Weybridge Hospital Update
Update 12th June: Earlier in the week we requested a copy of the report commissioned into the cause and extend of the fire at Weybridge Hospital.
This has now been received but as this is a 30 page document consisting of over 10,000 words we have only published the section relating to “Observations, Conclusions, and Recommendations for Further Action” below.
(for complete context the full report is available to download at the end of this post).
From the official NHS Property Services – Weybridge Hospital Fire – Investigation Report
6. Observations, Conclusions, and Recommendations for Further Action
6.1 As with most fires, the cause and subsequent damage cannot be attributed to one single event that occurred at Weybridge Hospital but because of a combination of several factors that came together to cause the eventual damage and destruction of the building.
This investigation has concluded that the most likely cause of ignition can be attributed to the AC unit, but it is the combined apparent failure of all the following conditions that eventually caused the development and spread of fire and the resultant destruction of the building.
The following points summarise critical issues and factors that can be linked to the fire;
6.2 Documentation
6.2.1 This investigation has encountered significant problems in acquiring important documents and relevant information. This has caused an extension to the anticipated duration of the investigation, particularly where documents cannot be traced or found. T o some extent this can be attributed to the many organisational changes the NHS has experienced during the lifetime of Weybridge Community Hospital. Information under the control of tenants, contractors and third- party organisations has also, at times, being difficult to obtain.
6.2.2 The level and extent of the damage sustained by the building prevented any examination of the scene from taking place. The investigation has therefore taken available information and evidence from various sources to identify the cause and development of the fire.
Recommendation 1a – This inability to refer to back to records and empirical information on buildings within the NHS estate is encountered frequently by NHSPS and therefore this report recommends that NHSPS review how building related information is stored and retrieved.
6.3 Management of Fire Safety
6.3.1 The Responsible Persons (as defined under the RRO) failed to recognise that a significant change affecting the use of the building had taken place when the Hospice moved out in April 2017 and the risk assessment for the premises was not reviewed. Central Surrey Health may not have been aware that as new occupiers they would need to undertake a fresh assessment of the premises when they replaced Virgin Care. It is evident that a review of the existing FRA was not carried out.
6.3.2 The investigation encountered difficulties trying to determine ownership of the room. It was only after several email communications with CSH IT department and Virgin Care, the previous occupier and installer of the equipment, that ownership was established. It is reasonable for CSH, or sections of CSH, if they considered that the room was not part of their demised area or did not contain equipment under their ownership, not to direct an assessment of that area.
6.3.3 Failure to review the premises FRA following the change of use also failed to alert the occupants and NHSPS that the building was not being monitored when the premises were unoccupied. An earlier response by the fire service may have restricted the extent of the damage caused by the fire. Only weak evidence exists to prove that all actions from the 2015 and 2016 FRA were completed.
6.3.4 It is evident from the speed at which the fire spread through the structure, information provided by the attending fire crews and details determined by this investigation that the lines of fire resistance separating the compartments at roof level did not provide an effective barrier to fire. It is difficult to conceive that given the 154 fire related defects found on the second floor and roof void none related to the roof structure.
6.3.5 The investigation has identified at least two occasions when essential inspections or assessments have been unable to access the Server Room (and the control room behind it), one being the Electrical Installation Condition Report and the second being the FRA carried out by Virgin Care Limited. This has also been reported as a similar issue across other properties in the NHSPS estate. Server rooms are considered as Hazard Rooms and should be an essential aspect of any inspection or assessment.
6.3.6 Several process issues regarding the fire alarm system have been identified during the investigation. These relate to inaccurate details recorded on certificates and records, incorrect time recorded on the fire alarm panel and failure to replace defective batteries.
Recommendation 2a. NHSPS to ensure all tenants are made aware of their obligations under the Regulatory Reform (Fire Safety) Order and the requirement to inform NHSPS of any changes affecting the premises.
Recommendation 2b. NHSPS to review company position on the monitoring of the fire alarm systems in its premises.
Recommendation 2c. NHSPS to continue to improve its arrangements for obtaining assurance that actions resulting from inspections, servicing of equipment and risk assessments are addressed.
Recommendation 2d. NHSPS continue to progress the intrusive fire surveys of in-patient and high- risk health centres to assess the standard of fire separation of these properties.
Recommendation 2e. NHSPS to continue to progress the Lease Regularisation Programme to ensure leases clearly identify landlord and tenant demises and responsibilities.
Recommendation 2f. NHSPS to evaluate the effectiveness of current governance and management arrangements for principal contractors and sub -contractors.
6.4 Probable Cause
6.4.1 The fire started at approximately 23:30hrs on the evening of the 11th July 2017. It most likely started in Server room 204 on the second floor of the premises.
6.4.2 The most likely cause of fire is a fault within DeLongi Air Conditioning unit eithe r, as a result of electrical ignition or heat generated by a mechanical fault. The root cause of this incident can be attributed, to some extent, on the age of the installation in combination with the evidence of overrated overcurrent protection devices operating at full capacity and the apparent redundancy of the AC unit, but again to note the AC unit was serviced only three months prior to the fire and no reported faults at the time.
