Emergency Preparedness, Resilience and Response Adverse

This document is uncontrolled if printed, for the latest version please see the Trust’s Intranet

Emergency Preparedness, Resilience and Response

Adverse Weather Response Plan Incorporating Flooding, Snow and Heatwave Arrangements

Authoring Department: EPRR & Risk Management Version Number: Version 1.0

Author Title: Head of EPRR & Risk Published Date: February 2019 (CP83)

Authoriser Title: Accountable Emergency Officer Review Date: February 2021

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Document Control and Governance

Emergency Preparedness, Resilience and Response

Executive Division Owner

Chief Executive’s Office Service Transformation Nursing Finance

Trust Wide Corporate Affairs Operations People and Business

Development

Document Control Information

Workstream Business Continuity EPRR

Document Purpose: Policy / Strategy Supporting Guidance Operational Plan

Document Name: Adverse Weather Response Plan

Author: Head of Risk and Emergency Preparedness, Resilience and Response

Target Audience: • All staff and contractors within CPFT,

• All staff within SERCO directly involved in providing services to CPFT,

Additional Circulation:

This document will be shared with the following organisations:

• NHS England (East of England) Locality Team

• Members of the Cambridgeshire and Peterborough Local Health Resilience Partnership (LHRP).

Cross Reference

• The Civil Contingencies Act (2004)

• The Health and Social Care Act (2012)

• NHS Standard Contract

• NHS Commissioning Board Business Continuity Management Framework (service resilience) (2013)

• NHS Commissioning Board Command and Control Framework for the NHS during significant incidents and emergencies (2015)

• NHS Commissioning Board Core standards for Emergency Preparedness, Resilience and Response (EPRR)

• BSI PAS 2015-Framework for Health Resilience

• Cabinet Office National Recovery Guidance

• NHS England Planning for the Shelter and Evacuation of people in healthcare settings

• All internal CPFT EPRR and Business Continuity published guidance

Superseded Documents: This version supersedes all previous versions of this document.

Timing / Deadlines: For immediate implementation by all Directorate and Services

Contact Details for further information

Head of EPRR and Risk Cambridge and Peterborough NHS Foundation Trust Trust Headquarters, Elizabeth House, Fulbourn Hospital Cambridge, CB21 5EF [email protected]

Document Status

This is a controlled document. Whilst this document may be printed, the electronic version posted on the CPFT intranet is the controlled copy. Any printed copies of this document are not controlled. As a controlled document, this document must not be saved onto local or network drives but should always be accessed from the CPFT intranet.

Version Control

https://www.legislation.gov.uk/ukpga/2004/36/contents

https://www.legislation.gov.uk/ukpga/2012/7/contents/enacted

https://www.england.nhs.uk/nhs-standard-contract/2017-19-update-may/

https://www.england.nhs.uk/wp-content/uploads/2013/01/bus-cont-frame.pdf

https://www.england.nhs.uk/wp-content/uploads/2013/01/bus-cont-frame.pdf

https://www.england.nhs.uk/wp-content/uploads/2015/11/eprr-framework.pdf

https://www.england.nhs.uk/wp-content/uploads/2015/11/eprr-framework.pdf

https://www.england.nhs.uk/publication/nhs-england-core-standards-for-eprr/

https://www.england.nhs.uk/publication/nhs-england-core-standards-for-eprr/

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https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/253488/Emergency_Response_and_Recovery_5th_edition_October_2013.pdf

https://www.england.nhs.uk/wp-content/uploads/2015/01/eprr-shelter-evacuation-guidance.pdf

https://www.england.nhs.uk/wp-content/uploads/2015/01/eprr-shelter-evacuation-guidance.pdf

mailto:[email protected]?subject=RE:%20EPRR%20Strategy%20and%20Framework%202019




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Version Control Information

Version Date Amendments Author

0.1 24/12/18 Document creation EPRR Consultant

0.2 25/01/19 Final Draft for approval EPRR Consultant

0.3 28/01/19 Addition of comments by Director of Corporate Affairs (AEO)

EPRR Consultant

1.0 09/02/19 Final Document EPRR Consultant




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Contents

Introduction ..................................................................................................................................................... 4

Adverse Weather Planning ............................................................................................................................. 4

Scope of Planning ........................................................................................................................................... 4

Aims & Objectives ........................................................................................................................................... 5

Vulnerable Patients ......................................................................................................................................... 5

Roles and Responsibilities .............................................................................................................................. 6

Activation and Response ................................................................................................................................ 6

Key Groups for Prioritisation ........................................................................................................................... 8

Communicating with Staff ............................................................................................................................... 9

Maintaining Trust Activity .............................................................................................................................. 10

Communications Messages .......................................................................................................................... 10

Response Arrangements .............................................................................................................................. 12

Recovery ....................................................................................................................................................... 13

Appendix A – Summary of Cold Weather Actions ......................................................................................... 14

Appendix B – Heatwave Actions ................................................................................................................... 16

Appendix C – Heatwave Actions for Community and Individuals .............................................................. 17

Appendix D – Heatwave Alert Cascade ........................................................................................................ 18

Appendix E – Heatwave Trust Actions by Alert Level .................................................................................... 19

Appendix F - Cold Weather Trust Actions by Alert Level ............................................................................... 21

Appendix G – Staff Guidance - Working in Hot Weather ............................................................................... 24




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Introduction This document outlines and establishes the framework for responding to Adverse Weather events and incidents for Cambridge and Peterborough NHS Foundation Trust. These procedures aim to be a reference to provide information, a prompt for action, and summary of priorities and responsibilities in relation to these incidents.

