Calls for the creation of a national “cold weather plan” have sparked concerns over who should deliver it among health and social care, and primary and acute care.
In his final annual report as chief medical officer, Sir Liam Donaldson said this week most of the 30,000 excess winter deaths in England were due to increased cardiac deaths, strokes and respiratory problems.
Most of the plans for the acute sector are to do with how you respond to an increase in demand, which is the wrong approach
These illnesses occur in a “predictable pattern following cold weather” and developing a national cold weather plan “could save thousands of lives each year” he said.
In the report, which also identifies four other core areas that he feels need addressing - increased physical fitness, rare diseases, grandparents, and climate change - Sir Liam said healthcare providers should identify patients at increased risk of harm from cold weather and refer them appropriately.
Homerton University Hospital Foundation Trust medical director John Coakley said a cold weather plan would be “much more useful” than the existing national heatwave plan.
But Dr Coakley told HSJ: “Most of the plans for the acute sector are to do with how you respond to an increase in demand, which is the wrong approach. The point is how other services can help to reduce the demand.”
He said although acute trusts could notify GPs that certain patients may be at risk of death in a cold snap, the role of the acute sector was “very limited” and the job of identifying at-risk patients was “essentially down to primary care”.
PCT Network director David Stout said a cold weather plan “would help acute providers cope better with the increased level of demand on NHS services in winter months”, but warned it may require “increased availability of GP and community services”.
Department of Health national clinical lead for quality and productivity Sir John Oldham said developing a national cold weather plan could not be done by primary care services alone and that social care may play “an even bigger part than the NHS”.
“It is absolutely essential that this would have to be a jointly produced plan with local government and voluntary agencies,” he said.
Nottingham University Hospitals Trust medical director Stephen Fowlie agreed that “effective interventions”, with local authorities would be needed to deliver the plan.
“Reductions in winter excess morbidity and mortality might reduce demands on acute services in winter months. But the actions required of such a plan are not principally for the NHS, let alone acute trusts - the key is ‘winter-related disease due to cold private housing’,” he said.
Chief medical officer’s 2009 annual report - key findings
- Increased physical fitness: minimum physical activity requirements should be built into public health programmes
- Rare diseases: a national clinical director for rare diseases should be appointed to oversee the development of clear standards and pathways for treatment
- Grandparents: the importance of grandparents’ contributions to children’s health and wellbeing should be recognised
- Climate change: national targets should be set to double travel on foot in England’s towns and cities and to increase travel by bicycle eight-fold