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 more.

Our key partners

Barnsley residents are at the heart of our collaborative approach to 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 Healthcare Federation
• Barnsley Integrated Care Board
• South Yorkshire Fire and Rescue
• Barnsley CVS
• Healthwatch Barnsley
• Barnsley Children, Young People and Families Trust
• BPL

What do we want to achieve?

Winter mortality

Our aim is to reduce the overall winter mortality rate in the borough, now known as the Winter Mortality Index (WMI). The purpose of the WMI is to compare the number of deaths that occur in the winter period with the average of the non-winter periods. Winter mortality is not solely a reflection of temperature, but of other factors as well. These include respiratory diseases and pressure on services, which have been more intense than usual during and following the height of the COVID-19 pandemic.

The WMI is an important measure as it allows us to assess whether our local cold weather plan is having an impact on mortality risks during the winter period.

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:

• older people aged over 65 years old
• people with pre-existing chronic medical conditions such as heart disease, stroke or TIA, chronic obstructive pulmonary disease or diabetes
• people with mental ill-health that reduces individual's ability to self-care (including dementia)
• pregnant women (in view of potential impact of heat and cold on risk of preterm birth)
• children under the age of five
• people with learning difficulties
• people assessed as being at risk of, or having had, recurrent falls
• people who live alone and may be unable to care for themselves
• people who are housebound or otherwise low mobility
• people living in deprived circumstances
• people living in houses with mould
• people who are fuel poor
• people experiencing homelessness or people sleeping rough
• other marginalised or socially isolated individuals or groups

To meet our target we will:

• Reduce the vulnerability and increase the capacity of those affected by 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 with emergency planning strategies for adverse weather.

Our outcomes

The overarching aim of the plan is to tackle winter mortality and cold-related harm, in line with the national Adverse Weather and Health Plan. This includes five 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

Winter mortality is a statistical measure used to quantify the effect of winter months for a given population. This is reported annually by the Office of National Statistics.

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.

Nationally, the main underlying causes of winter mortality are COVID-19, dementia and Alzheimer's disease, and respiratory and circulatory diseases. England and Wales have higher rates than other European countries with colder climates; therefore, many deaths are preventable.

Who is affected by cold?

Winter mortality represents 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 winter mortality 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 winter mortality is becoming increasingly complex. 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 the 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 the concurrency of impacts, change in patterns of health and social care use, access and delivery and health-seeking behaviour.

Local evidence

Barnsley’s most recent Winter Mortality Index (WMI) of 17.7% is significantly lower than the national average (36.2%). However, the time period for this data (August 2020 to July 2021) includes the winter of 2020. In 2020, the coronavirus (COVID-19) pandemic led to a large increase in deaths, mainly in the non-winter months of April to July, impacting the WMI for this period. The scale of COVID-19 deaths during non-winter months means the data is skewed and should be interpreted with caution.

The WMI is also partly dependent on the proportion of older people in the population, as most winter deaths affect older people (there is no standardisation in this calculation by age or any other factor). Barnsley’s ageing population will likely impact our WMI, with 20% of our resident population aged 65 or over.

Before COVID-19, local analysis of winter mortality rates (previously called Excess Winter Deaths (EWDs)) revealed that:

• 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 the 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. 

There are plans for further local analysis of winter mortality data to include data beyond the time period of COVID-19 being the leading cause of death. The WMI for August 2021 to July 2022 might be the first data point, which allows us to be reasonably confident that COVID-19-related deaths are not significantly skewing the data.

Further plans for reviewing local mortality data are briefly outlined in this report into excess deaths between March 2020 and June 2022.  However, it is worth noting that there is currently a discussion at a national level about how we calculate excess deaths post-pandemic, which may identify new fit-for-purpose measures.

Falls and frailty

• Barnsley has the highest rate of hospital admissions due to falls in people aged 65 or over in the Yorkshire and Humber region. Data for 2021/22 shows an admission rate of 2864 per 100,000 population. This equates to just under 1300 people admitted to hospital due to a fall. Compared to near statistical neighbours, Barnsley has the second-highest rate of falls.
• Similarly, the rates for those aged 65-79 and 80+ are significantly higher than the England average.
• Frailty is increasing two and a half times quicker than the population in Barnsley is ageing.
• Recent data shows a significant increase in hip fractures in 2022 which is likely down to deconditioning as a result of the COVID pandemic.
• Previous analysis has shown that emergency admissions for falls are 3% higher in winter compared to non-winter months.
• Previous 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

• For the period 2012-2020, the main underlying causes of winter mortality in Barnsley are respiratory diseases. During this time, there were 75.5% more deaths from influenza and pneumonia and 75.5% more deaths from chronic lower respiratory disease in winter months than in non-winter months. This trend has been consistent over time and up until the point in which COVID-19 became the leading cause of death.
• 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.
• Previous analysis undertaken in 2022 showed that emergency attendances at A&E in Barnsley are higher for respiratory conditions, with higher admissions rates from wards around the town centre, North East and Dearne areas.
• Emergency admission rates for cardiovascular disease (CVD) are also highest in the over-75 population, with significantly higher rates for women in Kingstone ward and 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. These rates are the cause of inequality in life expectancy
• 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.
• Despite data for 2021 showing a slight decrease in the proportion of households that are considered fuel poor, Barnsley has a higher proportion of homes considered fuel poor under the new Low Income, Low Energy Efficiency measure at 17.3% (compared to the England average of 13.1%). The highest concentrations of fuel-poor households are in Central, Kingstone, Dearne North, and St Helens.