Adverse Weather Planning

Heatwave Planning Heatwave planning within CPFT is aligned to the Heatwave Plan for England 2018. This plan is intended to protect people who use our services, patients and visitors from heat-related harm to health. It aims to prepare for, alert people to, and prevent, the major avoidable effects on health during periods of severe heat in England. CPFT’s plan builds on the depth of experience within the Trust and the wider NHS around developing and improving the ability of the Trust to deal with significant periods of hot weather. There are significant changes that will be taken into consideration to reflect the changes in the health, care and public health landscape. This will assist the Trust in aligning planning activity with that undertaken relating to Cold Weather Planning, and links to the Trust’s planning for severe heat with the Public Health Outcomes Framework.

Cold Weather Planning Cold Weather Planning for CPFT is aligned to the Cold Weather Plan for England which is issued annually to cover the period from September through to March. This plan is a framework intended to protect people who use our services, staff and visitors from harm to health from cold weather. It aims to prevent the major avoidable effects on health during periods of cold weather by alerting the above groups to the negative health effects of cold weather and enabling them to prepare and respond appropriately. This will also cover the Trust’s response to flooding, snow and thunderstorms by providing a framework for the notification, response and recovery from these sudden, often unforeseen adverse weather events.

Scope of Planning

General Scope Any Adverse Weather event or incident affecting the Trust will require the activation of a multi-agency response via the Local Resilience Forum and health partners. These types of events are varied in both their nature and scale; this plan is designed to give responders at all levels within the Trust advice and guidance in the event of Adverse Weather either affecting just CPFT, or as part of a wider response. The plan’s focus is on the arrangements for the activation and response in relation to an adverse weather incident or event, in line with the National Guidance provided by the Met Office and other relevant organisations. The plan is written to supplement and work in conjunction with the CPFT Incident Response Plan (IRP) and should not be read or used in isolation but with the IRP. The plan links to, but does not replace, the plans developed and held by Cambridge and Peterborough Local Resilience Forum, NHS England and Clinical Commissioning Groups




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Specific Scope As the Trust is the main mental health provider for the populations of Cambridge and Peterborough, we will seek to support all other health and social care providers with the mental health needs of their patients during adverse weather events. This will involve providing support to evacuation centers, rest centers and other support as required.

Aims & Objectives The aim of this plan is to detail the policies and procedures employed by CPFT in response to the presence of contaminated persons at one of the Trust’s sites. The objectives of this plan are to describe the Trust’s plans for the provision of the following:

• Procedures and triggers for the activation of the plan;

• Command and control structures, including key links with partner agencies;

• Procedures for the appropriate notification of the effects of an adverse weather event or incident of staff and patients;

• The specific roles and responsibilities;

Vulnerable Patients

Management of Vulnerable Patients Within the Civil Contingencies Act (2004) the needs of vulnerable persons are recognised. These individuals are defined as

“people present or resident within an area known to local responders who, because of dependency or disability, need particular attention during

incidents”. Vulnerable persons could therefore include children and older people; BAME communities, particularly those for whom English is a second language, and people with disabilities, including physical disabilities and impairments, learning disabilities, mental illness and those with complex physical and/or mental health needs.

Black and Minority Ethnic Communities

Care will be taken when producing and distributing information to ensure that it is accessible to all. This may necessitate the production of translated materials, the use of health advocates, and the use of interpreting services.

Children

Many major incidents involve children, and, in some cases, children are the main casualties. Children have special needs that are different from adults in terms of their size, physiology and psychological needs – all of which have an impact on their care. The On-Call Managers and the Incident management Team will need to consider and take account of the children’s needs in planning and response to a major incident. Special consideration must be given to schools, nurseries, childcare centres and psycho-social support for children.

People with inhibited physical ability




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This may be by reason of age, illness, disability, pregnancy or other reason. Attention should be paid to hospitals, residential homes, care homes and day centres likely to be housing any people with inhibited physical ability, who may be at risk of higher acuity mental health problems. Access to the records of residents in the community who have inhibited physical ability is also important and may be achieved in partnership with other services e.g. social and community providers.

People with learning disabilities and people with mental illness

The Trust will respond as appropriate in order to assist people with learning disabilities or mental illness by using existing facilities and arrangements wherever possible. If there is a need for additional or specialist assistance, then help will be sought from wider health partners as appropriate.

Specific Advice – Ramadan Many members of the Muslim community may be fasting during the daylight hours in the month of Ramadan (which is determined by the lunar Islamic calendar). All staff within the Trust, especially those working within community services and on the 24/7 Crisis Support Line should familiarise themselves with the dates of Ramadan each year, following notification from the Equality and Diversity team. The Trust will build appropriate actions into contingency plans if it falls during the summer months or a period of sustained heat. For the Muslim Community, it is common to have one meal just before sunrise and an evening meal after sunset during Ramadan. During hot weather, dehydration is a common and serious risk. It’s important to balance food and fluid intake between fasts and especially to drink enough water. The advice for Muslim’s celebrating Ramadan, in the event of feeling unwell, disoriented or confused, or collapse or faint, is to stop fasting and have a drink of water or other fluid. This is especially important for older adults, those with poorly controlled medical conditions such as low/high blood pressure, diabetes and those who are receiving dialysis treatment. The Muslim Council of Britain has confirmed that breaking fast in such conditions is allowable under Islamic law. Staff on community visits must make sure they check on relatives of people who use our services in the community who may be at greater risk and keep an eye on children to ensure they are having a safe and healthy Ramadan. Guidance has been produced to help ensure that members of the Muslim community have a safe and healthy Ramadan – Ramadan Health Guide: A guide to healthy fasting produced in association with the NHS.

Roles and Responsibilities The roles and responsibilities will be as described in the Trust’s Incident Response Plan, which can be obtained through the Risk and EPRR Team.

