RCN position on asbestos in health and social care buildings

Background

Asbestos is a fibrous mineral which is resistant to heat, fire, chemical and biological breakdown. Due to these properties, asbestos was widely used in the construction and infrastructure of UK buildings over the last century, especially between 1950s and 1980s, this was until a total ban on the use and import of all asbestos was introduced in 1999.

There are three main types of asbestos:

• Crocidolite (also known as blue asbestos)
• Amosite (also known as brown asbestos)
• Chrysotile (also known as white asbestos and the most commonly used)

 Asbestos containing materials can be found in the following areas (non-exhaustive):

• Lagging (boilers and pipework)
• Spray coatings
• Insulation boards
• When added to cement
• Tiles/floor linings
• Textured coatings and paints (e.g artex)
• Sealants and gaskets

In addition, asbestos was also used in ironing boards, filing cabinets, safes, fire blankets and vehicle brake linings.

Exposure to even very small amounts of asbestos fibre can cause serious and fatal lung disease, including asbestosis, pleural thickening and a cancer known as mesothelioma which primarily affects the lungs. Mesothelioma can take a number of years to develop, often 30 years, with death rates increasing with age, especially in the over-75 category. The UK has one of the highest rates of mesothelioma in the world (Asbestos.com 2023).

The health risks of asbestos exposure have been known for over a century, with Factory Inspector Lucy Deane highlighting her concerns about the “evil dust” back in 1898.

However, it took decades of campaigning by pressure groups and trade unions to bring into force legislation to ban the importation, supply and use of asbestos, along with stronger controls on the safe management of asbestos already in situ.

There is no safe level of exposure to asbestos. The Control of Asbestos Regulations 2012 and The Control of Asbestos Regulations (Northern Ireland) 2012 place strict controls on all non-domestic building owners, tenants, or those in control of buildings, to protect their workers and others who use their buildings, for example patients, visitors and contractors, from exposure to asbestos.

 

Work and Pensions Committee Report

The 2022, cross-party Work and Pensions Committee report into the Health and Safety Executive’s (HSE) approach to asbestos management (Work and Pensions Committee 2022a) made a number of recommendations including:

• Setting a deadline for the removal of asbestos in non-domestic premises within 40 years
• A digital central register of asbestos in public buildings, starting off with schools and hospitals
• Increased inspection and enforcement activity by the HSE in relation to asbestos management

However, in their response to the report (Work and Pensions Committee 2022b), the UK Government did not accept the recommendation of a deadline for disposal or a central register, arguing existing legislation is adequate, and that a register would lead to extra work and duplication for those with a duty to manage asbestos.

 

Asbestos in healthcare

Due to the extensive use of asbestos in healthcare buildings over the past decades, healthcare workers have potentially been exposed when working in/regularly accessing areas where asbestos is in a poor condition. This is sometimes referred to as the third wave of asbestos related exposure and deaths. Exposure may also occur to nursing staff working in or adjacent to building or repair work which is taking place in an area where asbestos is present and when proper controls have not been put in place by the contractor or maintenance team.

 

Healthcare Statistics

Official statistics on nurse deaths from mesothelioma are thought to be unreliable and underestimate the risk, particularly as most are dying over the age of 75 and the Office for National Statistics (ONS) does not record the occupation of the deceased in the over 75 age group. 

Howie (2022) scrutinised the available data and estimated that nurses experienced approximately twice the number of mesothelioma deaths than would be expected from typical asbestos fibre concentrations where asbestos containing materials were in good condition.

Freedom of Information (FOI) requests by Mesothelioma UK (Allwork et al 2020) also found discrepancies between the ONS data on deaths of NHS staff due to mesothelioma and NHS claims data for negligence that had resulted in mesothelioma.

 

Asbestos in Health and Social Care Buildings

Health and social care buildings or buildings rented by health or social care providers built or refurbished before 2000 may contain asbestos.

A Labour Research Department report (2023), commissioned by the Trade Union Congress and the Scottish Trade Union Council, to look at the extent of asbestos in healthcare buildings, found two thirds of NHS premises and buildings in London and Scotland (which had been surveyed) still contained asbestos. Two thirds of these NHS premises and buildings with asbestos, are open to access by the public.

The high level of asbestos remaining in healthcare buildings, 23 years after a ban on its use, is of concern, and this concern is made greater by the state of the NHS Estate. Both the Kings Fund (2019) and the British Medical Association (2022) have recently published reports highlighting the deterioration and poor maintenance of NHS buildings and whilst neither reports specifically mention asbestos, it is likely that a backlog of maintenance and investment in hospital building infrastructure is increasing the risk of exposure to asbestos for those working and accessing these buildings.

The 2020 MAGS: The Heathcare Staff Mesothelioma Asbestos Guidance Study (Allmark et al) highlighted significant concerns, including the adequacy of data on deaths of healthcare workers from asbestos, and a lack of awareness amongst healthcare staff on the risk of asbestos related disease, including mesothelioma.  The project which was funded by Mesothelioma UK, also looked at the experiences of doctors and nurses who had developed mesothelioma.  The project report made a number of recommendations including improving quantitative data on mesothelioma deaths in the NHS, mandatory training on asbestos risks for new and existing members of NHS staff and better asbestos management processes and systems.

 

RCN Position

As nursing staff are at risk of exposure to asbestos and of developing asbestos related diseases, including Mesothelioma, the RCN wants to see positive action being taken to protect healthcare workers now and in the future. The perception that asbestos is a hazard of the past and that healthcare buildings are low risk environments needs to be challenged.

