ECRI Institute, one of the leading patient safety and medical technology research organizations, places health technology cybersecurity at the top of its just-released 2019 Top 10 Health Technology Hazards.
Asbestos is a hidden killer
Managing the risks from asbestos in hospitals is a legal duty, says Sarah Haslam of the Asbestos Removal Contractors Association
The risks from asbestos must be taken seriously because it is a class 1 carcinogen which is the greatest cause of work-related deaths in the UK. Current figures show that approximately 4,500 people die each year in the UK from asbestos related diseases (predominantly mesothelioma, lung cancer and asbestosis). These people are not just those who have worked on construction and demolition sites, but also teachers and doctors.
According to an article in The Guardian from 2000: ‘A plastic surgeon died of an asbestos-linked lung disease, more than 20 years after he unwittingly inhaled blue asbestos dust in hospital corridors. He was 47 when he died of mesothelioma in August 1995. Under the hospital were underground passages carrying a network of cables and pipes covered with asbestos lagging. The passages were used by staff and students to travel between buildings, especially the main hospital and the medical school.’
The same paper reported last year that a ‘teacher died from cancer after decades of exposure to asbestos. Inquest rules death was a result of industrial disease, after years spent pinning pupils’ work to boards resulting in asbestos dust inhalation.’
It is vital that organisations take the risks from asbestos seriously and deal with asbestos in a controlled and safe manner. When asbestos is managed well, inadvertent exposure can be prevented so that the health and safety of individuals is not put at risk.
UK law places responsibilities on property owners to ensure that both employees and non-employees are not exposed to health and safety risks as a result of the presence of unmanaged asbestos. The Health and Safety at Work Act 1974 places a duty on every employer to ensure, so far as is reasonably practicable, the health, safety and welfare at work of all employees and non-employees who may be affected by the employers’ activities. The Control of Asbestos Regulations 2012 (CAR 2012), places a legal duty to ‘manage asbestos in non-domestic properties’, on those who own, occupy, manage or have responsibilities for premises that may contain asbestos. Lastly, the Construction (Design and Management) Regulations 2015 (CDM 2015) places explicit responsibilities on clients, for example, if asbestos removal is required the client needs to appoint a competent asbestos removal contractor.
To explain the Control of Asbestos Regulations 2012 (CAR 2012), Regulation 4, a little more, it places a legal duty on those who own, occupy, manage or have responsibilities for premises that may contain asbestos. Those who have these responsibilities will either have a legal duty to manage the risk from this material; or a legal duty to cooperate with whoever manages that risk.
The CAR 2012 places a legal duty to ‘manage asbestos in non-domestic properties’ by: finding out if there is asbestos in the premises, the amount and what condition it is in; presuming the materials contain asbestos, unless there is strong evidence that they do not; making and keeping an up-to-date record of the location and condition of the Asbestos Containing Material’s (ACM) or presumed ACM’s in premises; assessing the risk from the material; preparing a plan that sets out in detail how to manage the risk from this material; taking the steps needed to put this plan into action; reviewing and monitoring the plan and the arrangements made to put it in place; and providing information on the location and condition of the material to anyone who is liable to work on it or disturb it.
The requirement is to manage asbestos
If materials are in good condition and managed so that they cannot be disturbed, a periodic check might be all that is needed. For some premises, that see a large number of employees and visits, such as hospitals, maintenance work is inevitable and accidental damage is often possible.
Therefore, all premises which were constructed prior to the year 2000, will require an asbestos management plan based on a management survey. The purpose of the management survey is to manage asbestos containing materials (ACMs) during the normal occupation and use of the premises. The duty holder can compile a management survey where the premises are simple and straightforward. Otherwise, an asbestos surveyor is needed.
When a premise, or part of it, needs upgrading, refurbishment or demolition a refurbishment/demolition survey is required. This survey, normally carried out by an asbestos surveyor, is to locate and identify all ACMs before any structural work begins at a stated location or on stated equipment at the premises.
Asbestos removal is a licensed industry, meaning to undertake most asbestos removal projects clients, like the NHS, need to appoint a licensed contractor (licences are granted by the Health and Safety Executive - HSE). Also, under the CDM 2015 regulations they need to appoint suitably competent people, they need to make reasonable enquiries to satisfy themselves that contractors are appropriately resourced and competent for the work.
One way is to choose a contractor who is a member of a trade association / professional body. Guidance on the CDM 2015 regulation states: ‘When considering the requirements for designers and other construction professionals, due weight should also be given to membership of an established professional institution or body. For example, do these bodies have arrangements in place which provide some reassurance that health and safety is part of the route to membership of their profession?’.
However, do clients assume what that membership, that logo, means? Don’t assume what a logo means as they can mean different things. At the Asbestos Removal Contactors Association (ARCA) we believe membership is more than a logo. Members don’t just pay to join ARCA, they have to continually prove that they can meet the standards which the logo represents.
For example, ARCA is the only trade association for licensed asbestos removal contractors, who conducts all site audits of members as ‘unannounced’. These audits are a requirement to maintain membership and provide reassurance that health and safety standards, and good practices, are continually demonstrated.
The asbestos issue for the NHS
The asbestos problem facing the NHS is essentially no different to the problems faced by any property owner/employer with a large portfolio of premises constructed prior to the year 2000. That is, they are responsible for ensuring that employees and non-employees are not exposed to health or safety risks as a result of the presence of unmanaged asbestos.
In the case of the NHS this includes in-house maintenance teams, members of the public visiting the premises and external contractors. The main difficulties for the NHS arise due to scale. The NHS is responsible for a large number of pre-year 2000 properties and a large number of employees.
Earlier this year, BBC London reported that 94 per cent of hospitals in the capital contain asbestos, and about 1,000 people have died from mesothelioma since 2011 in London, seven of whom were doctors and nurses.
All asbestos projects require good coordination and cooperation between all parties. Clients’ decisions, actions and inaction have an enormous impact on how work can be delivered, causing contractors to fail to meet industry and legal standards, and potentially leaving clients with substantial criminal and civil liabilities, lengthy delays and disruptions to projects.
With a well communicated structured approach to asbestos management, the NHS can ensure that they continue to meet the challenge to comply with health and safety regulations across their extensive portfolio.