Activation and Response

Met Office Alerts The Trust will monitor the Heatwave warnings issued by the National Severe Weather Warning Service (NSWWS) alongside utilising the following services to inform activation of the plan and appropriate response:

http://www.communitiesinaction.org/Ramadan%20Health%20and%20Spirituality%20Guide.pdf




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Service Purpose Timing

Heatwave warning

• To provide early warning of high temperatures. The alert levels have been set with thresholds known to cause ill health from severe hot weather.

• They are to help ensure that healthcare staff and resources are fully prepared for hot weather periods that might impact on health and;

• to raise awareness for those individuals who are more vulnerable to hot weather conditions.

Alert issued as soon as agreed threshold has been reached and when there is a change in alert level. Issued between 1 June and 15 September

Heatwave planning advice

To provide advice throughout the summer period relating to high temperatures.

Twice a week (9am each Monday and Friday from 1 June to 15 September)

National Severe Weather Warning Service (NSWWS)

To provide warnings of severe or hazardous weather that has the potential to cause danger to life or widespread disruption. These warnings are issued to: • the public, to prompt consideration of actions they may need

to take • emergency responders, to trigger their plans to protect the

public from impacts in advance of an event, and to help them recover from any impacts after the event

When required

General weather forecasts

To enable the public to make informed decisions about their day to day activities

Every day

Heatwave Threshold Temperatures for Activation In the event that any of the threshold maximum day and night temperatures defined by the NSWWS region are reached, the Trust will stand up the Adverse Weather Plan and the Adverse Weather Surveillance Group (which is co-ordinated by the Risk and EPRR team in conjunction with the Director on Call):

Maximum temperatures (°C)

National Severe Weather Warning Service Region Day Night

East of England 32 18

Cold Weather Threshold Temperatures for Activation In the event that either of the following criteria are met the Trust will stand up the Adverse Weather Plan and the Adverse Weather Surveillance Group (which is co-ordinated by the Risk and EPRR team in conjunction with the Director on Call):

Minimum Temperatures for Activation

Mean temperatures of 2°C and/or widespread ice and heavy snow is predicted with 60% confidence

Mean temperatures of 2°C and/or widespread ice and heavy snow has occurred




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Adverse Weather Surveillance Group The Trust will operate an adverse weather surveillance group all year round with responsibility for oversight and planning for adverse weather and the Trust’s response. Core membership of the group will be as per the list below, however this will be flexed as required dependant on the nature of the adverse weather event forecast:

Trust Accountable Emergency Officer Director of Operations

Head of Communications Head of Risk and EPRR

Director of Estates and Facilities Cambridge and Peterborough CCG

Director of Workforce NHS England – East of England

The Group can meet either on a virtual or face to face basis for all Level 1 and 2 alerts that are issued. In the event of a Level 3 or Level 4 alert being issued, the Group will meet face to face and will act as a specialist sub-group of the Trust’s Tactical Coordination Group with responsibility for advising on all matters relating to Adverse Weather response arrangements.

Key Groups for Prioritisation

Cold Weather The following key groups have been identified for prioritisation in event of a cold weather spell and cold weather alerts being issued. All of the identified categories are of key importance to CPFT as a mental and physical health provider.

• older people (those over 75 years old, otherwise frail, and or socially isolated)

• people with pre-existing chronic medical conditions such as heart disease, stroke or TIA,

asthma, chronic obstructive pulmonary disease or diabetes

• people with mental ill-health that reduces individual’s ability to self-care (including dementia)

• pregnant women (in view of potential impact of cold on foetus)

• children under the age of five

• people with learning difficulties

• people assessed as being at risk of, or having had, recurrent falls

• people who are housebound or otherwise low mobility

• people living in deprived circumstances

• people living in houses with mould

• people who are fuel poor

• homeless or people sleeping rough (many of these also suffer with mental health conditions)

• other marginalised or socially isolated individuals or groups The Trust will use the current arrangements in place to pull off and extract relevant lists from Trust patient data systems for use when identifying patients for prioritisation.

Heatwave Like the groups previously highlighted, the Trust will utilise a similar approach when identifying key groups of patients for prioritisation.




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As for the Cold Weather planning, The Trust will use the current arrangements in place to pull off and extract relevant lists from Trust patient data systems for use when identifying patients for prioritisation. The Trust will also provide additional support and enhanced checks on all patients referred to CPFT during both Heatwave and Cold Weather periods in support of the wider Health and Social Care community through the relevant Cambridge and Peterborough Local Resilience Forum plans.

Communicating with Staff The Trust’s Communications & Engagement Team is responsible for ensuring that clear and timely messages are made available for CPFT staff regarding the Trust’s plans and actions in response to an adverse weather event. This includes prior communication in order to educate and prepare staff members as well as communicating during a response. Whilst these messages will be prepared and distributed by the Communications & Engagement Team it is the responsibility of directorates and heads of department to ensure that they are made available to all staff and that staff understand their responsibilities in relation to the information provided. Staff should be encouraged to check local news websites and other official social media sources for travel information relating to their journey to and from work and discuss concerns with line managers earlier rather than later.

Attending Trust Locations During an adverse weather event staff will be expected to, wherever possible, make all reasonable efforts to safely make their own way to their place of work. As transport issues are generally confined to the ‘first 100yds’ of staff members journeys, the following actions will alleviate many of the potential reasons for non-attendance:

• Not parking cars on sloping driveways.

• Parking on roads that are on priority gritting routes and walking to and from your car.

• Making contact with colleagues who live nearby to arrange car shares.

• Checking and using public transport services.

• Staff living within the immediate locality of the site are encouraged, where it is safe to do so, to walk to work.

4x4 Volunteer Transport Where staff are unable to utilise public transport or walk to site and they meet the criteria their line manager may request that a 4x4 vehicle is sent to collect them in line with the current arrangements in place through the Cambridge and Peterborough Local Resilience Forum. As this service is provided by a volunteer group and is shared with other local agencies its availability cannot be guaranteed and managers should not rely on it. It should also be noted that any abuse of this service is likely to result in its withdrawal. Managers wishing to use the service should contact the appropriate manager with the staff member’s location, role and reason for needing the service. The 4x4 volunteer groups will only accept requests from the named manager or Head of Risk & EPRR.

Emergency Accommodation In the event that staff are unable to travel home after their shift due to the situation, weather conditions, or if their shift patterns makes travel home unrealistic, Associate Directors (in-hours) and Trust On-call Directors




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(out of hours) may authorise the provision of trust-funded emergency accommodation or taxi services (if appropriate).

Maintaining Trust Activity

Business Continuity It is the responsibility of all directorates to establish and maintain business continuity plans. These should identify and plan to maintain the directorate’s critical functions. During adverse weather events these plans will allow the directorate to manage its activity with the potentially limited resources available. All directorates will ensure that the Adverse Weather Meeting is kept informed as to its current ability to deliver its critical functions. Should one or more directorates declare an inability to maintain its functions, it is the responsibility of the Adverse Weather Surveillance Group in conjunction with the On-Call Director to arrange Trust-wide distribution of staff and prioritising of functions.

Cancelation of Activity During an adverse weather event it may be necessary to cancel some clinics and activity due to:

• A significant reduction of resources and staffing

• A significant reduction in attendance

• For the safety of patients and staff All community activity should must be reviewed, taking into account the available resources and safety of staff and patients (for example, does cancellation increase or decrease journeys?) Any decision to cancel or postpone planned clinics or procedures should be made by the directorate manager, clinical director and head nurse with the support of the relevant Director and reported to the Adverse Weather Surveillance Group at the earliest opportunity.

Communications Messages

Heatwave Level 1: summer preparedness and long-term planning The Trust’s Heatwave Planning Cycle commences in April and the Trust will stand-up the Adverse Weather Surveillance Group from 1 June to 31 September. The Trust will not issue any internal warnings, unless the situation worsens to warrant a level 2 alert being issued by the Met Office.

No warning will be issued by the Trust unless there is a 60 per cent probability of the situation reaching Level 2 for the East of England within the next three days.: Level 2: alert and readiness

“If this does turn out to be a heatwave, we’ll try to give you as much warning as possible. But in the

meantime, if you are worried about what to do, either for yourself or somebody you know who you

think might be at risk, for advice go to NHS Choices at www.nhs.uk/summerhealth. Alternatively,

ring NHS 111. In the event that you require support with managing your condition, please

contact the 24/7 crisis line and a member of our team will be happy to help. “

http://www.nhs.uk/summerhealth




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In the event of a Level 2 alert being issued by the Met Office, the Trust will stand up the Adverse Weather Surveillance Group to daily virtual meetings and will arrange for the following messages to be disseminated to all staff and people who use our services. This will be supported through additional support through our Community Teams.

Level 3 and 4: heatwave action/emergency In the event of a Level 3 or 4 alert being issued by the Met Office, the Trust will stand up the Adverse Weather Surveillance Group to daily meetings and will enact the Trust’s Major Incident arrangements. The Trust will arrange for the following messages to be disseminated to all staff and people who use our services. This will be supported through additional support through our Community Teams.

Cold Weather Level 1: Winter preparedness and action The Trust’s Cold Weather Planning Cycle commences in September and when necessary, the Trust will stand-up a Adverse Weather Surveillance Group from 1 November to 31 March. The Trust will not issue any internal warnings, unless the situation worsens to warrant a level 2 alert being issued by the Met Office. In the event of the forecast predicting a spell of chilly weather the Trust will issue the following message:

Level 2: Alert and readiness In the event of a Level 2 alert being issued by the Met Office, the Trust will stand up the Winter Surveillance Group to daily virtual meetings and will arrange for the following messages to be disseminated to all staff and people who use our services. This will be supported through additional support through our Community Teams.

“Heatwaves can be dangerous, especially for the very young or very old or those with chronic

disease. Advice on how to reduce the risk either for yourself or somebody you know can be

obtained from NHS Choices at www.nhs.uk/summerhealth, NHS 111 or from your local chemist.

In the event that you require support with managing your condition, please contact the 24/7

crisis line and a member of our team will be happy to help. “

“Stay out of the sun. Keep your home as cool as possible – shading windows and shutting them during the day may help. Open them when it is cooler at night. Keep drinking fluids. In the event that you require support with managing your condition, please contact the 24/7 crisis line and a member of our team will be happy to help. “

“If this does turn out to be a spell of severe cold weather, we’ll try to give you as much warning

as possible. But in the meantime, if you want advice about protecting your health from the cold

go to the winter health pages at NHS Choices (www.nhs.uk). In the event that you require

support with managing your condition, please contact the 24/7 crisis line and a member of our

team will be happy to help. “

http://www.nhs.uk/summerhealth

http://www.nhs.uk/




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Level 3 and 4: Severe cold weather action/emergency In the event of a Level 3 or 4 alert being issued by the Met Office, the Trust will stand up the Winter Surveillance Group to daily meetings and will enact the Trust’s Major Incident arrangements. The Trust will arrange for the following messages to be disseminated to all staff and people who use our services. This will be supported through additional support through our Community Teams.

Response Arrangements

Command and Control The Trust will stand up a Business Continuity Incident and the associated Command and Control Framework in the event that a Level 3 or 4 warning is issued. The Tactical Coordination Group chaired by the nominated Manager On-Call, who will lead the response for CPFT with a virtual Strategic Coordination Group in operation to support the Trust as required. The Command and Control arrangements will follow the arrangements within the Major Incident Plan.

