MEDICAL GAS SAFETY
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.
strongest when these plans are agreed before an incident, not improvised during one.
The golden thread: information as a safety control
Good governance depends on good information. An AP cannot plan a safe isolation if the drawings are wrong. A designer cannot assess an extension properly if previous modifications are undocumented. An MGSG cannot make an informed capacity decision if the organisation does not know the validated design basis of the system. The technical file and golden-thread philosophy in Part
recorded and the AP controls progression through the subsequent stages. This separation is deliberate. The person who installs or modifies the system should not simply decide what testing is sufficient and then provide their own assurance that the work is acceptable. The CP carries out the work and performs the required engineering tests; the AP provides independent engineering control and acceptance. Where pharmaceutical QC is required, that remains a distinct assurance stage before clinical return to service. The strengthened permit arrangements also improve
traceability. Clear work descriptions, current drawing references, isolation information, sketches or mark-ups, hazard classification, contingency arrangements, and defined test requirements reduce the opportunity for assumptions. In a complex hospital, knowing exactly which valve was isolated and which part of the system was affected can be as important as the physical work itself. Why make this more robust? Because MGPS work frequently takes place on live healthcare infrastructure. A small modification can have consequences beyond the immediate work area if the isolation boundary is misunderstood, a valve is incorrectly identified or testing is incomplete. The PTW is therefore a patient-safety control, not a contractor administration form.
Richard Maycock
Richard Maycock has worked in the Medical Gas Pipeline Systems (MGPS) industry since 1994, holding engineering, training, and management roles with several leading organisations before establishing Medical Engineering Systems Limited in 2016. An IHEEM-registered Authorising Engineer (MGPS), Richard provides AE services to NHS and MOD healthcare facilities and is chair of the IHEEM Medical Gas Technical Platform and an author of HTM 02-01:2026.
Operational resilience: making the engineering usable in an emergency Part B also reinforces that installed resilience must be operationally usable. A tertiary oxygen arrangement, emergency manifold, or cylinder stock provides limited protection if staff do not know when to deploy it, the connections are inaccessible, the required equipment cannot be located, or clinical teams have not considered how patients will be prioritised during a prolonged interruption. Emergency planning therefore needs engineering, clinical, pharmacy, and operational input. Scenarios should consider not only complete source failure but abnormal demand, distribution restrictions, electrical failure, loss of a pressure-control component, plant maintenance, and the practical deployment of temporary supplies. Business continuity arrangements should recognise that medical gases can be a limiting factor in maintaining clinical services. This is another area where pharmacy contributes more
than gas-quality testing. Cylinder stocks, medicinal gas availability, contingency supply routes, and changes in consumption all have medicines-management implications. Clinical teams, meanwhile, need to understand what equipment can be supported and what actions may be required if supply becomes constrained. Resilience is
68 Health Estate Journal October 2026
A therefore have a direct Part B consequence. Design assumptions, calculations, material records, commissioning results, drawings, and subsequent modifications need to remain usable throughout the life of the system. Permits, maintenance records, risk assessments, and operational changes add to that evidence base. The objective is continuity of knowledge. Healthcare
staff change, contractors change and buildings are repeatedly altered, but the safety-critical information should remain. In that sense, good documentation is not an administrative by-product of the MGPS; it is part of the system’s resilience.
Conclusion: Two parts – one safety system
Taken together, Parts A and B create a much stronger life cycle approach. Rob’s Part A perspective asks: What does the patient and clinical service require, what can the infrastructure genuinely deliver, and what is the most appropriate engineering solution? Richard’s Part B perspective asks: Who owns the risk,
who is competent to make the decisions, how is the system controlled, and how does the healthcare organisation know it remains safe? The two cannot be separated. An informed design needs effective operational management. Equally, excellent operational management cannot compensate indefinitely for an MGPS that no longer meets clinical demand. That is perhaps the biggest change in HTM 02-
01:2026. It moves the conversation beyond individual pieces of plant, pipework, and permits, towards whole- system, whole-life medical gas safety. For healthcare Estates teams, APs, AEs, designers,
pharmacy, and clinical colleagues, the challenge now is not simply to read the new HTM. It is to understand what has changed, identify what those changes mean for the systems we already operate, and ensure that engineering, pharmaceutical, clinical, and governance arrangements work together. For capital projects, that means challenging inherited assumptions and documenting the evidence behind the selected design. For operational teams, it means knowing the system’s limitations and maintaining competent control. For pharmacy and clinical colleagues, it means being active participants in decisions that affect medicinal gas quality, availability, and patient care. For Boards and senior leaders, it means recognising MGPS as a safety- critical organisational risk that requires visible assurance. Ultimately, the measure of a successful MGPS is not
how large the plant is, how new the pipework is, or how many compliance boxes have been ticked. It is whether the right medical gas, at the right quality, pressure, and flow, remains safely available to the patient when it is needed most.
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