In a letter from NHS England issued yesterday (5 September) to healthcare bosses, NHS England’s chief commercial officer, Jacqui Rock, and the national director for emergency planning and incident response, Dr Mike Prentice, also advised boards to ensure they plan for RAAC incidents, including the decant of patients and services, as part of business continuity measures.

A regional evacuation plan has been tested in the East of England, with learnings from this exercise having been disseminated to other regions.

Says the letter: “We would recommend that all boards ensure that they are familiar with the learning from this exercise and that they are being incorporated into standard business continuity planning as a matter of good practice. This exercise is, however, essential for those organisations with known RAAC, and should be done as a matter of priority if it has not already been completed.”

RAAC planks were used in building roofing, walls and flooring from the 1960s to the early 1990s. RAAC planks are considered relatively weak and prone to degradation over time, with the useful life of such planks estimated to be around 30 years.

Seven RAAC hospitals to be rebuilt

The recent issues around RAAC in hospitals go back to 2019, when, following an alert issued by the Standing Committee on Structural Safety, the NHS in England put in place a programme to identify the material, support providers to put appropriate mitigations in place, and plan for eradication.

NHS England says it has worked closely with trusts managing 27 previously identified sites, including securing funding for investigative, safety/remedial and replacement work, with three of those sites now having eradicated RAAC.

In May, NHS England sent out additional guidance to organisations, including all provider trusts, following updated national guidance from the Institute for Structural Engineers (IStructE) on RAAC identification, management and remediation.

That same month, the Government confirmed investment of more than £20 billion to be spent on new hospital infrastructure. Seven hospitals – Airedale in West Yorkshire; Queen Elizabeth King’s Lynn and James Paget Hospital, both in Norfolk; Hinchingbrooke in Cambridgeshire; Mid Cheshire Leighton in Cheshire; Frimley Park in Surrey; and West Suffolk Hospital – need a full replacement and will be rebuilt through the New Hospital Programme (NHP) before 2030 using a standardised design known as Hospital 2.0.

A national RAAC programme team are collating information from trusts' assessments of their estate, requested following the updated IStructE guidance, including where appropriate mitigation plans and the steps necessary to remove this material from use.

In a statement issued last week, a Department of Health and Social Care spokesperson said: “The NHS has a mitigation plan in place for hospital buildings with confirmed RAAC, backed with significant additional funding of £698 million from 2021 to 2025, for trusts to put in place necessary remediation and failsafe measures. We remain committed to eradicating RAAC from the NHS estate entirely by 2035.”

North of the English border, NHS Scotland issued a safety action notice in February this year on the risks of RAAC planks in healthcare buildings in Scotland. It subsequently completed a “desktop survey” of its estate in June to assess which properties should be investigated for the presence of RAAC.

In July, the BBC reported that on-site investigations were underway to determine whether RAAC is actually present at hospitals, and these could take up to eight months to complete.

Maintenance backlog

Responding to the letter from NHS England, the deputy chief executive of NHS Providers, Saffron Cordery, said: “Long overdue investment is now being made available through the New Hospital Programme. The seven trusts with the most critical RAAC risk will be replaced by 2030 but it is concerning that those with remaining RAAC planks have to wait until 2035 before they’ll be removed from the NHS estate.

“With these and many more buildings in desperate need of modernisation and restoration – and a burgeoning repair bill of more than £10bn, much of it high-risk – there is a major worry that these buildings will fall into a further state of disrepair as time goes on, worsening the risk to patients, visitors and staff.”

Responding last week, as the wider RAAC crisis engulfing schools and other public buildings was developing, Matthew Taylor, chief executive of the NHS Confederation, said: “The RAAC issue is part of a much bigger problem facing the NHS where the current cost of the maintenance backlog for repairs, building upgrades and new equipment stands at £11bn and where over one in five primary care premises in England are not fit for purpose.

“As capital spending in the NHS over the last ten years to 2020 has been around half that of other OECD countries, it’s clear this will require further and sustained attention from the Government to put right.”