A risk-based approach supported by guidance

Any form of derogation from guidance is perceived by some as incorrect. This article discusses the role of derogations, but perhaps more importantly how guidance should be perceived and utilised in ensuring the safe design, construction, and commissioning, of healthcare facilities. NHS England has recently published a process for managing derogations.1 This is most welcome to help ensure that derogations are not used as ‘a back door’ for inappropriate decisions, and such a format should provide the necessary transparency. Annex A of the new publication lists derogations in the context of the business case process referred to in the HBNs and HTMs, which are seen as best practice guidance (Table 1).¹

To some, any form of derogation is regarded as inappropriate. This likely stems from the HTM and HBNs being promoted as ‘best practice’. The latter terminology is not only incorrect, but just as derogations for the wrong reason can result in patient harm and increase costs, failure to derogate will also result in avoidable patient harm, in addition to being a wasteful use of health service funds. Derogations which can be evidenced as providing a higher standard should not only be encouraged, but are fundamentally necessary to ensuring patient safety 

All guidance has limitations, including: