HVAC SYSTEMS
theatres having to be closed, with several operating lists cancelled, meaning a delay in surgery for many patients. It is thus important that Estates teams liaise with clinical
and project management teams when developing a risk that will be added to the Trust risk register, setting out the full impact of any outages, so that the Trust Board is fully informed of the consequences of non-funding. The service impact is also dependant on the duration of the disruption. In the case of a failure of a direct drive EC fan, the time to fit a replacement – assuming one is available – could be less than an hour. However, if failure occurred in an ageing HVAC plant where components are obsolete or in short supply, the disruption could last weeks, or even months, while replacements are sought.
Contingency plans Hospitals should have contingency plans in place in the event of plant failures. In many ways the service impact is influenced by the contingency plans. If HVAC plant supplying a general ward fails, many hospitals will have escalation wards/areas where patients can be moved to, whereas if an HVAC system feeding an individual operating theatre fails, the contingency plan may be to move surgical procedures to another theatre, assuming one is available. A further complication here is where a theatre is set up for specialist procedures such as laparoscopic surgery, where another theatre with the same services may not be available. The contingency plan could also be wider in scope, for example seeing patients transferred to another hospital, although this can introduce delays, involve complex transportation logistics, and increase costs. HVAC systems are expensive, and furthermore the lead time for installation and commissioning can be significant, not to mention the challenges of relocation of services and provision of temporary services. We have mentioned before that the potential loss of income from the closure of a single operating theatre for a single day could amount to five or six-figure sum. Patients may have to stay in hospital for a longer period, or be sent home to return at a later date, or may even need to transferred to another hospital Trust. The knock-on effect of this is ‘bed blocking’, which puts further strain on capacity. Even a relatively short-term failure can have a financial impact in the order of £50,000-£100,000. There is also the potential for legal claims on the basis of negligence. If an HVAC system requires replacing, then the funding envelope is likely to be in excess of £1 m – a worrying cost pressure on an NHS Trust’s already over-stretched budget. Failures in hospitals readily attract the attention of the media and the public, and can damage the reputation of a hospital Trust. The level of media interest is likely to be largely based on the severity of the failure. A minor failure may thus only attract attention from the local media, but a more significant one – particularly if it has seen one or more patients sustain harm, may attract interest from national, or even international, media, potentially resulting in a severe loss of public confidence. As patients can now to some extent ‘choose’ where
they receive treatment, reputational risk can also impact on financial risk. If patients elect to move away from their local hospital Trust due to a ‘negative’ reputation, then the money for the treatment will move with them. Much of the funding is activity-based, and termed ‘Payment by results’ – for example where there is a tariff attached to each total hip replacement surgical procedure, or outpatient clinic appointment. The amount of funding will depend upon the activity, so if an HVAC system servicing an operating theatre where orthopaedic procedures are performed has failed, this will have a greater impact on the tariff
Single isolation room HVAC plant.
received than, say, a cardiac ECG clinic. Furthermore, a significant failure impacting on patients could also lead to intervention by the Care Quality Commission (CQC) under its Key Line of Enquiry (KLOE) for the organisation being ‘well-led’, and might ultimately see the Trust or other healthcare provider rated ‘requires improvement’ or ‘inadequate’.3
Conclusion With the cost pressures on NHS hospitals still severe, and competing demands being placed on the capital budgets available, it may be prudent to take a risk-based approach to informing HVAC strategic replacement programmes. This approach also enables the risk of a delayed replacement to be appropriately assessed, where it can be added to the appropriate risk register, to cater for a scenario where the organisation might be subject to regular scrutiny and review. It is important too to appreciate that a single risk cannot be considered in isolation. Ultimately, such an approach may also serve the healthcare facility’s patients best, and will ensure that public funds are being used optimally. Therefore, our key recommendations are: 1 Ensure an up-to-date and accurate asset list. 2 Conduct risk assessments on all HVAC systems. 3 Update the six-facet survey. 4 Develop a strategic replacement plan. 5 Link the replacement plan to the Trust risk register (ensuring that the Executive Board is fully informed).
References 1 NHS England and NHS Improvement. Health Technical Memorandum 03-01 Specialised ventilation for healthcare premises Part A: The concept, design, specification, installation and acceptance testing of healthcare ventilation systems. London: NHS England and NHS Improvement., 2021.
2 National Patient Safety Agency. A risk matrix for risk managers. London. NPSA, January 2008.
https://tinyurl.com/5n8wre2m
3 Care Quality Commission. Key lines of enquiry for healthcare services. 13 July 2022.
https://tinyurl.com/h4m895xr
Further reading n National Quality Board (2024). Principles for assessing and
managing risks across integrated care systems. NHS England, 4 December 2024.
https://tinyurl.com/ysbap86h
Simon Everett
Simon Everett is Programme leader for Building Surveying and a Senior Lecturer in the Built Environment at Wrexham University, specialising in Building Services Engineering. With over 20 years’ industry experience, he has held various engineering and leadership roles within NHS Estates and Facilities across England and Wales. His career includes positions at Betsi Cadwaladr University Health Board, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Shropshire, Telford and Wrekin Integrated Care Board, and Wirral University Teaching Hospitals. An Incorporated Engineer registered with the Engineering Council, Simon is also a Member of the IHEEM, and an Associate Member of the CIBSE, and has delivered modules in the Healthcare Engineering Management degree programmes at Eastwood Park. His academic interests focus on hospital infrastructure, specialist critical ventilation, operating theatres, and associated building services.
September 2025 Health Estate Journal 41
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