Source · Select Committees · Public Accounts Committee
Recommendation 20
20
Accepted
RAAC in hospitals causes severe disruption and clinical risks, impacting patient care.
Conclusion
Reinforced autoclaved aerated concrete (RAAC) is a lightweight building material that was widely used from the 1960s to the 1980s. From the late 1990s, industry bodies warned that it was unlikely to remain structurally sound for more than 30 years after construction. NHS England became aware of its problem with RAAC from around 2019, after a school roof collapse led to a national alert in 2019 about the risk of sudden failure.40 Mitigating the risk of structural failures from RAAC can be very disruptive to a hospital’s operations. We visited two hospitals with RAAC and saw for ourselves the impact on clinical work. This included wards having to close urgently and the managing of patient admissions based on weight because of the risk of a floor collapse. DHSC confirmed that there was an impact on clinical spaces and NHS England told us “the management of RAAC can be really burdensome for local teams” and that mitigations could not completely eliminate risks.41
Government Response Summary
The government confirms the New Hospital Programme now includes the replacement of all seven RAAC hospitals, with early works to prepare sites beginning by the end of 2025, and existing hospitals remaining safe through ongoing monitoring. The department will assess RAAC in other health and social care systems and name a senior official responsible for the plan.
Government Response
Accepted
HM Government
Accepted
Following a reset of the programme in May 2023, NHP now includes the replacement of all seven hospitals built entirely of reinforced autoclaved aerated concrete (RAAC) which has become structurally unsound. 3. PAC conclusion: Recent events have shown that DHSC will need to go faster with its efforts to deal with reinforced autoclaved aerated concrete (RAAC) in hospitals 3. PAC recommendation: DHSC should revise its plans for managing the RAAC crisis, including: • Expediting surveys of the NHS estate and publishing the results in full so the extent and scale of the RAAC problem is known. • Reviewing whether the commitment to eradicate RAAC from the NHS should be brought forward from 2035, and, in light of NHS estate survey results, reviewing whether the existing £685 million fund up to 2024–25 is sufficient. • Aiming to start construction before the end of 2025 on replacements for the seven entirely RAAC hospitals. • Appointing a named senior official to oversee delivery of its RAAC plan and to support NHS trusts to make the right decisions on the safety of RAAC buildings. • To ensure transparency on this issue, writing to the Committee alongside its Treasury Minute response with its latest assessment of the scale of RAAC in other parts of the health and social care systems, including community settings, GP practices, and the adult social care sector. 3.1 The government agrees with the Committee’s recommendation. Recommendation implemented 3.2 The NHS has been at the forefront of the public sector response to RAAC and has been surveying sites since 2019. The department will continue to work with NHS Trusts to expedite surveys where possible RAAC is identified. While publishing surveys in full will not be possible due to the commercially sensitive information contained within, the government commits to continuing to publish and update information on confirmed RAAC within the NHS on Gov.uk. 3.3 The department will continue to keep the commitment to eradicate RAAC from the NHS estate by 2035 under review. Significant RAAC eradication will occur before 2035, including the work to rebuild the seven hospitals most affected by RAAC as part of the NHP. The department supports construction on the replacements for the seven entirely RAAC hospitals as a priority, and at a minimum, we aim to begin early works to prepare sites by the end of 2025. The existing hospitals will remain open and safe due to ongoing monitoring and mitigation of existing RAAC, in line with current evidence and recommendations from the Institution of Structural Engineers. 3.4 The department regularly assesses the financial implications of increased RAAC identification. Work is on-going with Trusts where RAAC has been recently identified to assess the financial and clinical implications of eradicating RAAC from these sites. The funding needs for RAAC mitigation and eradication beyond 2024-25 will inform the department’s bids at subsequent Spending Reviews and future budgets. 3.5 The department will write to the Committee with an assessment of the scale of RAAC in other parts of the health and social care system, noting there is no obligation for private owners to report the presence of RAAC to the department. The letter will include the name of the senior NHSE official responsible for its plan on RAAC.