Hospital fire strategy reports
A hospital fire strategy differs from a standard building because most patients cannot evacuate themselves. The design therefore relies on progressive horizontal evacuation, moving people sideways into an adjoining fire compartment rather than out of the building. That demands smaller compartments, higher fire resistance, more robust construction and staffing levels that make assisted movement realistic.
Everything else follows from that single fact. If patients cannot leave, the building itself has to become the refuge, and the document is fundamentally about compartmentation and staffing rather than about escape routes.
The guidance framework for healthcare
Healthcare buildings comply with the Building Regulations like any other, and Part B applies. The sector then works to its own technical standards on top, and those are usually what is written into the contract.
In England, Health Technical Memorandum 05-02, “Firecode: guidance in support of functional provisions, fire safety in the design of healthcare premises”, is the design guidance. It carries a 2015 edition date, and it sits inside the wider HTM 05 firecode series alongside HTM 05-01, “Managing healthcare fire safety”, version 3 of July 2016, and HTM 05-03, “Fire safety in the NHS: operational provisions”, which is published in lettered parts.
Wales runs a parallel series. Welsh Health Technical Memorandum 05-02, first edition 2014, covers fire safety in the design of healthcare premises for providers of NHS-funded healthcare in Wales and is published by NHS Wales Shared Services Partnership Specialist Estates Services, with WHTM 05-01 and the WHTM 05-03 parts alongside it. Approved Document B is also published separately for the two nations: the England documents are the 2019 edition incorporating the 2020, 2022 and 2025 amendments, while Wales works from 2006-edition documents last amended with effect from 20 December 2025.
Care homes and other residential care settings sit differently again. They are usually assessed against BS 9991:2024, which was published on 27 November 2024, replaced BS 9991:2015 and for the first time brings care homes expressly within its scope, and they carry duties to the relevant care regulator alongside fire safety law. Note also that the 2025 amendments to the England Approved Document B make provision for sprinklers in all new care homes.
Before anybody scopes a healthcare fire strategy, establish which standard the client is contractually working to. Writing to the wrong one is expensive and the error surfaces late.
Progressive horizontal evacuation and what it demands
Progressive horizontal evacuation means moving patients from the compartment where the fire is into an adjoining compartment on the same floor, separated by fire-resisting construction. If conditions worsen, they move again, to a further compartment or vertically.
For that to work, several things must be true at once, and the document has to establish each of them.
Compartments must be sized to receive the patients from next door. A receiving compartment needs space for beds, chairs and equipment, plus the staff moving them, without blocking the onward escape route. Compartment sizing in healthcare is driven by this rather than by area limits alone.
Compartment construction must actually perform. Fire resistance periods, door specifications, glazing, and above all the sealing of the many services crossing compartment lines. Medical gas pipelines, nurse call, data, ventilation and drainage penetrate walls repeatedly. Poorly sealed penetrations are the most common defect found in healthcare estates, and they defeat the whole approach.
Staffing must be sufficient to move patients in the time available. This is a design assumption and it has to be written down. A document that assumes a staffing ratio the ward does not actually run at night is not valid. Night-time staffing is the binding case.
Equipment must be available and usable. Evacuation aids, movement routes wide enough for the beds actually in use, and door widths that accommodate them.
Patient dependency changes the design
A ward of ambulant day patients and an intensive care unit are not the same fire safety problem. Healthcare strategies therefore work from patient dependency, meaning how much assistance each patient needs in order to move.
How patient dependency drives the fire strategy in a healthcare building.
Higher dependency drives smaller compartments, higher construction standards and, often, suppression. The strategy states the dependency assumption for each area and designs to it.
Some areas need specific treatment. Operating theatres, where a procedure cannot simply stop. Intensive care and high dependency units. Neonatal units. Imaging, particularly MRI, where the magnetic field constrains what equipment can enter and how the fire and rescue service responds. Mental health units, where locked doors, ligature-resistant design and patients who may not co-operate all interact with fire safety in ways that need explicit resolution rather than a generic paragraph.
Hazards specific to healthcare buildings
Medical gases, particularly piped oxygen, are the defining hazard. Oxygen enrichment makes materials burn far more readily. The strategy must address pipeline routing, area valve service unit locations, isolation procedure, who holds authority to shut off a supply, and cylinder storage. Isolation is a clinical decision as well as a fire safety one, and the document should say how that decision is made and by whom.
