the supply of this care is projected to rise by only 20%, according to Carers UK.

Despite these funding issues, however, cost savings have also been identified in relation to public expenditure savings of improved support for carers, according to the DH’s recent impact assessment, which also states that these cost savings outweigh other new costs overall. The potential benefits of the Act for people with care and support needs which could also lead to savings were identified as: “improved wellbeing, better prevention of care and support need, greater clarity, consistency and equality of access to care and support and reduction of unmet need.”

It will undoubtedly be challenging to implement the provisions of the Care Act and it remains to be seen whether the funding provided will be adequate.

Only time will tell whether the proposed reforms will truly transform the currently outdated adult social care system.


 

Further reading

The Idox Information Service has a wealth of research reports, articles and case studies on a range of adult social care issues. Items we’ve recently summarised for our database include:

The Care Act and the care market: conference summary

Adult social care in England: sixth report of session 2014-15 (HC 518)

Using technology to deliver social care, IN Local Government Chronicle, No 7598 17 Jul 2014

Carers’ quality of life and experiences of adult social care support in England, IN Health and Social Care in the Community, Vol 22 No 4 Jul 2014

Transforming adult social care (improving efficiency in council social care services), IN Local Government Chronicle, 5 Jun 2014

Care Act 2014

Understanding personalisation: implications for social work, IN Journal of Social Work, Vol 14 No 3 May 2014

State of caring 2014

Care home top-up fees: research with local authorities

Making our health and care systems fit for an ageing population

N.B. Abstracts and full text access to subscription journal articles are only available to members of the Idox Information Service.

Literacy matters … and we’re still not doing enough to improve it

Image by Elke Wetzig under Creative Commons License, via Wikimedia Commons

Image by Elke Wetzig under Creative Commons License, via Wikimedia Commons

By James Carson

Three new reports published in September have highlighted the significance of literacy in our lives.

The first report, from the National Literacy Trust (NLT), discusses how low levels of literacy can contribute to health inequalities, poverty and crime. Among the findings, the NLT notes that:

  • Those with lower levels of literacy are more likely to be obese, smoke, and drink heavily;
  • Those with low literacy are more likely to live in disadvantaged housing conditions and more deprived areas;
  • Young people who are not in education, employment or training (NEET) are 20 times more likely to commit a criminal offence.

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