The extent of potentially deadly asbestos present in Northern Ireland's hospitals has been revealed.
The dangerous fibres have been found in 23 of our hospitals, including maternity units, children's wards, labs, staff accommodation and kitchens.
Described as a hidden killer, asbestos can lead to serious illness such as lung cancer and mesothelioma.
In some cases our hospitals contain crocidolite, more commonly referred to as blue asbestos and the most lethal form of the material.
The scale of the problem is revealed just days after a Northern Ireland health trust was fined £10,000 over asbestos-related safety breaches.
Belfast City Hospital was known to contain the material but the information was not passed on to maintenance contractors working at the site.
Details of asbestos in hospitals were released following a Freedom of Information request by this newspaper.
The documents reveal:
• Asbestos is present at hospitals across all five health trusts, including Altnagelvin, Belfast City, Craigavon, Daisy Hill and Antrim Area;
• Crocidolite has been found in the Royal's maternity hospital and the old part of the children's hospital;
• The fibres are also present in doctors and nurses' accommodation at Whiteabbey Hospital.
Asbestos was widely used as a building material between the 1950s and mid-1980s but is now banned. Yet it remains in many schools, hospitals, ships, offices and factories.
Last year the Belfast Telegraph reported how 876 of Northern Ireland's schools – around 75% – contain asbestos.
It becomes dangerous when disturbed and, if inhaled, its fibres can cause lung problems. Every year around 4,000 people die from mesothelioma and asbestos-related lung cancer across the UK.
Each health trust said that provided the fibres are properly managed and not disturbed or damaged, they pose little risk to health. Campaigner Tony Whitston, who chairs a UK-based asbestos victims' group, said it can be deadly if great care is not taken.
"We have seen electricians or engineers who worked on hospitals when they were being built coming back to the same hospitals years later having developed mesothelioma.
"We have also heard of doctors and nurses developing mesothelioma."
Mr Whitston said asbestos can be safely managed provided it is not disturbed, but in practice this can prove unworkable.
"The problem is when it is in an area of potential disturbance, say a corridor where trolleys come thundering down and can smash into a wall. The case in Belfast shows that their management of asbestos was absolutely flawed and useless."
Last Monday the Belfast Trust was ordered to pay over £11,000 for three breaches of health and safety at its City Hospital site.
It was fined £10,000 plus costs of £1,750 after two Newry construction workers were potentially exposed to asbestos when repairing a floor in January 2011.
Alliance MLA Kieran McCarthy, who sits on the Assembly's health committee, said lessons must be learnt from the incident.
"It is very well to say asbestos is safely managed, but the Belfast Trust case shows that it isn't always the case," he said.
"It is vital that lessons are learnt from what happened so that staff and patients are not put in danger."
Katherine Murphy, chief executive of The Patients Association, said safety must be a priority for every hospital. "Clear plans should be in place to manage the risks associated with asbestos," she said.
"Where building works are taking place the public need to be reassured that asbestos does not pose a threat to their health. It is the last thing patients, relatives and carers should have to worry about when visiting a hospital."
A spokesman for the Department of Health said Health and Social Care bodies were expected to comply with all applicable legislation including the Control of Asbestos Regulations.
Questions and answers
Q: What is asbestos and why is it a problem?
A: A soft, grey-white material which does not burn, asbestos is a naturally occurring fibrous substance which was used extensively by the UK building industry between the 1950s and mid-1980s. Although the substance is now banned because of the risks to health, it is estimated at least 50% of all asbestos ever used in the construction of buildings is still present. Any building which was built before 2000 may contain asbestos.
Q: Are all types of asbestos dangerous?
A: Yes, but some types are more deadly than others. There are three main varieties of the substance – chrysotile (white asbestos), amosite (brown) and crocidolite (blue). The latter is the most lethal form and was banned in 1985. It is said to be 500 times more dangerous than chrysotile, and is present in seven hospitals across Northern Ireland.
Q: What is the danger posed by the material?
A: If asbestos isn't damaged then there is little risk. However, once disturbed, it breaks down into fibres up to 1,200 times thinner than a human hair. When inhaled, they become trapped in lung tissues. The fibres are very dangerous if inhaled in high concentrations over a period of time.
Q: What are the health risks from asbestos exposure?
A: Asbestos is a hidden killer that can cause serious disease, including lung cancer. It is linked to mesothelioma, a cancer which affects the lining of the lungs and asbestosis, a scarring condition of the lungs.
Q: What are the health trusts doing about it?
A: Each of the five trusts has an asbestos management plan in line with legislation and guidance from the Health and Safety Executive. Buildings are surveyed and details of asbestos presence is recorded. In most cases the asbestos is "safely managed" – in other words it is considered safer for it to be left alone. Asbestos which is deemed a risk is removed.
Area by area: the affected locations and what the trusts say
Asbestos is present at 24 locations in five hospitals across the trust area.
These include the Mater, Royal Group of Hospitals, Belfast City and Musgrave Park.
A spokeswoman said: "The trust manages all asbestos containing materials in accordance with legislation and HSE guidance. This is also reflected in the trust's Asbestos Management Plan.
"In accordance with the plan, legislation and guidance, all buildings are surveyed and a priority risk assessment conducted. This considers the type of asbestos, occupancy, likelihood of disturbance, exposure potential and the maintenance activities."
She said the trust invests in a prioritised asbestos removal programme.
"Any remaining asbestos is being managed safely so as not to pose any risk to patients, staff or visitors using our buildings," she added.
Eight hospitals in the trust area contain asbestos including Antrim Area, Holywell Hospital, the Moyle Hospital, the Mid-Ulster Hospital in Magherafelt and Whiteabbey Hospital.
According to the trust, there is no asbestos register for Causeway Hospital in Coleraine, however, a survey has been commissioned.
A spokesman said the trust had an asbestos register for all its facilities and confirmed that "the asbestos in its current state, undisturbed, poses no threat to patients or staff".
Asbestos is present in parts of the trust's two main hospitals – Craigavon and Daisy Hill.
Asbestos is also in Lurgan Hospital and the South Tyrone Hospital in Dungannon.
A spokeswoman said there were no records of the crocidolite form in the trust's hospitals.
"Regarding the asbestos that is present, all of the amosite asbestos is contained within non-patient areas and more specifically it is confined to areas... where only authorised staff have access."
She said the trust had asbestos management plans and registers in place. In addition, she confirmed that all recent hospital construction developments use asbestos-free products.
South Eastern Trust
Asbestos was found at 15 sites at the Ulster Hospital and Lagan Valley Hospital.
A spokesman said: "The majority of incidents discovered relate to composite products such as floor tiles and the permanent shuttering used during construction of the original blocks. These areas are continuously monitored.
"The trust has a rolling programme in place to remove, where possible, all incidents of asbestos."
Asbestos is present at three hospitals in the trust's area – the Altnagelvin Hospital in Londonderry, the Tyrone County Hospital near Omagh and the Tyrone and Fermanagh Hospital.
A trust spokesman said recent developments, including the new South West Acute Hospital in Enniskillen, do not contain asbestos.
"The trust has an asbestos management plan to minimise any risks arising to staff, patients and the public from asbestos.
"Where crocidolite is recorded as present, this would be in specialist services or plant areas which are not accessible by patients, public and general staff," the spokesman confirmed.