MODULAR BUILDINGS
Above: A hospital corridor.
Right: Scrub sink in theatre suite.
valuable in large acute hospitals where services must remain operational throughout building projects. Modular construction also enables more predictable timelines, as fabrication in factories is less subject to weather delays and other on-site variables. Furthermore, when the same design is replicated across multiple sites, time is saved not only in construction but also in the planning stages. Building layouts, as well as detailed Mechanical and Electrical (M&E) specifications, can be standardised and reused, ensuring consistency and efficiency from project to project.
The structure of the checks
Design Stage Review n An Authorising Engineer – Ventilation (AE (V)) (or the equivalent specialist for other services) reviews the design drawings and specifications.
n They check that the system (e.g. ventilation) meets HTM requirements: n Correct air change rates (e.g. 22 for operating theatres). n Correct airflow direction (clean → dirty). n Specialist cases (e.g. isolation rooms must have negative pressure).
Construction Stage Checks n During construction, the AE (V) (or relevant Authorising Engineer) conducts regular site inspections.
n These spot checks confirm that the installation of equipment and ducting matches the approved design and complies with standards.
n Many systems are bespoke to the facility, so this process is critical.
Commissioning and Verification n Once installation is complete, the system undergoes commissioning tests (e.g. air velocity, pressure differentials, filtration performance). n The AE (V) reviews commissioning results and certifies compliance.
Handover and Ongoing Compliance n Only when compliance is demonstrated can the facility be signed off. n For ongoing assurance, Authorised Persons (APs) and Competent Persons (CPs) carry out routine maintenance, monitoring, and re-verification against HTMs.
Summary n Design review (paper compliance). n Onsite inspections (build quality). n Commissioning tests (system performance). n Handover sign-off and ongoing monitoring.
52 Health Estate Journal March 2026
Beyond speed and convenience, modular methods also contribute to the NHS’s sustainability agenda. The process typically produces less material waste, requires fewer deliveries to site, and consumes less energy overall, making it a lower-carbon alternative to traditional building approaches. Taken together, these factors explain why modular construction has become such a powerful tool for the NHS in its efforts to modernise facilities, reduce environmental impact, and deliver better healthcare spaces for patients and staff alike.
How are compliance checks carried out currently on traditional builds? In the NHS currently, there are a number of building services compliance standards known as Health Technical Memorandums (HTMs). There are also standard documents known as Health Building Note (HBNs). These standards cover all the building services in a clinical building such as ventilation, electricity, water, and medical gases. There is also a HTM for Fire Safety, known colloquially as the Firecode, which is the HTM05 which comprises 14 documents. Taking the example of healthcare ventilation in new building being constructed using a traditional building process where the building is being constructed on a building site. The ventilation is supplying a new Ultra Clean Ventilation (UCV) theatre. In this case the compliance checks may be carried out by an Authorising Engineer – Ventilation (AE (V)). The first process would be to review the design of the new theatre and its associated air handling unit and assess whether the air flows are compliant, which means that air flows from clean to dirty and that there are sufficient air changes for the particular area of the healthcare building. For example isolation rooms have to be supplied with air flows to make them negative pressure and theatres are expected to have 22 air changes. This is all deduced by a close inspection of the drawings. When the building of the new facility commences the AE (V) will carry out regular spot checks to ensure the ventilation system including the ducting is being installed to a required standard. The ventilation equipment may have been built bespoke to that particular healthcare facility.
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