Supporting vulnerable people before and during cold weather: for healthcare professionals
Source: gov.uk (2025-09-24)

This guidance is for healthcare professionals working in community, care home or hospital environments, including those working in managerial and in patient-facing roles.

Who this guidance is for

This guidance offers advice on caring for people most at risk during cold weather. Healthcare professionals should also consult the Cold-Health Alert action card for healthcare providers (https://www.gov.uk/guidance/cold-health-alert-action-card-for-health-and-social-care-providers). This summarises the suggested actions that healthcare providers should consider when preparing for and responding to each Cold-Health Alert (CHA) type (yellow, amber or red). Additionally, it identifies some of the long-term strategic actions which will help to protect health and reduce healthcare demands during cold weather periods. Find out more about the Cold-Health Alert system (https://www.gov.uk/government/publications/cold-weather-and-health-supporting-vulnerable-people/supporting-vulnerable-people-before-and-during-cold-weather-healthcare-professionals#aboutcha).

Main messages

When the temperature drops (such as prolonged periods below 2°C, or a sudden drop in temperature) and cold conditions impact on health, this is known as adverse cold weather. Adverse cold weather can put people at greater risk of ill-health and even death, primarily because it increases the probability of complications from existing disease and of injury due to falls.

Actions you can take to protect people under your care include:

signing up to weather health alerts and clarifying how these will be used in your organisation

identifying who is at risk

being alert to increased cardiovascular, respiratory and other complications from

adapting individual care plans to respond to adverse cold weather

promoting vaccination for those eligible to reduce risks from COVID-19 and flu

having adverse weather and health plans in place for your organisation and/or place of work tailored to the local context cold exposure

signposting people to sources of support for housing (https://www.gov.uk/housing-benefit), energy bills (https://helpforhouseholds.campaign.gov.uk/) and other needs as appropriate, including specific support for those on low incomes (https://www.gov.uk/browse/benefits/low-income)

About cold weather and health

Deaths and illnesses during the winter months are significantly higher than at other times of the year. Cold weather can cause people to become unwell in various ways. Direct cold exposure can result in death or severe illness due to hypothermia, although deaths where hypothermia is the primary cause are relatively rare. Exposure to cold can lead to direct effects including:

increase the risk of blood clots forming in the body, in turn increasing the risk of heart attacks and strokes

increase susceptibility to chest infections

worsen breathing problems

increase the risk of falls

Cold exposure can also result in indirect effects such as increased risk from mental health conditions such as depression and anxiety. Cases of carbon monoxide poisoning typically increase during the winter months. This is because people are more likely to use cooking or heating systems at home that worsen indoor air quality and are less likely to ventilate their homes as they would during warmer weather.

Other factors also contribute to increased risks to health during cold weather. These include fuel poverty, poor-quality housing and particularly cold homes. The risk of exposure to an underheated home is greater among those on low incomes, and those who are housebound.

Who is at risk

Many people are vulnerable to the effects of cold weather. These include:

people who have chronic medical conditions

those living with learning and/or physical disabilities that may prevent them being able to keep warm (for example because they are unable to move around) or leave them at greater risk of developing chest infections

those who cannot afford to keep warm enough during the winter months

Those at risk include:

older people (aged 65 and over)

people with cardiovascular conditions

people with respiratory conditions (in particular, chronic obstructive pulmonary disease and childhood asthma)

people with mental health conditions

people with learning and/or physical disabilities

young children (particularly those aged under 5)

pregnant women

people on a low income

People who are sleeping rough are also at greater risk from cold exposure. Further guidance is available for those working with people sleeping rough (https://www.gov.uk/government/publications/cold-weather-and-health-supporting-vulnerable-people/supporting-vulnerable-people-before-and-during-cold-weather%20people-homeless-and-sleeping-rough).

Managing cold-related illnesses

Hypothermia is defined as a core body temperature less than 35°C. However, best practice clinical guidance is available on how to recognise and manage those suffering from hypothermia (https://bestpractice.bmj.com/topics/en-gb/3000179), for whom signs and symptoms may include:

shivering

cognitive impairment

changes in pulse and respiratory rates

changes in blood pressure levels

frostbite

The National Institute for Health and Care Excellence (NICE) offers advice on early recognition of, and action on, complications of cold exposure including strokes (https://www.nice.org.uk/guidance/conditions-and-diseases/cardiovascular-conditions/stroke-and-transient-ischaemic-attack), heart attacks (https://www.nice.org.uk/guidance/ng185) and pneumonia (https://www.nice.org.uk/guidance/cg191).