Key Priorities - Heatwave The key priorities for CPFT during any response to an Adverse Weather Event are:

• Reduce the risks to health to our staff, visitors and people who use our services from prolonged exposure to severe heat.

• Raise awareness and trigger appropriate actions to support people who have mental health, or associated circumstances that increase their vulnerability to heat.

• To providing guidance to our staff on how to prepare for and respond to a heatwave

• To provide psycho-social support to health and social care partners in managing the needs of vulnerable patients as required.

Key Priorities – Cold Weather

“Severe cold weather can be dangerous, especially for the very young or very old or those with

chronic disease. Advice on how to reduce the risk either for yourself or somebody you know can

be obtained from the winter health pages at NHS Choices (www.nhs.uk) or from your local

chemist. In the event that you require support with managing your condition, please contact

the 24/7 crisis line and a member of our team will be happy to help. “

“Make sure that you stay warm. If going outside, make sure you dress appropriately. If indoors,

make sure that you keep your heating to the right temperature; heating your home to at least

18°C in winter poses minimal risk to your health when you are wearing suitable clothing. If there

is anyone you know who might be at special risk, for example, an older person living on their

own, make sure they know what to do to stay warm and are well stocked with food and

medications. In the event that you require support with managing your condition, please

contact the 24/7 crisis line and a member of our team will be happy to help. “

http://www.nhs.uk/




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The key priorities for CPFT during any response to an Adverse Weather Event are:

• Reduce the risks to health to our staff, visitors and people who use our services from prolonged exposure to cold weather, snow or flooding.

• Raise awareness and trigger appropriate actions to support people who have mental health, or associated circumstances that increase their vulnerability to heat.

• To providing guidance to our staff on how to prepare for and respond to a cold weather, snow or flooding.

• To provide psycho-social support to health and social care partners in managing the needs of vulnerable patients as required.

Specific Actions – Heatwave In the event of a Level 3 or 4 Heatwave alert being issued, the actions in the Action Card within the Director and Manager On-Call Pack will be followed, in addition the following key priorities will be considered:

• Identification of additional cooling required within public, office and in-patient areas to ensure the temperature remains at acceptable levels;

• Review of visiting times to ensure visiting can take place during the cooler part of the day;

• Review of staffing work arrangements and implement work from home where possible to avoid need for staff to travel unnecessarily;

• Cancellation of all non-essential meetings and training;

• Review of cooling arrangements for IT Infrastructure to ensure service continuation;

• Cancellation of non-prioritised services as per Business Continuity Plans.

Specific Actions – Flooding In the event of a Flooding Alert being issued, the actions within the Action Card within the Director and Manager On-Call Pack will be followed, in addition the following key priorities will be considered:

• Review of all sites to ascertain the risk of flooding and take any necessary action to preserve life.

• Support to Local Authority and Health & Social Care partners in managing the impact on vulnerable patients.

Specific Actions – Snow

• Ensuring that all sites have appropriate gritting and snow clearance arrangements to ensure continued access to prioritised services.

• Cancellation of all non-essential community work and diversion of patients towards the 24/7 Crisis Line.

Recovery Following from an adverse weather event, there may be a significant amount of remediation work that will need to be carried out. Recovery arrangements to return to the new normality will be coordinated through the Trust’s Recovery Working Group, chaired by the Strategic Commander.




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Appendix A – Summary of Cold Weather Actions

Level 0 Level 1 Level 2 Level 3 Level 4

Year-round planning All Year

Winter preparedness and action

1 November to 31 March

Severe winter weather forecast - Alert and

readiness Mean temperatures of 2°C and/or widespread ice and heavy snow predicted with 60% confidence

Severe weather action Mean temperatures of 2°C and/or widespread ice and heavy snow

Major incident – Emergency response

Pro

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1. Ensure organisation can identify and support most vulnerable.

2. Plan for joined up support with partner organisations.

3. Work with partners and staff on risk reduction awareness (eg flu vaccinations, signposting for winter warmth initiatives).

1. Ensure cold weather alerts are going to right staff and actions agreed and implemented.

2. Ensure staff in all settings are considering room temperature.

3. Ensure data sharing and referral arrangements in place.

1. Continue level 1 actions. 2. Ensure carers receiving support and

advice. 3. Activate business continuity

arrangements as required; plan for surge in demand.

1. Continue level 2. 2. Implement emergency and

business continuity plans; expect surge in demand in near future.

3. Implement local plans to ensure vulnerable people contacted.

1. Level 4 alert issued at national level in light of cross-government assessment of the weather conditions, coordinated by the Civil Contingencies Secretariat (CCS) based in the Cabinet Office.

2. All level 3 responsibilities to be

maintained unless advised to the contrary.

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1. Use patient contact to identify vulnerable people and advise of cold weather actions; be aware of referral mechanisms for winter warmth and data sharing procedures.

2. Ensure awareness of health effects of cold and how to spot symptoms.

3. Encourage colleagues/clients to have flu vaccinations.

1. Identify vulnerable clients on caseload; ensure care plans incorporate cold risk reduction.

2. Check room temperatures and ensure referral as appropriate.

3. Signpost clients to other services using ‘Keep Warm Keep Well’ booklet.

1. Continue level 1 actions. 2. Consider prioritising those most

vulnerable and provide advice as appropriate.

3. Check room temperatures and ensure urgent referral as appropriate.

1. Continue level 2 actions. 2. Implement emergency and

business continuity plans; expect surge in demand in near future.

3. Prioritise those most vulnerable.




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Year-round planning All Year

Winter preparedness and action

1 November to 31 March

Severe winter weather forecast - Alert and

readiness Mean temperatures of 2°C and/or widespread ice and heavy snow predicted with 60% confidence

Severe weather action Mean temperatures of 2°C and/or widespread ice and heavy snow

Major incident – Emergency response

Ind

ivid

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ls

1. Seek good advice about improving the energy efficiency of your home and staying warm in winter; have all gas, solid fuel and oil burning appliances serviced by an appropriately registered engineer.

