Fire safety for healthcare estates
Independent advice for hospital estates, where compartmentation has to hold for patients who cannot self-evacuate and the building cannot close for the works.
Health Technical Memorandum (HTM) 05-01 has NHS trusts commission a standing independent fire adviser rather than a one-off assessor — the role earlier editions titled Authorising Engineer (Fire), recast by the February 2026 revision as an Independent Expert Advisor (Authorising Engineer) with specialist fire engineering alongside. The shape survives the retitling: an appointment commissioned to audit the trust's fire safety management system and to support the estates department on whatever refurbishment and capital schemes are live at any one time. The appointment belongs to the trust. What it buys is continuity, and continuity is how the recurring problem on an acute estate gets caught, because that problem is rarely a single bad decision. It is compartmentation that was sound when built and has been quietly defeated since by ordinary maintenance, in buildings that cannot close while the fix goes in. Apex works inside that arrangement and alongside it: advising estates and capital projects teams on the schemes that are live now, and auditing what a fire strategy actually depends on rather than what the drawings say it depends on.
The regime
The Regulatory Reform (Fire Safety) Order 2005 applies to a hospital in the same way it applies to any other workplace or premises to which the public have access: a responsible person must ensure a suitable and sufficient fire risk assessment is in place, that significant findings are recorded, and that the measures identified are maintained. Alongside it sits a body of technical guidance written specifically for the healthcare estate. HTM 05-01 sets out the fire safety management arrangements, including the standing adviser appointment described above; HTM 05-02 covers fire safety in the design of healthcare premises; the HTM 05-03 suite covers operational provisions; and specialised healthcare ventilation has its own memorandum in HTM 03-01. Together they go into a level of technical detail — sub-compartmentation of fire hazard rooms, cause-and-effect strategies for air-handling on fire alarm — that general fire safety legislation does not reach.
The escape strategy in an acute hospital departs from the general assumption that occupants can move themselves to a place of safety. Wards and theatres hold high-dependency patients who cannot walk to a final exit unaided, so the strategy has to work by moving them horizontally across compartment lines into an adjoining part of the same storey, in phases, rather than by emptying the building. That makes compartmentation an operational tool as much as a passive one: compartment and sub-compartment walls, fire doors held open on the alarm, and vertical separation all have to support a phased evacuation that clinical staff can actually carry out mid-procedure, in a building that has to keep functioning while any of that work is done around them.
Compartmentation in a healthcare estate is also unusually easy to defeat by accident. A fire-resisting ceiling tile lifted to reach a service, and refitted without the same fire performance, does not show up on a drawing or a maintenance log the way a fire door does; nobody inspects a ceiling tile as a fire safety product. Where that degradation has already happened, the proportionate response is often not to restore the original design but to change it: replacing horizontal compartmentation that depends on maintained ceiling elements with vertical, slab-to-slab separation that can be inspected, evidenced and left alone. The same distinction between what a product is tested to do and what an installer actually did applies to fire doorsets bought for estate works — a strong fire test result is evidence of the product, not the workmanship, and Approved Document B points buyers toward third-party installer certification schemes for the second half of that evidence.
The pressures
- Keeping wards, theatres and departments operating while compartmentation, fire doors or ventilation are remediated around them — the building cannot close for the works.
- Running a phased evacuation that depends on staff moving high-dependency patients across compartment lines, not on occupants leaving the building themselves.
- Compartmentation quietly defeated by ordinary maintenance — ceiling tiles lifted and refitted, service penetrations left unsealed — with nothing that logs the loss.
- Separating fire doorset product certification from installer certification, particularly where a supplier's own sign-off is offered as proof of both.
- Maintaining a standing independent fire adviser relationship of the kind HTM 05-01 describes across a live programme of refurbishment and capital schemes, rather than one-off assessments.
In practice
An acute NHS hospital trust holds a standing Authorising Engineer (Fire) appointment, commissioned as HTM 05-01 then recommended, and the work described here was carried out in that role. The estate's operating theatre suite had relied on fire-resisting ceiling tiles for horizontal compartmentation, sound in principle but degraded in practice by years of maintenance access that lifted tiles, refitted them incorrectly and fixed non-fire-rated items into the void above. A site survey, read alongside a specialist compartment survey, confirmed the tiles no longer delivered the separation the strategy assumed. Rather than chase like-for-like repairs across a suite that would keep being opened up for maintenance, the recommendation was to stop relying on the tiles and rebuild the compartment lines vertically, floor slab to floor slab, one theatre at a time so the suite kept operating throughout. The Trust Board agreed a three-year programme on that basis. A parallel review of new fire doorsets at the same estate found the product test evidence sound but the installation evidence — a self-declared supplier sign-off — not yet sufficient to rely on.
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