Alignment with Barnsley 2030 outcomes

This plan is aligned with the following outcomes from Barnsley 2030:

Healthy Barnsley

• People are safe and feel safe
• People live independently with good physical and mental health for as long as possible
• We have reduced inequalities in health and income across the Borough

Learning Barnsley

• People have access to early help and support

Growing Barnsley

• People are supported to have safe, warm, sustainable homes

Sustainable Barnsley

• Fossil fuels are being replaced by affordable and sustainable energy and people are able to enjoy more cycling and walking

Our key partners

Barnsley residents are at the heart of our collaborative approach working with key partners:

• Barnsley Council, area councils and ward alliances
• Age UK Barnsley
• DIAL
• Barnsley Citizens Advice Bureau (CAB)
• South West Yorkshire Partnership NHS Foundation Trust
• Berneslai Homes
• Barnsley Hospital Foundation Trust
• Barnsley Clinical Commissioning Group
• South Yorkshire Fire and Rescue
• My Best life (Social Prescribing)
• Barnsley CVS 

What do we want to achieve?

Our priorities

• Falls and frailty
• Health conditions made worse by the cold
• Housing
• Seasonal flu, pneumococcal and COID-19 vaccination uptake amongst priority groups
• Marketing and communication

Excess winter deaths

Our target is for early winter deaths in the borough to remain within 3% of the national average (currently 17.4%, and Barnsley is currently at 18.3%). 

Our vulnerable groups

Every contact counts for all front line workers who support residents in our communities, particularly those people who are vulnerable to the cold. These include:

• households with young children (from new-born to school age)
• older people (especially those over 65 years old and those who are frail or socially
  isolated)
• people with pre-existing chronic medical conditions (especially cardiovascular and
  respiratory conditions- in particular, chronic obstructive pulmonary disease and
  childhood asthma)
• people living in deprived circumstances, particularly on a low income or in fuel poverty
• people with cognitive impairment, mental health conditions or learning difficulties
• pregnant women
• people experiencing homelessness or rough sleeping
• people who have attended hospital due to a fall 
• people with addictions
• Recent immigrants and asylum seekers

To meet our target we will:

• Tackle the causes of cold related harm year-round and over the winter period
• Understand the issues and challenges affecting communities over winter
• Use national guidance and frameworks on reducing cold-related harm to inform our plans
• Identify, prioritise and work alongside those who need our support the most
• Work collaboratively with partners and communities to reduce the impact of cold weather on health and wellbeing, dovetailing in with Emergency Planning strategies for adverse weather

Our outcomes

The overarching aim of the plan is to tackle Excess Winter Deaths and cold-related harm, in line with the national Cold Weather Plan (preventative – year-round planning). This includes 5 key outcomes, agreed with our partners:

• Cold related inequalities are reduced across the borough
• People keep themselves, and those they support, warm and well this winter
• A joined up, collaborative strategic approach to winter planning and response
• People have access to cold related prevention, support and early intervention
• People live independently with good physical and mental health throughout the winter

National evidence

Excess Winter Deaths (EWD) is a statistical measure used to quantify the effect of winter months for a given population.

It can be expressed as the number of extra people who have died, or as an index comparing winter deaths to the number of deaths that occur at other times of the year.

Although the main underlying causes of EWDs are respiratory or cardiovascular diseases, England and Wales have higher rates than other European countries with colder climates and therefore many EWDs are preventable.

Who is affected by cold?

EWD’s represent an important health inequality and those in greater socioeconomic deprivation are more likely to be affected. There are several complex and interlinked factors that contribute to excess winter deaths and cold related harm. These include:  

• housing and economic factors (household income, cost of fuel and energy efficiency of the home)
• seasonal factors (including temperature, physical hazards such as snow and ice)
• circulating infectious diseases (particularly flu and COVID-19)
• individual vulnerability to health effects of cold
• attitudes to cold and associated behaviours

The focus on tackling EWDs is becoming increasingly more urgent. In response to the COVID-19 pandemic in November 2020, Public Health England presented evidence about the links between cold weather and COVID-19 and accompanying guidance on how to address these issues, including:

• Shared risk factors amongst population sub-groups affected by both cold temperatures and COVID-19
• Clinical impacts arising due to concurrence of cold weather and COVID-19
• Social isolation and reduced access to support networks and resources
• Increased exposure to cold temperatures due to changes in patterns of energy use at home, fuel poverty and reduced access to warm public spaces
• System level risks related to concurrency of impacts, change in patterns of health and social care use, access and delivery and health seeking behaviour

Local evidence

Barnsley’s excess winter deaths rate (August 2019 to July 2020) of 18.3% is not significantly different to the England rate of 17.4%. When compared to nearest neighbours, Barnsley’s rate is the joint 8th highest (out of 16 authorities).​

• The most recent rate of 18.3% is a slight increase from the 2018-2019 rate (17.7%) but remains half what it was in the two time points previous to this (2016-2017 and 2017-2018)​
• During 2012–2020, there were 75.5% more deaths from influenza and pneumonia in winter months than in non-winter months.​
• Large geographical differences exist within Barnsley. During the period 2013–2020, rates of excess winter deaths ranged from 11.1% in Old Town ward to 41.2% in Darton East ward
• Excess winter deaths were higher in the older age bands; in those aged 85+, there were almost a third (32.4%) more deaths in winter months than in non-winter months

Falls and frailty

• Barnsley has higher rates of hospital admissions due to falls in people aged 65 or over (2019/20 data), and the rate is on an increasing trend. Out of 16 similar local authorities, Barnsley’s rate was the third highest. Just over 1,300 people aged 65 and over in Barnsley were admitted to hospital as a result of a fall in 2019/20. Similarly, the rates for those aged 65-79 and 80+ are significantly higher than the England average.
• Emergency admissions for falls are 3% higher in the winter months compared with non-winter months.
• English Housing Survey (EHS) data shows that levels of fall hazards in private sector homes are notably worse in Barnsley compared to the EHS average for England. This may be due to higher proportions of older dwellings and relatively low proportions of flats.
• The wards with the higher concentrations of fall hazards in private sector dwellings are Kingstone, Old Town and Dearne North.

Health conditions made worse by the cold

• The main underlying causes of excess winter deaths in Barnsley are respiratory diseases. In the most recent period (2012-19), there were 75.5% more deaths from influenza and pneumonia and 75.4% more deaths from chronic lower respiratory disease in winter months than in non-winter months.  This trend has been consistent over time and provisional data for England and Wales in 2019/20 shows that respiratory illnesses continue to be the leading cause of excess winter deaths.
• Data also shows there were 45.4% more deaths as a result of dementia, though further dementia deaths could be masked by the code recorded on the death certificates. Dementia could be recorded as a secondary cause or as frailty/old age.
• Emergency attendances at A&E in Barnsley (2019/20 data) are higher for respiratory conditions, with higher rates of admissions from wards around the town centre, North East and Dearne areas.
• Emergency admission rates for Cardiovascular Disease (CVD) are highest in the over 75 population, with significantly higher rates for women in Kingstone ward and for men in Dearne North, Darton East and Central ward.
• Barnsley has higher mortality rates than England for Cardiovascular Disease (CVD) and respiratory diseases. Rates of mortality from respiratory diseases are particularly high in St Helens, North East, Dearne South, Stairfoot and Central Wards.
• Rates of mortality from CVD are particularly high in Dearne North, Worsbrough and Kingstone.

Housing

• English Housing Stock (EHS) data shows the performance of the housing stock in Barnsley is mixed compared to the EHS England average. Barnsley performs slightly better for excess cold and disrepair, but worse for all hazards, fall hazards, fuel poverty, and low income households.
• Looking at the hazard of excess cold in Barnsley the highest levels overall are in Penistone East, Penistone West and Darfield. The predominance of excess cold in the rural areas is likely to be a result of older, detached properties which will have a greater heat loss area and may also be off the gas network.
• Barnsley has a significantly higher proportion of homes considered fuel poor under the new Low Income, Low Energy Efficiency measure at 18.6% (compared to the England average of 13.4%). The highest concentrations of fuel poor households are in Dearne North, St Helens, Kingstone and Monk Bretton.

Seasonal flu reduction/vaccination uptake

• Barnsley’s 2020/21 seasonal flu uptake rates for the over 65’s, under 65 years (at risk), pregnant women and two to four years olds are all higher than the England rates.
• Barnsley also has good uptake rates in children, with rates in all 2 and 3 year olds meeting or exceeding the national average for 2020/21.

COVID-19 vaccination uptake

• The first dose uptake of the COVID-19 vaccination in Barnsley for those aged 12 and above (82%), compares favourably to the England average (76.9%) as of 5 November 2021.
• Second dose uptake is at 75.5%, higher than the England average (70.4%).

Community engagement research

We've commissioned qualitative research to understand the lived experience of the impacts of cold weather on Barnsley residents. This took place between August to September 2021 and involved:

• A literature review of key evidence
• one-to-one detailed interviews with providers and local people
• an online survey to gather views from Barnsley residents

The findings from this research resulted in key recommendations:

• A system wide approach focused on prevention with partnership at it's core
• Strategies to find people that are hard to find
• Working with communities
• Communications strategy that is not reliant on signposting or digital approaches
• Practical support

We're continuing to use this insight to inform our EWDs cold weather action plan for this winter.

Introduction: How we'll deliver the plan

We want to ensure that everyone in Barnsley works together to tackle excess winter deaths and improve cold related ill health. This will be achieved by having a joined up, strategic year-round approach to winter planning that ensures Barnsley residents are aware of and can access to the services, advice and support they need over the winter months.

Using our collaborative planning and research, this year’s plan is focused on understanding the needs of vulnerable groups and aims to improve the services on offer this winter and increase awareness and improve the access to help that’s available. This includes looking at how we can improve Barnsley’s response to winter over the coming years; make sure that we improve health and wellbeing; and reduce inequalities by targeting those most at risk of the impacts of cold weather.

Developing local action, guidance and information based on national frameworks

This year, we have based our plan on national guidance that sets out the responsibilities for tackling excess winter deaths and cold related harm including:   

• National cold weather plan
• Excess winter deaths and illness and the health risks associated with cold homes
• How to reduce the risk of seasonal excess deaths systematically in vulnerable older people to impact at population level
• Falls in older people: assessing risk and prevention
• National flu immunisation programme plan 2022 to 2023

How the plan links with relevant Barnsley strategies

This document is a supporting strategic plan delivering the Barnsley Health and Wellbeing strategy. It covers year-round planning (Level 0), aligned to the tactical adverse weather plan in response to the winter period November – March (Level alerts 1-3).

• Health and Wellbeing Strategy
• 2030 Strategy
• Barnsley Tactical Adverse Weather Plan and Winter Service Policy
• More money in your pocket
• Better Lives programme
• Integrated Care Board (emerging Integrated Care Strategy)
• Private Sector Housing Strategy
• Area councils and ward alliance plans
• Barnsley Age Friendly Partnership
• Barnsley Sustainable Energy Action Plan
• Barnsley's Older People's Physical Activity Alliance (BOPPAA)

Falls and frailty

Objective: Reduce the number of hospital admissions for falls amongst over 65 year olds

The risk of falls and frailty is more likely, and more acute during the winter months. Around 30% of over 65s in Barnsley living at home fall each year. This rises to 50% for those aged 80 or over who are living at home or in care homes. Of these falls, 20% of people will require medical attention and 5% of those who fall each year will suffer from fractures and hospitalisation.

The impact of falls includes pain, injury, distress, loss of confidence and a greater risk of death – around a third of people who experience a hip fracture die within a year, usually caused by underlying health conditions (of which the fall may be a symptom), rather than the fracture itself. Many falls can be prevented using evidence based, effective interventions.

The COVID-19 pandemic has led to many older people being less physically active and mentally stimulated, the impact of which is an increase in physical deconditioning and mental decline. As a result of this Public Health England has predicted a 3.9% increase in the number of people having at least one fall and a total increase in falls of 6.3% for men and 4.4% for females if interventions are not put in place to mitigate the risks. Achieving the objective will be a challenge, however the key actions below are how we will aim to do so.

