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Sub-standard fire protection and the NHS

Sub-standard fire protection and the NHS


Design teams need to incorporate higher standards of fire safety into hospital builds right at the outset of the project, urges Fire Safety Engineer, Darren Kirk in an interview with Jane Renton.

 

 

Darren Kirk has spent much of his career working in fire rescue, in auditing and assisting the NHS to create better fire prevention systems, and surveying the built environment, including the NHS estate. In this regard he is the bearer of both good news and bad. The good news is that considerable effort is being made by the NHS to manage fire safety to a high standard and training is often found to be of a high or even very high standard. 

 

“Training of fire safety is usually done very well and that’s reflected in the number of fires that are contained through the quick-thinking actions of staff,” he states.

 

Unfortunately, the flip side of this is that hospitals are still being built using improper specifications or the correct project specifications are ignored from a fire protection perspective. 

 

“Inspections have revealed that Carillion used non-complaint cladding on the Royal Liverpool University Hospital that it was building at the time it went into liquidation,” a recent article, published on September 13 in Planning & Building Control Today, stated.

 

Such revelations come as little surprise to Darren: “I have surveyed [hospital] buildings, some of which were built as late as 2010, that have numerous defects which are down to the way the materials were used, or poor workmanship, and sometimes due to the quality of the original design in my opinion.” 

 

These concerns have also been voiced previously by the fire authorities and fire safety organisations. 

 

Healthcare fire incidents

There have been large fires involving hospitals over the decades. In 2009 some of those culminated in the report, Review of five London hospital fires and their management, January 2008 - February 2009. Within the report it is evident there was a failure of passive fire protection, quoted in at least two of the incidents. This demonstrates that the industry is failing to learn as we are witnessing similar issues nearly ten years on. 

 

Acute, mental health and community hospitals rely heavily upon horizontal fire evacuation (PHE). This reduces the need to evacuate patients outside of the building for reasons of care and is intended to provide time for staff to safely evacuate. But if the built environment does not provide the levels of protection and tenability for Required Safe Escape Time (RSET), then the Available Safe Escape Time (ASET) may be greatly reduced in any Public Health evacuation. 

 

There is certainly no room for complacency. It may surprise some to learn that there were 1,462 fires in the NHS in 2016/17 according to ERIC data. There were also 13,244 false alarms, or situations that did not require a fire brigade call out. Mercifully, there were very few fatalities. The same 2016/17 figures show two fatalities as a result of fire.

 

The effects of fire - and smoke - in any premises, domestic or public can be serious, but in the case of hospitals, potentially catastrophic given their large numbers of in-patients, many of whom are dependent or highly dependent, who may require immediate evacuation. 

 

The causes of fire in the NHS vary. Smoking incidents have reduced significantly due to bans on public smoking. Electrical fires remain the single most common cause of fire and the NHS estate is also vulnerable to arson.

 

Fires in hospitals are particularly frightening, given the size and complexity of the buildings and the difficulties faced by the need for safe evacuation. Apart from the flames and heat, smoke can travel significant distances often distributed through ventilation systems, cavities and voids. The primary consideration in such circumstances must always be the safety of patients, visitors and staff on the premises.

 

Protecting against fire

How well hospitals deal with such stressful situations is often determined by the quality of the passive fire protection in place, something that Darren believes must be addressed much more robustly than is often the case currently. However, there are good examples of how it should be done. 

 

This involves including an experienced fire safety professional right at the outset (RIBA stages 0 or 1) of any hospital building design or refurbishment, which is not always the case in his experience. It also means developing a robust fire strategy that drives how the building will be designed, specified, constructed, managed and used. 

 

It is very easy to get it wrong. At one Trust Darren inspected, he discovered that 165 of 168 dampers installed into a hospital’s ventilation system to prevent the spread of fire and smoke through air ducts had been wrongly installed by the ventilation system installer. These were exchanged at great disruption to the Trust and its patients. It also involved additional expense to the original builder.  

 

Much of the NHS estate is pre-war and a sizable proportion of that turn-of-the-Twentieth-Century, which presents significant challenges for modern fire safety. There is also a correlation between the level of outstanding maintenance backlog and fire safety standards. The bigger the backlog maintenance, the more vulnerable it is to having a fire incident. 

