AC Daly welcomed delegates to the LFB/NHS Fire Safety Seminar, which is now in its 10th year. Working collaboratively with their partners in the NHS and elsewhere, LFB’s focus is on fire protection and prevention rather than the response to fire when it occurs. AC Daly has recently written to the LFB Management Board noting the good work done by the NHS in reducing the instance of Unwanted Fire Signals (UwFS) and also noting the way forward for charging for them and the method in which charges are collected. Unfortunately, as there has been no response to these proposals from the LFB Management Board as yet, AC Daly was not able to share any further details of the proposals made.
While it is not possible to completely eradicate risk it is possible to manage the issues that arise from it. This is particularly important in healthcare premises where sick, vulnerable and/or immobile people are likely to be present. The Regulatory Reform (Fire Safety) Order 2005 (RRO) offered a flexible means to manage risk and the Fire Risk Assessment (FRA) is the first stop in identifying any such risk. The NHS is still coming to terms with the loss of Crown Immunity in 1994 when it found itself with a lot of old and sometimes poorly maintained buildings as well as a significantly increased workload in surveying, managing and monitoring a wide range of new requirements to fulfill its statutory obligations.
Fire safety relies on trained staff such as Fire Officers to perform FRAs to ensure compliance with the RRO. The FRA process includes the collection and analysis of data to help draw up an action plan to present to the Board to achieve compliance and manage risk. The Audit ToolKit (ATK) software assists in this process by automating non-specialist tasks such as writing reports, archiving assessments (minimum requirement of 6 years based on the Data Protection Act), the raising and assignment of remedial actions resulting from FRAs, reporting of remedial actions required, tracking compliance and the identification and resourcing of trends based on archived data.
The ATK product is loaded on mobile tablet devices using bespoke software designed specifically for conducting FRAs. The database that stores all of the data is sold on a ‘Software As A Service’ (SaaS) basis so there is no IT Department involvement required in its day-to-day running or maintenance. The database is web-based and the tablet devices communicate with it via 3G or 4G. All identified issues can be automatically assigned to a person for remedial action. Assigned issues are notified by e-mail, tracked, progressed and reported. Any comments, actions or changes to FRAs are all fully audited and recorded by the system.
ATK has already been proved to save a significant amount of time in the completion of FRAs and this time can be utilised elsewhere for strategic development and planning (supported by ATK data as evidence), fire safety training, spot inspections, fire engineering duties, Fire Authority liaison or just conducting more FRAs in a shorter space of time.
Nulogic offer a flexible solution to suit a range of working methods and they can also provide qualified FRA assessors, a 3-stage quality assurance process to check and validate submitted FRAs, a cloud based solution to minimise the need for technical IT input and a dedicated admin team.
The LFB/NHS Concordat has been in existence for 10 years and was originally set up with a number of purposes: to help implement the requirements of the RRO in the NHS, to reduce UwFS and to improve communication and co-operation between LFB and the NHS. Since the Concordat was set up, NHS London has been dissolved and this has effectively rendered the Concordat obsolete.
LFB has decided to replace the Concordat with a Memorandum of Understanding (MoU) between LFB and each individual NHS Trust in the London area (estimated to total around 30). Although this will not be a binding or statutory requirement, each Trust will agree to work with LFB to improve fire safety standards in their Trust. The objectives are:
- To share best practice and knowledge
- To continue with the annual seminar, probably in collaboration with NAHFO London
- To help maintain and improve fire safety standards in the NHS through a series of MoU meetings with individual NHS Trusts
- Ensure compliance with the RRO
- Help reduce UwFS
The first 4 London NHS Trusts to sign their MoU with LFB were announced. Their inaugural meetings with LFB will be arranged shortly:
- Imperial College Healthcare NHS Trust
- South London & Maudsley NHS Foundation Trust
- Camden & Islington NHS Foundation Trust
- St Georges University Hospital NHS Foundation Trust
Barts Health NHS Trust has buildings ranging in age from 16th Century to just 5 years old. Clearly, all their buildings have operative and routinely maintained fire alarm systems and they have a progressive horizontal evacuation procedure in place. In addition to this they also have a sprinkler system (with two large capacity water tanks), bed escape lifts, smoke extraction systems, fire barriers and a fire control room in operation. Although there used to be four Fire Stations nearby there is now just one (in Whitechapel). Their UwFS have reduced from 350 a year down to just one a month.