6.4.3 The conclusions and wider findings documented in the text of the report, relating to the AC unit are issues that warrant further attention.
Recommendation 3a. NHSPS should review the age and condition of all fixed electrical equipment, including AC units fitted in premises across the Estate. Tenants and owners of server rooms should
review the adequacy of installed cooling equipment to ensure it matches the heat output of the equipment installed particularly if new or additional equipment is installed.
Recommendation 3b. NHSPS will inspect all risk rooms (including server rooms) as part of the Landlord’s Fire Risk Assessment, irrespective of the actual or perceived ownership.
Recommendation 3c. NHSPS to review its managements arrangements and governance of electrical safety.
6.5 Fire Development and Spread
6.5.1 Following initial ignition, fire appears to have spread from the unit through to the combustible underlay of the roof structure and timber battens. It most likely spread rapidly across the roof void causing the roofing tiles to dislodge and allow the fire to vent through the roof, where it was then observed by a member of the public and reported to the fire service.
6.5.2 Fire crews witnessed the fire spreading rapidly through both sides of the roof void seemingly unaffected by any fire compartment walls or barriers. Documented evidence of poorly constructed or missing fire compartmentalization can explain why the fire spread rapidly through the roof void. Eventually the fire spread to lower levels in the building.
6.5.3 The apparent rapid rate of the fire spread through the upper compartments and the danger from exploding oxygen cylinders prevented the fire service from mounting any form of offensive firefighting measures, instead relying on adopting a defensive approach by restricting any form of attack to being mounted from the outside of the building only. Fire crews also report, that during the early stages of firefighting operations the water supply was poor and so limited the impact of firefighting jets directed from the outside of the building onto the fire.
The rapidity of fire spread through the structure was such that in addition to the recommendation already made regarding the integrity of fire compartments, NHSPS should review:
Recommendation 4a. NHSPS should review their portfolio of properties to identify the construction type, with particular reference to timber frame buildings.
Recommendation 4b. Where responsible, NHSPS to review its inspection and maintenance arrangements for onsite fire hydrants ensure they are being suitably maintained.
6.6 Communication
6.6.1 The final recommendation is made to help inform the wider NHS of the learning made from this incident.
Recommendation 5a. NHSPS to ensure learning from Weybridge Hospital is shared with the wider NHS and other stakeholders.
A link to the original report can be found here:
NHS Property Services – Weybridge Hospital Fire – Investigation Report
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Update 8th June: The following is from a document published on the http://www.nwsurreyccg.nhs.uk/ – the original document can be downloaded from a link at the end of this post.
June 2018
What is happening with the walk-in centre in Weybridge?
The walk-in centre was located in the same building as a wide range of GP and community services. Since the devastating fire in July 2017, we have managed to ensure the continuation of primary care services by getting the existing two GP
practices back on the site along with a range of community clinics provided by CSH Surrey e.g. phlebotomy clinics.
It has not been possible to provide the facilities required for a walk-in centre to operate fully. The nearest alternative urgent care centre is a few miles away from Weybridge at St. Peter’s Hospital (next to the A&E department). We appreciate this is not preferable for people who used and valued the previous walk-in centre in Weybridge.
The local NHS has committed to re-developing and maintaining local health services on the Weybridge site and we are currently considering options for their future composition. We fully intend to involve members of the local community with
development of these options and details regarding ways to get involved will be shared soon.
Is it possible to have a temporary walk-in centre for Weybridge?
A walk-in centre requires certain infrastructure that cannot be provided in temporary buildings e.g. X-ray facilities. There were also restrictions on space that meant it would not be possible to accommodate all elements of a walk-in centre.
Finally, there was a need to prioritise those services used most regularly by the local community, these being the GP services and community clinics.
Is the local NHS going to sell the site?
No. We recognise the value of having services provided locally to the people of Weybridge and as such we are committed to delivering comprehensive health and care services at this location. Our long-term aim and commitment is to extend these services on this site.
NHS policy is clear that we only sell sites that are surplus to requirement. There are therefore no plans at present to sell the site of the old Weybridge hospital.
Will there be another walk-in centre in Weybridge?
The NHS across England has received a national directive to expand and improve all previous forms of community based urgent care (Walk-in-Centres, Minor Injury Units etc.) to become Urgent Treatment Centres. All of these centres across the country will have a standard service offering that will include:
- Access to urgent care appointments with highly trained practitioners, under GP leadership
- Diagnostics such as X-ray and basic blood testing
- Convenient access to appointments bookable directly online or through NHS111, which will reduce waiting times for patients
As a result of this directive and prior to the fire, the CCG was already planning how this type of care would be best provided for patients across North West Surrey as part of the overall provision of urgent and emergency care.
We will be entering into a formal public consultation to agree the design, location and deployment of these key services and we hope the public will help us by taking part and sharing their views on the different options.