Then the rest: dense electrical and battery-powered equipment at bedsides, sterile services and decontamination plant, kitchens at scale, laundries, plant rooms and service risers, laboratories and pathology, pharmacy stores including flammable and controlled substances, clinical waste, and helipads on some acute sites. And, on almost every campus, equipment stored in corridors, which is a management problem the strategy will inevitably make assumptions about.
The estate problem: hospitals are never one building
Acute hospital sites are among the most complicated estates in the country. A typical district general has a post-war main block, decades of extensions, a wing built under a different procurement route to a different standard, modular ward units, and a network of link corridors and tunnels.
The consequences are predictable. Compartment lines that no longer correspond to anything built. Alarm systems from four eras interfaced together. Escape routes that pass through three buildings. Historic approvals nobody can locate. And a fire risk assessment carrying the same unresolved findings year after year, because the design intent is unknown.
A whole-site strategy plus a coherent drawing set is the way out. For most existing estates that is a retrospective fire strategy, and the fire strategy drawings are what the estates team uses daily.
Continuous occupation and continuous construction
Two further constraints shape healthcare work.
Hospitals never close. There is no quiet period in which to take a compartment line out and rebuild it. Works have to be phased, and each phase needs interim fire safety arrangements covering temporary compartmentation and escape routes, alarm coverage during changeover, and hot works control. The strategy should say who produces those and to what standard.
Healthcare estates are also almost permanently under construction somewhere, so the document is a living one. It needs an owner, a review trigger and a revision history, or it will be inaccurate inside a year.
How to take this forward
For a new build or major refurbishment, the document wants commissioning at concept stage and developing through the design, with dependency and staffing assumptions agreed with clinical teams early rather than assumed by the design team.
For an existing estate, the priority is a whole-site document with accurate compartmentation drawings that estates, the risk assessor and the fire and rescue service can all use. A fire strategy report is the deliverable in both cases.
Competence matters more here than almost anywhere. Ask what comparable healthcare buildings the author has worked on, what their position is under BS 8670-1:2024, the competence framework code of practice that superseded BSI Flex 8670 v3.0:2021, and whether they will attend clinical meetings to agree the staffing assumptions.
Healthcare is treated as a high-liability sector here, so hospital and care projects are taken case by case rather than as standard work. Describe the site, the works and the stage they are at, and fit is confirmed before any quote is issued. Reports are arranged across England and Wales through a network of chartered fire engineers, so matching the project to the right engineer is the first step rather than an afterthought. For the wider service, see fire engineer or fire strategy consultant.
Frequently asked questions
What is progressive horizontal evacuation?
Moving patients sideways into an adjoining fire-resisting compartment on the same floor instead of out of the building. It is the standard healthcare approach because most patients cannot use stairs, and it requires compartments sized and built to receive the patients from next door, plus enough staff to move them.
Which guidance applies to NHS hospitals?
The Building Regulations apply, with HTM 05-02, carrying a 2015 edition date, as the sector design guidance inside the HTM 05 firecode series, alongside HTM 05-01 on managing healthcare fire safety and the HTM 05-03 operational provisions parts. NHS Wales bodies work to the Welsh series instead, where WHTM 05-02 dates from 2014. Always confirm which version the client mandates.
Do care homes follow the same approach as hospitals?
Not identically. Care homes are typically assessed against BS 9991:2024, which brought care homes expressly into its scope, with sector considerations, and progressive horizontal evacuation is used where resident dependency justifies it. Staffing levels, particularly at night, drive the analysis, and the care regulator’s requirements sit alongside fire safety law.
How does staffing affect the fire strategy?
Directly. Progressive horizontal evacuation only works if enough staff are present to move patients within the time the compartment protects them. The document must state the staffing assumption, and the operator must maintain it. If night staffing falls below it, the design basis no longer holds.
What is the most common defect found in hospital estates?
Breached compartmentation, usually from services installed or altered through fire-resisting walls without proper sealing. Works are continuous and penetrations accumulate. A compartmentation survey against an accurate drawing set is the usual remedy.
Can one document cover a whole hospital site?
Yes, and for an acute site that is normally the right approach, with building-specific sections beneath a site-wide framework. A folder of unconnected historic approvals cannot support a coherent evacuation approach across linked buildings.
Can you take on our hospital or care home project?
Healthcare is a high-liability sector and is considered case by case rather than accepted as standard work. Send the site details, the scope and the stage the project has reached, and fit is confirmed before a quote is issued.
Need a fire strategy?
Fixed fee, verifiable competence, England and Wales.