The building cannot close
By webmaster · · 6 min read
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Every estates director who has run a refurbishment inside a working
hospital knows the constraint before anyone writes it down. The ward is
full. The theatre list is booked. The building has to keep doing its job
while you change it.
The ventilation guidance does not solve that for you. But its
structure explains why the argument in your project meeting keeps
happening.
Two
phases that are normally sequential, happening at once
Health Technical Memorandum 03-01 was published on 22 June 2021 in
two parts, split by lifecycle. Part A covers “the concept, design,
specification, installation and acceptance testing” of healthcare
ventilation systems. Part B covers “the management, operation,
maintenance and routine testing of existing” ones.
Build it, then run it. On a greenfield hospital those phases are
sequential and the split is unremarkable: Part A during construction,
Part B from handover.
A live refurbishment collapses the sequence. Part A applies to “new
installations and major refurbishments of existing installations”. Part
B applies to “all ventilation systems installed in healthcare premises
irrespective of the age of the installation”. So on the same estate, on
the same day, two lifecycle phases that are normally consecutive
are running side by side.
That is worth naming, because it reframes a familiar argument. When
the project team and the operational team disagree about a ventilation
decision, they are frequently not disagreeing about the standard. They
are reading different halves of it, and both halves are in force.
Note what the split is not. It does not divide the building into your
bit and their bit. Part A reaches directly into the existing estate,
because a major refurbishment of an existing installation is Part A
work. Part B reaches into the area you just finished, the moment it is
handed over. The division is by activity, not by geography, which is
exactly why it cannot be settled by drawing a line on a plan.
The
guidance is not mandatory, and that is stronger than it sounds
HTM 03-01 states its own status in a box on page ii: “This guidance
is not mandatory (unless specifically stated).”
Anyone who has been told “the HTM requires it” has been told
something loose. The document is careful here. It sets out its own
drafting convention: “must” indicates compliance with the law, “should”
indicates a recommendation, and “shall, in the obligatory sense of the
word, is never used in current HTMs/HBNs”.
Almost every containment provision an estates team relies on is a
“should”.
So where does the obligation live? In the derogation regime, and it
has teeth. Departures need “the scrutiny and agreement in writing by the
VSG”, the ventilation safety group. The preface is blunter: “Derogations
to standards will potentially jeopardise business case approval and will
only be considered in exceptional circumstances.” The starting point for
every project, at strategic outline case stage, “is one of full
compliance”, meaning compliance with this document, about
ventilation.
And on the evidence required for a departure, a line worth pinning
above a project manager’s desk: “It will not be enough to state that the
derogation or alternative design strategy proposed has been used
elsewhere.”
Guidance that is not mandatory still binds, because departing from it
is an auditable, written, board-visible act that puts the business case
at risk. That is a more accurate description of an HTM than calling it a
rulebook, and a more useful one.
What the
guidance concedes, and what it refuses
Paragraph 4.70 is the most realistic passage in the document, and it
is the one that tells you how to run a refurbishment:
The physical constraints of the building may mean that some
derogation in terms of layout and room dimensions are unavoidable, but
it is vital that the infection control aspects, clean airflow paths,
cascade of air from clean to less clean areas and fire and smoke
requirements are not compromised and that the complete facility will be
fit for purpose. The VSG should be consulted and agree in writing to any
derogations.
It concedes the reality first. Old buildings force compromise on
layout and room dimensions, and a design that pretends otherwise is a
design nobody can build. Then it fixes what does not move: infection
control, clean airflow paths, the cascade from clean to less clean, and
fire and smoke. Four things. Room dimensions are a conversation.
Those four are not.
Then it closes the loop back to governance. Even the unavoidable
derogation goes to the VSG, in writing.
The same realism runs elsewhere. The 2021 edition retains older
theatre designs because they “will remain applicable to older theatre
suites that are being refurbished within their original footprint”. On a
change of use the ventilation requirement should be completely revised,
and an existing air handling unit should only be retained if it is not
more than 10 years old and is, or can be made, fully compliant with
current standards.
Nobody has the
stop button you think they have
Here is the part most teams have not tested, and it is worth being
direct about.
Search HBN 00-09 for a power to stop the works and you will not find
one. The infection prevention and control team has an escalation route,
not an authority. The ventilation safety group has a consent right over
derogations, which is a different thing again. The only person who can
actually halt a job is an inspector serving a prohibition notice under
section 22 of the Health and Safety at Work etc. Act 1974, or article 24
of the Health and Safety at Work (Northern Ireland) Order 1978.
So the stop-work authority everyone assumes exists is a thing
you either wrote into the contract at the outset or do not have at the
moment you need it. Not because anyone was negligent. Because
no statutory power sits with the people who would use it, and the only
remaining route is contractual.
The limits of all this
Three caveats, because the reader deserves them, and because the
first one governs everything above.
HTM 03-01 is about ventilation. Every quotation on
this page is about ventilation and nothing else. It is not a general
infection-control document, not a decant document and not a phasing
document. The dust and containment risk matrix lives in HBN 00-09, a
different publication with a different job.
It is an acute care document. For GP practices,
health centres, mental health facilities and community estate, it
applies by local risk assessment rather than by default. “HTM 03-01
applies to all NHS buildings” is wrong.
And it is English. Scotland’s SHTM 03-01 has a
broader stated scope, covering general and specialised ventilation in
all types of healthcare premises. A design assumption carried across the
border can be scoped wrongly before anyone notices.
The estate has to keep running while you change it. The guidance does
not remove that problem. It does tell you which of the arguments it
causes are worth having.