2. Check your entitlements and benefits; seek income maximisation advice and other services.

3. Get a flu jab if you are in a risk group (September/October).

1. If you are receiving social care or health services ask your GP, key worker or other contact about staying healthy in winter and services available to you.

2. Check room temperatures – especially those rooms where disabled or vulnerable people spend most of their time

3. Look out for vulnerable neighbours and help them prepare for winter.

1. Continue to have regular contact with vulnerable people and neighbours you know to be at risk in cold weather.

2. Stay tuned into the weather forecast ensure you are stocked with food and medications in advance.

3. Take the weather into account when planning your activity over the following days.

1. Continue level 2 actions. 2. Dress warmly; take warm food

drinks regularly; keep active. If you have to go out, take appropriate precautions.

3. Check on those you know are at risk.

1. Follow key public health and weather alert messages as broadcast on the media.

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cto

r

1. Engage with local statutory partners to agree how VCS can contribute to local community resilience arrangements.

2. Develop a community emergency plan to identify and support vulnerable neighbours.

3. Agree arrangements with other community groups to maximise service for and contact with vulnerable people.

1. Test community emergency plans to ensure that roles, responsibilities and actions are clear.

2. Set up rotas of volunteers to keep the community safe in cold weather and check on vulnerable people.

3. Actively engage with vulnerable people and support them to seek help.

1. Activate the community emergency plan.

2. Activate the business continuity plan.

3. Continue to actively engage vulnerable people known to be at risk and check on welfare regularly.

1. Continue level 2 actions.

2. Ensure volunteers are appropriately supported.

3. Contact vulnerable people to ensure they are safe and well and support them to seek help if necessary.

1. Level 4 alert issued at national level in light of cross-government assessment of the weather conditions, coordinated by the Civil Contingencies Secretariat (CCS) based in the Cabinet Office.

2. All level 3 responsibilities to be maintained unless advised to the contrary




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Appendix B – Heatwave Actions


Long-term planning All year

Heatwave and summer preparedness programme

1 June to 15 September

Heatwave is forecast – alert and readiness

60% risk of heatwave in the next 2 to 3 days

Heatwave action Temperature reached in one or more Met Office National Severe Weather Warning

Service regions

Major incident – emergency response

Professional staff (all settings): 1. develop systems to identify and

improve resilience of high-risk individuals

2. request an HHSRS assessment from EH for clients at particular risk encourage cycling/walking where possible to reduce heat levels and

3. poor air quality in urban areas Care homes and hospitals: 1. work with commissioners to develop

longer term plans to prepare for heatwaves

2. make environmental improvements to provide a safe environment for clients in the event of a heatwave

3. prepare business continuity plans to cover the event of a heatwave (eg storage of medicines, computer resilience, etc)

4. work with partners and staff to raise awareness of the impacts of severe heat and on risk reduction awareness (key public health messages – box 1)

Professional staff (all settings): 1. identify high-risk individuals on your

caseload and raise awareness of heat illnesses and their prevention among clients and carers (see key public health messages – box 1)

2. include risk in care records and consider whether changes might be necessary to care plans in the event of a heatwave (e.g. initiating daily visits by formal or informal care givers for those living alone)

Care homes and hospitals: 1. ensure business continuity plans are

in place and implement as required; ensure appropriate contact details are provided to LA/NHS emergency planning officers to facilitate transfer of emergency information

2. identify or create cool rooms/areas 3. (able to be maintained below 26°C) 4. install thermometers where

vulnerable individuals spend substantial time

Professional staff (all settings): 1. check high-risk people have visitor/

phone call arrangements in place reconfirm key public health messages to clients

2. check client’s room temperature if visiting

Care homes and hospitals: 1. check indoor temperatures are

recorded regularly during the hottest periods for all areas where patients reside

2. ensure cool areas are below 26°C review and prioritise high-risk people ensure sufficient cold water and ice

3. consider weighing clients regularly to identify dehydration and rescheduling physio to cooler hours

4. communicate alerts to staff and make sure that they are aware of heatwave plans

5. ensure sufficient staffing 6. implement business continuity

Professional staff (all settings): 1. visit/phone high-risk people

reconfirm key public health messages to clients

2. advise carers to contact GP if 3. concerns re health Care homes and hospitals: 1. activate plans to maintain business

continuity – including a possible surge in demand

2. check indoor temperatures are recorded regularly during the hottest periods for all areas where patients reside

3. ensure staff can help and advise clients including access to cool rooms, close monitoring of vulnerable individuals, reducing internal temperatures through shading, turning off unnecessary lights/equipment, cooling building at night, ensuring discharge planning takes home temperatures and support into account

National emergency 1. Continue actions as per Level 3

unless advised to the contrary 2. Central government will declare a

Level 4 alert in the event of severe or prolonged heatwave affecting sectors other than health and if requiring coordinated multi-agency response

High-risk groups Community: Over 75, female, living on own and isolated, severe physical or mental illness; urban areas, south-facing top flat; alcohol and/or drug dependency, homeless, babies and young children, multiple medications and

over-exertion Care home or hospital: over 75, female, frail, severe physical or mental illness; multiple medications; babies and young children (hospitals).

