Snow Angels CIC /
10/13/2013 /
Introduction
Dear Colleagues
Every year as we enter the Winter period, we know that falling temperatures and difficult external conditions have the potential to create immense pressures both for our residents and the wide range of care and service providers across Cheshire East who are charged with mitigating them.
This document therefore represents a co-ordinated response to events as they may arise, in line with national recommendations and local conditions. In particular, the Cheshire East Cold Weather Plan is designed to support our older and most vulnerable residents, in order to improve their overall health and well-being and reduce the number of excess winter deaths that occur each winter.
Whilst it is not possible to accurately predict the severity of the Winter to come, this Plan is a multi-organisational response, offering a wide range of interventions to both prepare for, and implement during periods of cold weather.
I would therefore like to thank our staff and all our partner organisations for their contributions in the design of the plan, and their committed support in implementing it in the months to come.
Cllr Janet Clowes
Portfolio Holder: Health & Adult Social Care, Cheshire East Council
.
Contents
Executive Summary
Background
Strategic Planning
Development of a “list of lists”
Keeping warm
Encouraging uptake of flu and pneumococcal vaccinations
Implementation of brief health interventions
Reducing social isolation
Healthy Eating
Staying Active
Assessment and support to prevent falls
Provision of personal contingency plan e.g. buddy scheme
Assessment for assistive technology and cold weather alerts
Advance warning and advice during the winter months
Levels of Cold Weather Alerts
Health Impacts and Time
Cascade of Cold Weather Alerts
Local Resilience Forum and Local Health Resilience Partnership
Communicating with the Public and Service Providers
Communications Plan
Brand
Press Releases
Community Organisers
Social media
Leaflets
Engaging with the Community
Winter Well Being Portal
Making Every Contact Count
Referral scheme
Training resources
Posters and leaflets etc.
Directory of services
Cold weather alerts – sign up
Events Calendar
Executive Summary
Cheshire East has the fastest growing older population in the North West and this presents opportunities and challenges for service providers and local communities, particularly during the winter months.
The production of a local Cold Weather Plan (CWP) provides the opportunity to target services and resources towards people who are potentially most at risk during the winter.
The CWP has been written for partners and stakeholders and does not replace the individual plans for partners – its primary aim is to reduce the health impacts of cold weather, specifically excess winter deaths and emergency admissions to hospitals. The plan specifically addresses Levels 0 – 3 in the Cold Weather Planning process – the Local Resilience Forum is responsible for implementing Level 4 responses.
The majority of excess winter deaths during the winter are preventable and the plan outlines a number of actions which will help to reduce health impacts. The population who are most at risk in Cheshire East are likely to be over 75 years old and will possibly have respiratory or cardio-vascular diseases.
The plan also outlines a number of research studies which demonstrate the importance of geographical targeting, for example over half of 85 year olds living in Crewe were admitted as emergency admissions to hospital during the year in 2011/12 and this figure increased during the winter months, and the prevalence of off gas properties in the rural areas across Cheshire East poses particular challenges relating to fuel poverty.
This is a challenging agenda with diminishing financial resources. There are opportunities to develop community resilience projects, engage with community organisers, ensure that key messages are transmitted through “Making Every Contact Count”, and have a combined communications plan throughout the winter months.
A summary of the local Cold Weather Plan is included at Appendix A.
Background
The national Cold Weather Plan for England (Department of Health, 2012) includes a number of key recommendations to improve health and wellbeing including the production of local Cold Weather Plans (CWP’s). “In winter 2010/11 there were about 23,700 “excess winter deaths….many of these winter deaths are preventable and the Cold Weather Plan recognised that more needed to be done to protect vulnerable people during cold winter months”[1].
Cheshire East faces particular challenges through the winter months with a high rate of excess winter deaths primarily amongst older people and a high rate of excess winter emergency admissions amongst older people to hospital. There are over 200 excess deaths each winter which “is an additional 19.7% risk of dying at this time of year”[2]. The area also has the fastest growing older population in the North West and England and there are currently over 75,000 people over 65 years old living in East Cheshire[3].