Key actions include:

• Review Barnsley Falls Pathway
• Deliver a pilot service for anticipatory care for frailty with Age UK
• Scale up the frailty virtual ward
• Invest in an uplift of the urgent community response
• Evaluate first year pilot and continue development of the Barnsley Older People Physical Activity Alliance (BOPPAA)
• Continue the urgent response service for falls without injury - Assisted Living Service and Yorkshire Ambulance Service.
• Develop materials for professionals, older people and their families to better understand falls prevention and de-conditioning
• Deliver community reablement pathway/adult social care front door work for early intervention and prevention

Health conditions made worse by the cold

Objective: Reduce admission rates for all cold related health conditions amongst vulnerable groups

A wide range of people are more vulnerable due to a medical condition, such as heart disease; or a disability that, for instance, stops people moving around to keep warm, or makes them more likely to develop chest infections. This includes:

• people with cardiovascular conditions
• children and adults with respiratory conditions (in particular, chronic obstructive pulmonary disease and childhood asthma)
• people with mental health conditions
• people with disabilities
• people with dementia

Key actions include:

• 3rd Sector Dementia Alliance
• Continue the delivery of BREATHE community respiratory service
• Target housing support for residents at high risk
• Identify vulnerable groups and the support available
• Community blood pressure monitoring - Healthy Hearts Alliance
• Health checks for people with learning disabilities and mental health
• Neighbourhood proactive health care for residents with health conditions

Affordable warm and safe homes

Objective: Address fuel poverty and improve housing conditions across all sectors

The risk of death and ill health associated with living in a cold home is well known and the impact begins to take effect when temperatures drop below 6°C outside. The recent private sector housing stock condition survey commissioned by Barnsley Council estimated that there are over 80,000 homes across all sectors that need upgrading to EPC C by 2035 to meet national government targets and an estimated 28,441 low-income households are living in fuel poverty with the associated impacts on inequalities and health and wellbeing.

It is estimated that poor housing conditions in Barnsley are responsible for over 970 harmful events requiring medical treatment every year. The estimated cost to the NHS of treating accidents and ill-health caused by these hazards is £4.4 million each year and if the wider costs to society are considered, the total costs are estimated to be £31 million.

Key actions include:

• Continue to deliver property related support for residents in energy inefficient homes or living in fuel poverty
• Provide the Affordable Warmth Grant for private sector housing - funded boilers and first time heating
• Develop and promote the affordable warmth charter amongst businesses
• Prioritise actions to keep homeless and rough sleepers warm and safe
• Promote fire safety in residents’ homes
• Ensure longer term investment of retrofit housing solutions for residents living with cold related ill health
• Delivery of private sector housing action plan to improve housing conditions and energy efficiency

Homeless and rough sleeping

One of the most vulnerable groups affected by cold temperatures are homeless or rough sleepers. The following documents and webpages explain how we're working with our partners. We're tackling the impacts of the cold for people who are homeless or sleeping rough:

• Barnsley Homeless Alliance
• Homeless prevention and rough sleeping strategy
• Homeless and housing advice

Private sector landlords

Through the Private Sector Landlord Accreditation Scheme, we work closely with landlords to improve the quality of private rented housing in the borough. We're also improving the quality of support given to private rented tenants. The scheme will make sure that landlords are aware of opportunities to improve the energy efficiency of their homes. This will reduce carbon emissions and tackle fuel poverty. Find out more about advice for landlords.

Affordable warmth charter

The affordable warmth charter brings together our partners across the borough. they'll share knowledge, expertise and resources to collaborate in tackling the health inequalities caused by fuel poverty. The charter requires partners to make a commitment/pledge using one or more of the five key priorities listed in the charter. These are:

• energy efficient
• affordable energy
• employment, education and skills
• partnership working
• low carbon commitments

Partners who make this commitment will be awarded the Affordable warmth charter mark. They can display this on websites and literature.

Welcome spaces

We've opened up a number of welcoming, warm and inviting spaces for anyone who is feeling the cold. You can visit our libraries, museums and other venues to get warm, stay warm and even enjoy a little company.

Find out more on our wellbeing support page.

