Care homes must become heatwave compliant, MPs warn

With temperatures rising, MPs are urging inspectors to check care homes for ‘heatwave resilience’ after a heatwave caused the number of heat-related deaths in nursing homes to rise by 42 per cent.

As the British summer brought a series of heatwaves, the call to action to protect older people came from a report by MPs in the House of Commons Environmental Audit Committee.

MPs concluded: 'The Care Quality Commission should inspect for heatwave resilience, and ensure that overheating risk forms part of its inspection for safety and suitability of health and social care premises.'

'Care homes vulnerable to overheating’

Older people are particularly vulnerable and suffer increased fatalities from cardiac and respiratory disease and are at greater risk of strokes during heatwaves.

The Environmental Audit Committee report referred to the August 2003 heatwave when temperatures rose to 38.5°C in England resulting in 2,193 heat-related deaths in the UK (between 4-13 August) – a quarter of which occurred in care homes. Heat-related deaths in care homes rose by 42 per cent that month.

As the UK heatwave continues, Dr Nick Scriven, president of the Society for Acute Medicine, said: “There was an increased pressure both on emergency departments and the number of admissions numbers during the main part of the heatwave.

“Heatwaves causing dehydration can lead to many issues, especially in the frail elderly, causing dizziness and falls through to an increased risk of infections (particularly urinary), heart attacks and strokes.

“The other heat-related issue is air quality the can really affect those with respiratory conditions such as asthma or COPD.

“I would not be surprised at all if an effect on mortality is shown. Compounding the heat is the fact that this is prime holiday season and there is little slack in the system regarding staff numbers as this is traditionally the time we have to recharge ahead of winter.”

The Committee said: ‘Hospitals, care and nursing homes are vulnerable to overheating’.

The Met Office has predicted UK summer temperatures could regularly reach 38.5C by the 2040s and the number of heat-related deaths in the UK is expected to more than triple to 7,000 each year by the 2050s.

MPs highlighted a study by Professor Rajat Gupta at Oxford Institute for Sustainable Development, which concluded that due to a perception that older people “feel the cold” there was a lack of recognition of the health risks of overheating in care homes.

The study of four care homes found the heating was left on 24 hours a day even during summer months. It also found that while all care managers interviewed were aware of the Heatwave Plan for England, awareness among frontline staff was lower.

When MPs asked the Minister for Primary Care and Public Health Steve Brine, where the responsibility lay for improving awareness amongst care home staff, Mr Brine told them: “It depends on who commissions the beds”.

After the Committee’s Chair asked: “If the council commissions the beds it is PHE [Public Health England] and if the NHS commissions the beds it is NHS England?”, Steve Brine replied “Correct. You are probably thinking that seems a bit fragmented, Chair.”

No central data on care home heatwave preparedness

MPs said the Government’s written evidence confirmed: 'There is currently no central data set on care and nursing home preparedness against which to judge the risk of overheating during heatwaves and the impact of climate change on this risk.'

Overheating risk is not part of the NHS EPRR approach and the Care Quality Commission do not inspect for it.

MPs revealed: ‘Although excess deaths in nursing homes increased by 42 per cent in some parts of the UK during the 2003 heatwave, homes are still not required to report against NHS England’s core standards of Emergency Preparedness, Resilience and Response [EPRR].

'NHS England should include overheating as part of EPRR assurance, and ensure that all hospitals and NHS operated nursing homes are compliant.'

Stephen Groves, head of EPRR at NHS England told MPs that due to “capacity issues”, NHS England has not yet been able to require nursing homes to demonstrate compliance with EPRR core standards.

Kathryn Brown, head of Adaptation at the Committee on Climate Change, told MPs about barriers to inspecting for overheating, explaining: “In our last report we had a recommendation on assessing and managing the risk [of overheating] in care homes. We did go to talk to the Care Quality Commission about what that might look like. Their feeling was at the moment they are not sure what they should be inspecting for.”

MPs have recommended the Department of Health and Social Care ‘provide guidance to the Care Quality Commission on how to inspect for overheating risk'.

The Committee also urged NHS England to ‘issue guidance on planning for summer pressures, to ensure that adequate steps are taken to prepare the healthcare system for more frequent heatwaves’.

CQC response

A day after news of the report's conclusions broke, the Care Quality Commission (CQC) launched its #TempAware campaign to raise awareness of how care homes can protect older people by helping them stay cool during hot weather.

Andrea Sutcliffe chief inspector of adult social care at the CQC, said: “The risks of overheating and not getting enough to drink are much greater for older people and people in vulnerable circumstances.

“Most of this is common sense – thinking about the environment and having person-centred care plans will help you to identify people at greatest risk and make sure they have the support they need.

“There’s also lots of good advice available from Public Health England and NHS England in the Heatwave Plan for England including specific advice for care homes as well as hospital services. Information published by the Care and Support Alliance has a useful section on extreme weather conditions too."

What does 'good' look like in terms of heatwave preparedness?

In response to the Committee's findings suggesting the CQC don’t and should be inspecting care homes to make sure people are not overheated, a CQC spokeswoman told carehome.co.uk: "We already do cover this in our existing assessment framework (guidance) that we use.

"I think what has got a bit lost in translation in the Committee’s report is, what our regulatory guidance doesn’t currently allow us to look at, is what good looks like in terms of services’ preparedness for heatwaves/any extreme weather situation – this would need to be developed further in conjunction with NISE / NHSE / PHE etc."

The CQC stated its assessments of care services focus on the importance of people experiencing a safe environment that is responsive to individual's personal needs.

'This includes considering the building temperature, how individual hydration and nutritional requirements are being met – and is all underpinned by the clear guidance we use'.

When considering if a care home is ‘safe’, the CQC wants to see evidence of:

- How risks to people are assessed and their safety monitored and managed so they are supported to stay safe and their freedom is respected?

- How is equipment, which is owned or used by the provider, managed to support people to stay safe?

- How are the premises and safety of communal and personal spaces and the living environment, checked and managed to support people to stay safe?

- How does the provider manage risks where they provide support in premises they are not responsible for?

The CQC is urging people to spread awareness about heatwave risks on Twitter using the hashtag #TempAware.

To read the Environmental Audit Committee's report: 'Heatwaves: adapting to climate change' click here.