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The Special Forces of an NHS Acute Hospital

21 November 2019

I love this task I’ve set myself of spending time at least once a month in a different area of the Trust and then sharing it with everyone.

I’ve started to receive invites now and that’s how I came to be at the ‘Works’ Department at the Royal Lancaster Infirmary recently.  I knew they had something to do with fixing things and the boiler, but that was about it.
I arrived with all of my preconceptions bubbles about to be burst. I wore my ‘best dad going to do real work clothes’ - Jeans polo shirt and combat boots!

“Not working today dad?” the kids asked me at breakfast. 

I met Keith the manager in the hospital canteen, for a brew first! We could then get to know each other before heading over to the Works Department, before a hearty bacon sarnie. 

I arrived at the Works Department office with Keith only to find there was no smell of freshly cooked bacon and ketchup in the air!

What’s going on?  I used to have a ‘real’ job once, before I developed office workers’ hands. The only smell here was of hard graft. Keith introduced me to the staff in the office – apologies I can’t recall your names, but you made me feel very welcome, even if there weren’t any bacon butties!

My dad clothes needed to go and I was issued with branded ‘works’ polo-shirt and steel toe-capped boots.
I felt like I could take on the world! Puffed out my chest and got stuck into learning/quizzing Keith and Nigel the Estates Manager.

I started by asking the question that’s frustrated me for the past ten years at the Trust, “Why is the hot water so hot?”, followed by “why don’t we have USB points for patients to re-charge their mobile phones?”  

All helpful questions I thought. Tere was no lightbulb moment for Keith or Nigel such as “thank goodness a Director has visited, we can turn the boiler down now!”

The water is heated in the boiler house and has to travel a long way to get to the tap and to kill the legionella bacteria it needs to leave the boiler house at 60 degrees C. and returns to the boiler house at 50 degrees C or above. This requires water temperature sensors to monitor this delicate and precise operation. Patient areas have their temperature lowered to reduce the risk of scalding.

And my ‘ground-breaking’ USB points for patients if you’re like me you might have swapped out some of your three-pin sockets at home for those new ones that also have convenient USB points too? 

Well, they informed me due to NHS safety guidance they are not permitted in healthcare premises as they pose a risk as they are always powered on without any fused protection and therefore you can have the potential of any fault coming down the cable.  We’ve all had the phone cable with the frayed part, now imagine touching that when it’s live – bang!  Fire and health risk!

Nigel and Keith didn’t seem to be blown away that I knew what PPM meant (planned preventative maintenance).
They have thousands of items that need to be scheduled to be monitored and tested every day throughout the year, the legionella issue, imagine how many taps and water outlets there are in a city hospital, every one of them needs to be tested for effectiveness you can’t have any standing water anywhere through a tap that hasn’t been turned on regularly or poor tap design, same with showers. 

I have to admit I’ve taken all this for granted for decades. The Works/Maintenance Department, like the ‘Special Forces’ of the NHS, go about their business quietly and professionally almost stealth-like 24/7/365.
Next time I buy an electrical item, I’ll give it a bit more thought as I learned that just between the Royal Lancaster Infirmary and the mostly outpatient hospital in Morecambe 17,500 electrical items need to be inspected and tested annually (PAT – Portable Appliance Testing).

I was also given the honour (apparently it is one. Not even our CEO has done it) of setting off the 11 o’clock fire alarm test – I received some admiring Tweets on how people we impressed with my control-key turning abilities – I was just excited that they let someone with a brain injury (me!) undertake a time-critical task!

I spent a large part of the da  out around the hospital site with Ben one of our electricians and despite him being a Man Utd supporter, he was a good bloke!

My time with Ben saw the following jobs all dealt with swiftly - with my expert input, of course:

• Testing a new microwave on a ward
• Checking a leaking dishwasher on a ward– reassigned to the plumber
• Repairing and replacing switches in the pathology labs
• Repairing an electric hot water dispenser

Lunchtime came and went without a bacon sarnie still – and they call themselves tradespeople!

Now to embarrass Ben, one of his colleagues told me that on Remembrance Day this year one of our wards that generally cares for older patients, some with dementia didn’t have a working TV, so despite it not being Ben’s job, he repaired the TV so that the patients could watch the remembrance day events. Just perfect Ben, what a star, you'll make a great Liverpool supporter one day!

My visit to the boiler house was somewhat different from what I expected. The hospital has three boilers, and they are monsters, each boiler needs to be stripped and checked every year for safety and they can only be turned back on if our Insurers ‘sign off’ on them.

I saw one boiler which was being inspected and it was the depth of the inspection that was eye-opening, it’s not just Dr Who that has a sonic screwdriver. The weld on the boiler housing needs to be ultrasonically inspected for integrity. I’ve learned that “Radiographic and ultrasonic weld inspection are the two most common methods of non-destructive testing (NDT) used to detect discontinuities within the internal structure of welds.” (Courtesy of ESAB).

At the end of my day, hungry from lack of crispy bacon, I realised what the works department does and why so many people I think don’t know much about them: what they do first and foremost is they keep staff and patients safe, and they do it so well they go unseen.

It isn’t just at the Royal Lancaster Infirmary and the QVH in Morecambe where this great work is taking place, it’s happening across all hours at Westmorland General Hospital in Kendal and at Furness General Hospital in Barrow too.

I was pleased to see how technology was being used to remain efficient and effective too. Maintenance requests can be requested via the staff intranet on a form, no phone call needed and the information goes straight into their system ready for allocation. All of the tradespeople carry portable digital devices which are updated by Wi-Fi.

If your micro on your ward isn’t working, I promise I wasn’t allowed actually to repair anything or touch any electrics! I was also pleased that on the day I was able to make so many nurses laugh when they saw me in my new work clothing! What’s so funny, nobody laughed at Ben!