The climate has changed. We can no longer suggest the time for action is somewhere in the future. We must act now.
It is recognised that both the social care sector and the NHS face enormous pressures and are working at unprecedented levels. The added strain of increased hospital admissions due to heat stress must be addressed. If we are to support people in social care and reduce unnecessary admissions, we must work together through co-production and plan ahead. The future has caught up with us.
The impact of rising temperatures
We all now face a changing climate. In July 2022, temperatures reached a record 40°C in the UK. It can impact on us negatively when we are facing higher temperatures for prolonged periods both at work and home. Humans regulate their temperature through a part of the brain called the hypothalamus. Internal and external elements can impact on a person’s ability to maintain their temperature at a safe level.
People who share their space in a social care setting are facing the challenges of living and working in this new, hotter world. Statistically, they are much more at risk of harm or death and are reliant on others to control the temperature around them.
The changing weather patterns will impact on our existing health infrastructure. Already, research is showing mortality rates, hospital admissions, ambulance use, physical and mental health and wellbeing demands increasing in tandem with rising temperatures. In addition, supporting an older person who is living with a diagnosis of dementia to maintain their hydration and cognitive function will require additional resources and clinical observation.
Putting skills to the test
As providers and clinicians, it is paramount we recognise the impact of rising temperatures on our services and those who use them. We need to utilise all our skills and experience and adapt to the changes faced. As a sector, we must question if we are doing all we can and understand how we can think differently.
In a social care setting, we can support people to maintain a safe and comfortable temperature and mitigate some of the risks of extreme temperatures through an individual and dynamic risk assessment. As providers and clinicians, we must take measures to support those who are assessed as high risk and can learn lessons from countries managing warmer climates more regularly. This may include those who are unable to independently change their position, those who are at risk of developing dehydration and those who are unable to voice their discomfort about conditions they find uncomfortable.
As providers and clinicians, we must make social care environments and hospital spaces feel like home. The need to meet an individual’s wants and choices, alongside those who have equally challenging clinical, psychological and wellbeing needs, takes skill and is an ever-changing dynamic.
In addition, dressing for the weather, providing natural fabrics and choosing loose-fitting clothing may take the idea of a summer wardrobe to a whole new level. The social care sector inherited its style of work wear from the NHS. However, is it now time to review how the workforce dresses in the setting to meet this change?
Using risk assessments for change
Crucially, we must consider the development of non-intrusive visual and environmental risk assessment processes that can quickly identify individual and environmental areas of concern.
Countries with warmer climates have been developing risk assessments and acknowledge the impact that heat can have on outcomes for the most vulnerable in hospital admissions and mortality rates and the pressure that heat places on these services. A thermal risk assessment conducted in Australia could be transferable to the social care sector. Assessing different hazards associated with an increase in temperature could be incredibly useful to protect residents and staff.
Health and safety assessments in social care environments support people’s right to choose how to live their lives, both in private and communal spaces. To implement assessments like this, we need an urgent review of the impact of increased temperatures on resources and to consider budget responsibility. An individual and community-level dynamic risk assessment would require quality data collection.
An urgent audit of all our provision is essential to establish what our immediate priorities are and focus on what our future plans will be.
This could include collecting data on:
- Those living and working in the setting who know where it gets hot and remains cool.
- Temperature and humidity level recordings at certain times of day internally and externally. This could mean investing in low-cost digital thermometers that show temperature and humidity.
- Availability of safe outside spaces.
- The capacity for short-term resource investment to establish priorities.
- Shade sails, shaded seating areas and alternative outside communal spaces with security and accessibility in mind.
- The impact and availability of safe ventilation, fans, air-con and other heat reduction methods.
- Location, elevation, ventilation, orientation, time of day and seasonal changes that will impact on heat risk.
- Obesity, capacity, age, mobility, co-morbidity and frailty.
As well as this data, thorough consultation with those sharing community spaces would be necessary to hear staff and residents’ voices. Comprehensive, research-based guidance through co-production is essential to getting it right, as both the users of the service and the NHS will pay a high price if we don’t. Find a useful resource on conducting risk assessments on the Health and Safety Executive website.
Supporting staff
We must think of those who are beholden to others, spending their time in communal spaces and often unable to express how higher temperatures impact on their mental and physical health. Our challenge as providers and commissioners of services is to mitigate the risk of heat stress in those environments and to consider and support the needs, goals and aspirations of our most vulnerable. However, it is crucial to think too of the people providing care, meeting the demands of those sharing a roof, often in environments that were not built to adequately deal with a rapidly changing climate.
It is all too easy from the comfort of an air-conditioned building or sat in a cool space at home to imagine the impact of strenuous work in heat. Times are changing. Working 12-hour shifts in 25-35°C heat, wearing a stiff tunic with limited ventilation and no access to outside space is extremely unpleasant. The wellbeing of our workforce and how they feel about their roles impacts on the performance and approach to work. In turn, that impacts the experience of those receiving support.
Some small ways staff can be helped could include:
- Offering increased drinks breaks and joining residents in taking a drink.
- Access to laundry facilities to keep uniforms/work wear fresh.
- Access to showers to freshen up and cool down.
- Flexible working patterns.
It is worth noting that existing Cold Weather Payments address the financial impact of maintaining a warm and safe environment for the older and more vulnerable in our society. Therefore, it would not be unreasonable to expect a similar policy for a warm weather payment. This would need to reflect the increased running costs of equipment and additional workforce resources required to make spaces habitable and maintain health needs in these new circumstances.
Heat mapping the future, now
Time has caught up with us. We face challenges as clinicians, commissioners and policy makers to review where we are regarding heat management.
Through audit and data collection, we can use this information to focus on what is possible. What small changes can we make to reduce the risk of heat stress both internally and externally in our communities? We must not stop collecting data and using it to develop our ways of working, influencing guidance and driving research to enhance the experiences of those sharing a roof.
Is your organisation taking steps to combat rising temperatures? Leave a comment on this article or join the conversation to share your thoughts.
Karen Davies is a Senior Nurse – Projects at HC-One.
Email: [email protected]