How professionals can support rough sleepers in hot weather, including new heat-health alerts.
Published June 2023
Rough sleepers at high-risk during hot weather
People sleeping on the streets are at high-risk during periods of hot weather. There can be severe impacts on their health and well-being.
Rough sleepers can find it very difficult to cool down. They might be exposed to intense heat, sleeping on hot tarmac or in direct sun, with little shelter or access to water. Without safe storage for belongings, they might need to wear all their clothes: winter coats, many layers, heavy shoes. This makes it difficult to regulate body temperature.
People sleeping on the streets might have health conditions or addictions. Alcohol and some drugs are dehydrating. These vulnerabilities can mean that they are less able to respond to hot weather: to move out of direct sunlight and seek help.
Health effects of hot weather on rough sleepers
Rough sleepers might experience serious heat related illnesses such as heat exhaustion and heatstroke.
A rough sleeper who has collapsed from heat exhaustion or heatstroke might be mistaken for being asleep or drunk. It’s important to respond quickly as heat exhaustion and heatstroke are potentially life-threatening conditions.
The NHS has heat exhaustion and heatstroke health advice.
Heat exhaustion
Heat exhaustion happens when a person overheats. Symptoms include heavy sweating, dizziness, and feeling faint. A rough sleeper can be frailer than their age might suggest.
To help someone experiencing heat exhaustion, the NHS advises to:
move them to a cool place
remove their unnecessary clothing
get them to drink a sports drink or cool water
cool their skin with a fan or wet sponge
They should feel better within 30 minutes.
Call for medical help if you are not able to take these steps, for example because there is a concern for your safety or the safety of others.
Heatstroke
If a person doesn’t cool down and hydrate they can develop heatstroke. The NHS advises the signs of heatstroke include:
seizures
confusion
loss of consciousness
very high body temperature
A person with heatstroke can have skin that is very sweaty or very dry. This happens because the body’s systems start to shut down.
Heatstroke is a life-threatening condition and can very quickly result in death. Anyone showing symptoms of heatstroke needs emergency medical help.
Other health effects of hot weather
During a heatwave, the main causes of illness for the general population are respiratory and cardiovascular diseases. Air pollution tends to be worse during hot weather.
People might have accidents in bodies of water if they try to cool down. Food spoils quickly especially if left in the sun. Pressures on health services can delay medical care.
Summer 2022: lessons for the future?
The summer of 2022 was the fourth warmest on record for the UK. It was the first time the Met Office issued a red extreme heat warning and the first Level 4 heat-health alert. July 2022 saw temperatures exceed 40-degrees Celsius, with record breaking night-time temperatures.
For rough sleepers, night-time is particularly important for recovery. This is when the body needs to sleep and release heat.
Temperatures are likely to continue to rise in the coming years. Local authorities, charities and other services need to consider the impact this will have on vulnerable groups, including rough sleepers.
Challenges for organisations helping rough sleepers
In many places in the UK there are few cool spaces tailored for rough sleepers. In some areas there is a low take up of emergency provision. Rough sleepers might not access cool spaces or accommodation because they don't feel that they need or want it.
The UK is more used to responding to extreme cold weather during the winter. The plans for a cold weather response are often unsuitable for extreme heat
Heat-health alert system
The UK Health Security Agency (UKHSA) provides a heat-health alert service from 1 June to 15 September, in partnership with the Met Office. It is aimed at health and social care professionals and anyone with a role in reducing the harm extended periods of hot weather can have on health. This includes the health effects on rough sleepers.
From 2023, the system is impact-based rather than purely based on temperature. This provides information over and above the fact that hot weather is likely to occur. For example, how an NHS strike during a predicted heatwave could worsen health impacts.
What the alert levels mean
The Met Office monitors forecasts and assesses potential impacts of high temperatures. Where an alert is needed, the Met Office releases one at a level based on the suspected impacts.
The alert levels are:
yellow – impacts are expected for the most vulnerable, including rough sleepers
amber – impacts are expected across the population
red – a significant risk to life even for healthy people
Find out more about the alert levels from the Met Office.
How professionals can support rough sleepers in hot weather
Every local authority should have a severe weather emergency protocol (SWEP) to assist people sleeping on the streets. Severe weather includes heatwaves.
The guidance on supporting people homeless and sleeping rough includes information about how organisations responsible for rough sleepers can prepare for hot weather and take action.
The alert service builds on the Adverse Weather and Health Plan.
Support a rough sleeper to make a homeless application
People who are homeless can apply for help from any local authority. Find out how to contact your council's homeless team.
A local authority has a duty to provide interim accommodation if it has reason to believe the person might be:
homeless
eligible for assistance
in priority need
A person can have a priority need if they are vulnerable, for example because of a physical or mental health condition. A person’s circumstances can be relevant. For example, a person sleeping rough might be more vulnerable during a heatwave.
Find out more about the homeless application process.
Sign up for the new alert system
The heat-health alert system dashboard is available online. It’s important that professionals are up to date with changes to the alert level so they can respond quickly.
Anyone can register to receive alerts on the Met Office website.
Train staff to recognise heat exhaustion and heatstroke
The health effects of heat can be severe and life threatening, particularly for vulnerable groups such as rough sleepers. Outreach staff and others should understand the signs of heat-related illnesses and know to take quick action, particularly if someone might be experiencing heatstroke.
Staff working outside in hot weather should take preventive measures for their own wellbeing. They need to know what action to take if they recognise the signs of heat-related illness in themselves or colleagues.
Staff should call 999 for emergency medical help if they think anyone is suffering from heatstroke.
Prepare services for hot weather
Local authorities and other organisations should consider developing or improving their local heat severe weather plans and risk assessment strategies. They could start to identify cool spaces and plan to make their emergency accommodation suitable during hot weather.
Authorities could pre-emptively build relationships and trust with people sleeping rough. Some cool spaces were not used by rough sleepers in 2022. Permanent facilities with built-up trust might be more likely to be used compared with emergency pop-up facilities. For example, rough sleepers might be more likely to use a familiar day centre with air conditioning and extra fans. A cool space might include access to refreshments such as water and food.
Organisations could prepare resources, such as a map of cool spaces, water fountains, and public toilets. Find the London cool spaces map.
Hot weather also impacts staff, volunteers, and other sectors. Organisations should build this into their plans. For example, summer 2022 saw the busiest day on record for the London Fire Brigade since the Second World War. Staff and volunteers might experience health effects from the heat or not be able to travel to work in hot weather.
Take action when the temperature rises
When there are heat alerts, local authorities and organisations could work together to provide rough sleepers with:
food and cool water
shade, appropriate clothes and sunscreen
effective information and resources
access to cool spaces, including outdoor areas
Action could be taken in a staged process as the alert levels rise. This contrasts with a cold weather response, where it is common for action to be taken only when the temperature falls below freezing. A staged approach might include:
extra outreach to check on rough sleepers during a yellow alert
providing cool spaces and accommodation during an amber alert
Anyone worried about someone sleeping rough can contact StreetLink to connect the person with support services.