The Ageing Well programme is a five year initiative developed by partners which seeks “to make the borough a good place to grow old by maximising the opportunities for the ageing population to prepare for the later stages of like, maintain their quality of life during later life and have access to person centred services when required.”[4]Cheshire East Council is responsible for ensuring that the Services it provides or commissions are ready for winter and have in place the appropriate escalation procedures for when cold weather alerts are received. As part of this wider programme Cheshire East Council began hosting a winter planning partnership in May this year to ensure that existing resources were focused on making the most impact and this built on previous winter planning activities since 2010. Through discussions it became clear that there was a need for both a local Cold Weather Plan and a co-ordinated communications campaign and Snow Angels – a social enterprise based in Cheshire - was commissioned through the Innovation Fund to produce these.
The national CWP recommends that “at a local level, a cold weather plan should feature as an integral element of wider winter preparedness and response measures developed by the NHS, local authorities and local resilience forums (LRFs).” The report goes on to recommend that there aresix essential elements of a local plan including strategic planning, advance warning and advice during the winter months, communicating with the public, communicating with service providers, and engaging the community. This plan concentrates on these key elements – each of the constituent partners will have their own emergency plans which will include cold weather.
Strategic Planning
The number of excess winter deaths in Cheshire East has been highlighted in the Joint Strategic Needs Assessment (JSNA) produced in 2012 and is a key priority for the area (the rate for Cheshire East is 12% above the average for England). The key recommendations from the JSNAto reduce excess winter deaths are the production of a local plan dealing with the health impacts of cold weather, increased uptake of flu vaccinations, and the development of a referral mechanism for fuel poverty.
Emergency admission rates for hospital for people over the age of 65 years old in Cheshire East are worse than the national average and this rate is worst in the Crewe LAP which is in the worst quarter nationally. Across Cheshire East the rates for emergency admissions for this age group are highest in the towns of Middlewich, Macclesfield and Crewe and a third of all emergency admissions are for people over 85 years old – in the Crewe LAP nearly half of those aged over 85 years old were admitted to hospital on an emergency basis during 2011/12. There is a relationship with deprivation – however this only accounts for one third of emergency admissions.
The aim of this project is to reduce excess winter deaths in Cheshire East and to reduce emergency admissions to hospital. The main target audience is older people over 75 years old who are the most likely group of people to be adversely affected by cold weather, particularly if they have respiratory or cardio-vascular diseases. A provisional analysis of excess winter deaths in England for 2010/11 demonstrated that people who died were more likely to be female and the majority were over 75 years old – however the number of deaths of people under 75 years old was increasing[5].
The JSNA includes an analysis of excess winter deaths by LAP area and the highest rates are found in the Nantwich LAP and the Wilmslow LAP although these differences are not statistically significant. “The risk is also higher for people with certain chronic health conditions, for example it is 55.9% higher locally for respiratory disease and 22.3% higher for cardiovascular disease” according to the Annual Report of the Director of Public Health (2011-12).
A key element of effective winter planning is enabling the communication of key messages through a wide range of means and integral to this is the development of the portal to ensure that people have access to resources and referral mechanisms to ensure the effective implementation of “Make Every Contact Count” – a key recommendation from the National Institute of Health and Care Excellence.
There are a number of actions which are recommended by the NHS and associated toolkits[6] and these are outlined below.
Development of a “list of lists”
In Cheshire East there are a number of organisations who have details of older people who could benefit from additional support during the winter months. A “list of lists” has been developed which includes the main contact details of the list holder and this will ensure that relevant information is cascaded to various groups and in the event of cold weather will provide a mechanism for providing more active support. The list includes a wide range of service providers including statutory, voluntary and private sector providers.
This range of services covered by this “list of lists” is included on the portal and the list holders will be encouraged to register to receive text or email alerts through the portal. During periods of cold weather and/or snow fall the main contacts will be texted with advance cold weather alerts.
The “list of lists” covers older people who are registered with various services including assisted bins and adult social care clients and provides coverage for those older people who are in receipt of a range of services. The cold weather alerts will also be cascaded to a wider range of community networks who will be able to alert other older people in their communities.
This “list of lists” approach also gives the potential to target key messages at specific people, for example the priority service provided by the utility companies includes customer profiles. A good example of this is the electricity companies who hold information about customers who rely on respiratory aids which need power, e.g. nebulisers.