Seasonal flu reduction/vaccination uptake

• Barnsley’s 2022/23 seasonal flu vaccines continued to increase across most cohorts. In general, cohorts continued to improve weekly despite the extra challenges of the COVID-19 vaccination booster programme. 
• Uptake for the 2022/23 season was lower than 2021/22; however, the general trend is higher than pre-pandemic uptake. Uptake was particularly low for pregnant women and two and three year olds.  It is felt that the COVID-19 pandemic potentially resulted in increased uptake due to higher public awareness and concerns regarding respiratory viruses.
• Barnsley’s aim for season 2023/24 is to increase awareness and uptake across all cohorts, focusing on those falling into at-risk categories and two and three year olds.   
• 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 two and three year olds meeting or exceeding the national average for 2020/21.

COVID-19 vaccination uptake

• Following the autumn 2022-23 booster campaign, the uptake of the COVID-19 vaccination in Barnsley for those aged 75 and above was 82.2% (compared to 85.6% for the Yorkshire and Humber).
• During the spring 2023 booster campaign, the uptake of the COVID-19 vaccination in Barnsley for those aged 75 years and above was 68.7% (compared to 72% for the Yorkshire and Humber).
• We continue to collaborate with partners to increase vaccination uptake and protect health for our vulnerable communities.

Community engagement research

During the summer of 2021, we commissioned qualitative research to understand the lived experience of the impacts of cold weather on Barnsley residents, which 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 its core.
• Strategies to engage people not in contact with services.
• 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 plan for this winter.

Introduction: How we'll deliver the plan

We want to ensure that everyone in Barnsley works together to tackle winter mortality 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 the services, advice and support they need over the winter months.

Using our collaborative planning and research, this year’s plan continues to focus on understanding the needs of vulnerable groups. It aims to improve the services offered this winter, increase awareness and improve the available access to help. This includes looking at how we can improve Barnsley’s response to winter over the coming years, improving health and wellbeing, and reducing 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 winter mortality and cold-related harm, including:

• Adverse Weather and Health 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 2023 to 2024

How the plan links with relevant Barnsley strategies

This document is a supporting strategic plan delivering the:

• Barnsley Health and Wellbeing Strategy
• Barnsley Place-Based Partnership’s Tackling Health Inequalities in Barnsley
• 2030 Strategy
• Barnsley Tactical Adverse Weather Plan and Winter Service Policy
• More Money in Your Pocket
• Better Lives programme
• Integrated Care Board and Integrated Care Strategy
• Private Sector Housing Plan 2030
• Area councils and ward alliance plans
• Barnsley Age Friendly Partnership
• Barnsley Sustainable Energy Action Plan
• Barnsley's Older People's Physical Activity Alliance (BOPPAA)
• Barnsley Health and Care Plan 2023–2025
• Homeless prevention and rough sleeping strategy
• Children and Young People's Plan 2023 to 2026
• Housing strategy

Our priorities to meet our aims and objectives are set out in more detail below:

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

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.

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, 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 challenging; however, the key actions below are how we will aim to do so.

Key actions include:

• Review Barnsley Falls Pathway and implement agreed recommendations.
• Review South Yorkshire Fire and Rescue Safe and Well checks.
• Scale up the frailty virtual ward.
• Further work with Yorkshire Ambulance Service around push/pull from the stack to reduce conveyances and emergency department attendances.
• Commission Barnsley Older People Physical Activity Alliance (BOPPA) service for three years.
• 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 understand fall prevention and de-conditioning better.
• Increased frailty screening and assessment as a priority and ongoing piece of work.
• 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.
• Undertaking a dementia pathway review.
• Running a scheme in primary care around dementia and carers which aims to increase identification, sign/post uptake of support and helping practices to become more dementia friendly.
• Undertaking a GPS tracker project.
• Continue the delivery of BREATHE community respiratory service.
• Work with GP surgeries to target warm homes support for patients at high-risk.
• Identify vulnerable groups and the support available.
• Community blood pressure monitoring through the 'How’s Thi Ticker' project with plans to promote early signs of stroke'
• Continuing health checks for people with learning disabilities and mental health. Primary care staff going out to people’s homes and uptake now improving considerably.
• Neighbourhood proactive health care for residents with health conditions.
• Hypertension early case finding in primary care.
• Follow up for potential missed diagnosis of asthma.
• Diabetes prevention, early case finding and optimal treatment.
• Lipid optimisation for patients with coronary heart disease to reduce risk of heart attacks and strokes.
• Targeted lung health checks.

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 8°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 17% of all Barnsley households 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 yearly. If the wider costs to society are considered, the total costs are estimated to be £31 million.

