Asbestos in hospitals - a question of trust?

The problem of asbestos in hospitals is not going away any time soon and there are no easy solutions. The UK Asbestos Training Association discuss asbestos awareness within UK hospitals and the best way to manage it on the NHS estate

Successful and safe asbestos management can be a challenge for any organisation and the NHS faces more obstacles than most when it comes to asbestos. Budget and logistical issues are key factors in the current financial climate but with the right approach, it is possible to protect staff and patients from a substance that remains the UK’s biggest workplace killer without breaking the bank.

The news has been full of worrying reports of asbestos in hospitals over recent years. In July this year, hospital asbestos was described as a ‘ticking time bomb’ in a BBC article and many others tell a similar story. As most hospitals in the UK are older buildings, they almost certainly contain asbestos and total removal is not always a practical or cost-effective solution. If the latest discoveries of asbestos in hospitals tell us anything, it is that strict compliance with regulations is vital. Failing to abide by current regulations runs the risk of potentially large fines, compensation claims and criminal convictions. This is without the very real human suffering caused by asbestos related diseases such as mesothelioma.

Estimates suggest that over 1.5 million buildings in the UK still contain asbestos, yet diagnosis is one thing – treatment for this unwanted legacy is quite another for those NHS trusts charged with managing and maintaining buildings saddled with asbestos. The majority of these buildings are still in regular use and 94 per cent of London hospitals alone contain asbestos. The case of hospitals poses particular problems at a time when both NHS budgets and A&E departments are under unprecedented pressure and now have this legacy problem to confront.

Trusts must fulfil their statutory obligations to conduct proper and regular surveys on asbestos in hospital buildings, to ensure that all those who might encounter the material are properly warned of its existence and all steps for its safe control in buildings are observed. Trusts are now appearing to act and not before time. Remedial works are expensive in themselves, not counting the potential cost to patient care with beds out of action. Yet this must be weighed against the cost of doing nothing and the need for safety to be the top priority.

When removing asbestos, it is also important that it is replaced with suitable products. The Grenfell Tower tragedy has shown just what can happen if asbestos is replaced by inferior products, unfit for purpose, so hospitals have a difficult balancing act to complete.

No one-size-fits-all solution
Each hospital and each building will present its own unique set of features, challenges and type of asbestos in situ, meaning that each case in each hospital must be judged on its merits. Asbestos management is one field where a one-size-fits-all approach is hard to apply. Serious cases may need removal, but in others a policy of watchful waiting may be fine if there is confidence the asbestos present can remain safely undisturbed. There are already strict rules and regulations in place nationally so asbestos is registered and contained, but these must be adhered to and the necessary trained and competent experts brought in to manage and (where deemed necessary) dispose of the substance.

Asbestos was only banned outright in the UK in 1999 so any building constructed before this date may contain it in some form. In the case of hospitals, it was widely used, particularly below ground level, with boiler rooms and central heating systems. Where hospitals have been found to contain crocidolite, (more commonly known as ‘blue asbestos’) for example, leaving it in place is rarely an option, as this is one of the more lethal forms of the material.

Breathing in asbestos fibres can cause a variety of illnesses, from mesothelioma to asbestosis. Those diagnosed with mesothelioma have a life expectancy of just under a year and there is no cure. It is not always easy to tell whether a product contains asbestos, so it is not surprising it remains at the root of so many deaths, decades after its use was discontinued.

What is needed in all cases is a proper asbestos risk register of what asbestos is in the hospital building in question and where. This must be a reliable and up to date document and not just part of a box ticking exercise. UKATA has been writing and commenting on this issue for the last four years and given the number of cases still being reported, many industry watchers fear this registration and containment is not being done everywhere to an acceptable standard. However, as mesothelioma can take years to develop, it can be some time before a change in cases (up or down) is seen.

A national database
Far from being a central government responsibility, the Department of Health makes clear that each local NHS organisation is the ‘duty holder’ required under health and safety legislation to assess the risk to staff and patients from asbestos within their buildings, although NHS Improvement, part of the Department for Health, clearly has a role to play and now work with trusts to ensure the hospital environment is a safe one.

UKATA agrees with the HSE view that providing asbestos is sealed and well maintained, staff and patients should not be at risk during normal activities. However, given the list of breaches there have been of hospitals not keeping proper records and cases of poor maintenance and record keeping, a case can be made for central government and/or NHS Improvement having an increased role.

A national database of asbestos in public buildings and a central asbestos register have been suggested and certainly merit a closer look but the current approach can and does work – if correctly implemented. While the level of risk is very real, it needs to be kept in perspective. So long as proper reviews are undertaken and staff are aware of their role, asbestos can be managed safely. A culture of reporting any concerns needs to be the rule rather than the exception, together with the full understanding that concerns will be listened to, investigated and if necessary, addressed appropriately.

Healthcare professionals must be vigilant and common sense, coupled with awareness training, can go a long way. Damage to walls inside buildings for example should be reported, on the assumption they may contain asbestos. Nurses who have developed mesothelioma could have been exposed while walking in underground passageways, where pipes and insulation panels that were almost certainly lagged with asbestos were not properly maintained, again any such situations should be reported.

Regulations
Contact with asbestos and its removal is regulated by law. If you own, occupy, manage or have responsibilities for premises which may contain asbestos, you have a legal duty to manage the risk from the material. The key legislation known as the ‘Duty to Manage’ Asbestos, or Regulation 4, was originally enshrined in the Control of Asbestos at Work Regulations 2002. This legislation applies to all non-domestic buildings and includes commercial, public and industrial premises.

These Asbestos regulations were significantly updated again five years ago in the Control of Asbestos Regulations 2012. Coming into force on 6 April 2012, these modified the 2006 regulations in response to European Commission opinion. The commission felt the 2006 regulations omitted certain key terms from the European Directive for the protection of workers from the risk of being exposed to asbestos and demanded the UK fully implement the Directive, which led to the update.

The problem of asbestos in hospitals is not going away any time soon and there are no easy solutions. Yet, if the existing rules and regulations are implemented in full, then we should start to see a reduction in cases coming to court and a safer working environment for all.

UKATA exists to set and verify standards and to emphasise the importance of best practice in training when it comes to the safe handling, removal and disposal of asbestos. Public sector managers should ensure asbestos is only handled by trained professionals. Tasked by the HSE in 2008 for taking-on, managing and developing the list of training providers for licensed asbestos work in the UK, UKATA is now the leading authority in all levels of asbestos training in the UK.