The recent prosecution of Bupa Care Homes over the death of an 86-year-old resident from Legionnaires’ disease highlighted significant failings in the management of water hygiene at the Hutton Village care home. In this article we take a look at the important Legionella control lessons to be learned from the tragedy, which are relevant to any dutyholder, whether as an employer, building owner or landlord.
During its investigation the Health & Safety Executive (HSE) identified a wide range of problems in the management and monitoring of Legionella risks at the home, the severity of which resulted in a very large fine of £3m. While the managing director of Bupa Care Services, Joan Elliot, asserted that the company has made “a number of improvements across all of our care homes”, particularly in relation to staff training, the incident shines a light on several areas of concern.
A care home setting is a particularly high risk environment for Legionella as residents are likely to be elderly, as well as having underlying health conditions which could increase their susceptibility to Legionnaires’ disease. In any building, it’s vital that the Legionella risk assessment takes into account the age and health of those who live in, work at or visit the premises, particularly since we have an ageing population and many people are living with conditions such as heart disease, diabetes or other ailments which increase their risk.
As HSE principal inspector Vicky Fletcher said after the Bupa case, “Residents were exposed to the risk of contracting Legionnaires’ disease because adequate controls were not in place…We would expect those who have a duty of care to understand this and have the necessary controls in place to manage the risk.”
When it comes to controlling the risk of Legionella, there are three key areas to consider: the water management strategy in place, the implementation of regular checks, and staff training procedures. In this case, there were worrying failures across the board.
Judging by press reports, water management in general was not given the necessary focus or attention at the home, despite the high risk nature of the setting. The HSE found that “Bupa had failed to implement the control and monitoring measures required to safely manage the hot and cold water systems” for over a year. The fact that the company pleaded guilty to the charges suggests that there were no mitigating circumstances or evidence to the contrary, and the situation was out of control for a significant period of time.
The backbone of any Legionella control programme is the implementation of regular checks to ensure that risks are being managed. Again, Bupa failed to maintain any kind of system of temperature checks and paperwork was found to be missing or falsified.
The kind of monitoring measures required in such a situation, such as taking water temperatures, flushing little-used outlets, descaling and carrying out visual checks, are the very basics of Legionella control and must be done regularly and methodically. Proper records should be kept and staff must be adequately trained.
Without such controls in place, bacteria levels can quickly escalate unseen and no-one will know there is a problem until it is too late and someone has fallen ill. As in this case, only by taking a water sample will you know that Legionella has taken hold.
Unless and until someone finds a way to eradicate Legionella, it’s very much a case of ‘know your enemy’. Therefore, training is arguably one of the most important parts of managing the risk. Given its particular resilience and ability to flourish in manmade water systems, it’s vital that all those responsible for management and maintenance of the facility understand the bacteria and how to control it.
Training must be kept up-to-date and be appropriate to the various members of staff and their role. Managers as well as the hands-on maintenance staff need to be educated, and all staff should have a basic understanding of the main issues so they can report any relevant problems quickly.
Aside from the everyday matters relating to lack of Legionella control, there is one other piece of evidence in this case which stands out: the fact that the care home had been undergoing large scale refurbishment.
Building work or any changes to the plumbing system are important red flags when carrying out a Legionella risk assessment. Changes to the flow of water, alterations to pipework, pumps or tanks can all affect the risk level and also invalidate any existing risk assessment and schematic drawing, so careful attention must be paid to Legionella control during and after such works, and the assessment reviewed every time changes are made.
The golden rule with Legionella control is to seek professional advice if you are unsure of any aspect of your responsibilities or how to fulfil them. As the Bupa case illustrates so clearly, non-compliance can cost lives, as well as prove extremely expensive and damaging to any business.
Water hygiene compliance isn’t always complicated, but for large buildings, complex plumbing systems or facilities where risks are heightened, it always pays to invest in specialist help.