New building standards pave way for taller hospitals
As margins improve,will medical inflation and healthcare costs also reduce for patients and their families? Healthier margins should also mean healthier patients, right?
The Bureau of Indian Standards’ (BIS) recently released the National Building Construction Standards (NBCS) 2026 on April 30 comes after sustained efforts by hospital associations like the NATHEALTH Healthcare Federation of India.
The association points out that the notification eases long-standing height restrictions for hospitals. NBCS 2016 capped total height at 45 metres, which is 12-15 floors, with ICUs below 30 metres. NBCS 2026 removes the 45 metre cap, with ICUs “prefered” to be kept within 45 metres, subject to enhanced fire safety provisions.
Four days later, at an event marking this year’s Nationwide Fire Safety Week (May 4-10, 2026), the Union Ministry of Health and Family Welfare unveiled the National Guidelines on Fire and Life Safety in Healthcare Facilities (2026), with enhanced protocols for high-risk areas including ICUs, NICUs, PICUs, and operation theatres.
As per a PIB report these guidelines have been developed through extensive consultations with experts from a wide range of leading institutions and hospitals, so let’s hope that there will be wide adherence to these new guidelines in letter and spirit. In fact hospitals and schools are the focus of this year’s Nationwide Fire Safety Week. There have been numerous incidents of fires in hospitals. The new guidelines, if implemented and monitored closely, should prevent such future tragedies.
Speaking at the same event, Krishna S. Vatsa, Member and Head, National Disaster Management Authority (NDMA), emphasised a proactive, systems-based approach to fire safety in healthcare facilities, and mentioned that the NDMA is planning to organise five regional programmes, along with similar initiatives at the State and district levels, to build capacity and enhance preparedness. Importantly, he highlighted the importance of instituting self certification mechanisms for regular audits, coupled with sustained awareness efforts on fire safety. He also touched on the need for adequately trained healthcare professionals equipped to respond to fire emergencies, along with clearly defined and practiced evacuation procedures.
Taller hospitals will house more patients, but also call for more medical and more crucially, more paramedical and nursing staff. India’s doctor/nurse: patient ratio will have to improve drastically to keep pace with vertical expansion projects.
Exactly a year ago, my May 2025 editorial, ‘The case for taller hospitals’, pointed out that vertical expansion allows hospitals to maximise the utilisation of land, ultimately bringing down the cost of healthcare delivery. However I also raised concerns on whether we have strong enough monitoring mechanisms to check that enhanced safety norms are being followed as hospitals add more floors.
The structural constraints are more real one year down the line. India’s metros have one of the priciest real estate rates in the world and this high cost of land means that hospitals had to grow vertically. Which translated to limited bed capacity and underutilised equipment for hospitals. Leading to higher healthcare costs for patients.
NATHEALTH’s press note hopes that the NBCS 2026 will reduce the need for greenfield projects that are both capital-intensive and time-consuming. This is expected to improve operational efficiencies and, over time, contribute to lowering the cost of care for patients.
Ravideep Singh, Associate Director, Creative Designer Architects (CDA) cautions that once hospitals expand beyond 45 metres, fire and life safety systems require far greater integration to accommodate the complexity of vertical evacuation and critical care operations. Key norms include dedicated fire lifts, refuge areas at prescribed intervals, pressurised staircases, compartmentalisation to prevent smoke spread, sprinkler systems, fire command centres, and emergency power backups for essential medical functions.
Additionally, Singh points out that vertical circulation must also be segregated for patients, visitors, staff, and services to avoid congestion during emergencies. Structural systems should be reviewed for additional loads, while HVAC, waterproofing, and evacuation planning must align with updated compliance frameworks.
Singh believes that architectural planning becomes critical in ensuring vertical hospital expansion remains compliant without disrupting operations. As he explains, “The design must embed fire safety into the planning framework through strategically located escape staircases, refuge floors, fire-rated compartments, and clearly separated circulation cores. Department stacking also matters in high-footfall outpatient zones, which should remain on the lower floors, while critical care and inpatient functions require efficient, segregated emergency access. Architects must also anticipate future expansion by designing adaptable structural grids and service shafts that can scale with additional floors.”
While Singh points out that the inclusion of refuge terraces with medical gas support reflects a stronger understanding of healthcare-specific evacuation needs, he cautions that implementation remains the real challenge. “Detailed MEP guidelines for critical care infrastructure at higher levels are still unclear, especially for HVAC, oxygen lines, and backup power. Stronger enforcement, independent audits, and stricter facade fire safety regulations will be equally critical.”
Thus the uncapping of height restrictions, combined with greater regulatory oversight on fire and life safety call for increased investment in automated, modern fire and health safety measures, as well as trained staff. Thus the savings on land costs might not be as high as envisioned.
Secondly, will the new building code divert or slow the trend of expansion and consolidation in tier 2/3/4 locations? Will it see more centralisation rather than decentralisation of healthcare facilities? Thirdly, reading the fine print, experts have pointed out that the shift from National Building Code (NBC) to National Building Construction Standards, the crucial sections like fire and life safety are now advisory instead of mandatory, pointing to the shift in the language from “shall” to “should”.
While this shift may ease the legalities of constructing high rise hospitals, will it make them safer? With these changes in NBCS 2026, the centre puts the onus of implementation and monitoring of these standards on local state level administrations. Unless state regulators make these standards mandatory, implementation will be patchy
All corporate chain hospitals are in expansion mode and with PE money pouring in, they are flush with funds. Implementing the required fire and life safety standards while adding to existing facilities as well as greenfield projects is a business need, as they need to protect their hard earned reputations.They also need to keep up with global standards to continue to attract overseas patients. But smaller facilities will struggle to implement these norms or end up cutting corners. This endangers patient safety unless local authorities are vigilant. Finding the right balance between protecting lives, without adding bureaucratic hurdles, will be key.
Hospital associations and organisations like NDMA will also play an important role in spreading awareness about the need to implement these standards in both letter and spirit. All in all, healthcare infrastructure in India seems set for a huge boost. As margins improve, will medical inflation and healthcare costs also reduce for patients and their families? Healthier margins should also mean healthier patients, right?
VIVEKA ROYCHOWDHURY, Editor
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