A ticking time bomb?

'Mass casualty plan' leaked amid fears hospitals could collapse due to faulty concrete

Hospitals bosses in the East of England are said to be drawing up a ‘mass casualty plan’ amid fears that hospitals built with lightweight concrete could be on the brink of collapse.

According to documents leaked to the BBC by a whistleblower, West Suffolk NHS Foundation Trust is so concerned over the threat that it has hired a law firm to assess the risk of being charged with corporate manslaughter should any hospital collapse and kill patients, staff, or visitors.

Concerns were first raised over the use of reinforced autoclaved aerated concrete (RAAC) planks as long ago as 2018, following the collapse of a school roof in Essex.

The planks, which were widely used in construction during the 1960s and 1990s, are said to be much weaker than traditional concrete and can deteriorate over time and become unstable.

To address the issue, the Government set aside £100m earlier this year to carry out ‘urgent remedial’ work at seven hospitals built using RAAC planks.

These include four operated by the West Suffolk trust – West Suffolk Hospital, Hinchingbrooke Hospital, and the Queen Elizabeth and James Paget hospitals in Norfolk.

An accident waiting to happen?

Also on the list were Airedale in West Yorkshire, Leighton Hospital in Cheshire, and Frimley Park Hospital in Surrey.

The leaked documents from West Suffolk show an emergency scheme – known as Operation Rapture – would come into effect in the event of a ‘significant hospital structural failure’.

It would result in ambulances being diverted to other sites and non-urgent beds freed up to house patients transferred from hospital impacted by any collapse.

In its report, the BBC claims that, last year, the hospitals in West Suffolk took part in a simulation exercise to test their response to a potential disaster.

This deeper understanding of building products and their performance is positively impacting approaches to hospital refurbishments, as well as the specification of materials for and design of new facilities

And the BBC said a report by the trust earlier this year found a roof collapse was ‘almost certain’ and could be ‘catastrophic’ if immediate action was not taken.

However, it is believed this threat has since been downgraded after metal reinforcements were fitted to shore up the failing planks.

West Suffolk Hospital currently has 27 metal beams under the planks for additional support, while the James Paget in Great Yarmouth has 18.

The Queen Elizabeth Hospital in King's Lynn has more than 200 metal supports and Hinchingbrooke Hospital is said to have restricted patients weighing more than 19 stone from being treated on certain wards where the structure has weakened.

Getting the full picture

Craig Black, interim chief executive of West Suffolk NHS Foundation Trust, said he was saddened by the leak, adding that the report was commissioned to get the full picture of the work needed, rather than for sinister reasons.

And he said the trust had reached out to financial, technical, and medical professionals.

He told the BBC: “We have weekly briefings on the situation around RAAC; we have posters up around the hospital; we talk to staff continuously.”

And NHS England insists hospitals are safe.

Depending on the condition of the RAAC, there are three ways of proceeding: leave it because it’s in good condition, but with a monitoring regime; strengthen the planks where there are signs of degradation; or replace them where they’re beyond remediation

A spokesman said: “Trusts in the East of England work in line with specialist industry advice and have been given more than £67m to help them manage their estates programme.

“Trusts have maintained safe services for patients, who should access hospital care as they normally would, and also introduced a number of measures, including improved surveillance and use of specialist equipment to help identify and fix any issues immediately.”

The way forward

Speaking about the impact of the problem to BBH, Rob Barnes, director of civil, structural and engineering consultancy, Perega, said: “At its peak, RAAC was specified for its relative-light weight and good thermal insulation properties. But, eventually, the industry started becoming aware of issues with the bond between the reinforcement and the concrete matrix, demanding a different approach.

“The structural and civil engineering community has known about these problems for a while, and has been addressing them where there are concerns around safety and quality.

“However, it has only relatively recently become more mainstream knowledge following a 2019 Standing Committee on Structural Safety (SCOSS) report.”

He added that the biggest legacy problems in existing applications tend to involve roofs, owing to their susceptibility to damage from water ingress.

He said: “Depending on the condition of the RAAC, there are three ways of proceeding: leave it because it’s in good condition, but with a monitoring regime; strengthen the planks where there are signs of degradation; or replace them where they’re beyond remediation.”

And different approaches can be taken to strengthening RAAC.

The simplest, says Barnes, is to specify additional steelwork below to reduce their spans, but there are also reports of strengthening above to effectively create another slab.

All too often, budget is the highest priority. However, this kind of thinking is sometimes exactly what leads to costly and disruptive refurbishments 20 or 30 years down the line

The best solution varies depending on the individual project needs.

Barnes said: “We now know the lifespan of RAAC is around 30 years, considerably less than that of modern new builds, for which the norm is in excess of 50 years.

“Ultimately, the lifespan of a building has to be discussed and agreed with the client, balancing capital cost and the longevity of the building.

“All too often, budget is the highest priority. However, this kind of thinking is sometimes exactly what leads to costly and disruptive refurbishments 20 or 30 years down the line.

“Ideally, we’d like to see more-joined-up thinking between the capital cost, maintenance costs, and running costs of the building in the design phase, leading to quality construction.

“Fortunately, there’s a greater awareness now of the full building lifecycle, and how certain materials behave within a structural fabric.

“The new regulatory framework and testing regime will help to ensure appropriate components are specified, are properly recorded, and can be correctly maintained to last the full life of the building they make up.

“This deeper understanding of building products and their performance is positively impacting approaches to hospital refurbishments, as well as the specification of materials for and design of new facilities.”

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