Considering the fire risks

Living in a cold property is uncomfortable and potentially dangerous. We recognise and support the need for homes to be kept at a temperature of around 18 degrees Celsius.

However, It's vital that people heat their homes in a safe way, and don't put themselves at risk from fire.

Our key advice is that people take extra care with portable electric heaters. Keep them away from curtains and clothes, don't leave trailing wires and make sure they're turned off when you're out.

We also ask that people are careful with electric blankets. You should also use a fireguard to stop flying embers from wood burners and open fires. Residents should never, under any circumstances, use portable gas rings to keep warm during the winter months. They also shouldn't bring braziers or burning bins inside.

Finally, we'd encourage everyone to make sure they have working carbon monoxide alarms in their homes. It's really important to put them near fuel burning appliances such as boilers.

Seasonal flu and COVID-19 reduction / increased vaccination

Objective: Improve uptake of flu and COVID-19 vaccinations amongst priority groups

Flu can be serious, and each year flu causes thousands of people to be hospitalised and hundreds of deaths across the country. Older people and people with existing or underlying conditions, such as heart or circulatory disease, are more at risk of becoming seriously ill from flu.

With coronavirus still circulating, it’s vital that we continue to promote flu vaccinations alongside the COVID-19 vaccinations for adults and children, to reduce the risk of our most vulnerable groups from becoming unwell and prevent any further demand on NHS services.

The flu programme in Barnsley will be expanded this year, to offer free flu vaccinations to the following priority groups, in line with national flu immunisation programme plan 2022 to 2023:

• Increased uptake amongst 2 to 3 year olds
• Support for residents living in the most deprived areas
• Support for ethnic minority groups
• Support for people with learning disabilities and autism
• Care homes staff and residents

Key actions include:

• Organisational staff flu vaccination programmes in place
• Delivery of GP practices, community pharmacies and school- based flu vaccine programme
• Continued promotion of first, second and booster doses of COVID-19 vaccinations
• Promoting flu vaccine uptake, reviewing vaccine status for children at every contact
• Co-ordination of seasonal flu and COVID-19 programmes via Barnsley Flu Operational group and COVID-19 Community Vaccination Group

An upgraded dual vaccine which tackles both the original Covid-19 virus and the newer Omicron variant will be available as an autumn booster to provide better protection against variants.

Communication and engagement

Objective: Co-ordinate and co-produce a marketing and communications campaign to empower residents to self-care, stay warm and well throughout winter.

It's essential that we continue to co-ordinate our communications and marketing plan and key messages across all organisations to align with national government guidelines and campaigns.

Our plan includes support and resources for organisations, people and their carers. It encourages people to self-care and find the support they need to stay well during colder months.

We also want to encourage residents to look after each other by developing community networks during winter months.

Key actions include:

• Annual collaborative communication plan across traditional and digital marketing
• Keep warm and well toolkit for frontline workers
• Keeping warm and well resources for Barnsley residents
• Workforce development and training resources
• Targeted communications to groups that need the most support

A safe and warm winter for everyone, supported by everyone

Our plan this year has brought together local and national information and evidence to make sure we are doing all we can to support Barnsley residents over the winter. Alongside promotion of the support available to our communities, Barnsley partners have been encouraged and supported to develop their own plans for winter 2021/22. These plans should include self-care support for residents and when to seek treatment for colds/seasonal flu.

The Area Council and ward alliances continue to provide community support in winter months through a range of interventions including winter warmer packs, falls prevention and social isolation initiatives.

We want everyone to support the need to keep warm and well this winter, so we’ve created some key sources of information for Barnsley residents, as well as those who are working with communities to keep them safe over the cold weather.

We’ve created an 8-page leaflet which will be circulated through frontline teams and partner organisations. The keep warm and well leaflet provides supportive information and tips for staying well in winter, with phone numbers and website details to find further information. We have also updated our centralised stay well this winter pages and created a key messages toolkit for frontline staff.

Further into the winter period we will be creating top tip animation videos and creating an impactful case study video to spread a message of support and hope.  

More information can be found on the pages below:

• Stay well this winter
  • Keeping warm
  • Keeping healthy and staying well
  • Local Support
  • Top tips
• Winter weather