MEDICAL GAS SAFETY


Medical gas safety: the new chapter


This year sees the publication of the revised HTM 02-01 – its first revision for 20 years. Here, the authors of HTM 02-01:2026 – Authorising Engineer (MGPS) Rob McCrea and Authorising Engineer (MGPS) Richard Maycock, chair of the IHEEM Medical Gas Technical Platform – discuss in-depth the principal changes to both Parts A and B, and what they mean for Estates teams.


After 20 years, HTM 02-01 has changed. The 2026 revision is much more than an update of technical references or a replacement for an ageing document. Parts A and B together establish a stronger lifecycle approach to Medical Gas Pipeline Systems (MGPS), linking the way systems are conceived and designed with the way they are validated, handed over, operated, maintained, modified, and governed. The underlying engineering principles remain familiar:


the supply must be adequate, correctly identified, continuous, and of the required medicinal quality. What has changed is the context in which those principles are applied. Clinical practice has evolved, oxygen demand has changed, healthcare estates have become more complex, sustainability is a strategic requirement, and the COVID-19 pandemic demonstrated that installed capacity does not always translate into usable resilience at the patient. At the same time, experience has shown the limitations of treating medical gases primarily as an Estates engineering service rather than as a safety-


critical clinical, pharmaceutical, and engineering system. The new HTM therefore asks organisations to


make decisions using better evidence and stronger governance. Design should start with clinical need and risk. Resilience should consider the complete route from source to patient. Validation and verification should demonstrate that the installed system actually delivers the design intent. Operational management should make risks visible to the organisation, while competence, pharmacy input, and clinical engagement should be built into the assurance process rather than added at the end.


In this article, Rob McCrea considers the principal changes in Part A – Design, installation, validation and verification – and what they mean for designers, Estates teams, and existing hospitals. Richard Maycock then examines Part B – Operational management – with particular emphasis on governance, pharmacy, competence, risk management, and the strengthened Permit-to-Work process.


Part A: Designing for what healthcare actually needs Rob McCrea


The first major revision of HTM 02-01 Part A in 20 years asks a different question of medical gas designers: not simply “What did we install before?” but “What does this healthcare service actually need?” That question captures an important change in


philosophy. The 2006 edition provided the industry with a strong and dependable framework, but two decades of projects, refurbishment schemes, operational experience, and changes in clinical practice inevitably exposed areas where interpretation could vary. Some requirements became treated as fixed solutions even where the original clinical rationale was no longer clear. Historic room data, familiar plant arrangements, or long-standing rules of thumb could be carried from one project to another without always challenging whether they remained appropriate for the service being provided. This could create several problems. One was the risk of unnecessary oversizing. Larger plant, additional pipework, and greater installed capacity may appear inherently safer, but oversizing can bring higher capital cost, increased energy use, additional maintenance, and more equipment to manage. It can also obscure the more important question of whether the complete system is


resilient. A large oxygen vessel, for example, is of limited benefit if the evaporators, pressure-control equipment, or downstream pipework cannot deliver the required flow to the patients who need it. At the other end of the scale, ambiguity can also lead


to under-appreciated risk. A system that has operated for many years may be assumed to be satisfactory simply because it has not yet failed. That assumption becomes increasingly fragile when a ward changes use, high- flow therapies are introduced, bed numbers increase, or the concentration of dependent patients changes. Patient safety requires a design basis that reflects the clinical service of today and the reasonably foreseeable demands of tomorrow. Sustainability is another reason for change. Healthcare


organisations cannot ignore energy, carbon, lifecycle cost, and the environmental impact of medical gases, but sustainability cannot be pursued by reducing resilience or transferring risk to clinical teams. The revised approach is therefore not ‘use less at any cost’; it is to select the lowest- impact solution that still demonstrably meets clinical need and preserves patient safety. That makes good option appraisal, rather than automatic repetition of historic solutions, increasingly important.


October 2026 Health Estate Journal 63


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