THE HYWEL DDA UNIVERSITY HEALTH BOARD has today (Aug 15) declared an internal major incident at Withybush Hospital as it seeks to identify the scale and impact of the Reinforced Autoclaved Aerated Concrete (RAAC) found in the hospital building.

The health board has decided to declare an internal major incident in relation to RAAC at Withybush Hospital to enable it to stand up its command and control structures (Gold, Silver and Bronze). In doing so, the health board is also able to prioritise the work of our teams to deal with the emerging issue and draw upon support from partner agencies that are members of the Dyfed Powys Local Resilience Forum.

RAAC is a material that was commonly used in the construction of buildings between the 1960s and 1990s. Its presence has been confirmed at Withybush hospital and at a limited part of Bronglais hospital. It has also been identified at a range of NHS properties across the UK, including several properties in Wales. 

The health board said that it is working with a Welsh Government approved external contractor to identify the scale of the issue – this involves surveying each of the RAAC planks on site. Where structural issues are identified, the extent of the remedial work is also being assessed.

Plans were put in place in May 2023, at the start of the survey process, to manage the impact on the operation of day-to-day services at the hospital and prioritise the availability of hospital beds. However, as they survey progresses the scale of the issues identified is putting additional pressure on the availability of clinical space and is likely to have a knock-on impact on services.

The health board’s statement reads: “To date, three wards in Withybush have needed to close due to the condition of the RAAC planks found, with the situation being managed and patients relocated to other health board locations in Pembrokeshire.

“Our intention is to manage as much of the relocation of patients within Pembrokeshire as possible.

“While best efforts are being made to conduct survey work as quickly as possible, the resulting findings of the survey work is, in some cases, requiring patients to be moved from wards to alternative locations and adapting services to reflect the availability of the site.

“As time progresses, this is likely to have an impact on other health board services at other sites as we move patients and services to alternate locations. Local mitigations are also being put in place, including structural props and temporary closure of impacted areas.

“Unless notified otherwise, patients should continue to attend their appointments and access services at Withybush Hospital as usual. However, this may be subject to change at short notice. Wherever possible, patients will be communicated with directly should a change be made to the service or clinic they are due to attend. Further information will be made available on the health board website at hduhb.nhs.wales/RAAC

“We know that the survey work and remedial action can cause considerable disruption and concern amongst members of our community and we apologise for any inconvenience caused. The health board would like to thank hospital staff, patients and visitors for their patience and understanding over the coming months while we carry out this essential work.”

Concrete safety under investigation

WORK continues on a programme of surveys at Withybush Hospital to determine the condition of concrete roof planks in wards at the hospital site in Haverfordwest.

Withybush’s principal construction is concrete panel and plank. The panels form the walls, and the planks support the panels. Due to several significant design flaws dating to its original construction, Withybush has chronic roof problems.

Those problems are additional to the fact Withybush’s fabric is beyond the end of its predicted service life.

When the then-Pembrokeshire Health Authority’s Estates Directorate carried out surveys of Withybush between 1989 and 1991. Those surveys predicted end-of-life within 20-25 years due to the inferior materials used in construction and the cost of maintaining the building.

The surveys began in May 2023. They aim to manage the risks around reinforced autoclaved aerated concrete (RAAC) planks. They are expected to continue for at least another seven months.

RAAC is a material commonly used in building construction between the 1960s and 1990s. Its presence has been confirmed in National Health Service properties across the United Kingdom, including several properties in Wales.

The UK’s Standing Committee on Structural Safety reported risks associated with aerated concrete in 2019. The product is still manufactured and installed worldwide.

It can be an appropriate construction material if properly designed, manufactured, installed, and maintained.

Professor Chris Goodier, a Materials Scientist from Loughborough University, said: “It is RAAC from the 1950s, 60s and 70s that is of main concern, especially if it has not been adequately maintained. RAAC examples have been found with bearings (supports) that aren’t big enough and RAAC with the steel reinforcement in the wrong place, which can have structural implications. Prolonged water ingress (not uncommon on old flat roofs) can also lead to deterioration.”

NHS England issued an instruction to NHS Trusts affected requiring aerated concrete’s removal by 2030.
Hywel Dda University Health Board’s Director of Operations, Andrew Carruthers, said: “In response to Welsh Government and wider industry alerts on this product, we have put in place a range of measures to manage the risk.

“In May 2023 we appointed a structural engineering company to undertake further intensive surveys of the areas in question and provide a full report on each RAAC plank.”

Survey work is being undertaken at pace and is likely to continue for several months. The work includes a visual survey of affected areas before a plank-by-plank detailed survey.

Where structural issues are identified, the extent of the remedial work is also assessed. This may see more local mitigations, including structural props and temporary closure of impacted areas.

Mr Carruthers continued. “Survey and repair work will have an impact on clinical areas and hospital wards, so all arrangements for repair work are being supported by the clinical hospital managers.”

Plans were put in place at the beginning of the survey process to manage the impact on the operation of day-to-day services at the hospital, with the availability of hospital beds a priority.

The order of surveys and associated remedial works have been arranged to maximise clinical capacity and ensure routine and emergency surgery can continue with minimal disruption to patient care.

To compensate for the temporary loss of beds at Withybush, 14 additional beds have been made available in Cleddau Ward at South Pembrokeshire Hospital in Pembroke Dock.

“Our hospital and community teams are working closely together to provide effective alternatives to the reduced capacity at Withybush, ensuring our patients are cared for in a place that best suits their needs, and this includes more beds and treatments in our community hospitals,” said Mr Carruthers. “This, in turn, has enabled us to treat more patients who have required hospital care and reduce the time they stay in hospital.”

Teams are now implementing plans for the next phase of the surveys on the remaining wards and offices on the ground floor at Withybush Hospital. This includes a visual inspection of planks in the first instance, which will identify any areas of concern.

Mr Carruthers continued: “We know that the survey work can cause considerable disruption and I would like to thank hospital staff, patients and visitors for their patience and understanding while we are carrying out this essential work.”

Professor Goodier said: “The Department for Education (in England) has requested all of the country’s 20,000+ schools to check if they contain RAAC, but some still have not, and hence urgently need to. Several have found RAAC and have been advised to seek expert guidance from a qualified Structural Engineer.

“The Ministry of Defence also issued a safety alert in 2019 on the back of the SCOSS report and is also investigating the problem.”

Preseli Pembrokeshire MS Comments

Preseli Pembrokeshire Senedd Member Paul Davies said: “It’s of critical importance that survey work is done quickly and I hope that Hywel Dda University Health Board is doing everything possible to make sure that happens.”

“The Welsh Government also has an important role to play in supporting the Health Board and ensuring it has the support and resources it needs to understand the scale of the problem – and to ensure remedial work takes place as quickly and safely as possible, so that patients can continue accessing services at Withybush hospital.”

“Given the seriousness of the situation and the impact it will have on the delivery of services in Pembrokeshire, I will be writing to the Health Minister to ensure the Welsh Government provides the Health Board with the support that it will need.”

“Remedial work needs to take place as soon as possible so that services continue at Withybush hospital.”