Matter for Discussion: Crumbling buildings – the best place for care?

This resolution was passed by voting members at Congress 2024.

The 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 or working on the premises.

Specific risks such as degradation of Reinforced Autoclaved Aerated Concrete (RAAC) and risk of buildings collapsing are well documented. However, many buildings containing RAAC also contain asbestos, which when damaged or disturbed, presents a risk of serious lung disease and cancer to those exposed to fibres.

Other risks in buildings include water ingress causing flooding, unsafe floor surfaces, ceilings collapsing and sewage leaks, which present a risk of infection.

Not only are there risks to health, safety, and wellbeing from working or being cared for in dilapidated buildings, it impacts on staff morale and the delivery of care.

Employers and building owners have legal duties to protect workers and others who use their buildings from risks to their safety and health, but with the NHS needing an estimated £14 billion to return its run-down buildings and equipment to a suitable condition, many NHS organisations are only able to patch up the damage or take buildings out of use (British Medical Association, 2022).

According to a report published by the Department of Health in Northern Ireland, the cost of addressing the backlog of maintenance across the Health and Social Care service was £1.3 billion in 2021-2022. Some £256 million of this total was classed as high risk and represented 7% of the overall estate freehold value (Department of Health in Northern Ireland, 2023).

At the end of 2022, the NHS Scotland backlog maintenance bill sat at £1.1 million.    Furthermore, the Scottish government’s capital investment in health spending will see a reduction of at least 10% in the next two years, resulting in the postponement of new and replacement health care facilities. 

These issues aren’t unique to the NHS, the RCN has supported members who have become ill by working in buildings that are owned by private landlords, including a member who developed Aspergillus from working in mouldy conditions (Healy, 2021). Earlier this year, RAAC was also reported in a Marie Curie Hospice, causing it to close (Foot, 2024).

Calling for action to protect members, in 2023, RCN Wales wrote to the Senedd Health and Social Care Committee suggesting an amendment to the Environment (Air Quality and Soundscapes) Bill concerning ventilation in health care settings.

The RCN has a position statement on asbestos and has provided information for representatives and members on the risks from RAAC and asbestos, alongside raising concerns through the NHS Staff Council structures (Royal College of Nursing, 2023a).

The reading list for this debate is available here.

References

British Medical Association (2022) Building the future: Brick by brick: The case for urgent investment in safe, modern, and sustainable healthcare estates. Available at: www.bma.org.uk/media/6579/bma-infrastructure-1-report-brick-by-brick-estates-dec-2022.pdf (Accessed 19th March 2024).

Department of Health in Northern Ireland (2023) State of the estate report 2022. Available at: www.health-ni.gov.uk/publications/state-estate-reports (Accessed 19th March 2024).
Foot T (2024) Concrete risk forces Marie Curie Hospice in Hampstead to close, 15 Feb, Camden New Journal. Available at: www.camdennewjournal.co.uk/article/concrete-risk-forces-marie-curie-hospice-in-hampstead-to-close (Accessed 19th March 2024).

Healy R (2021) Workplace safety concerns: what can you do? 25 May, Royal College of Nursing. Available at: www.rcn.org.uk/magazines/Advice/2021/May/workplace-safety-concerns-rcn-law-compensation (Accessed 19th March 2024).

Royal College of Nursing (2023a) RCN position on asbestos in health and social care buildings. Available at: www.rcn.org.uk/About-us/Our-Influencing-work/Position-statements/rcn-position-statement-on-asbestos-in-health-and-social-care-buildings (Accessed 19th March 2024).

Further reading

Royal College of Nursing (2023b) Asbestos: tackling the toxic legacy, 4 Oct, Royal College of Nursing. Available at: www.rcn.org.uk/magazines/Action/2023/Oct/Tackling-the-toxic-legacy-of-asbestos (Accessed 19th March 2024).

Royal College of Nursing (2024) RAAC: what you need to know, 5 Mar, Royal College of Nursing. Available at: www.rcn.org.uk/magazines/Advice/2023/September/RAAC-what-you-need-to-know (Accessed 19th March 2024).

Trueland J (2024) Asbestos risk for NHS staff: why is this not a danger of the past, Nursing Standard, 39(3). Available at: https://rcni.com/nursing-standard/newsroom/analysis/asbestos-risk-for-nhs-staff-why-not-a-danger-of-past-204076 (Accessed 19th March 2024).

Wickens C (2023) The NHS estate continues to deteriorate, 14 Dec, The King’s Fund. Available at: www.kingsfund.org.uk/insight-and-analysis/blogs/nhs-estate-continues-deteriorate (Accessed 19th March 2024).