When a fire alarm sounds, instead of calling LFB as they used to the controller now alerts the Fire Response Team to attend the incident. The Fire Team will attend immediately and call LFB if the incident requires it. If an evacuation lift is in the affected area it will automatically ground and either LFB or the local Site Manager will take control of the lift when they attend site. Likewise, only sprinklers in the affected area will activate (at 68oC) and only LFB can turn them off when they attend site.
The importance of staff training, both induction and regularly refresher training, were highlighted as key to the provision of a good and consistent fire prevention:
- The importance of keeping fire doors closed
- Need to ensure all rooms are kept clean, tidy and well maintained, and that fire doors are not obstructed
- Report anything suspicious such as the smell of smoke
- Patient equipment is correctly operated and consistently logged
- Report any broken equipment and take it out of service
- Do not leave unattended electrical equipment switched on
- Safely store and manage bottled gas
- Provide clear signage for all fire evacuation routes and stairs
The presentation concluded by looking at photos of minor fire incidents in the Trust.
Imperial College Healthcare NHS Trust consists of five main hospitals (spread over 4 sites). All of their sites are mainly old buildings, some dating back 100s of years, and they collectively have £1.2bn in backlog maintenance.
The Trust conducted a review of their fire safety in October 2015 and subsequently drew up a six year plan to maintain their compliance with the RRO and HTM Firecode regulations and, hopefully, to improve on this standard. As part of the North West London STP (Sustainability and Transformation Plan), the St Mary’s Hospital site will bring together outpatient services from 40 existing peripheral sites as part of a large-scale renovation of the area that includes major works to the Bakerloo Line, Paddington Station and the building of a ‘mini Shard’. The plans include the disposal of some hospital land and the building of a 10 to 12 storey hospital building that will link to the existing buildings on site, the cost of which has already been built into the six-year development plan. The Trust’s short-term plan is to increase their current level of compliance and to introduce new wireless and cabled fire alarm technology into the new buildings to help attain this increased level of compliance.
Although they have experienced problems engaging with staff on fire safety issues, one of their other short-term goals is to increase the level of staff fire safety training from the current level of 60% to at least 90%. The Trust is happy to support new ways of delivering fire safety training and the reintroduction of the ‘smoke filled room’ experience and the opportunity to operate a fire extinguisher to put out a small simulated fire incident are considered worthwhile exercises. One of the innovative ways they have improved the level of fire safety awareness amongst staff is to introduce ‘Internal Fire Enforcement Notices’ (IFEN) where necessary. They have also embraced technology to conduct FRAs and reduced the time for a typical FRA from four hours down to just one hour, using the data collected to identify high-risk areas.
The Trust estimates that they are a third of the way into the improvement programme and they have allocated £3-4m from the Estates and Facilities Management budget to address Estates issues in this area in 2016-17.
After a 27 year career in healthcare – as a Director of Estates at Great Ormond Street Hospital for Children NHS Foundation Trust and then at Croydon Health Services NHS Trust – Mike has left the NHS to become Head of UK Healthcare Engineering at Sodexo. In his new role he is working with the British Engineering Services Association (BESA), who provide a library of industry standard maintenance specifications known as SFG20, to develop a set of healthcare specific documents. The SFG20 document set helps specify maintenance activities, schedule planned maintenance to industry standards, benchmark maintenance performance, control costs and stay updated and compliant.