Older people are at greater risk of falls during periods of adverse cold weather, especially when these are accompanied by snowfall and/or ice. The Office for Health Improvement and Disparities (OHID) has produced guidance for health and care professionals (https://www.gov.uk/government/publications/falls-applying-all-our-health/falls-applying-all-our-health) on measures to reduce the risk of falls and fractures in older people in the community.

How to prepare for cold weather

Preparation for cold weather should occur year-round, and plans for managing adverse cold weather events should be agreed and distributed before 1 November each year. The UK Health Security Agency’s (UKHSA) Adverse Weather and Health Plan (https://www.gov.uk/government/publications/adverse-weather-and-health-plan) outlines 9 important areas for action that healthcare organisations and their partners can consider when developing local cold weather plans.

Make as much use as possible of existing care plans to assess which individuals are at particular risk, and to identify what extra help they might need. Where possible, involve their family and any informal carers in these arrangements.

An action card for healthcare providers (https://www.gov.uk/guidance/cold-health-alert-action-card-for-health-and-social-care-providers) can be found on GOV.UK . This card covers recommended actions under different CHA levels, spanning preparedness and response.

If you are advising, visiting, supporting, or caring for someone in the community, the following steps should be taken before adverse cold weather happens to reduce health risks to the public.

Actions to take all year round

In preparation for winter, there are actions that you can take depending on the role in which you work.

Managerial role

If you are working in a managerial role, you should establish methods to identify, alert and monitor individuals most vulnerable to cold-related illnesses on your caseload. Consider seeking specialist advice from clinical teams if you are unsure how to determine whether someone is at risk.

You should ensure data sharing agreements or protocols are in place to allow organisations to share data or intelligence, including details of the most vulnerable people where appropriate.

Patient-facing role

If you are working in a patient-facing role, you should consider the needs of carers, the support they can continue to give during periods of adverse cold weather, and what additional support they may need to fulfil their roles during periods of adverse cold weather.

You should develop approaches to include risk in care records and consider whether changes might be necessary to care plans in the event of cold weather.

You should ensure plans are in place to be able to monitor room temperature and, in clinical settings, body temperature, pulse rate and blood pressure.

Actions to take during the winter months

To prepare for adverse cold weather, there are certain actions you can take to identify and protect those at risk, protect yourself, and support training and capacity development.

Managerial role

If you are working in a managerial role, you should support staff training and capacity development by ensuring staff are aware of and understand business continuity plans and/or cold weather plans that apply in their setting, and what actions they may need to take if they are activated.

You should be supporting staff to complete training, where available, to help identify those most likely to be at risk from adverse cold weather, for example by drawing on resources such as UKHSA’s ‘Helping People Living in Cold Homes’ e-learning module (https://www.e-lfh.org.uk/programmes/cold-homes/).

You can support staff by testing out systems and ensure that local dissemination systems for the CHAs are fully operational and effective and that colleagues you work with understand what actions to take when they receive them. This may include reviewing and updating relevant distribution lists for information and weather alert cascades.

Patient-facing role

If you are working in a patient-facing role, you should help to identify and protect those at risk by ensuring that you have identified all those vulnerable to cold weather on your caseload and that arrangements are in place to support and protect them appropriately. This may include developing and maintaining a register of the most vulnerable individuals to ensure they can be offered appropriate support where required.

You should ensure that you offer COVID-19 (https://www.gov.uk/government/collections/covid-19-vaccination-programme) and/or flu (https://www.gov.uk/government/collections/annual-flu-programme) vaccinations to all those who are eligible, as a preventive measure to reduce the risk of respiratory infections during winter.

For those working in hospital settings, ensure prompt identification of those at risk from adverse cold weather on admission, and put in place plans to enable discharge to warm accommodation.

You should ensure that appropriate home checks are being carried out when visiting clients, for example checking temperatures in rooms (such as living rooms and bedrooms) in which people spend most of their time at home and reviewing medication stocks and food supplies.

You should establish where relevant, referring those that you identify as being at risk from a cold home to local services (for example housing services), who may be able to help improve their living conditions.

You should be ensuring carers are receiving advice and support, for example on signs and symptoms to look out for suggesting that those vulnerable to cold are becoming unwell, or on sources of additional clinical or financial support where necessary.

