The private or independent healthcare sector in the UK is largely made up of hospitals and clinics run independently of the National Health Service (NHS). Commonly administered by a commercial company, some are also run by charities or other non-profit organisations.
Private Healthcare sites may also include mental health facilities, rehabilitation centres, care homes, and many other site-specific facilities.
In 2025, Legionnaires' disease (LD) prevention remains a key concern to Private Healthcare providers.
A significant example of a Legionnaires' disease incident involved BUPA and the associated consequences of local Legionella risk management failings in 2018 - https://www.bbc.co.uk/news/uk-england-essex-44483283.
More recently in 2024, although not strictly a private healthcare organisation, a sheltered housing organisation with vulnerable occupants was handed a large fine for similar failings without a confirmed case of LD being identified. Residents put at risk of deadly disease as company fined £900k | HSE Media Centre
Legionella Regulation and Guidance
In common with all non-healthcare businesses, private healthcare operators have a clear duty of care to protect residents, staff, visitors, and anybody else affected by their day-to-day undertakings, from foreseeable risks to their health, safety, and well-being.
All Healthcare estates are assessed against a set of legal requirements and governance standards – the associated principles of health and safety are enshrined within the Health and Social Care Act 2008 (Regulated Activities), Regulations 2014, and specifically Regulation 12(2)(h) and Regulation 15 of the Act.
Failure to comply with the aforementioned ‘Regulation’ or ‘Act’ is an offence and as such the CQC has ‘enforcement powers’ to ensure compliance with accepted standards. Such enforcement powers include: issuing time-defined warning notices, prosecution, and cancelling a healthcare provider’s registration – removing its ability to provide regulated activities.
HTM04-1
Despite the ever-present Legionella risks for providers, extensive guidance is available. Health Technical Memorandum [HTM 04-01] sets out the standards for water safety within health estates by acknowledging within its three parts (A, B, and C) the regulatory requirements of the Health and Social Care Act as well as the role of the Health and Safety Executive (HSE) for the safe management of healthcare estates.
There are many commercially run private healthcare sites and the skills and competencies of staff within these varying sites may well be adequately specialised and relevant to ensure good water hygiene management practices are implemented. Alternatively, staff may have a more general managerial skill set and be unlikely to possess specialist knowledge in water systems safety.
ACoP L8
It’s important to question whether we can identify the measures to provide assurance individually at the site level and at a more strategic level. Regardless of the level of care or the standards to be applied, the key to managing Legionella risk is the implementation of the following five steps, as advocated under the HSE’s Approved Code of Practice [ACoP] L8:
- Appoint a manager to be responsible for others;
- Identify and assess sources of risk i.e. carry out Legionella risk assessments;
- Prepare a scheme to prevent or control risk i.e. a water safety plan;
- Implement, manage, and monitor the scheme of precautions;
- Keep water safety records of the precautions.
In their most skeletal form, these five steps are no less fundamental to an individual property or organisation’s safe operation today than when initially documented in earlier editions of ACoP L8. The document elaborates on these points whilst also detailing specifically the nature and make-up of a ‘Written Scheme’ or in healthcare parlance, the ‘Water Safety Plan’:
- For preventing or controlling the risk from exposure;
- Ensuring proper implementation and management;
- Specifying measures undertaken to ensure that it remains effective.
BS8680:2020 Water Quality – Water Safety Plans – Code of Practice
More recently BS8680:2020 Water Quality – Water Safety Plans – Code of Practice has been issued to provide unequivocal recommendations and guidance on the development of a Water Safety Plan (WSP). The standard is intended to be used as a code of practice to demonstrate best practice and compliance, and private healthcare providers should now be looking to integrate the document’s evolutionary approach into their water compliance system.
How to reduce the risk of Legionella?
Private Healthcare providers may also follow the basic checklist below, for reducing the risk from Legionella and other waterborne pathogens in association with the aforementioned HSE and DoH guidance:
- Have specifically appointed person(s) responsible for Legionella (water safety) control;
- Ensure the current Legionella risk assessment is available at the local level, understood by the appropriate manager(s), and with a management plan in place to act on any findings;
Ensure a logbook system is in place detailing the site’s communication pathway, planned preventative maintenance tasks undertaken, and frequencies, including records, contingency measures, and any other relevant information. Note: the logbook system should be appropriate to the site it concerns;- Ensure all identified relevant person(s) have Legionella training and experience to be able to carry out the role competently and other relevant staff are trained to be aware of the importance of their role in controlling Legionella;
- Keep hot water hot and circulating at all times: 55°C - 60°C throughout the entire hot water system;
- Keep cold water cold, at all times. It should be maintained at temperatures below 20°C throughout the system and to all outlets (this may not be possible when the ambient temperature is high, but every effort should be made to ensure that cold water entering the premises and in storage remains as cold as possible);
- Run all outlets including showers in all areas (healthcare or otherwise) for several minutes to draw through water (until the shower feed reaches the temperatures stated in points 5 and 6)) at least twice a week (or daily if an augmented care area) if rooms are unoccupied, and always before occupation;
- Keep shower heads/hoses, taps, and other facilities dispensing water, clean and free from scale;
- Clean, drain, and disinfect hot water generators on an annual basis;
- Clean and disinfect all water filters regularly, as directed by the manufacturer, at least every three months;
- Inspect cold water storage tank[s] condition and record the maximum temperatures of the stored and supply water – carrying out any remedial work where necessary;
- Ensure any TMVs installed are suitably inspected and maintained on a 6-monthly basis;
- Identify any ‘other’ water system via the current water risk assessment and ensure relevant PPM tasks are implemented;
- Ensure that when carrying out system modifications or new installations, they do not create pipework with intermittent or no water flow, and disinfect the system following any work;
- Keep water safety records of all water systems readings such as temperature, pH, and chlorine concentrations and ensure they are checked regularly by the appropriate manager;
- Consider and undertake microbiological sampling to demonstrate monitoring compliance and safe water systems.
*This checklist is not exhaustive and is more appropriate for smaller sites. Healthcare sites of significant size would require a significantly more detailed approach.
In summary, we may ask ourselves if we have learnt our lesson since the mid-1970s when Legionnaires' disease first came into public consciousness. Despite the wealth of straightforward health and safety advice from regulators such as the Health and Safety Executive, learned societies, and other Healthcare industry bodies, this largely avoidable disease continues to be a concern for Estates Facilities Managers, and occupiers alike.
If you have questions regarding the issues raised above or you would like to speak with one of our consultants please click here to get in touch.
Editor’s Note: The information provided in this blog is correct at date of original publication – May 2021 (Revised January 2025)
© Water Hygiene Centre 2025
