This note explains how the Building Safety Act 2022 (BSA) and its secondary legislation apply to hospitals, care homes and other healthcare settings where patients or residents may be accommodated for a period of time.
Key takeaways
Hospitals, care homes and similar facilities are not automatically outside the BSA.
The key questions are usually whether the building meets the 18 metre / 7 storey threshold (as measured under the regulations) and whether the works involve a higher-risk building.
If the design and construction regime applies, expect Building Safety Regulator (BSR) building control, gateway approvals, enhanced dutyholder obligations, stricter change control, and increased information management requirements.
Why healthcare projects can fall into one regime but not the other
When does the higher-risk building regime apply during design and construction?
For certain higher-risk buildings, the BSR is the building control authority, and enhanced “gateway” and control procedures apply. This is driven by the BSA and the Building (Higher-Risk Buildings Procedures) (England) Regulations 2023. Hospitals and care homes over the statutory height threshold fall into scope for design and construction purposes, even though they typically fall outside the BSA once occupied.
Why are most hospitals and care homes outside Part 4 once occupied?
Part 4 of the BSA imposes ongoing duties on “accountable persons” for occupied Higher-Risk Buildings (HRB). However, an HRB for Part 4 purposes must be of the requisite height and contain “residential units”. Hospitals and most care homes do not contain “residential units” as defined, so they are usually excluded from the occupation regime.
Instead, in-occupation fire and life safety in hospitals and care homes is primarily governed by the Regulatory Reform (Fire Safety) Order 2005 (FSO). There can be edge cases (for example, mixed-use buildings with general needs flats alongside a care facility). In mixed schemes, carefully assess whether any part of the building contains residential units triggering Part 4.
When does a healthcare building become “higher-risk”?
The BSA sets two core tests for higher-risk building status:
18 metres or more; or
at least 7 storeys.
The details of how to measure height and storeys, and which uses are in or out, are set out in the Higher-Risk Buildings (Descriptions and Supplementary Provisions) Regulations 2023 (SI 2023/275).
You should not rely on informal measurements. For example, height is measured by a prescribed method, not simply the tallest parapet, and storey-counting excludes certain plant storeys and basements. Misapplying the measurement rules risks using the wrong control route.
What happens if the higher-risk building procedures apply?
These regulations operationalise the BSR building control route for higher-risk buildings. In outline, they:
Establish the approval process at key stages, including pre-construction application to the BSR, staged approvals during construction, change control, and completion certificates before occupation.
Require competence and appointment of dutyholders aligned with the Building Regulations framework.
Mandate occurrence reporting and set out the prescribed information to be created, managed and handed over (the “golden thread” in practical terms for HRB work).
Define notifiable work to existing higher-risk buildings, triggering BSR control, even where not a full new-build.
Who holds the key dutyholder responsibilities?
Amendments to the Building Regulations 2010 introduce dutyholder roles and competence obligations across all building work, but with additional rigour for HRBs. Key roles include the client, principal designer and principal contractor, each with defined duties to plan, manage and monitor compliance. Clients must appoint competent dutyholders and ensure arrangements for design control, change control, testing and verification.
How does Mandatory Occurrence Reporting work in practice?
Under the 2023 procedures regulations, HRB projects must operate a Mandatory Occurrence Reporting (MOR) system. The principal contractor and principal designer must ensure that safety occurrences which could present a risk to life or reveal a significant breach or latent defect relevant to compliance are identified and reported to the BSR within prescribed timescales, and that corrective actions are tracked.
Practically, this requires integrating MOR into site reporting, quality assurance and incident management processes, training teams on trigger criteria, and retaining records to demonstrate timely escalation and resolution.
What information needs to be created, managed and handed over?
For HRB design and construction, the 2023 procedures regulations require the creation, management and handover of prescribed information about the building and the work, to maintain an accurate, accessible record. In practical terms, project teams should:
Define information requirements at project start, aligned to the regulations.
Maintain controlled, up-to-date design, specification and change records, including as-built data.
Collate testing, commissioning, product information, and installation records for safety-critical systems and elements.
Handover a coherent package to the owner or operator at completion, ensuring it is usable for maintenance, future works and, where relevant, future regulatory interactions.
Do not overclaim by labelling every dataset the “golden thread”. Focus on what the regulations prescribe for HRB work and ensure traceability, accuracy and accessibility.
What is the main fire safety regime once the building is occupied?
For hospitals and care homes, the FSO is the principal in-occupation fire safety regime. The responsible person(s) must:
Undertake and keep under review a suitable and sufficient fire risk assessment.
Implement and maintain appropriate fire safety arrangements, including means of detection, alarm, escape, compartmentation and staff training proportionate to the risks of sleeping occupants and evacuation strategies.
Maintain records and cooperate with any other responsible persons in multi-occupied premises.
Care Quality Commission requirements and NHS guidance may inform standards, but the legal duties flow from the FSO and related fire safety legislation. The BSR’s Part 4 regime will not usually apply to occupied hospitals and care homes because they do not contain residential units. However, where a healthcare facility is part of a mixed building that includes residential units above the threshold, there may be an Accountable Person for that residential element under Part 4, alongside FSO duties for the healthcare areas.
What should estates and project teams do in practice?
Early scoping: Use the SI 2023/275 measurement rules to confirm HRB status at RIBA Stage 1–2. Record your analysis.
Choose the correct control route: If the building is a higher-risk building, plan for BSR-controlled building control, a longer programme and evidence gateways. Adjust procurement and appointments accordingly.
Appoint competent dutyholders: Under the Building Regulations 2010 dutyholder framework, make timely, competent appointments and define deliverables for HRB compliance, MOR and prescribed information.
Build MOR into site processes: Train teams, set up reporting channels, and document occurrence triage and escalation.
Plan the information handover: Define and manage the prescribed information set from the outset. Verify as-built records and product traceability for safety-critical elements.
Align with the FSO in occupation: Ensure the fire risk assessment, management plan, maintenance regimes and staff training reflect sleeping risks and any phased or progressive horizontal evacuation strategy.
Watch mixed-use interfaces: Where residential units exist alongside healthcare, map responsibilities between accountable persons (if any) and responsible persons under the FSO, including cooperation duties.
Keep governance tight: Maintain decision logs, change control, and evidence of compliance to support BSR interactions and eventual handover.
Conclusion
The key message is simple: hospitals and care homes should not be assumed to sit outside the Building Safety Act. The right legal analysis at the outset and procurement planning can materially affect programme, cost and compliance strategy.
