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.
The Cold Weather Plan (CWP) evaluation:
1) Assessed the implementation of the CWP in 2012-13 at the local level and examined how this compared with expectations.
2) Took a preliminary look at the level and nature of support received by 'at-risk' individuals in the population.
3) Characterised the health-related impacts of low temperature (e.g. mortality, hospital admissions, A&E attendance) in order to look at the impact of the CWP on health and the demand for health care.
4) Modelled the probabilities of various forms of extreme weather events and associated health impacts, under varying assumptions of the effectiveness of the CWP, in order to inform the likely costs and benefits of the CWP.
'Local health and social care responses to implementing the national cold weather plan' was published in the Journal of Public Health in September 2018. This article can be accessed here>>
A number of journal articles were published in the journal Public Health in January 2016 including:
'The experience of potentially vulnerable people during cold weather: implications for policy and practice'. This article can be accessed here>>
'Evaluation of the cold weather plan for England: modelling of cost effectiveness'. This article can be accessed here>>
'Public health vulnerability to wintertime weather: time-series regression and episode analyses of national mortality and morbidity databases to inform the Cold Weather Plan for England'. This article can be accessed here>>
The final report was completed early in 2015 and can be accessed here>>
A draft report was provided to the Department of Health in July 2013.
An abstract of the evaluation was published in The Lancet in November 2013. To see the abstract please click here>>