Crumbling concrete issue ‘alarming’ for nurses

Nurse leaders have warned that nursing staff must be properly informed and protected, as trusts in England have been told to prepare to evacuate staff and patients in the event of buildings collapsing.

NHS chiefs have this week written to every trust in England about their estates, following the full or partial closure of more than 100 schools recently due to concerns about a crumbling concrete.

Dozens of NHS sites in the country are thought to also contain the reinforced autoclaved aerated concrete (RAAC) which has forced the school closures.

RAAC is a lightweight concrete containing air bubbles, that is commonly found in roofs, and sometimes walls and floors.

It was frequently used in public sector buildings in the UK from the mid-1950s to the mid-1990s, however it is now reaching the end of its lifespan.

Following an alert issued by the Standing Committee on Structural Safety (SCOSS) in 2019, NHS England has been surveying its sites and undertaking RAAC mitigation work.

However, it was identified earlier this year by The Mirror that there were still 19 NHS buildings across England at risk of collapse due to having RAAC.

These included seven hospitals that were made “nearly exclusively” from RAAC. According to The Mirror, they are: Queen Elizabeth Hospital, King's Lynn; Leighton Hospital; James Paget Hospital; Frimley Park Hospital; Hinchingbrooke Hospital; Airedale Hospital; and West Suffolk Hospital.

Now, following the intervention in schools, NHS England chiefs have asked trusts to ensure their buildings are properly assessed for the concrete, and that the correct mitigation plans are in place to manage it.

A letter published yesterday from NHSE’s chief commercial officer, Jacqui Rock, and national director for emergency planning and incident response, Dr Mike Prentice, told all trust leaders to “ensure they are familiar” with the regional evacuation plan which exists in England.

It said: “A regional evacuation plan was created and tested in the East of England. Learnings from this exercise have been cascaded to the other regions.

“We would recommend that all boards ensure that they are familiar with the learning from this exercise and that they are being incorporated into standard business continuity planning as a matter of good practice.

“This exercise is, however, essential for those organisations with known RAAC, and should be done as a matter of priority if it has not already been completed.”

The letter was sent to all chairs, chief executive officers and estate leads for all NHS trusts and integrated care boards (ICBs) in England.

It added: “Planning for RAAC failure, including the decant of patients and services where RAAC panels are present in clinical areas, is therefore part of business continuity planning for trusts where RAAC is known to be present, or is potentially present.”

The Department of Health and Social Care said its approach to the situation was in line with the recommendations by the Institution of Structural Engineers (IStructE) which said that where RAAC is identified, it should be regularly monitored, mitigated or replaced.

In a statement, a spokesperson for the department said: “The NHS has a mitigation plan in place for hospital buildings with confirmed RAAC, backed with significant additional funding of £698m from 2021 to 2025, for trusts to put in place necessary remediation and failsafe measures.

“We remain committed to eradicating RAAC from the NHS estate entirely by 2035.”

The spokesperson added that the seven hospital sites “most affected”, and therefore most at risk, would be replaced by 2030 through the new hospital programme – backed by £20bn.

“The technical advice received from the NHS is that the current approach to monitoring and mitigation remains appropriate,” the spokesperson said.

NHS leaders echoed this in the letter, noting that the health service had been surveying its sides and undertaking RAAC mitigation work since 2019 and planning for the eradication of the concrete.

It said it had been working with trusts that had previously been identified as having RAAC, and had helped them secure funding “for investigative, safety/remedial and replacement work”. As such, three of those sites have now completely got rid of RAAC.

However, in the letter, leaders suggested that more NHS building could be constructed with RAAC than first thought.

Therefore, it said that initial assessments of any further sites were “already being undertaken and are expected to be completed by the end of this week”.

Meanwhile, where RAAC has been confirmed and is being managed, the letter said trust boards must ensure that plans to monitor the concrete were “sufficiently robust and being implemented”.

Responding to the letter, the Royal College of Nursing head of health, safety and wellbeing, Leona Cameron, said: “Nursing staff and patients deserve to feel safe and will be alarmed at this letter warning trusts to get ready to evacuate hospitals if they are at risk of collapse.”

Ms Cameron said that nursing staff should be “properly briefed by their employer”, which have a legal duty to ensure that all employees, as well as patients and visitors, are safe.

She added: “For those trusts where there’s an ongoing risk of buildings collapsing – we expect those responsible for management and maintenance to act urgently.

“This means investigating where RAAC has been used and taking appropriate action to make buildings safe.

“RAAC stopped being used in the 80s and is at the end of its lifespan – there’s a real risk here.

“The UK Government must prioritise providing funding to tackle maintenance backlogs in NHS buildings.”

Also responding, Matthew Taylor, chief executive of the NHS Confederation, said health leaders had “welcomed the government’s commitment to fully-fund and accelerate building work for the hospitals most significantly affected”.

He said: “This is important as the mitigations in place at these sites are affecting how much care can be delivered, for example where wards need to be closed, as well as adding to daily running costs at a time when staff are making every effort to tackle the treatment backlogs and stabilise urgent and emergency care.”

However, Mr Taylor warned that the RAAC issue was part of “a much bigger problem facing the NHS” in terms of its estates, with a maintenance backlogs bill of almost £11bn.

He added that it would “require further and sustained attention from the government” to put this situation right.

Meanwhile the deputy chief executive of NHS Providers, Saffron Cordery, said: "Trust leaders repeatedly warned that RAAC presented a major risk to patient and staff safety and they will do everything they can to ensure patients, staff and services remain safe, including having stringent monitoring and evacuation plans in place for hospital buildings built with RAAC planks.”

Ms Cordery said that while the trusts with the most critical RAAC risk would be replaced by 2030, it was “concerning” that others would have to wait until 2035 to be removed from the NHS estate.

She said: "With these and many more buildings in desperate need of modernisation and restoration – and a burgeoning repair bill of more than £10bn, much of it high-risk – there is a major worry that these buildings will fall into a further state of disrepair as time goes on, worsening the risk to patients, visitors and staff."