 

Tragedies such as Grenfell Tower, however, tend to focus minds on fire prevention and building adaptions. It reminds us that fire is not just something that happens to other people.  

 

The recent independent review of building regulations and fire safety headed by Dame Judith Hackitt in the wake of the Grenfell fire, was long overdue and thus highly welcome, but simply didn’t go far enough, asserts Darren. 

 

“She produced a comprehensive review, but one that only covered high-rise and complex buildings, which leaves a lot of buildings outside that particular classification.”

 

Focusing on just a limited number of high-rise buildings is a missed opportunity. It still leaves us with the fundamental problem of not defining what a complex building actually is, something that applies to other critical infrastructure as well as, for example, laboratories. The lack of definition has created a potentially dangerous loophole whereby fire risk resilience is not of a high enough standard. It potentially results in too many buildings of questionable robustness to provide the critical time needed to evacuate, contain and tackle fire.

 

Given the severe challenges faced in handling a large scale evacuation of a hospital building and the number of trained competent staff required, it is imperative the building’s fire resilience is robust.

 

Darren refers to a previous audit he undertook alongside the Fire and Rescue service regarding the potential evacuation of a Trust’s special baby care unit. Each baby in an incubator would need potentially three to four staff members to move, while there could be as many as 30 babies in incubators in the unit at any one time. “You can see how many medical staff are required in the event of an evacuation. It would require significant numbers of staff to do it safely and quickly.”

 

Engagement with the experts

Hackitt called for nothing short of root and branch reform of our building regulations. As far as hospital design goes, Darren believes that those responsible for fire safety within the Trust or the appropriate authorising fire engineers need to be engaged in the design process right at the outset, something which he maintains generally doesn’t happen.

 

“You wouldn’t dream of designing a hospital without clinician involvement and you should not design a hospital building without engaging a suitably qualified fire safety professional.”

 

He suggests that a number of fire protection companies have grown in recent times beyond the available capacity of existing skilled installers to undertake the works involved. The move towards larger companies hasn’t necessarily led to improved standards, asserts Darren, who continues to come across serious fire safety defects even after an installation has been verified. It would appear there is a skills shortage that needs to be addressed by the industry.  

 

“I have inspected hospitals where fire prevention works undertaken by third party accredited companies are incorrectly specified and installed and the work is deficient.”

 

One of the more positive developments of recent months is the re-emergence of the project clerk of works, whose role it is to provide an independent assessment of the works undertaken, checking the quality of the build, M&E, structural and architectural works. This important role had diminished in recent years all too often as a result of cost cutting.

 

As Darren points out, if you were building a new aircraft, you wouldn’t wait for two or three months after its maiden flight to carry out your snagging checks as there is a significant life risk. However, this is what happens all too frequently in construction projects that include critical fire prevention systems.

 

What more needs to be done

Suppliers’ specification (fire doors) was something that Hackitt also picked up on. The cladding used at Grenfell met the fire specification test but was used in a different way from the one specified by the supplier.

 

“We need to apply more rigorous quality assurance checks throughout,” urges Darren. All of this should and could happen, but the construction industry needs to make it happen. 

 

Improved fire safety is a requirement for the NHS, but stronger leadership and buy-in at board level of Trusts is needed if we are to improve. It has been long recognised that leadership is paramount in the creation of a safe culture. Trusts need to be pro-active as we wait for not just better guidance, but also for improved regulation.

 

“Board directors in my view need to have a good understanding about significant fire risks” says Darren.

 

He adds that this awareness needs to be balanced with clinical risks, such as infection control, which boards tend to prioritise because they appear to pose a far greater risk than building issues. Darren argues that risk governance systems in Trusts should ensure all risks are treated the same.

 

He refers to one particular Trust where the board are actively involved in fire prevention, and where he sits down with the Chief Executive and his senior management team on a regular basis, which is not always the case elsewhere.   

 

“I do have contact with most of the boards of the Trusts I work for, but actual direct engagement with them on a regular basis is rare.”

 

 

As someone declared after Grenfell, a tragedy is not a conclusion. But unremitting determination to secure the very best fire-safe buildings could be.