Chlorine contamination at NHS flagship sparks investigation

The Queen Elizabeth hospital in Birmingham, a gleaming steel and glass edifice near the university, was meant to be a state of the art facility – the very best that the NHS could offer. When the country’s second largest hospital opened four years ago, it looked top notch. It was a behemoth, replete with 30 operating theatres, and constructed with 10,000 tons of steel and 35 miles of concrete foundations.

Like just over a hundred hospitals all over Britain, it was built under the private finance initiative. (PFI). But this one was a flagship, and the last Labour government was so proud of it Gordon Brown used it as the backdrop to his entire election campaign in 2010.

But although it will cost the taxpayer a cool £2.6bn under the controversial PFI, whistle-blowers have told us the buildings have been beset with construction and maintenance failings. Within the last few weeks alone, the police were called in after two patients died.

The problems uncovered by Channel 4 News range from the water supply to the fire safety system. And critics say those kind of problems are emerging up and down the country for this simple reason: the companies which are paid billions to build and maintain hospitals, schools and colleges are trusted to monitor themselves and report when things go wrong. But that doesn’t always happen – because it can result in big financial penalties.

Whistle-blowers – ‘concerns for five years’

The Queen Elizabeth was a project run by Balfour Beatty Workplace, which was sold to the French energy giant Cofely last year. Whistle-blowers have told us they have had concerns for five years. But things really came to a head this summer when the water supply was contaminated with chlorine on three separate occasions. In one incident it was 16 times higher than the limit recommended by the Drinking Water Inspectorate.

On August 4, high chlorine levels were first detected, and staff and patients were told not to drink tap water. They were given bottled water instead, and an internal investigation was launched.

On August 7, an email was sent to all staff stating: “Estates have been testing chlorination equipment at the Trust and have corrected the fault that caused higher than acceptable levels of chlorine to enter the drinking water. Water across all areas of the Trust has been tested, and it is safe to drink.”

But we have learnt that during that period two patients in critical care died. They had been receiving dialysis treatment from machines which had used the contaminated water. In a statement the hospital told us that because of the “possibility of a connection” with what it called “the chlorine occurrence”, the deaths were referred to the coroner’s office. The police were also called in.

But the very day the second patient died, higher levels of chlorine were again detected – this time in the radiotherapy department. And a day later, two further emails were sent asking nursing staff in the old hospital to “flush all toilets, macerators…and all taps both hot and cold…for at least 5 minutes each time”. This needed to be done “each day in the morning and late afternoon, until further notice”.

Ongoing investigation

West Midlands Police told us the investigation was ongoing but we understand they have not found any evidence connecting the deaths and the chlorine in the water.
In its statement, the hospital said: “A review of all chlorine systems has been completed and the implementation of any necessary works is being carried out. We have enforced additional safety measures which include 30-minute monitoring, 24 hours a day, with 4-hourly reporting back to the trust on chlorine levels across the hospital. There are twice weekly meetings between the trust and contractors.” They added “no patients or staff were adversely affected” during this period.

Cofely said in a statement: “We took action immediately and the problem was rectified on the same day.”

But this is just the latest in a series of problems we have uncovered at the hospital during a six month investigation. We have discovered crucial basic flaws in the design of the building which have made it difficult to maintain life-saving equipment.

Throughout the hospital, fire dampers are supposed to close to stop a blaze spreading.

Less than a year before the hospital opened, though, a technical report raised concerns about fire dampers in buildings operated by the mental health trust. It stated: “There is no suitable safety procedure available to enable BBW [Balfour Beatty Workplace] staff [to] safely carry out maintenance”. The report showed images of a damper sealed with tape, one propped open with a piece of metal, preventing it working in a fire, and others built into the wall so they couldn’t be accessed for testing.

Just two months before the hospital opened in 2010, Balfour Beatty management were clearly worried. One emailed: “I don’t need to tell anyone of the implications of not being able to test them [the dampers] for what is now 2 years.” In June, the month the building did open, another manager raised concerns the main hospital building was also affected. “I anticipate we will have the same issue on the main acute [site]”.

One thing that has to be kept in mind is that these are self-monitoring contracts. Robert Eyre, PFI expert

Between March and June 2010, 418 fire dampers in the Mental Health sections of the hospitals were inspected. Only 218 passed. 3 units were damaged and 197 could not be tested because of insufficient access.

In the acute section of the hospital the following year 31 dampers were tested, and only 1 passed. A year after the hospital opened there were still problems. One Balfour Beatty manager conceded “there is a risk they [the dampers] may seize when they are required to operate”.

Under health and safety law, fire dampers have to be tested every 12 months. In a statement, Birmingham and Solihull Mental Health NHS trust acknowledged that when the Queen Elizabeth opened in 2010, they were made aware that Balfour Beatty “needed to improve access arrangements for BBW staff to maintain fire dampers”. It added “a programme of works was provided, which commenced in 2010 and were completed in 2011. No payment for these works has been made by the Trust”.

Was the hospital safe?

One whistle-blower who worked for Balfour Beatty Workplace says staff were well aware of the issue. So was the hospital safe? The whistle-blower told me: “If you are not able to gain access to the fire dampers, in order to test them and maintain them then there is no way of telling whether they work correctly or not. So in the event of a fire there is no way to know.”

Despite these concerns, an inspector at West Midlands Fire Service told us fire dampers are only one line of defence, and as a whole the buildings are safe. He admitted, though, he was surprised he had never been informed about the untested dampers. But could that be because of a fundamental flaw with the way the private finance initiative is run?

One man who thinks so is Robert Eyre, a health and safety advisor for Balfour Beatty at the Queen Elizabeth, who left to set up his own company remedying Private Finance projects that have come unstuck.

