The fire safety management regime within any healthcare setting must be wholly focused on protecting people and premises from fire (or the effects of fire). That objective seems straightforward, argues Peter Aldridge from NAHFO, but it will only prove to be so if organisations have competent people in post with the required levels of knowledge and experience.

Every time I write about fire safety within healthcare I seem to reflect the challenges that currently face the NHS and this time is no different. As the Building Safety Act evolves, the discussions about mandating accreditation for fire risk assessors continue and clarity is in place regarding the new hospital programme; the challenges continue. 

With these challenges, those responsible for delivering and managing fire safety in healthcare premises continue to balance them, whilst striving to maintain statutory compliance, financial restrictions, competency and other day-to-day responsibilities. 

Although healthcare environments are very well controlled and regulated, the nature of the clinical processes delivered within means that they are not risk averse. While clinical risks and patient procedures are well managed, the likelihood of harm being visited upon patients can be a more likely occurrence than any fire episode. When the plethora of 
risks is listed, it’s more likely patients or staff could be harmed by those not connected 
with fire. 

Taking this into account, fire safety professionals can begin to see fire safety management dropping down the list of priorities for host organisations. Generally speaking, this isn’t because organisations don’t understand or appreciate the risks associated with fire, but more that the occurrence of fire is low in the National Health Service (NHS). Other incidents occur more frequently and the harms associated with them divert attention.

The likelihood of a fire in healthcare premises may well be low, but the severity of any one fire could be catastrophic. In premises with patients who cannot do anything for themselves, are wired to life-critical support systems or who simply don’t know what to do, organisations must discharge their statutory duties. Indeed, a key element of any healthcare sector fire safety professionals’ role is to consistently remind the host organisation that the severity of fire is more important than the likelihood. 

Examining the challenges
Now that there is clarity on the New Hospitals Programme, there are NHS organisations that will experience delays to their anticipated builds. Such organisations may well have had plans in place that have limited investment into existing premises. If builds are delayed this means that investment priorities will need to change and deficiencies to fire safety standards that have been risk managed will now need to be re-assessed. Against a backdrop of lack of capital this is going to be a real challenge for NHS organisations and fire safety professionals. 

NHS organisations seemed to be experiencing unprecedented demands on services. The traditional winter bed pressure season has seemed to be in place unabated since last winter. Such demand on services has seen healthcare facilities having to enact surge plans on a consistent basis. Whilst the need to treat patients is fully understood, organisations have had to work with fire safety professionals to balance the consequences of not treating patients with the need to assure safe evacuation. Not having the means of escape compromised, having sufficient staff to evacuate and risks such as oxygen are a vital consideration. During periods of surge, a constant review of fire risk assessments, training and fire safety housekeeping are essential.

Legislation change post-Grenfell has continued to be implemented. There is debate around whether there are unintended consequences arising from the Building Safety Act 2022 that contradict the Regulatory Reform (Fire Safety) Order 2005. 
Some NHS Trusts have sought legal clarification regarding their compliance with the Building Safety Act and the potential unintended consequences of breeching their statutory obligations relating to compliance with the Fire Safety Order. Prior to the Building Safety Act, an organisation would have a programme of works unearthed by the significant findings of fire risk assessments that they would then undertake to comply with the Fire Safety Order.

These significant findings would then be recorded on the Risk Register and, upon the allocation of annual capital funding, form part of the organisation’s agreed programme for reducing critical infrastructure risk. A business case for the funding and the Scope of Works would be prepared in advance of the capital financial year, with the work commencing from April onwards.  

This process generally enabled an organisation to discharge its duties under the Fire Safety Order by reducing the identified risks to acceptable levels. The identified programme of works would allow the organisation to demonstrate to statutory enforcers (and other parties) at what juncture risks would be reduced and allow for internal planning around this.

All in the planning
While statutory compliance should be the foundation of an organisation’s approach to fire safety, the internal planning of works for risk reduction is a significant consideration. The NHS Trust needs to plan for the closure of bed spaces, bed bays, restriction of the means of escape and the isolation of fire alarms, etc in order to progress works in many areas. Given the patient flow through hospitals, clinical backlogs and other day-to-day pressures impacting the delivery of clinical services, securing the occupancy of specific areas requires a level of detailed planning. 