*Because Level 2 is based on a prediction, there may be jumps between levels. Following Level 3, wait until temperatures cool to Level 1 before stopping Level 3 actions. ** Level 4: A decision to issue a Level 4 alert at national level will be taken in light of a cross-government assessment of the weather conditions, co-ordinated by the Civil Contingencies Secretariat




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Appendix C – Heatwave Actions for Community and Individuals


Long-term planning All year

Heatwave and summer preparedness programme

1 June to 15 September

Heatwave is forecast – alert and readiness

60% risk of heatwave in the next 2 to 3 days

Heatwave action Temperature reached in one or more Met Office National Severe Weather

Warning Service regions

Major incident – emergency response

Community: 1. develop a community emergency

plan to identify and support vulnerable neighbours in event of a heatwave.

2. assess the impact a heatwave might have on the provision and use of usual community venues.

3. support those at-risk to make sure they are receiving the benefits they are entitled to.

Individuals: 1. make environmental improvements

inside and outside the house which reduce internal energy and heat

2. install loft and wall insulation 3. identify cool areas in the house to

use in the event of a heatwave 4. If on medications, ensure that these

can be stored at safe levels in a heatwave

Community: 1. further develop community

emergency plan 2. support the provision of good

information about health risks especially with those vulnerable groups and individuals (see key public health messages – box 1)

Individuals: 1. find good information about health

risks and key public health messages to stay healthy during spells of severe heat (see key public health messages box 1)

2. look out for vulnerable neighbours

Community: 1. keep an eye on people you know to

be at risk 2. stay tuned into the weather forecast

and keep stocked with food and medications

3. check ambient room temperatures Individuals: 4. stay tuned into the weather forecast

check ambient room temperatures especially those rooms where disabled or high-risk individuals spend most of their time

5. keep an eye on people you know to be at risk – ensure they have access to plenty of cool liquids

6. look out for vulnerable neighbours

Community: 1. activate community emergency

plan check those you know are at risk

Individuals: 1. follow key public health messages

check those you know are at risk

National emergency 1. Continue actions as per Level 3

unless advised to the contrary 2. Central government will declare a

Level 4 alert in the event of severe or prolonged heatwave affecting sectors other than health and if requiring coordinated multi-agency response

High-risk groups Community: Over 75, female, living on own and isolated, severe physical or mental illness; urban areas, south-facing top flat; alcohol and/or drug dependency, homeless, babies and young children, multiple

medications and over-exertion Care home or hospital: over 75, female, frail, severe physical or mental illness; multiple medications; babies and young children (hospitals).

*Because Level 2 is based on a prediction, there may be jumps between levels. Following Level 3, wait until temperatures cool to Level 1 before stopping Level 3 actions. ** Level 4: A decision to issue a Level 4 alert at national level will be taken in light of a cross-government assessment of the weather conditions, co-ordinated by the Civil Contingencies Secretariat

OFFICIAL - SENSITIVE




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Appendix D – Heatwave Alert Cascade Notes

• ‡NHS England Regional and CCGs should work collaboratively to ensure that between them they have a cascade mechanism for heatwave

alerts to all providers of NHS commissioned care both in business as usual hours and the out of hours period in their area.

• *PHE Centres would be expected to liaise with Directors of Public Health to offer support, but formal alerting would be expected through

usual local authority channels.

• †LHRPs and HWBs are strategic and planning bodies but may wish to be included in local alert cascades.

Civil

Contingencies

Secretariat

Public, via media

eg TV, radio,

newspapers

Department

of Health

Other

government

departments

and agencies

Public Health

England

Local Authority Social

Services

(CE/ DASS/DCS/

Emergency Planner) Schools

NHS Choices

and Directors

of Public

Residential

homes

Ambulance trusts Health*

Pharmacies

Inc. Local

Resilience

Forums and

(Local Health

Resilience

Partnerships†)

Nurseries

and

kindergartens

Voluntary

organisations

GPs and district

nurses Day care

centres

Hospital trusts

Walk in centres

Community health

service providers

Clinical

commissioning

groups (CCGs)‡ Mental health

trusts

Health and

Wellbeing

Boards†

Care and nursing

homes

Regional‡

Regional Teams

Corporate

Team

NHS England

Summer

Resilience

Network





Page 19 of 25

Appendix E – Heatwave Trust Actions by Alert Level Level One: 1st June – 15th September

Area/

Department Action Notes

All Areas

Ensure that all CPFT Staff are aware of Heatwave, their responsibilities, and ways to protect themselves and patients

This should include the use of PHE materials, confirming the location of thermometers and reviewing the at-risk groups in the trust.

Wards/ Clinics/rehab departments

Distribution of thermometers to all clinical areas of the trust

Thermometers should be located out of direct sunlight or heat sources.

Wards Identification of ‘Cool Rooms’

A cool room is defined as areas that are consistently below 26°C and are for the use of ‘high risk’ patients during a Heatwave event. Support to identify and establish these areas id available from the estates department. A schedule of wards with cooling is maintained by the Estates department.

Level 2: 60% chance of Heatwave in 2-3 days

Area/ Department

Action Notes

Wards/ Clinics/ Rehab

Departments

Record temperatures twice daily Temperatures should be recorded using the pro forma at Appendix 1. Suggested times for recording are at 1200hrs and 1600hrs although local conditions may necessitate differences

Identify vulnerable individuals Using the definitions found at section 7 individuals most likely to require the use of a ‘cool room’ should be identified.





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Area/ Department

Action Notes

Ensure availability of ‘Cool rooms’ Review and update schedule of wards with cooling and cool rooms

Estates Support clinical areas as appropriate Preliminary contact with suppliers of temporary cooling units. Be prepared to respond to requests at short notice

All areas Support and inform staff regarding safe working in hot weather

Ensure appropriate drinking water arrangements are available for all staff, visitors and people who use our service

Level 3 – Heatwave temperature reached locally

Area/ Department

Action Notes

Wards/ Clinics/ Rehab depts

Implement appropriate protective actions

This should include:

• Regular supplies and assistance with cold drinks

• Increased monitoring of at risk patients

Ensure that cool rooms are consistently below 26ºC

Where temperatures cannot be maintained below 26ºC in a particular area, move vulnerable patients to areas with cool room or another ward with cooling

Check that indoor temperatures are recorded four times a day in all areas

Temperatures should be recorded using the proforma at Appendix 1. Suggested times for recording are at 0900hrs, 1200hrs 1500hrs and 1800hrs although local conditions may necessitate differences

Reduce internal temperatures This will include turning off unnecessary lights and electrical equipment. See Actions in appendix 2 for actions to reduce heat gains.





