On average, there are around 27,000 more deaths in England during winter months than expected from the death rates in other months of the year, as well as many additional hospital admissions and consultations in primary care. This 'excess' of winter deaths is greater than in many neighbouring countries of continental Europe. Studies suggest that many of these excess winter deaths and illnesses are related to cold weather and experts feel they are largely preventable. The government developed a Cold Weather Plan (CWP) which advises local health and social care organisations on what should happen before and during severe cold weather in order to reduce risks and help protect vulnerable (especially older) people. In 2012-13, PIRU evaluated the extent to which the CWP was implemented at the local level, whether it reached its target groups, looked at its potential cost-effectiveness, and how it could be improved in future years.
The evaluation had four elements:
1) A time series (20+ years) analysis of regional health data linked to weather data in order to characterise weather-health relationships and trends over time and their yearly variations. The trends provide a base for comparison of post-CWP implementation impacts.
2) Simulation modelling was used to evaluate its potential cost-effectiveness under different scenarios.
3) The third component looked at actions taken at local level by the health and social care system. Detailed information was obtained for 10 Local Authorities throughout England, and involved an analysis of policy documents and interviews with senior managers of health and social care organisations. A national survey of district/practice nurses was carried out to examine the responses of frontline staff to preparations arising from the CWP.
4) A small-scale preliminary study among a group of at-risk people involved interviews with patients and care home managers soon after a cold weather alert. The aim was to assess whether alerts reach their target groups and how people view and respond to these messages.
PIRU worked in collaboration with Paul Wilkinson, Shakoor Hajat and Zaid Chalabi from LSHTM's Department of Social and Environmental Health Research.