FIRE SAFETY
Figure 4: The remediation process for existing fire-
stopping seals (extracted from HTM 05-03 Part K (2024)).
Consider whether the seal is likely to provide the required fire resistance when repaired, including the substrata, services, size, suitability and overall condition (Quantitative assessment)
Yes
Does the original seal appear to be correctly fitted?
Yes
Is the manufacturer known?
No Remediate using industry tested proprietary products Maz Daoud
Mazin Daoud spent 30 years in the London Fire Brigade, starting as a firefighter in 1982. Among his roles he was Group manager for Fire Safety, Fire Safety Enforcement Team Leader for several London boroughs, Senior Fire Safety officer, Station Commander (including at Heathrow), and a Fire Safety Enforcement officer. On leaving the fire
brigade he was the Fire Safety advisor at two major London teaching hospitals, at one of which he was also the Emergency Planning officer. His career continued
working for Sodexo for six years as Fire engineer/Authorising engineer and Subject Matter expert for the UK and Ireland. This included responsibility for many diverse sites, including seven hospitals, such as Manchester Royal Infirmary. During this time he was a Crown Court expert witness. Since 2021 he has
been the head of Fire Safety for NHS England, an organisation tasked with leading the NHS in England.
employed staff or externally appointed contractors. Whatever the appointment status of the fire risk assessor, a robust process of due diligence should be employed to ensure that the appointed fire risk assessor holds an adequate level of competence, to the satisfaction of the responsible person. Only suitable persons who have relevant comprehensive training or experience in FRAs should assess healthcare premises. The level of the training and experience should be commensurate with the complexity of the premises to be assessed. Where relevant, the Fire Safety manager and appointed Authorising Engineer (Fire) should be consulted. The Fire Sector Federation has produced an Approved
Code of Practice: a national framework for fire risk assessor competency5
to establish industry standards for
assessing the competency of individuals who conduct FRAs. The guidance includes matters of behaviour and details of the knowledge, skills, and experience expected for a competent fire risk assessor. The Code sets out the requirements for fire risk assessors for: n appropriate third-party certification and/or accreditation and membership of professional bodies.
n core competencies. n functional requirements for specific sectors. n methods of assessing competence of persons. n competency assessment recording and reassessments. n maintenance of competence training and Continuing Professional Development.
Details of competence – such as records of training, knowledge, and experience – must be checked, including the risk assessment and method statements. In addition, it is important that the Authorising Engineer (Fire) validates the efficacy of at least a sample of fire risk assessments completed, including areas where there are very high dependency patients.
Remediation of existing passive fire protection (fire compartmentation), and fire door maintenance More comprehensive guidance on assessing and maintaining fire doors has been included. It outlines different options for existing fire doors that may not meet current standards, such as accepting ‘notional’ fire-rated doors if professionally assessed as likely to perform adequately, and upgrading them with new seals/strips as opposed to full replacement. Competent assessors must evaluate fire compartmentation, including fire doors, against their intended purpose in the fire strategy, considering factors such as fire load, patient dependency, and evacuation times.
46 Health Estate Journal April 2025 There is a new chapter on maintenance, recommending
that the frequency of it should be risk-based and evidence-backed. The overriding risk to healthcare from contamination, and the risk of infection, mean that there should be a proportionate maintenance programme that is unlikely to pose a risk to patient safety. This may result in varying the frequency of checks from generally accepted standards and recommendations, with a greater emphasis on utilising local staff. See also HTM 05-03 Part B for fire alarm maintenance.
Appendices now include guidance on assessing the remediation of existing passive fire protection, and a hazard room assessment matrix. In the case of existing fire compartmentation seals which require remediation, the process outlined in Figure 4 should be adopted.
Other sources of information Part K is, in part, a wayfinder to information provided by other organisations. This includes guidance documents from the National Association of Healthcare Fire Officers, IHEEM, the National Fire Chiefs Council, and the British Standards Institute. It supplements, and advances for complex healthcare facilities, the information in the Home Office Guide to Fire Risk Assessment in Healthcare Premises.6
It also provides information for mental health
facilities. The revised Part K provides extensive guidance and
a methodology to achieve a ‘fire safe’ environment in complex hospital environments, where the risk is to be reduced to ‘as low as reasonably practicable’. However, the process relies on the professional completing the assessment to be competent – not only in completing fire risk assessments, but also in the specific and unique environment of complex healthcare.
References 1 Health Technical Memorandum 05-03: Operational provisions Part K: Guidance on fire risk assessments in complex healthcare premises. NHS England, 2024. (Wales, Scotland and Northern Ireland have their own respective WHTMs, SHTMs etc).
2 The Regulatory Reform (Fire Safety) Order 2005. 3 PAS 79-1: 2020. Fire risk assessment – Premises other than housing. Code of practice. bsi. 31 December 2020.
4 PAS 9980: 2022 Fire Risk Appraisal of External Walls and Cladding of Flats. bsi. January 2022.
5 Approved Code of Practice: a national framework for fire risk assessor competency. Fire Safety Federation, 2020. https://
tinyurl.com/mwrzed7m
6 Guidance: Fire safety risk assessment: healthcare premises. Home Office, 25 September 2006.
Yes
Remediate using the manufacturer’s proprietary products
No No Replace
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