Asbestos in health facilities is dangerous; trusts need a management plan to keep patients safe, says Denis Morgan.
04 February 2019 | Denis Morgan
Nine out of 10 NHS trusts have asbestos in their hospitals, according to a BBC report last year, which has led to the government proposing audits to check on the extent of the problem.
If managed carefully, asbestos does not pose a risk to patients or staff, however, disturbance of the material could endanger lives. The BBC found that 352 claims were made against trusts between 2013 and 2017 by people who had contracted asbestos-related diseases in NHS buildings, resulting in £16.4 million in compensation.
Exposure to asbestos poses severe health risks to those inhaling asbestos fibres, with the most common being mesothelioma, a cancer of the chest lining, and asbestosis, a chronic lung disease.
Many hospitals were built years before the ban on materials containing asbestos, and like many other buildings constructed before 2000 they are likely to contain asbestos in many applications. Asbestos-containing materials (ACMs) include:
- Asbestos lagging used as insulation on pipes and boilers;
- Sprayed asbestos used for insulation, fire protection, partitioning and ducts;
- Asbestos-insulating board used for fire protection, thermal insulation, partitioning and ducts;
- Some ceiling tiles;
- Floor tiles;
- Cement roofing and guttering; and Textured coatings.
The presence of asbestos in hospitals and other public buildings should not in itself be a significant cause for concern.
Greater emphasis should be placed on control measures at hospitals to manage these materials. The encouraging element of the BBC article is that the 198 hospitals are aware of asbestos in their buildings, indicating that they are meeting their requirements to have a record of the location of asbestos.
It is a legal requirement under the Control of Asbestos Regulations 2012 that asbestos in healthcare premises (and other non-domestic properties) should be managed. Many NHS trusts and hospitals will already have robust procedures to prevent accidental disturbance of ACMs.
However, the more concerning numbers here would arguably be the 32 hospitals that failed to respond to the information request, raising questions about their records, knowledge and management of ACMs. More work should be done to raise awareness of the risks and responsibilities to guarantee compliance.
Five steps to manage ACMs
The guidance requires hospitals and all non-domestic premises to take these steps:
1. Undertake an inspection and maintain a register of ACMs in the hospital;
2. Assess the risks associated with ACMs in the hospital or premises;
3. Devise a plan for managing asbestos in the hospital;
4. Make sure that staff, visitors and contractors know the risks and precautions they need to take; and
5. Keep the management of asbestos in the hospital under review.
Do not disturb
If undisturbed, the asbestos present is not considered a health hazard as the fibres will remain encapsulated.
But refurbishment or maintenance works risk disturbing asbestos, which is why knowing the location of ACMs is fundamental to safety.
Within the guidance, duty holders are defined as the people responsible for maintenance or repair and/or access/egress from the hospital. Within all hospital buildings, these people must understand that they have the legal responsibility to locate and assess the risk posed by ACMs as well as develop a risk management plan.
As funding cuts stretch NHS resources, ACM management should remain a priority for trusts. Safe management of these materials should be the primary aim, with removal being an option for items in unsafe conditions. However, undertaking asbestos removal works in a hospital is challenging and costly; most hospitals will struggle to justify the removal of ACMs as they can be safely managed in situ using the correct procedures.
Denis Morgan is technical and training manager for Asbestos at SOCOTEC