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Make the most of cooling the area at night

This can be achieved by opening windows on opposite sides of the ward to achieve cross ventilation although the increase in potential cross infection should be taken into consideration

Seek early medical help if an individual starts to become unwell

Tactical Control group

Continue to monitor and support the Trusts response to the situation

Provide a representative to the health Strategic Coordinating Group as directed by the CCG.

Consider moving visiting hours Moving visiting to mornings and evenings can help to reduce afternoon heat from increased numbers of people

Appendix F - Cold Weather Trust Actions by Alert Level

Level One

Area/ Department

Action Notes

All Areas

Ensure that local contingency plans are reviewed and updated, and that cascade arrangements are tested every 3 months





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Ensure staff aware of the business continuity plan for winter weather; plan for a winter surge in demand.

Community Teams

Review all patients and assess those likely to be vulnerable to cold weather and that arrangements are in place to support them appropriately.

Ensure staff are undertaking appropriate home checks when visiting clients, e.g. room temperature; medications and food supplies.

Level 2 Cold Weather Alert

Area/ Department

Action Notes

Corporate Stand up the Adverse Weather Plan and Surveillance Group (Virtual Meetings)

All

Review arrangements for staff, people who use our services and visitors including the monitoring of temperature within all buildings

Estates and Facilities to conduct regular monitoring checks across all CPFT sites.





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Area/ Department

Action Notes

Wards Monitoring of all patients within wards and ensuring temperatures within acceptable levels.

Community Enhanced surveillance and support of patients within community settings

Advice to be provided in line with Public Health Messaging

Level 3 Cold Weather Alert

Area/ Department

Action Notes

Corporate

Stand up the Adverse Weather Plan and Major Incident Plan – Run significant incident command and control

Stand up internal Tactical Coordination Group with Virtual Strategic Coordination Group

All

Review arrangements for staff, people who use our services and visitors including the monitoring of temperature within all buildings

Estates and Facilities to conduct regular monitoring checks across all CPFT sites. Enact business continuity plans and review all staffing arrangements across the Trust.

Wards Monitoring of all patients within wards and ensuring temperatures within acceptable levels.

Review of visiting hours and discharges.

Community Enhanced surveillance and support of patients within community settings

Advice to be provided in line with Public Health Messaging





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Appendix G – Staff Guidance - Working in Hot Weather

Summary Temperatures in the workplace are covered by the Workplace (Health, Safety and Welfare) Regulations 1992, which places a legal obligation on employers to provide a “reasonable” temperature in the workplace in the particular circumstances. In addition to the Workplace Regulations, the Management of Health and Safety at Work Regulations 1999 require employers to make a suitable assessment of the risks to the health and safety of their workers, and to take action where necessary and where reasonably practicable. Heat stress occurs when the body’s means of controlling its internal temperatures starts to fail. As well as air temperature, factors such as work rate, humidity and clothing worn while working may lead to heat stress. Environmental factors (such as humidity and sources of heat) combine with personal factors (such as clothing staff are wearing and how physically demanding their work is) will influence what is called “thermal comfort”. The HSE guidance publication, Thermal Comfort in the Workplace, seeks to define thermal comfort and states:

“An acceptable zone of thermal comfort for most people lies between 13oC (56oF) and 30oC (86oF), with acceptable levels for more strenuous work activities

concentrated towards the bottom end of the range, and more sedentary activities towards the higher end.

Symptoms of Heat Stress Typical Symptoms of Heat Stress:

• An inability to concentrate;

• Muscle cramps;

• Heat rash;

• Severe thirst;

• Fainting;

• Fatigue, giddiness, nausea, headache, moist skin;

• Convulsions, loss of consciousness.

Manager’s Duties If thermal discomfort is a risk within the workplace, and staff are complaining and/or reporting illnesses, then the Trust will be required to undertake a risk assessment to meet the obligations to control the risks that staff may face. If staff raise concerns regarding thermal comfort problem in the workplace, Senior Management within the Trust have a responsibility to ensure that staff remain adequately hydrated. It is important that staff feel able to report any problems and that they can drink water frequently to keep hydrated. The following are possible control measures that could be considered and introduced following the risk assessment: Control the Temperature





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Key arrangements that the Trust will ensure are in place prior to the commencement of the Heatwave planning period are as per the below:

• Place insulating materials around hot plant and pipes;

• Provide fans, e.g. desk, pedestal, or ceiling-mounted fans (clinical areas - discuss infection control risks with the Infection Control Department before using fans);

• Ensure that windows can be opened;

• Shade staff from direct sunlight with blinds or by using reflective film on windows to reduce the heating effects of the sun;

• Site workstations away from direct sunlight or other situations or objects that radiate heat (e.g. machinery).

• Relax formal uniform/dress code – but personal protective equipment must continue to be used.

• Provide air cooling or air conditioning Reduce the Length of Exposure:

• Provide periodic rest breaks and rest facilities in cooler conditions;

• Introduce flexible working patterns, job rotation, workstation rotation, etc. Prevent Dehydration:

• Provide water and encourage staff to drink it frequently whilst at work;

• Additional facilities, e.g. cold-water dispensers (water is preferable to caffeine or carbonated drinks).

• Water can be cooled by storing and replenishing bottle of water in a local refrigerator.