Head of Estates Risk and Environment at Belfast Health and Social Care Trust, George McCracken, Susanne Lee of public microbiology consultancy, Leegionella, Consultant Medical Microbiologist, Dr Michael Weinbren, former Public Health England microbiologist, Dr Jimmy Walker, Consultant Clinical Microbiologist at Frimley Health NHS Foundation Trust, Dr Manjula Meda, and Consultant Medical Microbiologist at NHS Greater Glasgow and Clyde, Dr Teresa Inkster, discuss the role of derogations, and how guidance should be perceived and used to ensure healthcare facilities’ safe design, construction, and commissioning.
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:
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