As a result of global warming, many countries, including the UK, are experiencing increasing periods of hot weather, or heatwaves. These are a risk to public health, as high temperatures can lead to an increase in mortality and morbidity, particularly among vulnerable people. For example, the heatwave in 2003 led to an extra 2,000 deaths in the UK.
The Heatwave Plan for England (HWP) was developed as a result of that heatwave. The HWP aims to ‘prepare for, alert people to, and prevent major avoidable effects on health during periods of severe heat in England' (Public Health England 2015). It includes a heat-health alert system and provides advice and guidance on the dangers of hot weather to the public and to health and social care agencies. However, there was little information available on the effectiveness of the HWP and how it was implemented locally, particularly at the frontline of health and social care.
PIRU was asked by the Department of Health & Social Care and Public Health England to carry out an independent evaluation of the HWP so that it may be improved in future years.
The Heatwave Plan for England requires health care providers and councils to work together to develop local plans on how to prepare for and respond to heatwaves, and it provides guidance as to how these plans should work. When temperatures are expected to reach levels where people are more likely to be harmed, then warnings, or ‘heat-health alerts’, are sent to health, social care and public service providers, so that they can take the required actions to protect their local populations.
Our study looked at whether the Heatwave Plan has helped health care providers and councils prepare for hot weather and protect people’s health. We looked at whether there were any patterns in summer death and illness rates in England before and after the Heatwave Plan was introduced. We surveyed the general public about what they knew about, and how they behaved during, hot weather. We carried out a survey of nurses to see how familiar they were with the Heatwave Plan and its guidance. We also interviewed health and social care managers and emergency planners about how they were planning for hot weather in five areas in England.
We found that hot weather does cause an increase in death and hospital admissions. Since heat-related death and illness rates had been falling before the Heatwave Plan was introduced, and continue to go down, we could not find much evidence that the Heatwave Plan itself made a difference to this. However, as most of the increase in deaths and hospital admissions occurred in hot weather ‘outside’ of alert periods, when temperatures were not high enough to issue an alert, it could be suggested that the Heatwave Plan was good at protecting people during the alert periods, but not so good in hot weather where no alert was issued.
We also found that people were not always taking heed of the advice about hot weather. Overall, the general public felt positive about warm summer days and most did not feel that hot weather was a risk to their health, including people over the age of 75. As a consequence, many people, including the most vulnerable, were not taking all of the Heatwave Plan’s recommended actions to protect themselves and others.
Health and social care managers told us that the Heatwave Plan was useful for helping them prepare for emergencies as it prompted them to take actions when alerted to do so. However, the messages did not appear to reach all those working at the frontline with patients, as many nurses said that they were unaware of the Heatwave Plan, and took few or none of its recommended actions during a heatwave alert.
Nurses said that they often struggled to protect their patients as their organisations were not well-prepared for heatwaves. Also, those working in the community said that it was sometimes difficult for them to protect all those vulnerable to heat as many of these people would not be known to health or social care services, such as people who are not in regular contact with these services. The role that GPs played in this was also not clear.
That the government review and clarify its guidance to councils and health care providers so that people, including the most vulnerable, are better protected during all hot weather, not just during heat-health alert periods. This would include ensuring that all health and social care practitioners are better informed of the Heatwave Plan and its guidance.
That national and local governments consider how to ensure that local hospitals and other health and social care providers can plan and work together better to protect their communities, including those most vulnerable, from the effects of the heat.
That the government revise their public health information and advice about hot weather to ensure that people are better informed about their own risks and any actions they can take to better protect themselves. Messages should be targeted at different groups of the public, including both older and younger adults.