HTM Guidance Explained: What Healthcare Estate Teams Need to Know

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May 26, 2026

HTM Guidance Explained: What Healthcare estates need to know

Healthcare buildings are some of the most complex environments to manage from a fire safety perspective. Estates and facilities teams are responsible not only for maintaining compliance, but also for ensuring that fire safety measures continue to function effectively within buildings that are constantly evolving. 

From ageing infrastructure and phased refurbishments to operational pressures and changing clinical demands, healthcare estates face unique challenges that can directly affect ongoing fire risk management.

This is where Health Technical Memorandum (HTM) guidance plays a vital role.

What is HTM Guidance?

Health Technical Memoranda (HTMs) are a series of technical guidance documents developed specifically for healthcare premises. They provide detailed recommendations on the design, operation and maintenance of healthcare buildings and engineering systems.

For fire safety, the primary document is HTM 05: Firecode, which supports healthcare providers in managing fire precautions across hospitals, clinics, mental health facilities and other healthcare settings. 

HTM guidance recognises that healthcare environments operate differently from standard commercial buildings. Many occupants are highly dependent on staff assistance, meaning fire safety strategies must prioritise containment, resilience and managed evacuation procedures.

Why healthcare fire risk management is different

Unlike many commercial premises, healthcare buildings cannot simply rely on immediate evacuation during a fire emergency.

Healthcare estates teams must manage environments that often include:

Vulnerable or non-ambulant patients

24/7 occupancy

Critical medical equipment

Complex building layouts

High staff and visitor movement

Continuous operational demands

This means fire safety measures must remain effective even while services continue to operate around the clock.

The challenge of ageing estates

Many healthcare facilities across the UK operate within ageing buildings that may have undergone decades of modifications, extensions and service upgrades.

Over time, this can create several fire safety challenges, including:

  • Compromised compartmentation
  • Inconsistent fire stopping
  • Legacy building materials
  • Outdated fire doors
  • Poorly documented historical alterations 
  • Complex hidden voids and service routes

In older estates, fire safety systems that originally performed effectively may gradually become weakened through repeated building works or lack of coordinated maintenance.

Even relatively small penetrations made for cabling, pipework or ventilation can undermine compartment integrity if not correctly fire-stopped. 

Operational Pressures and live healthcare environments

One of the biggest challenges for estates teams is balancing fire safety improvements with the operational demands of live healthcare environments.

In many cases:

  • Wards cannot easily be decanted
  • Clinical services must remain operational
  • Access for intrusive inspections is restricted
  • Maintenance works are carried out in phases
  • Contractors work across occupied areas

These pressures can result in temporary arrangements, phased works and delayed remediation programmes that require careful management to avoid increasing fire risk.

Healthcare estates teams therefore need robust systems for:

01

Tracking deficiencies

02

Managing remedial actions

03

Monitoring compartmentation integrity

04

Coordinating contractors

05

Maintaining accurate fire safety records

The impact of phased alterations

Healthcare buildings rarely remain static. Departments are frequently reconfigured to meet changing patient needs, technological advancements or service demands. 

However, phased alterations can unintentionally affect the original fire strategy if fire safety considerations are not consistently integrated throughout the project lifecycle. 

Common issues include:

  • Breaches in fire compartment walls
  • Removal or alteration of fire-resisting construction
  • Unprotected service penetrations
  • Changes to escape routes
  • Incorrect replacement fire doors
  • Poor integration between old and new building elements

Without proper oversight, these changes can gradually erode the effectiveness of the building’s fire protection systems

robust fire strategy information

One recurring challenge within healthcare estates is ensuring that fire strategy information remains current and accessible.

Where records are outdated or incomplete, it becomes difficult to:

  • Understand compartment layouts
  • Verify fire resistance standards
  • Coordinate future works safely
  • Identify historical deficiencies
  • Support fire risk assessments effectively

Maintaining accurate fire strategy drawings, compartmentation records and asset information is essential for long-term compliance and risk management.

A proactive approach to fire safety

HTM guidance promotes a proactive, risk-based approach to fire safety management rather than reactive compliance alone.

For healthcare estates teams, this means focusing on:

Routine auditing and inspection programmes can help identify issues early before they develop into larger compliance or life safety concerns.

collaboration is key

Effective healthcare fire safety management relies on collaboration between estates teams, fire risk assessors, contractors, consultants and clinical staff. 

By ensuring fire safety remains integrated into maintenance, refurbishment and operational planning, healthcare providers can better protect patients, staff and visitors while maintaining compliance with HTM guidance and wider fire safety legislation. 

Need further support? Contact us today

For support with healthcare fire risk management, compartmentation surveys, fire door inspections or HTM-aligned compliance services, contact the Assured team today.

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