Homelessness or rough sleepers are one of the most vulnerable groups affected by cold temperatures. Following national guidance, our Severe Weather Emergency Protocol will be triggered over the winter during periods of adverse weather. This includes offering rough sleepers access to access safe accommodation to keep them off the streets and stay warm and well. The following documents and web pages explain how we work 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

Key actions include:

• Continue to support residents in energy-inefficient homes or living in fuel poverty.
• Provide the grants to private sector housing residents for energy efficiency improvements.
• Promote the Affordable Warmth Charter to businesses and community groups across Barnsley.
• 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.
• Adoption of the new Barnsley Housing Strategy and implementation plan.

Seasonal flu and COVID-19 reduction / increased vaccination

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

Seasonal flu vaccination remains a critically important public health intervention and a key priority for 2023 to 2024 to reduce morbidity, mortality and hospitalisation associated with flu at a time when the NHS and social care will be managing winter pressures whilst continuing to recover from the impact of the coronavirus (COVID-19) pandemic. 

Each year, the NHS prepares for the unpredictability of flu. For most healthy people, flu is an unpleasant but usually self-limiting disease with recovery generally within a week. However, there is a particular risk of severe illness from catching flu for: 

• Older people.
• The very young.
• Pregnant women.
• Those with underlying disease, eg chronic respiratory or cardiac disease.
• Those who are immunosuppressed.

The objectives of the national flu immunisation programme are to protect those at risk of serious illness or death should they develop influenza and to reduce transmission of the infection, thereby contributing to the protection of vulnerable patients who may have a suboptimal response to their immunisation.

Eligible groups for the 2023 to 2024 season are:

• Those aged two and three years on 31 August 2023.
• Eligible school-aged children (reception to Year 11).
• Those aged six months to under 65 years in clinical risk groups.
• Pregnant women.
• All those aged 65 years and over.
• Those in long-stay residential care homes.
• Carers, those in receipt of Carer’s Allowance or primary carer of an older or disabled person.
• Household contacts of immunocompromised individuals.
• Frontline health and social care staff.

The UK Health Security Agency (UKHSA) highlighted the risks presented by the new BA.2.86 variant of COVID-19, and the measures the NHS has been asked to take.

While it is difficult to predict the combined effect of a large number of mutations on severity, vaccine escape and transmissibility, expert advice is clear that this represents the most concerning new variant since Omicron first emerged. The UKHSA has determined the most appropriate intervention with the greatest potential public health impact is to vaccinate all those eligible quickly.

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 COVID-19 and all other vaccinations.
• Promoting flu vaccine uptake, reviewing vaccine status for children at every contact.
• Coordination of seasonal flu and COVID-19 programmes via Barnsley Winter Vaccination Operation Delivery Group.

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.

In our Place Health partnership, we need to work closely with our partner communications teams. Making sure we keep our communication and marketing plans in sync and share important messages across Barnsley. This way, we can align everything with national government guidelines and campaigns.

Our plan offers help and resources for groups, residents, and those who look after them. It encourages people to take care of themselves and find the help they need to stay healthy during the colder months. Including accessing resources from More Money In Your Pocket.

Additionally, we're keen on fostering a sense of community and encouraging residents to support each other by building strong connections during the winter months.

Key actions include:

• Collaborative communication plan using marketing mix that reaches the target audience.
• Keep warm and well toolkit for frontline workers.
• Keeping warm and well resources for Barnsley residents.
• Workforce development and training resources.
• Promoting key community events, including Fuel Poverty Awareness Day and area council events.
• Email newsletters: investigate development of a email newsletter that provides updates, tips, and resources to residents. Encourage subscribers to share this information with others.
• Emergency communication plan: develop a clear and concise emergency communication plan for extreme weather events. Ensure residents know how to access critical information during emergencies.
• Local media engagement: collaborate with local newspapers, radio stations, and TV channels to feature stories and interviews related to winter wellness and community events.
• Data-driven decision-making: continuously monitor the effectiveness of your communication strategies through data analytics. Adjust your approach based on what works best for your target audience.
• Storytelling: Share personal stories of community members who have successfully navigated winter challenges, highlighting the importance of your resources and initiatives.
• Social media campaigns: launch a targeted social media campaign that shares useful tips, resources, and updates related to staying warm and well. Utilise popular platforms to reach a broader audience.

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 promoting the support available to our communities, Barnsley partners have been encouraged and supported to develop their plans for winter 2023/24. These plans should include self-care support for residents and when to seek treatment for colds/seasonal flu.

The area councils and ward alliances continue to provide community support in winter months through various interventions, including winter warmer packs, fall prevention and social isolation initiatives. Barnsley Welcoming Spaces will be open across the borough; these will be open to everyone and will be somewhere our residents can  expect a warm and friendly welcome. For full details about Welcoming Spaces and other support that is available can be found on More Money In Your Pocket.

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 and those working with communities to keep them safe over the cold weather.

We’ve created a 12-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, we will create top-tip animation videos and an impactful case study video to spread a message.