• St George’s University Hospitals Foundation Trust has had two legionella cases in past two years
  • Trust to receive £27m in overall capital funding from DHSC, including £3.5m for water safety
  • News comes as NHS England’s finance chief tells trusts to scale back their capital bids

A teaching trust had to appeal to NHS Improvement for funding to ensure the safety of its “fragile” water system after two patients contracted legionella, HSJ can reveal.

In response to enquiries from HSJ, St George’s University Hospitals FT said the cases of legionella occured in October 2017 and April 2018, and most likely were caused by bacteria in the water supply. It had not confirmed what happened to the two patients as this article went to press.

The trust insisted its water supply was now safe. But, it also revealed it wrote to NHS Improvement, saying it could not take responsibility for some aspects of patient safety if it did not receive the necessary capital funding.

It confirmed it had received a commitment of £27m for 2019-20, with £3.5m allocated to water safety.

However, minutes of the trust April finance and investment committee meeting said a “deep dive” into estates risk had found “the mitigations in place for maintaining water safety were still fragile and were heavily dependent on individuals undertaking checks”.

The news comes after HSJ’s report of a leaked letter from NHS England’s finance chief to trusts telling them to scale back their capital plans for 2019-20. The most recent budget document, published last year, suggested the Department of Health and Social Care capital budget would be £6.7bn in 2019-20, up from £5.9bn last year.

The trust’s board has received several reports on water safety but has not made any of them public.

A report in April 2018 – the same month as one of the infections – said there had been “substantial operational effort to maintain safe services through reactive actions.

But it also reported there were: “significant gaps in the management and associated processes which undermined the successful operation of the water quality management regime. Previous assurances given to the board, based on reports from external engineering firms, were being reassessed following more detailed surveys and the publication of a detailed report by the new authorised engineers. Changes were being made to governance structures to provide greater oversight and assurance and a number of operational changes were planned. The director of estates and facilities explained that while the situation was not where he would want it to be there was a relentless focus on ensuring patients were protected.”

In practice, managing this risk can involve staff devising rotas to regularly flush “low-use water outlets” to stop dangerous bacteria building up in pipes, said the 2018 report.

In a statement to HSJ last week, the trust said: “The water at St George’s Hospital is safe to use, and we continue to take steps to reduce the risk of legionella bacteria growing in our water system. This includes regular testing and monitoring of the water supply and temperatures.

“Water outlets and pipework are regularly disinfected, and we’ve installed special filters to taps in a number of areas to ensure the water is safe to consume. This year we will be investing a further £3.5m, which will enable us to create additional water supplies to the site.”