NHS Disrepair Casts a Sector-wide Spotlight on Care Facilities and Provision
Kella Bowers, a partner and head of social care at Forbes Solicitors (www.forbessolicitors.co.uk), looks at why reports of disrepair in NHS buildings are a stark reminder for all care providers about the importance of maintaining satisfactory facilities.
A recent Freedom of Information Act request by the BBC found disrepair in NHS buildings. Reported examples include parts of a ceiling collapsing in a clinical area and temperatures in an operating theatre reaching 29 degrees Celsius, because of a broken air conditioning unit. Other issues were also highlighted, such as leaked sewage in a waiting area, growth of green algae in a hydrotherapy pool and power being lost in an operating theatre.
These examples were drawn from information provided by 86 NHS trusts, which had responded from a total of 210 that had been contacted. A key concern for all care providers is that disrepair and maintenance issues are impacting care provision. According to NHS data, the care of more than 2,600 acute hospital patients was disrupted last year by estates and infrastructure failures.
Any instances of compromised patient care and people being put at risk by poorly maintained facilities can quickly cast a spotlight on the entire care sector. Private care providers should take heed of this, especially now as organisations contend with potentially unsafe buildings caused by the historic use of Reinforced Autoclaved Aerated Concrete (RAAC).
Disrepair impacting care
Fundamental standards outlined by the Care Quality Commission (CQC) cover the requirement for care providers to deliver person-centred care that meets the needs and preferences of people. Alongside this, standards also specify that individuals should not be given unsafe care or treatment or be put at risk of harm that could be avoided.
The role – and expectation – of premises and equipment is also made clear by the CQC. Its standards emphasise the need for places of care and treatment, and equipment, to be clean, suitable, and looked after properly. The standards are a regulatory requirement under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and, at the very minimum, can be used by care providers as a check list for implementing and reviewing best practice.
Regular inspections and testing of premises and equipment can help care providers to maintain satisfactory and savoury conditions for people. This can be supported and formalised by policies that outline practical measures for the day-to-day running of premises. It’s advisable that this approach covers processes for quickly identifying any problems with facilities and triggering rapid responses to mitigate the impact on care provision and recipients of care.
Not all issues of disrepair and equipment failings can be fixed straight away. Generally speaking, this is understood by the Regulator, and demonstrating how any problems will be quickly isolated to minimise possible risks of harm can help to avoid compliance failures. Policies and plans can also outline acceptable periods of time for remediation of problems and short-term emergency measures, further helping to fulfil regulatory requirements that relate to ‘premises and equipment’ and ‘safe care and treatment’.
Upholding person-centred care
Looking beyond the regulations that specifically cover safety and facilities, care providers need to be mindful about how disrepair and maintenance issues impact upon care regulations covering ‘dignity and respect’ and ‘person-centred care’. This is particularly pertinent, as the presence of RAAC in structures can leave buildings unusable until deemed safe. If this limits access to facilities, disrupts routines and service provision, or means that recipients of care must be moved, it may compromise whether people are receiving the levels of care they actually need.
As well as being safe and effective, care provision must be compassionate and high-quality. There may be instances where disrupted routines or moving people from familiar settings causes stress. Similarly, delays to treatment or uncertainly about when services are being provided may lead to anxiety.
Levels of stress and anxiety can occur among both people in care, as well as staff, which risks further impeding levels of care provision. It’s important that organisations are considering scenarios where premises and equipment may be inaccessible and have contingencies in place for minimising the potential impact on the people in their care.
Widespread reports of the risks of RAAC and high-profile cases of disrepair, whether in the public or private sector, are likely to intensify the focus on the condition and quality of care facilities. It may be prudent for providers to take proactive steps to review how person-centred their facilities and services are, and ensure that they have the policies and practices in place to continually put people first, despite any change in circumstances. This could help to meet regulatory requirements and avoid complaints and claims, while also enhancing the quality of care provision.
