HEALTHCARE ESTATES 2021 CONFERENCE


leading to ‘something going wrong with the ventilation’. Malcolm Thomas said: “Put the people right, and – if I can put it like that – we’ll get the ventilation right. There’s a good pedigree, a good history, and we can have some confidence in past learnings and guidance. It isn’t just people’s opinion; it’s what works.” ‘Backing this up, he added, was ‘a fair amount of ongoing research by Department of Health, the NHS, and private companies’, with the findings taken on board when HTMs were revised and updated. He said: “So, in these guidance documents we try to avoid just featuring people’s opinion of what works and what doesn’t, and instead coming down to some facts. History appears to show that this is a correct way of doing it.”


Do we need the HTM guidance? ‘Back in 2017/18’, he explained, when it was decided to look at revising HTM 03- 01, one of the questions asked had been: ‘Do we need it?’ He explained: “We have, in fact, been trying to reduce the amount of guidance issued, because at one point there were something like 400 different pieces of guidance, and it’s almost impossible to keep that sort of volume of guidance up to date.” Over the years there had thus been some ‘pruning’, together with a ‘focus on what is different about ventilation in healthcare’. The speaker said: “What matters to us is, for example, whether CIBSE guidance on ventilation is adequate. If so, that’s great, but if not, do we need to do more than CIBSE is suggesting, or perhaps less in some cases? Things that CIBSE would allow may not be what we want to do. They may not be appropriate in a hospital or other healthcare setting. So,” he said, “having decided we did indeed need HTM 03-01, we questioned whether it needed updating, and, having determined that it did, began looking at how.” This resulted in a ‘scoping exercise’ which ran for over a year with wide-ranging consultation, to look at what was in the documents, whether the HTM could just be given ‘a dust down’ and a little updating, or whether indeed some fundamental changes were needed He said: “That led to the move to produce a new document, in two parts, with part A on design and installation for those putting in something new, and Part B about how you manage an existing healthcare ventilation system.”


A ‘complete re-write’ required He continued: “It was decided that Part A needed to be completely rewritten, it having become clear from the scoping exercise that in existing form it assumed that designers knew what the healthcare industry needed.” “Interestingly,” he added, “back when I authored the HTM for the first time, I was told: ‘Well, you


26 Health Estate Journal January 2022


The latest iteration of HTM 03-01 – on which Malcolm Thomas primarily focused – followed several previous guidance documents on healthcare ventilation.


can’t put that sort of thing in, Malcolm. People who do these things already know what they’re doing.’ On the contrary though, it became very evident – and particularly with the PFI process – that a lot of people designing hospitals and hospital systems in fact had no idea what their customer wanted.”


Historical context


Here Malcolm Thomas showed slides of Owen Lidwell’s report, followed by DV4, then HTM 2025, and then HTM 03-01, both in 2007 form and in the latest iteration. Referring to HTM 03-01 (2021), he said: “It was decided that we should produce the latest HTM 03-01 in two parts – it was clear that Part A needed to have more of an explanation, not just of what we wanted, but why – so that people understood the importance of things. We thus changed the title, the Concept, the Design, Specification, Installation, and Acceptance Testing – the whole process. We tended in the PFI days to say: ‘Give us a new hospital, and give me the key when it’s finished’, and clearly that wasn’t a good idea. While we have some very good hospitals, constructed and built and working well, some were much less successful than they should have been. Part A of the 2021 HTM 03-01 thus refers both to all new installations, and to refurbishments and changes in use of existing installations. I would stress that it’s not retrospective; you don’t have to rip everything out and re-start. However, if you’re in the middle of the project, and you find that the new HTM would suit you better, then providing everybody else agrees, and


you’ve addressed any cost implications, there’s no reason why you can’t move over to the new standard.” This, Malcolm Thomas said, applied even where a project team was working to guidance set out in the ‘old’ HTM.”


Part B of the new HTM He continued: “Part B is about the management, operation, maintenance, and routine testing, of existing healthcare systems. It’s much as it was, but there are some additional changes. The thing to remember with Part B is that it applies to all installations; it doesn’t matter how old.” He continued: “I’m often told a hospital installation dates from the time of HTM 2025, and that’s why it doesn’t conform. However, the minimum standards have been there ever since that HTM was published; in fact they were introduced because of the Stafford outbreak and Legionnaires’ disease in 1986, and were in the Big White Book, for which I wrote a section on standards for ventilation plant.” These had – he said – been carried forward in every HTM since.


Moving to the ‘major themes’ in HTM 03-01 Part A, he said: “ One thing we have had to focus on particularly is supporting the Government’s zero carbon policy – so there’s quite a push in terms of energy use, and how we go about things to support this objective.”


Also considered in compiling the new guidance, Malcolm Thomas explained, had been the EcoDesign Directive and regulations, which he pointed out were ‘legal requirements’; he was surprised many equipment manufacturers still viewed them as ‘options’.


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