Looking at a specific example, the routine maintenance of fire doors is described in Article 17 of the RRO as being ‘subject to a suitable system of maintenance’ (but does not specify what must should be checked or how frequently) while HTM 05-03 Part K suggests monthly checks to ensure ‘…fire doors are in good working order and closing correctly, and that the frames and seals are intact.’ Should a large hospital have, say, 8000 fire doors it would take two tradestaff a whole month to check them all. As this is not feasible a system of risk management must be introduced based on three factors: frequency of door use (low, medium, high); the criticality of the door based on the dependency of the patient(s) it protects; and, the likelihood of the door being damaged. The slides for this presentation show a sample matrix based on Dependency and Usage with the resulting frequencies being adjusted up or down for high or low damage potential, or left the same otherwise. A similar approach can also be adopted for fire dampers and fire compartmentation, for example.
The healthcare specific documents should be available from 5th October 2016. They are based largely on the HTMs drawing in key elements of other guidance and they have been drawn up with input from Healthcare Estate & Facilities Managers Association (HefmA) and the Institute of Healthcare Engineering and Estate Managers (IHEEM).
The presentation opened with photos and discussion around five major fires in London Hospitals during 2008/9 at the Royal Marsden Hospital, University College London Hospital (UCLH), Great Ormond Street, Chase Farm Hospital and Northwick Park Hospital. The main concern in each case was the safe evacuation of vulnerable or immobile patients, the disruption to service and the cost to recover from the incident.
Following the incident at their Trust, UCLH installed a sprinkler system. Sprinkler systems are considered to have low maintenance costs but a long service life; they only activate if there is a fire and then only the heads closest to the fire will operate; and, they help to quickly suppress fires to save lives and protect property. However, sprinkler systems should not be installed in buildings greater than 30m in height and particular note must be made of commercial enterprises in hospital buildings (such as Costa, Starbucks and so on).
The benefits of installing sprinklers in healthcare premises are to provide an early form of attack when fire occurs, reduce the need to move vulnerable patients, minimise service disruption and to give more time to evacuate staff, patients and visitors. The cost of installing sprinkler systems is roughly 1-2% of the total building cost and roughly equivalent to carpeting a new building. Although there is little healthcare specific guidance on the topic, Welsh Health Estates has issued a Guidance Note entitled “Sprinkler systems in healthcare premises”.
The closing message is “Think sprinkler!”
South London and Maudsley NHS Foundation Trust (SLaM) covers 4 London Boroughs and has 4 hospital sites plus another 300 other units. The Trust is also the national centre of excellence for patients with eating disorders and autism.
In 2015, HTM 05-02 introduced guidance specific to Mental Health in-patient services which in SLaM’s case includes:
- Acute in-patient beds
- Psychiatric intensive care unit
- Forensic services
- Low and medium secure units
- Recovery and rehabilitation services
- Child and Adolescent Mental Health Services (CAMHS)
- Dementia assessment
- People with learning disabilities
After discussing some of the specific guidance particularly in relation to the segregation of patients and accommodation types, some points were raised relating to fire doors and the use of door closers (which are not used or required).
A majority of Mental Health (MH) units are old and do not comply with current legislation. This provides a challenge, as budgetary constraints are tighter than ever both locally and nationally.
MH unit requirements raise specific challenges when it comes to fire safety as:
- Doors do not usually open and only staff have keys
- Secure escape routes and assembly points must be provided whilst also maintaining segregation of patients
- Special non-flammable textiles and furniture must be purchased
- The guidance on the use of swing free devices and self closers keeps changing
- Fire doors are frequently damaged by patients
- here is a high turnover of staff
- A lot of bank and agency staff are used
- Understanding of fire procedures, language and strategy can be limited
- May wish to take their own life and often seek to obtain lighters and matches
- Extinguishers are locked away as they can used as a weapon
- May not realise their actions are dangerous to themselves or others
- May set off fire alarms to facilitate escape
- May not be aware of what to do when the fire alarm sounds
- Can react in different ways
- May find creative ways to cause damage eve though it may be unintentional
The presentation concluded by looking at some photos of minor fire incidents that have occurred on SLaM sites and their causes (see slides).