Risk and risk perception

Emergency planners, senior managers and strategists in all five case study sites were asked to comment on their perceived risk of heatwaves within their geographical areas or organisations. All interviewees, including those working at the frontline of health and social care services, were asked to identify people most at risk of harm from severe heat and how those identified were protected during periods of hot weather.

As stipulated by the Civil Contingencies Act (2004), all LRFs are required to carry out assessments of the risk of hazards occurring in their areas and publish them in Community Risk Registers. These are, frequently, presented as a risk matrix (as illustrated in the National Risk Register (Cabinet Office, 2017) in which the level of severity is displayed against likelihood of the event taking place. As can be observed in Figure 4.1, heatwaves are rated as high-risk in three of the sites (C, D and E) and medium in Site A. One site, B, did not use a risk matrix, but presented the risk of a heatwave as the fourth of nine identified ‘top risks’. All sites, apart from E, classified risks from other natural hazards, such as flooding, severe weather, storms, gales and low temperatures, as higher than heatwaves, both in terms of their likelihood and impact. E assessed heatwaves as having a higher likelihood of occurrence than storms, gales and low temperatures, but similar in impact, and, therefore, rated heatwaves as an overall high-risk.

Risk of heatwaves happening in geographical areas

As can be seen from the matrix above, the assessment of heatwaves occurring in local areas ranged from medium-low to medium-high. Across all sites, heatwaves were viewed as likely to be both infrequent and short-lived and seen has potentially having less impact in their local areas than other natural hazards, such as flooding and cold weather, and therefore given lower priority on their agenda for emergency preparation.

Figure 4.1 Matrix of heatwave risk sites Ratings

Low Medium-low Medium Medium-high High

Relative likelihood

Managers and planners in one site where the overall risk was rated as medium, said that they were committed to planning for hot weather, but did not feel that the local climate posed much of a risk as the threshold temperature for a heatwave was unlikely to be breached, or if it was, it would not be for a prolonged period:

‘It isn’t one of our Community Risk Register main issues, because given where we live and that, we don’t really see a lot of good weather and we get a heck of a lot of rain. If we do get hot weather, our threshold is 30 degrees, isn’t it?

And it’s very unlikely, really, that we hit 30 degrees, and certainly it’s always in a short, sharp burst. It’s not ‘up there’ on our risk register.’ (Manager, Site A).

A manager in Site B observed that, although they were in an area that received more frequent bouts of hot weather, any impact was likely to be minor as the climate was moderate and there was no excess of built-up areas and dense housing, reducing the risk of harm to health. Even in sites that rated their risk as high, prolonged spells of severe hot weather affecting their local areas were seen as unlikely, as indicated in comments such as ‘I’ll believe it when I see it’ and ‘it’s England, you know, if it’s warm, it’s going to last for a day and a half and that will be the end of summer’.

Nevertheless, planning and preparation for heatwaves was considered important by all sites, largely due to an acceptance of climate change and the increased risk this poses to the population’s health and well-being in the future:

‘Well I think recent history tells us that actually some areas, some parts of Europe, have had extremely hot weather. So yes, it is a risk. But I think everyone’s conscious that with this changing climate, there is the potential for it to be on the increase. I think people are certainly sighted on it.’ (Manager, Site B) Risk of heatwaves to individuals and groups

Managers and frontline staff in all sites agreed that those most vulnerable to the heat, even short spells, were older people, particularly those over 75 years and living on their own. This accorded with information provided within the HWP. Frontline practitioners working with these groups emphasised that those with limited cognitive function, for example, people diagnosed with dementia, and those with limited mobility had the greatest risk and therefore required the highest level of support during this time. This risk was further exacerbated by the difficulty of identifying and reaching people most in need of support during heatwaves, particularly those who lived unsupported in their own homes, and not all providers felt they had the capacity to respond to their needs, particularly at short notice during a sudden hot spell. The importance of getting health messages to this group at the appropriate time and using suitable media was stressed by some providers:

‘There is a shortage of home care and home care support locally for caring for people in their home environments, so there’s a lot of vulnerable people out there. And I don’t think we’ve caught up with technology, the message of warning, informing and getting to those vulnerable groups. Without stereotyping everybody, the vast majority of older people are not using computers and they’re not using smartphones. So we’ve still got, I think, a group of people that […] for getting the information to them will be depending on the traditional system, will be the mailing, mailshot through the door, or dependant on your radio and television for getting that message across.’ (Manager Site A) Many, though not all, of those providing services and support to patients and clients said that they assessed heat-health risk through individual risk assessments.

Community health services staff in particular reported that they were regularly updating and sharing lists of patients they had assessed as most vulnerable to heat-related risks so that they might be prioritised for contact and visits during any spell of severe hot weather. Although one care home manager said that the home carried out a heat-health risk assessment for all its residents, this did not appear to be the case from interviews with the other four care home managers interviewed for the study.

Several managers in NHS Acute Trusts and care homes stated that they considered all their patients and clients as equally at-risk during periods of hot weather and would therefore not consider it appropriate to prioritise during this time.

‘But everybody in the hospital is an ‘at-risk’… I suppose [prioritising patient risk during heatwaves] is meant much more for in the community, because somebody’s in the hospital he’s an at-risk individual…. otherwise he wouldn’t be in hospital.’ (Acute Trust manager, Site D).

Risk of heatwaves for buildings and the immediate environment

Interviewees in several sites suggested that risks varied according to the environment occupied by those most vulnerable to heat-related health problems, as hospital buildings and residential or nursing homes provided variable levels of resilience to severe hot weather (i.e. their ability to maintain optimum temperatures during heatwaves). A visit to a recently built NHS Acute Trust in site C revealed a range of measures incorporated into the building to ensure the building was able to withstand excesses of heat or cold. This included insulation, natural (passive) ventilation with operable windows, solar shading devices, and mechanical ventilation systems to help the building remain comfortable for patients and staff even without electronic cooling systems such as air conditioning units. However, this hospital was the exception rather than the rule, and many providers spoke about delivering health and social care services in old surroundings that were difficult to ventilate and keep cool during periods of hot weather.

There was also concern expressed by both managers and frontline health and social care staff that not everyone might be aware of the dangers of heat as they observed the public still taking risks with their health by not taking protective measures during hot spells.

Managers spoke about specific groups identified, for example, rough sleepers, alcohol and substance abusers, who may lack the capacity and resources to protect themselves, as well as those employed largely outside in summer months such as agricultural workers, particularly those who are moved around frequently by ‘gang masters’, and who may not have either access to public health messages, or the ability to respond appropriately. Other groups considered to be a potential risk were tourists and holiday makers, including those attending large outdoor festivals during the summer.

Managers said that they used a variety of methods to communicate public health messages to these groups, including general and targeted public health messages through local media, as well as providing heat-health information to local community groups supporting vulnerable people, and to commissioned community services, such as substance misuse services. One site had a separate plan for large events such as festivals, where risks are assessed separately and compliance from stakeholders is assured through legislation specific to the council and to these type of events.

Risks to business continuity and services were also acknowledged. In one site, a 2015 report on monitoring the impact of severe weather on public services, showed that a recent heatwave had been costlier than all other severe weather events in the area in the same year, comprising three separate storms, due to loss of staff days and the costs of additional welfare support provided. Most local NHS Trusts and other organisations providing and commissioning services, were mitigating potential impact

of heatwaves through risk assessments and plans for business continuity as part of their organisational heatwave or severe weather operational plans. However, one emergency planning manager in an NHS Acute Trust said that he found it difficult to convey the risk at Trust meetings due to the infrequent number and short duration of heatwaves. He said that he would point out that a heatwave ‘could be costly to the Trust’, for example, the impact severe heat might have on the Trust’s IT systems.

4.1.7 Knowledge and perceived usefulness of the heatwave plan and alert system