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Asbestos in NHS trusts - what you need to know

As you may know asbestos is still present in over 1.5 million buildings in the UK.

Many of them are public buildings built before the year 2000. A significant portion of those are hospital sites.

As the NHS grew at a time when asbestos was being widely used, it’s not surprising that directors of compliance and estates at NHS trusts are on the ‘front line’ in dealing with the safety risks that it presents.

Make no mistake: NHS trusts go to great lengths to protect their patients and staff from the risks asbestos poses. However, they face an uphill battle against time and squeezed budgets – both of which can be stretched even further when urgent risks to patient health arise, such as extreme heatwaves or cold spells.

If you are a dutyholder, there is a lot that you already know about asbestos safety in your NHS trust. Read on to find answers to common questions that you may not have known about.

How prevalent is asbestos in the NHS?

Despite a total ban on the use of asbestos in construction in 1999, it was used prolifically when constructing or redeveloping NHS sites (as well as other public buildings) in insulation, fireproofing and textiles.

You will already know that if it doesn’t present a risk to human health, it is considered safe to leave it where it is (though you must continually re-assess whether that risk to health changes).

This fact alone can explain why it is still so widespread – and if you are reading this, it is likely that you are affected by it. The BBC reported in 2017 that it was installed in 94% of hospitals in London alone, and the Pharmacist’s Defence Association reported its presence in 695 NHS hospital buildings in Scotland.

Where exactly is asbestos present in a hospital?

In hospitals, many of the asbestos-containing materials (ACMs) you may be responsible for monitoring and managing the safety of will be in maintenance areas such as:

  • Ceiling and Loft spaces
  • Plant rooms
  • Lifts and stairwells (known as vertical service risers, which can include pipework, too)
  • Maintenance ducts and corridors
  • Boiler houses
  • Between floor voids
  • In pipe lagging

As you may notice, these areas aren’t unique to a hospital environment – and the regulations governing your management of the risk aren’t any different to another non-commercial facility.

However, given that the presence of asbestos in these locations can affect the operations of both staff and patient facilities, the speed and nature of your response to the asbestos risk are critical in averting a more significant facility safety or human health issue.

Compliance Tip: The areas where asbestos is installed in your hospital will all be indicated in your asbestos register. However, if you believe that it is incomplete or incorrect, you should immediately request expert advice – which may involve surveying or reinspection - to identify areas where it may be installed.

How likely is it to affect patients and staff?

It’s exceptionally unlikely that patients will be directly exposed to asbestos in a hospital ward – a lot of work to remove asbestos from patient areas has taken place over the last 20 years.

However, there are two dimensions that require particularly careful management from the duty holder:

1. “Knock-on” effects

If asbestos is found to present a sufficiently high risk in a maintenance area that provides a critical service for a ward (e.g., heat or air conditioning), it’s entirely possible for that area shutting down to have a knock-on effect that causes the ward to be temporarily closed as well.

2. Long-term exposure

As you might know, the risk posed by asbestos is low in a single case of exposure, and much higher in long-term, repeated exposure to airborne asbestos fibres.

It’s a misconception that only people who work directly with asbestos are at risk.

The Guardian reports that, since 2017, 53 healthcare professionals in England – none of whom are maintenance staff - have died of mesothelioma as a result of long-term ‘occupational exposure’ from working in NHS buildings where asbestos is installed.

Ø  Compliance Tip: if your staff are likely to be working near asbestos-containing materials (ACMs), you will need to communicate these risks to them as part of the ‘communication plan’ in your asbestos management plan.

What can I do if I have any doubts about the condition or location of asbestos in my trust?

The duty to manage asbestos in an NHS trust doesn’t always fall to the same person – much less the day-to-day compliance tasks.

Even if, as a director of compliance or head of estates, you are the duty holder in your trust, that responsibility may be held by someone else elsewhere – in particular, by the owner or leaseholder, such as NHS Property Services.

This is important because, regardless of who the duty holder is, they will often appoint an Authorising Engineer (AE) – an independent and legally competent advisor whose sole focus is to resolve these doubts and build a strategy for asbestos management.

So, whilst you can gain some clarity by reviewing your asbestos management plan and identifying gaps in knowledge, there is little time for many duty holders to do this, much less build a comprehensive, long-lasting strategy for asbestos management. This is why it’s often common practice to appoint an experienced AE.


Protecting ‘at-risk’ patients and staff, managing projects cost-effectively, and juggling these with other vital health, safety and energy-efficiency demands – whilst the regulations governing asbestos safety aren’t unique to the NHS, the scope and scale of challenges you face are.

You may already know what support you need – from short-term projects to long-term strategic guidance – and if you are ready to seek that support from a pragmatic, competent partner, get in touch with us.

Call 0203 384 6175 or contact us via email with any enquiries here.

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