Asset management and maintenance
Dangers of shutting down facilities
Shutting down operational areas of a building is a major logistical exercise, and expensive in itself, before one factors in the cost of remedial work. The recent junior doctors’ strikes have been a sobering reminder of how treatment paths fall down like a row of dominoes if appointments are missed, and the IT systems simply are not able to re-shuffle them and get every patient back on track. While, for example, a Legionella-positive result does not always necessitate a shutdown, there is never going to be much time for delay; and institutional checks and balances make it difficult to authorise significant expenditure sufficiently quickly, especially if the buildings involved have not been kept front of mind. There may simply be no time for competitive tendering or normal due process. It is the finance director’s nightmare – especially if there are still questions about where the responsibility lies – ‘landlord’ or ‘tenant’. Better financial and legal minds than mine are unravelling this, but I still have no doubt that it is the organisation delivering the healthcare services that has the immediate responsibility to act. Who pays further down the line is another matter.
Schematic and asset register A good head start on remediation is having the schematic and asset register in place, and indeed I would urge any organisation operating in older premises to challenge its estates manager on the accuracy of the existing register or registers. Even where risk assessments are thought to be in place, their inadequacy can be quite surprising, and that, in turn, can often be traced to lack of understanding of the assets and infrastructure. Yet it is a key requirement of HTM and other guidance – which has de facto legal status – that risk assessments be carried out by competent persons, so it is even more surprising that good risk assessments are nowhere near ubiquitous.
The requirement for detailed schematics,
Understanding the risk starts with updating the asset register.
and other requirements for risk assessment, are laid out quite clearly in the Health and Safety Executive’s (HSE) Approved Code of Practice and Guidance (ACOP). Legionnaires’ disease: The control of legionella bacteria in water systems (L8). For healthcare estates teams, there is an additional requirement to adhere to the relevant Health Technical Memorandum, the recently published ‘new’ HTM 04-01, Safe Water in Healthcare Premises (2016). It goes beyond the requirements of ACOP L8 in a number of areas. One example is the treatment of water outlets that are not in regular use, which are likely to be more prevalent in older buildings that have seen many changes in use over the years.
Best practice
British Standard BS 8580:2010, Water quality. Risk assessments for Legionella control – Code of practice, clearly lays out
the best practice for risk assessments, but takes the form of guidance and recommendations rather than being a definitive specification. It is down to the healthcare provider, and its chosen advisers, to get it right. There cannot be comprehensive assessment of the risks if there is no comprehensive asset register to identify potential problems. This is especially important with so many Trusts now preferring to manage routine work internally. It is a logical approach that offers significant cost savings, but these will quickly be wiped out if the regime fails to address the risks and there is an outbreak. Yes, it may uncover the need for unexpected works; more often than not, however, grasping the nettle and commissioning a survey avoids them. Above all, it avoids the biggest expense of all – that of dealing with emergency remediation.
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A BEST PRACTICE IN MANAGING ELECTRICAL COMPLIANCE Health Estate Journal 49September 2016 * Risk Reducing
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