The RCN broadly supports the recommendations made by the Work and Pensions Committee in 2022 and the 2020 MAGS report.

Specifically, we are making calls on the UK Government, the Health and Safety Executive, the Health and Safety Executive for Northern Ireland and other relevant enforcement authorities, higher education institutes, duty holders (building owners) and employers to take preventative action.

UK Government

The RCN calls for the UK Government to:

• Provide immediate ringfenced funding to tackle maintenance backlogs in NHS buildings which may be leading to damage or disturbance of asbestos.
• Mandate the phased removal of all asbestos in health and social care premises, over a 40 year period, as suggested by the Work and Pensions Committee (2021a), beginning with immediate effect. The priority being for asbestos which is in poor condition and in public areas/areas where workers can easily access or disturb, to be removed first. This could be part of refurbishment work and upgrades linked to net zero improvements.
• Fund the phased removal of asbestos in public buildings where health and social care services are delivered.
• Fully resource the Health and Safety Executives in both Great Britain and Northern Ireland to enable them to proactively inspect NHS and independent sector health and social care buildings and, where appropriate, take relevant enforcement action.
• Develop a publicly available digitalised central register of asbestos for public buildings, including health and social care premises, to enable workers to access real time and retrospective information on potential asbestos exposure.
• Retain and strengthen existing legislation on the control of asbestos at work.

Regulators

HSE Great Britain and HSE Northern Ireland

The RCN calls for the national regulators of health and safety in the workplace to:

• Implement a programme of proactive asbestos management inspections of a cross section health and social care buildings including the NHS, GP and health centre buildings built or refurbished before 2000.
• Act on intelligence and concerns about asbestos from the RCN and other union safety representatives working in health and social care.

Other regulators

The RCN calls for:

• Local authority inspectors to include checks on asbestos management when inspecting care homes and residential care buildings.
• Patient safety regulators to be aware of the risk to patients and users of health and social care services from potential exposure to asbestos and to know when to refer concerns to the Health and Safety Executive/Health and Safety Executive for Northern Ireland.

 

Higher Education Institutions

Asbestos education, including the risk of work-related mesothelioma and other asbestos related diseases, to be part of nursing undergraduate and postgraduate education programmes. This could be within occupational health or health and safety related training or related to modules on respiratory disease.

 

Duty Holders and Employers

• As a minimum, duty holders and employers need to ensure that they are compliant with the Control of Asbestos Regulations 2012 or the Control of Asbestos Regulations (Northern Ireland) 2012.
• Employers need to ensure RCN safety representatives have readily available access to asbestos registers and asbestos management plans, in accordance with the Safety Representatives and Safety Committee Regulations 1977 and Safety Representatives and Safety Committee Regulations Northern Ireland 1979.
• Health and social care employers need to provide suitable and sufficient information on asbestos risks, including why there are asbestos warning signs and how to escalate any concerns as part of mandatory health and safety training, for all staff.
• The RCN supports the MAGS recommendation to remind staff who are leaving work at the NHS that they may have worked in a building containing asbestos and to be aware that mesothelioma and other asbestos diseases are possible. This could be part of retirement courses or exit interviews. Similar provisions need to be in place for independent sector workers who, throughout their career, may have worked in NHS or other non-domestic buildings containing asbestos.

As a professional trade union, the RCN is committed to raising awareness of asbestos risks in the workplace amongst our members and to providing RCN safety representatives with relevant information and training to empower them to scrutinise asbestos management in their workplaces and know when and where to escalate concerns.

We recognise the need to raise awareness amongst nurse managers and leaders and provide them with relevant information. 

We will also continue to support members to pursue personal injury claims. We will collaborate with partners who share the same aims and lobby and campaign to get our calls put into action. 

 

References

Allmark P, Tod AM, Darlison L. (2020) MAGS: the healthcare staff mesothelioma asbestos guidance study. Mesothelioma UK. Available at: www.mesothelioma.uk.com/mags (Accessed 31 May 2023)

Asbestos.com (2023) Mesothelioma in the UK. Available at: Mesothelioma in the UK: When Did the UK Ban Asbestos? (Accessed 31 May 2023)

British Medical Association (2022) Estates Infrastructure. Available at Estates infrastructure (bma.org.uk) (Accessed 31 May 2023)

Howie R (2021) Written Evidence to the Work and Pensions Committee Inquiry into the Health and Safety Executive’s Approach to Asbestos Management. Available at: https://committees.parliament.uk/writtenevidence/43700/pdf/ (Accessed 31 May 2023)

Kings Fund (2019) The Deteriorating State of the NHS Estate. Available at: The deteriorating state of the NHS estate | The King's Fund (kingsfund.org.uk) (Accessed 31 May 2023)

Labour Research Department (2023) Asbestos Still Widespread Among NHS Trusts and Boards. Available at: AsbestosWidespreadAmongNHS.pdf (tuc.org.uk) (Accessed 31 May 2023)

Work and Pensions Committee (2022a) Work and Pensions Committee Report into the Health and Safety Executive’s Approach to Asbestos Management. Available at: The Health and Safety Executive’s approach to asbestos management - Work and Pensions Committee (parliament.uk) (Accessed 31 May 2023)

Work and Pensions Committee (2022b) Work and Pensions Government Response to Asbestos Management Report. Available at: Committee publishes Government response to asbestos management report - Committees - UK Parliament (Accessed 31 May 2023)