Hospitals must work proactively to reduce building structure risks

Andrew Rolf is a health sector technical advisor for UK and Europe at Mott MacDonald

Asbestos, high alumina cement and, more recently, reinforced autoclaved aerated concrete (RAAC) have highlighted potentially unseen risks that can exist within built public infrastructure, with hospitals being acutely affected. Each of these materials was heralded, when introduced, as delivering significant efficiencies and benefits, providing value for money. However, over time, all have created long-term challenges for healthcare buildings, increasing operational costs and having direct impact on clinical care.

“Designing for the lifecycle of a building is a more recent evolution in our thinking”

The industrialised construction methods of the 1950s post-war period aimed to accelerate construction and introduced a range of innovative structural systems and techniques. Buildings across healthcare estates were designed for immediate need, not necessarily long-term maintenance – designing for the lifecycle of a building is a more recent evolution in our thinking. However, that rapid development is now having a major impact on the operation of healthcare facilities.

Maintenance and renewal in hospitals often focuses on keeping the lights on – managing the systems that are critical to patient care – and there is an assumption that the building will always be there and be ok. It has recently been highlighted with RAAC that this is not always the case and that when the building structure presents a risk to its users, the implications on cost for remedy or repair, as well as the delivery of care, can be significant.

Managing future risk

It is clear there is a need to find techniques and methods to better manage this kind of risk in the future so the impact on patients and operational costs are minimised, if not avoided. Rather than needing to create a new solution, mechanism or guidance to do this, hospitals could voluntarily undertake a Structural Safety Case (SSC), as defined within the new Building Safety Act (BSA).

Implementation of the BSA approach to SSC means that, as well as an increased focus on fire safety, many buildings now have to produce a detailed inventory of the types and locations of materials within the building structure. This kind of information will be invaluable to faster assessment and response should materials prove to be a problem in the future. However, the requirement doesn’t currently apply to healthcare buildings.

Hospitals are exempt from the operational elements of the BSA as they are regulated as workplaces through the Regulatory Reform (Fire Safety) Order 2005. In a bulletin issued this summer, NHS Estates further detailed that hospitals are “also regulated by the Care Quality Commission, staffed round the clock, have multiple routes of escape, signage and emergency lighting to assist evacuation and have a higher level of detection and alarm systems than residential buildings”.

While existing guidance focuses on the fire safety aspects, voluntarily going through the process to generate an SSC would position trusts well to respond to any potential future materials or system-build crisis. The inventory the process creates will aid understanding of the construction techniques used, their potential vulnerabilities and management challenges to support proactive maintenance and prevent future challenge.

With limited budgets and a focus on clinical care, the current approach is understandable. But if the sector wants to protect itself from future shocks and proactively manage its existing assets, greater understanding of healthcare estates building stock is needed. That change could be delivered by considering the BSA’s SSC process. It could deliver better value for money in the long term and safer environments for patients and staff by arming healthcare providers and estate managers with real insight into their buildings.