To comply with the Building Safety Act, organisations have sought to discharge their statutory duties under both that Act of Parliament and the Fire Safety Order. Following detailed consultation, organisations’ current positions on several fire safety schemes are to seek the authority and approval of the Building Safety Regulator prior to commencement. In doing so, these organisations have become concerned that the delays witnessed in beginning any work is realising several unintended consequences.

For instance, there have been delays in schemes with identified risks starting on site. There’s often an inability to plan work to start on site due to a lack of timescales from the regulator. There’s also the inability to engage contractors to plan works on site. Delivering clinical services involves significant planning detail and the dates are critical for dealing with winter bed pressures, programming elective services for patients and other matters of ‘clinical flow’.
There’s a danger that the key findings of fire risk assessments will take more time to action. Further, there could be additional difficulty in demonstrating statutory compliance, while funding streams may be placed at risk. Such issues duly identified under the fire risk assessment programme may have limited mitigation attached to them other than closing specific areas of a given facility, which then has the potential to induce clinical risks.

Put simply, NHS Trusts cannot demonstrate that there are detailed action plans for mitigating and reducing risks without detailed timescales. In complying with the Building Safety Act, NHS Trusts may be compromising their compliance with the Fire Safety Order and, potentially, breaching their statutory duties.

Fire safety training 
Fire safety training is a fundamental part of any organisation’s fire safety management plan. In healthcare, the challenges of releasing staff for training are increasing with the clinical pressures and the need for staff to be fully engaged in maintaining flow. However, as discussed earlier, the likelihood of hospitals having to surge capacity because of patient flow and as such patient to staff ratios being a challenge, the need to train staff effectively in evacuation procedures is essential. All staff, irrespective of their designation must be able to understand their responsibilities in fire; raising the alarm, fire prevention, evacuation and basic use of fire equipment are fundamental. In almost all healthcare settings, the needs of patients and visitors will differ greatly; some will be very dependant, hooked up to equipment and oxygen, others will have mobility issues and others will need staff guidance. The delivery of training for staff groups, commensurate with their expected responsibilities in a fire, must be subject to robust risk assessment and a training needs analysis, it’s simply not adequate to have a one-size-fits-all training programme. It is very difficult to carry out fire drills in the traditional sense because to move patients could see care compromised, but simply doing nothing should not be accepted either. Staff familiarity with challenges during evacuation should be discussed, talked through and demonstrated. It’s unlikely that just e-learning would skill someone working in an ICU to have all the knowledge and skills necessary to evacuate critically ill people in a fire, but a blended approach of e-learning, practical and competency assessment may.
 

Public sector finances
Finances in the public sector are always under scrutiny. Any delay in conducting necessary project works will always carry the risk of seeing planned spend being diverted to other emerging risks. Clarity of purpose is everything. If those works are for premises that fall within scope of higher-risk buildings, then to not advance this work will mean progressive horizontal evacuation in a hospital cannot be achieved. The unmitigated spread of fire also becomes a risk.
In the event of any fire episode and subsequent investigation, NHS Trusts might well have to account for why identified and funded work designed to reduce known fire risk, and that would lessen the risk posed to the life safety of extremely dependant patients, has not been undertaken due to having to wait for Building Safety Regulator approval.
The $64,000 question arises. ‘Is non-compliance with the Building Safety Act deemed to be less of an offence in terms of its true practical consequence than non-compliance with the Fire Safety Order? If an NHS Trust applies for Building Safety Regulator approval and proceeds with the work to reduce the known risks from fire in lieu of full consent being received, but the fire risks are demonstrably reduced, is the Trust then in a defensible position?
Delivering fire safety planning and management within the healthcare sector remains a difficult task. Thankfully, the dedication, professionalism and experience exhibited by those practitioners within the National Association of Healthcare Fire Officers will continue to keep patients, visitors and staff, not to mention premises and equipment, safe from fire and the effects of fire. 

Peter Aldridge is general secretary of the National Association of Healthcare Fire Officers.