Read more from Channel 4 News on the NHS 

“One thing that has to be kept in mind is that these are self-monitoring contracts… The private finance initiative has to report its own deficiencies to the NHS on a monthly basis and where things are deficient a deduction in the payments are made. The problem with that is that there is a bit of a disincentive for a PFI company to always be completely transparent. If they tell the whole truth it’s going to cost them a lot of money,” he told me.

And that financial disincentive, critics say, is what’s gone wrong with the private finance initiative – not just at the Queen Elizabeth in Birmingham but far beyond. More than 700 buildings – the very fabric of the public sector – were built using private money. Many now face scrutiny, and until the contractors are made to pay, it’s the taxpayer who is footing the bill.

Mr Eyre said: “We’ve probably looked at 12 or 13 sites now and we’ve seen problems on each and every site, they range from schools to hospitals to colleges, to a fire station. We’ve got hospitals were we’ve got fire compartment problems and to make sure the hospital can stay open the only way we can do it is to deploy a number of fire marshals whose job is to sit in corridors and watch for something to happen. Just so people can go about getting their clinical treatment.”

He reckons that what we have unearthed at the Queen Elizabeth only hints at the scale of the problem. “It’s very widespread, and what we’re seeing is just purely the tip of the iceberg,” he said.

It is now eight years since the Birmingham project got the go ahead. The vision for the super hospital was hailed at the time as spectacular but one of the hospital trusts involved in running the site says there are still on-going maintenance problems which are being gradually resolved. But behind the thousands of tons of steel and glass, what went on at the Queen Elizabeth raises troubling questions about what the taxpayer is really getting for the tens of billions of pounds we will spend on privately financed hospitals like this.

Throughout the hospital, fire dampers are supposed to close to stop a blaze spreading.

Less than a year before the hospital opened, though, a technical report raised concerns about fire dampers in buildings operated by the mental health trust. It stated: “There is no suitable safety procedure available to enable BBW [Balfour Beatty Workplace] staff [to] safely carry out maintenance”. The report showed images of a damper sealed with tape, one propped open with a piece of metal, preventing it working in a fire, and others built into the wall so they couldn’t be accessed for testing.

Just two months before the hospital opened in 2010, Balfour Beatty management were clearly worried. One emailed: “I don’t need to tell anyone of the implications of not being able to test them [the dampers] for what is now 2 years.” In June, the month the building did open, another manager raised concerns the main hospital building was also affected. “I anticipate we will have the same issue on the main acute [site]”.

One thing that has to be kept in mind is that these are self-monitoring contracts. Robert Eyre, PFI expert

Between March and June 2010, 418 fire dampers in the Mental Health sections of the hospitals were inspected. Only 218 passed. 3 units were damaged and 197 could not be tested because of insufficient access.

In the acute section of the hospital the following year 31 dampers were tested, and only 1 passed. A year after the hospital opened there were still problems. One Balfour Beatty manager conceded “there is a risk they [the dampers] may seize when they are required to operate”.

Under health and safety law, fire dampers have to be tested every 12 months. In a statement, Birmingham and Solihull Mental Health NHS trust acknowledged that when the Queen Elizabeth opened in 2010, they were made aware that Balfour Beatty “needed to improve access arrangements for BBW staff to maintain fire dampers”. It added “a programme of works was provided, which commenced in 2010 and were completed in 2011. No payment for these works has been made by the Trust”.

Was the hospital safe?

One whistle-blower who worked for Balfour Beatty Workplace says staff were well aware of the issue. So was the hospital safe? The whistle-blower told me: “If you are not able to gain access to the fire dampers, in order to test them and maintain them then there is no way of telling whether they work correctly or not. So in the event of a fire there is no way to know.”

Despite these concerns, an inspector at West Midlands Fire Service told us fire dampers are only one line of defence, and as a whole the buildings are safe. He admitted, though, he was surprised he had never been informed about the untested dampers. But could that be because of a fundamental flaw with the way the private finance initiative is run?

One man who thinks so is Robert Eyre, a health and safety advisor for Balfour Beatty at the Queen Elizabeth, who left to set up his own company remedying Private Finance projects that have come unstuck.

Read more from Channel 4 News on the NHS 

“One thing that has to be kept in mind is that these are self-monitoring contracts… The private finance initiative has to report its own deficiencies to the NHS on a monthly basis and where things are deficient a deduction in the payments are made. The problem with that is that there is a bit of a disincentive for a PFI company to always be completely transparent. If they tell the whole truth it’s going to cost them a lot of money,” he told me.

And that financial disincentive, critics say, is what’s gone wrong with the private finance initiative – not just at the Queen Elizabeth in Birmingham but far beyond. More than 700 buildings – the very fabric of the public sector – were built using private money. Many now face scrutiny, and until the contractors are made to pay, it’s the taxpayer who is footing the bill.

Mr Eyre said: “We’ve probably looked at 12 or 13 sites now and we’ve seen problems on each and every site, they range from schools to hospitals to colleges, to a fire station. We’ve got hospitals were we’ve got fire compartment problems and to make sure the hospital can stay open the only way we can do it is to deploy a number of fire marshals whose job is to sit in corridors and watch for something to happen. Just so people can go about getting their clinical treatment.”

He reckons that what we have unearthed at the Queen Elizabeth only hints at the scale of the problem. “It’s very widespread, and what we’re seeing is just purely the tip of the iceberg,” he said.

It is now eight years since the Birmingham project got the go ahead. The vision for the super hospital was hailed at the time as spectacular but one of the hospital trusts involved in running the site says there are still on-going maintenance problems which are being gradually resolved. But behind the thousands of tons of steel and glass, what went on at the Queen Elizabeth raises troubling questions about what the taxpayer is really getting for the tens of billions of pounds we will spend on privately financed hospitals like this.