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Legionella in Healthcare & Care


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If you manage, run or own healthcare or care related premises then you have a legal obligation under Health & Safety Law & Regulation 12 of the Health & Social Care Act 2008 to have a valid and upto date Legionella Risk Assessment in place as well as carrying out other control and prevention measures.


The HSE have issued an Approved Code of Practice for the Control of Legionella Bacteria commonly called ACOP L8, this is in effect a legal document.  The ACOP L8 gives guidance on how to comply with the law in relation to Legionella, it states increased performance criteria for health & care related properties.  Failure to meet the requirements of the ACOP L8 can lead to substantial fines, prosecution and even imprisonment.


Healthcare Centres, Hospitals, Dental Surgeries & Care Homes are just some of the types of regulated activities that need to consider Legionella.  Unfortunately there has been alot of confusion around the requirements of the ACOP L8, some of the confusion is even caused by the CQC.


In March 2019 the Swindon & Wiltshire Coroners office wrote to the CQC after identifying that inspectors are not sufficiently trained to deal with water hygiene and instructed the CQC to reply with a written response detailing how they will rectify the education & training issues.  As a result service providers can expect a much more indepth and robust CQC inspection of water hygiene issues including Legionella.

What Do I Need To Do?


The first step is to have a Legionella Risk Assessment carried out.  The ACOP L8 explains in some detail that those who carry out risk assessments need to be "Technically Competent".  The risk assessment defines what Testing, Control & Prevention tasks may be required.  If your risk assessment is not carried out correctly you can put lives at risk as well as waste money.  It is also reasonable to assume that the recommended tasks may also be incorrect and ineffective.


It is for the Duty Holder to assess and decide who is competent to carry out the required tasks and that includes the hiring of specialist contractors.  In a high risk enviroment such as a carehome you will need to be able to demonstrate a much higher level of competence and will nearly always require the services of a specialist contractor.  We commonly see errors in temperature monitoring due to the confusion between the requirements of the ACOP L8 & the CQC's safe hand washing guidelines.

Why Choose Water Wise Services

Trust Mark Certified Specialists


Water Wise Services LTD is proud to be one of only a few businesses in the UK to have achieved the Government Endorsed TrustMark for our Legionella Services.  The scheme ensures it's members are fully vetted to ensure Technical Competence, Good Customer Service & Good Trading Practices.  Our team are also City & Guilds Accredited, Stroma Certified and members of the Water Management Society.

The Care Quality Commission Confusion


Under "Safe" the CQC are to inspect a service to ensure it is safe for users.  The "Safe" part of the inspection should include the Legionella Risk Assessment.  The guidance that the CQC gives to its inspectors and providers is misleading as it gives the impression providers may not need to carry out any control and prevention measures.  For example, in section 27 of "Nigel's Surgery" (part of the online advice the CQC gives to providers) it states "A simple risk assessment may show that the risks are low and being properly managed.  In many cases the risk assessment will lead the practice to conclude that the risks are insignificant and are being properly managed to comply with the law.  In these instances, the assessment is complete, and no further action is required."  This has caused many healthcare related premises to not carry out the correct level of control and prevention tasks.


Further reading of the ACOP L8 2.152 to 2.168 is entitled "Special Consideration for Health Care and Care Homes".  This special consideration explains that you need to consider the people using the service and implement most if not all the guidance given in the ACOP L8.  A vastly different recommendation in comparison to the advice given by the CQC in "Nigel's Surgery".  These measures include but are not limited to the flushing of outlets, regular temperature monitoring of the system (not just outlets), maintenance of TMV valves and much more.


In reality the risk of Legionella in a healthcare environment can never be "low" if you assess the risk correctly and take service users into account as the ACOP L8 requires.  If the risk can not be low then a "simple" risk assessment is not suitable and the level of competence to assess, control and prevent legionella becteria also needs to be of a higher level.


The CQC have rated us as "Safe" so must be happy with what we are doing!


In June 2018 BUPA was fined £3,000,000 plus costs of £151,482 by Ipswich Crown Court for a Legionella related death & other failures including lack of training.  BUPA Care Homes (BNH) Ltd pleaded to breaching Section 3 (1) of the Health and Safety at Work Act 1974.  The investigation found that for more than a year, during which time major refurbishment works were carried out, BUPA Care Homes (BNH) Ltd failed to implement the necessary control and monitoring measures required to safely manage their hot and cold-water system.  It also found "failings across the board” and that those responsible for overseeing legionella had a lack of "training and understanding".  The court noted that those involved in taking crucial water temperature measurements had not been trained to the required standard. 


What is interesting here is that the CQC inspection prior to the Legionella related death rated the home as meeting the required standards for "Care and welfare for people who use services " and "Cleanliness and infection control".  It was only after the death did the CQC rate the home as "Requires Improvement" under Safe.  Unfortunately, this is not the only incident of this type we have seen, and no blame has attached itself to the CQC in these cases.  But hopefully that is starting to change.


On the 01/04/2019 the Wilstshire & Swindon coroner sent an official notice to the CQC stating "Care homes and other healthcare premises are regularly inspected by the Care Quality Commission.  In recent years the inspection regime has included a duty on inspectors to check on water safety.  Expert evidence at the inquest
suggested that inspectors lacked training to help them identify risks relating to potential legionella infection." 


The coroner has given notice for the following action to be taken "In my opinion action should be taken to prevent future deaths and I believe your respective organisations have the power to take such action.  Specifically, consideration might be given towards providing relevant education and training."  The coroner has also instructed the CQC to respond to him in writing "Your response must contain details of action taken or proposed to be taken, setting out the timetable for action.  Otherwise you must explain why no action is proposed."  


The most common problem we find is the confusion between the requirements of the CQC's Safe Hand Washing Guidelines and the temperature monitoring requirements of the HSE's ACOP L8.  We often find providers recording temperatures as required by the CQC, but this is only a fraction of the work required under the ACOP L8.

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