You should advise on support measures or about how to stay warm and well during cold weather, namely by signposting to the following:
- Met Office guidance on how to get your home and property winter ready (https://www.metoffice.gov.uk/weather/warnings-and-advice/seasonal-advice/your-home/protecting-your-property-from-winter-weather) and keeping your home warm this winter (https://www.metoffice.gov.uk/weather/warnings-and-advice/seasonal-advice/your-home/keeping-your-home-warm-in-winter)
- GOV.UK page on help for households (https://helpforhouseholds.campaign.gov.uk/)
- Age UK’s website (http://www.ageuk.org.uk/financial-support) or call xx-xxxx-xxxx and quote ‘WINTER’
- NHS England information on how to stay well in winter (https://www.nhs.uk/live-well/seasonal-health/keep-warm-keep-well/)
If you are working in a managerial or a patient-facing role, you can protect yourself by getting vaccinated against COVID-19 (https://www.nhs.uk/conditions/covid-19/covid-19-vaccination/getting-a-covid-19-vaccine/) and/or flu (https://www.nhs.uk/conditions/vaccinations/flu-influenza-vaccine/) as a preventive measure to reduce the risk of respiratory infections during winter. You can check whether you are eligible for flu vaccination (https://www.nhs.uk/conditions/vaccinations/flu-influenza-vaccine/) and book an appointment with your employer occupational health service, your pharmacy (https://www.nhs.uk/conditions/vaccinations/book-flu-vaccination/) or your GP, provided that you are eligible. For COVID-19, the NHS will contact you (https://www.nhs.uk/conditions/covid-19/covid-19-vaccination/getting-a-covid-19-vaccine/) if your records suggest you may be eligible for vaccination.

Responding to cold weather

If a Cold-Health Alert is issued, there are certain actions you can take.

Implement general measures

If you are working in a patient-facing role, you should:

ensure local actions for the vulnerable are being carried out such as arranging daily contacts or visits

ensure that appropriate home checks are carried out when visiting clients, for example, room temperature, checking medications and food supplies and ensuring carers are receiving appropriate advice and support to help them continue providing care

ensure that rooms, particularly living rooms and bedrooms, are kept warm (for those in care, residential and nursing home facilities, and in the community)

advise carers to contact nominated clinical leads if they have concerns regarding the health of a patient or client

identify and actively monitor high-risk individuals during cold weather episodes, checking that individuals most vulnerable to cold-related illnesses have visitor or phone call arrangements in place

Consider extra care needs

Anyone in a high-risk category who is living alone is likely to need at least daily contact during adverse cold weather, by care workers, volunteers, or informal carers. Individuals at greater risk may need extra care and support.

If you are working in a patient-facing role, check that:

the person can contact the primary care team if one of their informal carers is unavailable

their care plan contains contact details for their GP, other care workers and informal carers

there are adequate arrangements for food shopping and other essentials, to reduce the need for them to go out in adverse cold weather

there are mechanisms for escalating the level of care and support available if there is a sudden increase in needs during a period of adverse cold weather

Protect yourself

Whether you are working in a managerial or a patient-facing role, day-to-day practice may be disrupted during adverse cold weather. You may find it difficult to commute to work, or to reach service users through street outreach work. Staff absences may also be more likely during this time due to, for example, respiratory illness. Business continuity plans may therefore need to be implemented.

You should consider:
- whether you have any vulnerabilities that you may need to take into account in planning your own work, or supporting staff in your teams
- general advice given in UKHSA’s keeping warm and well guidance (https://www.gov.uk/government/publications/keep-warm-keep-well-leaflet-gives-advice-on-staying-healthy-in-cold-weather)
- advice from the Health Safety Executive guidance on temperature in the workplace (https://www.hse.gov.uk/temperature/employer/cold-stress.htm#:~:text=The%20Approved%20Code%20of%20Practice,work%20involves%20rigorous%20physical%20effort)
Key resources for supporting vulnerable people:
- Supporting vulnerable people before and during cold weather - for healthcare professionals
- Cold weather risks and their impact on health: slide set (https://khub.net/documents/135939561/174099487/Cold+weather+impact+on+health.pdf/fb101025-ce62-6098-c1be-b9e28f04cbdc)
- Keeping warm and well: staying safe in cold weather (https://www.gov.uk/government/publications/keep-warm-keep-well-leaflet-gives-advice-on-staying-healthy-in-cold-weather)
- Adverse Weather and Health Plan: supporting evidence (https://www.gov.uk/government/publications/adverse-weather-and-health-plan#:~:text=Adverse%20Weather%20and%20Health%20Plan%3A%20supporting%20evidence)