Keeping warm
Keeping warm during colder weather is a key factor in reducing excess winter deaths. There are clear recommendations on the optimum inside temperature for older people and this is a major part of the communications plan.
The Housing Strategy for Cheshire East highlights that “older people are more likely to have Category 1 hazards present in their homes (40.1 per cent) posing a significant risk to their health and safety. Excess cold and falls on stairs pose the greatest risk to older owner-occupiers in Cheshire East”[7].
The JSNA report on fuel poverty[8] and key recommendations demonstrated that fuel poverty was highest in the Nantwich LAP. Suggested actions from the JSNA include targeting home repair loans at vulnerable households, assessment for affordable warmth, winter warmth campaign, and raising awareness amongst front line staff, Snow Angels community resilience projects, and assistance for people to access the Green Deal.
There has been a revised definition of fuel poverty and this illustrates that there are a number of Lower Level Super Output Areas (LSOA’s) in Cheshire East which have higher rates than the North West average of 12.5% of households living in fuel poverty. The revised definition is that total income is below the poverty line (taking into account energy costs); and that energy costs are higher than typical (the previous definition of a ‘fuel poor household’ is that a household would need to spend 10% of their income on energy a year).
The highest rates of fuel poverty in Cheshire East using the revised definition of fuel poverty are in Crewe and the town centre of Macclesfield. However there is a correlation between the rural areas which have higher rates of fuel poverty and the rural areas which are off gas, and most of these areas have rates of fuel poverty which are higher than the average for Cheshire East.
Age UK in their recent report “Later life in rural England”[9] stated that “fuel poverty is a huge problem across England, but it is particularly prevalent in rural areas. Due to the high number of stone-built, solid wall properties and off-mains gas households, household energy bills in rural areas are on average 27 per cent higher than in urban areas”.
As part of the winter plan partners will work together for a concerted campaign – Big Energy Week – during the first week in November. This will include key interventions for older people living in rural areas and LSOA’s with higher rates of fuel poverty than the regional average. There will also be a joint referral scheme on the portal and training resources aimed at front-line staff and volunteers to support the “Make Every Contact Count” approach.
There are a range of services provided through the Care and Repair team and other partner organisations including grants for urgent home repairs including heating, heater loans, prioritisation of home loans for heating, and activities carried out by registered social landlords.
Encouraging uptake of flu and pneumococcal vaccinations
The analysis of excess winter deaths in 2012-13 by Public Health England concludes that “statistical regression modelling of excess mortality over the past few seasons, including 2012-13, has shown influenza to be a major contributory factor”[10].
The key target audiences for this action in the context of reducing excess winter deaths are people over 65 years old, and people with certain chronic conditions. Older people with respiratory or cardio-vascular disease are particularly at risk.
The Public Health report (2012) shows that the take-up of flu vaccinations across Cheshire East is good in all areas for people aged over 65 years old. The rates are lower in the Crewe and Wilmslow LAP areas at 77.6% for both areas compared with a Cheshire East average of 79.4% - however these rates are above the England average for this age group of 74%. The rate of seasonal flu vaccination uptake for clinical risk groups is lower than the England average in the Wilmslow LAP area.
There has been a distribution of leaflets through community networks including Cheshire WI’s, Town and Parish Councils, Neighbourhood Watch etc. In addition there are a range of community transport providers in Cheshire East and they will be asked to distribute leaflets to their membership. The communications plan includes press releases encouraging people to take up the flu vaccinations.
The flu clinics also provide a clear opportunity to engage with older people and there are a number of services including Neighbourhood Watch who will be visiting them during October and these services will be asked to distribute key messages during their visits.
Implementation of brief health interventions
There are a number of brief health interventions which are recommended as part of the overall approach to maintaining wellbeing throughout the winter months, particularly for older people. The National Institute for Health and Care Excellence (NICE) recommend that “by investing in initiatives to promote healthy living, and training staff and volunteers to offer low-level, simple advice about changing their lifestyle, council can reduce hospital admissions and unnecessary healthcare visits, ease the burden on social services…”[11]The “Next Steps” guide gives more details to ageing well and is currently being updated.[12]
Reducing social isolation
In 2010 Central and Eastern Cheshire PCT and Cheshire East Council hosted a conference “Living well in Cheshire East: a call to action” and highlighted the impact of social isolation on health including information from the Marmott report -