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Background

The UK health and social care estate is aging, a lack of capital spend, alongside maintenance backlogs means that buildings in a poor state of repair present a risk to those being cared for on the premises as well as nursing staff working in these environments.  

Specific risks such as degradation of Reinforced Autoclaved Aerated Concrete (RAAC) and risk of building collapse have been well documented.  However, many buildings that contain RAAC will also contain asbestos, which when damaged or disturbed increases the risk of serious lung disease and cancer to those exposed to fibres.   

Other risks include water ingress causing floods, unsafe floor surfaces and the risk of ceilings collapsing. Mould and spores can accumulate leading to a risk of health conditions to those working or being cared for in these areas, especially those with weakened immune systems. Sewage leaks have also been documented in some buildings, presenting a risk of infections.   

A lack of maintenance and insufficient checks on water and heating systems presents an increased risk of legionella bacteria growth, which is of particular concern to older people and the immunocompromised. Poorly maintained ventilation and air conditioning (HVAC) systems can compromise efforts to reduce the spread of infection spread via the airborne route increasing the risk of exposure of those in receipt of care and staff to healthcare associated infections. Poorly maintained systems can also impact on the temperature control, leaving buildings too cold or too hot for those receiving care and staff.  

Poorly maintained environments where fixtures and fittings are damaged can also be hazardous to patients who are at risk of violence to themselves or others, and/or of taking their own lives. 

Not only are there risks to health, safety, and wellbeing from working or being cared for in dilapidated and poorly maintained buildings, it impacts on staff morale and the delivery of safe and effective care.  Units and buildings have needed to close due to unsafe conditions, adding pressure on already overstretched services.  

  

RCN Position

Governments  

• The UK Governments must invest in improving the physical safety of the public health and care estate and provide organisations with the capital to ensure the estate is maintained in line with statutory requirements. 
• Implement recommendations from public inquiries with direct implications for patient and staff safety, including Healthcare Acquired Infections and pandemic learning, into future work on the design, layout, infrastructure and maintenance requirements of new and existing health and social care buildings.   Ensure that the nursing voice and health and safety expertise is consistently included in governmental department level plans to redevelop and build new hospitals.   

 

Health and Social Care Employers

• Health and social care employers must, as a minimum ensure that they meet all statutory requirements to maintain their premises and equipment.   
• When new premises are being sought, organisations should assess how statutory compliance requirements can be met if the building is listed or the infrastructure e.g. old buildings with water storage tanks and old piping, with the ability to make changes and adaptions to implement safety measures etc. Due consideration of adaptation needs as part of the UK Net Zero ambitions should also be undertaken.  
• Ensure compliance with regulation 7 of the Management of Health and Safety at Work Regulations in terms of  access to competent advice to help them fulfil their legal duties.  
• Induction of independent health and social care registered managers should include awareness of statutory compliance needs within the premises, the importance of carrying out regular  checks and taking action outlined in risk assessments.  
• In the case of shared or leased premises,  cooperate and coordinate with the building owners and other occupants to enable them to comply with legal duties under regulation 11 of the Management of Health and Safety at Work Regulations, determine responsibilities and share information on risks arising/ in connection with their undertaking to ensure the workplace is safe for staff, patients and visitors  
• Consult, in good time, with health and safety reps, representatives of employee safety and professional nursing experts, including Infection Prevention and Control, prior to commencing any refurbishment and new builds.   
• Follow industry guidance and best practice in relation to the maintenance of the health and social care estate, including the effectiveness of ventilation systems.  
  
    

Workplace Health and Safety Regulators (HSE and HSE Northern Ireland)  

• To proactively inspect health and social care premises to ensure that employers and other duty holders are meeting their legal duties to maintain the safety of their estate, including but not limited to compliance with the following regulations:  
  • Control of Substances Hazardous to Health  
  • Control and Management of Asbestos   
  • Workplace (Health, Safety and Welfare)   
  • Lifting Operations and Lifting Equipment    
  • Pressure Equipment (Safety) Regulations   
  • The Electricity at Work Regulations  
• To ensure up to date guidance on legal compliance and good practice is available to duty holders in relation to statutory maintenance.   
• Ensure that those responsible for regulating health and safety in the independent health and social care sector have the right knowledge and skills to be able to inspect against and enforce relevant regulations.   
  
  

Commissioners of care   

• Ensure that commissioned spaces are safe, fit for purpose and meet statutory requirements.   
  
    

Footnote:

This position statement should be read in conjunction with the RCN's position statement on asbestos in health and care buildings.