We want to work with the local community and we are committed to making sure local people get the right kind of local services.
Are there any plans to involve patients in discussions about what will happen to these services in the future?
Yes, the CCG is finalising its plans to involve patients and the public in discussions.
We plan to hold a public consultation on where urgent treatment centres would be best located across North West Surrey to meet the urgent and emergency health needs of our patients. We are aiming to start this consultation in September, to run for a 12-week period through to December 2018.
There will be multiple opportunities to get involved with the consultation, to join the conversation about urgent and emergency care provision and to let us know your views on the different options.
Once we have reached a decision regarding the provision of urgent treatment centres in North West Surrey, following the public consultation, we will have a better idea of the full range of services to be developed and built on the Weybridge site.
- As well as these plans for the public consultation, you can already get involved with future health service planning in a number of ways:
- Many of our GP practices have patient participation groups (PPGs), including Weybridge GP practices. These forums discuss local health matters. North West Surrey CCG has a PPG Chairpersons’ group that meets regularly.
- We have a Patient and Public Engagement Forum (PPEF) which brings together patients and local health interest groups in North West Surrey on a regular basis to develop our engagement plans.
- We are establishing a specific Patient Reference Group to focus on this programme of work
How will the rebuild be financed?
NHS Property Services are responsible for funding any re-build. Money has not been taken from local health service provision for building works.
What we had before worked really well. We know there are funding pressures in the NHS so are you looking to reduce those services because of that?
No. As a CCG we are of course obliged to meet our financial obligations but equally important are quality of care, patient experience and clinical safety.
That means having the best patient outcomes, meeting the latest standards for clinical safety, providing a good experience for the patients who rely on them and services that are easy to access when needed.
We need to make sure we have the right mix of local health services, that’s why we will be consulting people locally and across North West Surrey.
We have a petition signed by almost 3,000 local people to keep the same health services here, what do you say to those people?
Our planned engagement and consultation will allow everyone to join the conversation about our suggestions across North West Surrey and let us know their thoughts. Where we can we will contact the people who signed the petition and
send everyone a consultation document.
We hope the local community will participate in the varied events and activities that we are planning to take place during the public consultation and let us know their views.
Are there any updates on the cause of the fire?
Following the fire at Weybridge Hospital, NHS Property Services (NHSPS) commissioned an investigation into the cause and extent of the fire.
You can request a copy of the report from NHSPS at the following email address:
customer.service@property.nhs.uk
Updates on the CCG’s plans to engage and consult patients and the public regarding the rebuilding of health care services on the site and out of hospital care in general will be published regularly on our website and shared directly with stakeholders who have confirmed that they wish to receive this information (http://www.nwsurreyccg.nhs.uk/weybridgehospital)
If you would like to receive updates on these plans from the CCG, please contact us using any of the following methods:
Email: nwsccg.comms@nhs.net
Post: North West Surrey CCG
58 Church Street
Weybridge
Surrey
KT13 8DP
Tel: 01372 232400
Text/SMS 07880 091328
[document ends]
A link to the original NHS document can be found here
Additonally, the North West Surrey CCG have set out a number of Community Engagement proposals which were published earlier this year, details of which can be found below:
1. Engaging local people across North West Surrey on our urgent care strategy
As we described at the public meetings in Weybridge on 17 October, we are starting to think about how we plan and improve access to urgent care services across North West Surrey. This will include services in Weybridge so it makes sense to start thinking about the wider picture first before we focus on the detail for a new healthcare facility in Weybridge.
To start this engagement, we are planning to hold a wider engagement event with up to around 50 people from across North West Surrey to start thinking about the best way to provide urgent care, on the day services for local people. This is likely to be a daytime event and we will also be inviting people from other parts of North West Surrey. This would include some facilitated table discussion.
2. A smaller working group to look at our developing urgent care strategy
Following the event above, we would look to create a smaller working group that might meet every 2-4 weeks for a period of several months while we work through options and move towards public consultation.
3. Weybridge Hospital Patient Advisory Group
Once we have clearer plans for urgent care access across North West Surrey, we would like to create a dedicated patient group to consider services and the look and feel/design for a new health facility in Weybridge. We anticipate a working group of up to around 20 people. This is not likely to meet until well into the New Year. This group is likely to meet approx. once a month for the duration of our planning for the new build (which could be up to around two years depending on how the planning moves forward).
As we indicated at the meetings in Weybridge, engaging the local community is a key part of our planning; we will continue to keep people updated via our website, the local press and other methods as appropriate and there will also be opportunities for more people to get involved during public consultation where we will also have further public meetings. During that wider consultation period we would also be very happy to come out and talk to local groups as much as possible.
In the meantime, we would be very grateful if you could indicate which of the above you would be interested in participating in; these are not mutually exclusive so you could opt for more than one if you wish. Please email your details to nwsccg.comms@nhs.net”
http://www.nwsurreyccg.nhs.uk/community-engagement
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