Transforming estates technical guidance for safer healthcare buildings

Every day the NHS sees more than 1.6 million patients in over 10,000 buildings across the country. Estates and facilities teams play a vital role in making sure these buildings run safely and effectively and that they are built to the latest standards.

For the past twenty years, technical guidance has been ensuring the safe and effective operation of healthcare facilities and the safety of patients in our care and the staff and visitors who spend time in our buildings. NHS England is legally responsible for producing Standards and Guidance for the whole of the NHS estate, ensuring that the information and guidance they contain remains up-to-date and relevant for users. They are held up by international health systems as exemplars.

They provide and bring together healthcare-specific elements of national and international standards, policies and up-to-date established best practice. Adhering to technical guidance is a requirement for business case approval for new projects. For existing buildings, healthcare organisations have a duty of care to meet the high standards set out in the technical guidance.

Types of guidance

There are currently 110 technical guidance documents, which can be categorised into one of several types:

  • Health building notes (HBNs) give best practice guidance on the design and planning of new healthcare buildings and on the adaptation or extension of existing facilities. This covers topics such as how certain departments should be laid out (e.g. cancer treatment, renal units or day surgery facilities), as well as more specialist guidance on infection control, dementia friendly environments and medicines storage.
  • Health Technical Memoranda (HTMs) give comprehensive advice and guidance on the design, installation and operation of specialised building and engineering technology used in the delivery of healthcare. This includes topics such as fire safety, electrical safety, medical gas pipeline systems, waste management and even acoustic design.
  • NHS Estates Technical Bulletins enable updates to guidance to be passed to local systems at pace and outside of the usual schedule of HTM or HBN updates. This is useful in the case of legislation change, safety learnings and innovation adoption.
  • Other technical guidance is developed in response to critical areas of innovation and safety. Such standards include the NHS Net Zero Building Standard, which supports the development of sustainable, resilient, and energy efficient buildings in support of the NHS’s net zero targets; The National Standards for Healthcare Cleanliness which support organisations to meet essential cleaning standards and the National Standards for Healthcare Food and Drink, which sets progressive requirements for organisations to improve nutrition and hydration for all patients.

Most of the technical guidance provides specialist information for healthcare engineers and those in related professions. However, some will have broader relevance and application to everyone within a hospital, such as the HTM 05-03 Firecode Part A that we have just published. This includes requirements around staff training and fire drills that all staff will need to know about.

How do we develop them?

NHS England has a rolling programme to update HTMs and HBNs. This financial year, NHS England’s national estates team has published updates to nine technical guidance documents and published four new technical bulletins.

Items are prioritised based on a range of criteria which includes how long ago the last update was, if there have been any known issues that could cause a safety risk to patients and staff, or any significant developments in that field such as technological advancements that mean the guidance is no longer as up to date as it should be.

The updating process is extremely thorough, taking on average 18 months from start to finish. Each document goes through a series of steps from scoping, drafting, several rounds of expert review and then final checks and approvals.

At all stages, we make sure to involve subject matter experts, clinicians, industry bodies and people who will use the guidance to make sure that it is both correct and appropriate for the audience. We also ensure alignment with the devolved nations and other key government departments.

Developing our technical guidance for the future

In 2024, we intend to publish updated guidance to a range of guidance including on fire risk assessments; the National Standards of Healthcare Cleanliness; HBNs on a range of specialist areas; and a supplement on water safety.

The safety of our patients and staff is of paramount importance, so we are introducing an annual review of five of the most safety critical documents – water, ventilation, fire, medical gases, and decontamination.

We are improving the efficiency of our rolling programme so that we can increase the amount of guidance we produce each year and boost its impact.

We’re also exploring with our academic partners how we may be able to incorporate the benefits of AI and large language models to streamline certain parts of the process, like qualitative data analysis, while still meticulously upholding the high standards we are known for internationally.

Finally, accessibility and usability of our technical guidance is vital – these documents are meant to be applied in real life. We want to engage with a wider community to understand how we can improve access to these documents and make it easier for people to give feedback on them.

We encourage everyone to familiarise themselves with these guidance documents, especially those related to their specialist practice, and to keep an eye out for critical updates. Documents can be found on the NHS England website.

Fiona Daly

As the National Deputy Director of Estates for NHS England, Fiona is tasked with leading the strategies, policies and national programmes to decarbonise of the NHS Estate, improve operational resilience and patient experience, and develop the 100,000 strong Estates and Facilities Workforce; driving innovation, engagement and delivery, and providing healthcare organisations with critical support they need to implement their plans.

Fiona has 17 years’ experience of working in Estates and Facilities Management and is passionate about reducing health and social inequalities, establishing an estate that supports the transition to sustainable models of care throughout the NHS. She is focused on driving the delivery of a healthy, resilient healthcare estate; tackling organisational leadership, investment in the built environment and developing the skills and capacity of the current and future NHS workforce. In 2018 she was made an honorary professor at University College London (UCL) for her contribution in supporting the development of students in her field.