Beyond Compliance: Embracing Recommendations in NHS HTMs for Better Asset Management

The NHS Health Technical Memoranda (HTMs) provide essential guidance for healthcare estates, outlining the standards and practices necessary to ensure safety, efficiency, and patient care. While compliance with mandatory requirements is critical, the recommendations within these documents often receive less attention despite their potential to significantly improve operational outcomes. Managing NHS assets with a focus on recommendations, rather than just compliance, can lead to enhanced efficiency, better resource allocation, and improved patient environments.

Compliance vs Recommendations in HTMs

Compliance refers to the mandatory requirements outlined in HTMs, such as legal standards for ventilation rates, water safety, or energy performance. Failure to meet these standards can result in penalties, reputational damage, and increased safety risks.

Recommendations, on the other hand, provide best practice advice designed to optimise performance, sustainability, and long-term asset management. While not legally enforceable, they offer insights into improvements that go beyond the baseline. For example, recommendations on system design, maintenance intervals, or energy-saving opportunities can help NHS facilities move from reactive management to a proactive, future-focused approach.

The Challenges of Ignoring Recommendations

1. Short-Term Mindset: Solely focusing on compliance may prioritise passing audits or inspections, neglecting opportunities for cost-saving upgrades or operational enhancements.

2. Increased Costs: Failure to act on recommendations often leads to premature asset failures, unplanned downtime, and reactive maintenance, driving up lifecycle costs.

3. Energy Inefficiency: Ignoring recommended measures to improve energy efficiency, such as upgrading ageing systems, can result in higher carbon emissions and missed savings opportunities.

4. Compromised Patient Environments: Recommendations around air quality, thermal comfort, and infection control directly impact patient outcomes. Overlooking these can lead to substandard care environments.

How to Manage HTM Recommendations Differently

1. Develop a Proactive Strategy

Establish a framework where compliance is seen as a baseline and recommendations as opportunities. By integrating recommendations into long-term planning, NHS facilities can avoid crisis-driven decision-making and focus on sustainable asset management.

2. Create a Risk-Based Priority System

Use risk assessments to evaluate recommendations in HTMs and prioritise those with the most significant impact on safety, efficiency, or patient care. For example, upgrading ventilation in high-risk areas like operating theatres or improving water management systems in ageing estates.

3. Engage Multidisciplinary Teams

Include stakeholders from clinical, engineering, and operational teams to align on the benefits of adopting recommendations. Collaboration ensures that recommendations are understood and valued across disciplines, leading to better buy-in for implementation.

4. Leverage Digital Tools

Employ Computer-Aided Facilities Management (CAFM) systems and Building Management Systems (BMS) to monitor compliance and track the implementation of recommendations. Advanced analytics can highlight areas where recommendations are particularly beneficial.

5. Incorporate Recommendations into Asset Lifecycle Planning

Align recommendations with asset lifecycle stages. For instance, during asset replacement cycles, consider recommended upgrades, energy-efficient options, and future-proofing measures outlined in HTMs.

6. Secure Funding with a Strong Business Case

Recommendations are often viewed as optional due to funding constraints. Building a robust business case highlighting cost savings, reduced risks, and improved patient outcomes can secure support from decision-makers.

Key Examples of HTM Recommendations

? HTM 03-01: Ventilation

Compliance ensures minimum airflow rates in critical areas. Recommendations, however, suggest optimising ventilation for energy efficiency, comfort, and reduced carbon emissions.

? HTM 04-01: Water Safety

While compliance addresses Legionella prevention, recommendations advise enhanced monitoring, advanced filtration, and temperature control for long-term water safety.

? HTM 07-02: Energy Management

Compliance requires adherence to carbon reduction goals. Recommendations promote investing in renewable energy sources, improving insulation, and integrating energy-efficient technologies.

The Benefits of Acting on Recommendations

1. Reduced Lifecycle Costs: Proactively addressing recommendations reduces emergency repairs, extends asset life, and improves budgeting accuracy.

2. Enhanced Patient and Staff Environments: Recommendations on air quality, thermal comfort, and lighting improve both patient recovery and staff productivity.

3. Sustainability Goals: Adopting energy-efficient measures and reducing waste aligns with the NHS Net Zero Carbon targets, creating a more sustainable healthcare system.

4. Future-Ready Infrastructure: Implementing recommendations ensures NHS facilities are adaptable to evolving healthcare needs and regulatory changes.

Conclusion

The recommendations within NHS HTMs are not just suggestions but opportunities for improvement that can redefine how healthcare estates are managed. By shifting the focus from mere compliance to proactive adoption of these recommendations, NHS facilities can achieve greater efficiency, sustainability, and patient satisfaction. Recognising the value of recommendations requires a strategic mindset, collaborative effort, and a willingness to invest in the future. In doing so, NHS organisations can build resilient and adaptable environments that truly support the delivery of world-class healthcare.

For those involved in NHS asset management, what strategies have you implemented to act on HTM recommendations? Let’s collaborate to share insights and drive positive change across the healthcare sector.