Victoria Hospital, Kirkcaldy, and Queen Margaret’s Hospital, Dunfermline, are the two main hospitals in Fife, serving the eastern and western halves of this large county. They both comprise buildings that mark significant periods in the history of post-war hospital architecture, and the Victoria has some of the earliest surviving NHS buildings in Scotland. The site is now dominated by a large, 500-bed ward block built in 2009-12 by Balfour Beatty to designs by Building Design Partnership.

As yet little studied, I have recently been looking into the development of the hospital during the 1950s and 60s, delving into the Department of Health for Scotland files, and the records of the East Fife Hospitals Board of Management. But the story begins long before the National Health Service, and at least one remnant survives of the earliest phase of this hospital. 

Although not the most architecturally exciting of buildings, at the heart of the modest brick-built building pictured above is an 1890s ward block, part of the original burgh fever hospital. This was built as a scarlet fever ward. There was a larger ward block to its west that was intended for typhoid patients in one half of the building, and diphtheria patients in the other. Between these two was an administration block which also housed some staff accommodation, and there was a laundry and disinfector, mortuary, and gate lodge on the site. Plans for the hospital had been drawn up by the Glasgow architects, Campbell Douglas & Morrison in 1897 to provide accommodation for 33 patients in all. 

The fever hospital was extended in 1908, with a sanatorium pavilion for tuberculosis patients (on the site of the present hospice, and possibly partly incorporated in the present building). Further additions were made in 1930 with another sanatorium building and a cubicle isolation block. By the 1940s the hospital had 124 beds, but by then the buildings were not considered up to modern standards. In the run up to the establishment of the National Health Service the plan was to use nearby Cameron Hospital for infectious diseases, and to convert the Victoria into accommodation for the aged and infirm. Cameron Hospital had been considerably extended in the 1930s, its relatively modern buildings and large open site offered the potential to develop a new general hospital there. 

Difficulties over the acquisition of the additional land required adjacent to Cameron Hospital caused considerable delays. This, together with the time consuming bureaucracy of the new health service, followed by drastic cuts in central funding for new building, lead eventually to the abandonment of the Cameron Hospital scheme in about 1958. In the mean time, a new surgical ward block and other additions had been planned at the Victoria Hospital, with a view to addressing the serious shortage of beds across Fife generally. Work on this extension was nearing completion when the Cameron plan was given up, and the decision taken to build a second, larger block at Kirkcaldy. The 1950s extension therefore became known as phase one, the 1960s development phase two. The contrast in style and planning between these two phases indicates how post-war hospital architecture was developing apace at this time. Both phases are rare survivals of a key moment, demonstrating the evolution of modernist architecture as well as of hospital planning.

Phase I

Preliminary plans for a 100-bed surgical unit at the Victoria site were on the drawing board of the architects’ department of the South East Regional Hospital Board in 1953. By October 1954 they had been broadly approved by the Department of Health and had been submitted to the East Fife Hospitals Board of Management based at Kirkcaldy for their consideration. John Holt, the Regional Board’s chief architect, attended meetings with the local Board of Management to explain the rationale behind the designs.  

The footprint of the ward block adhered to pre-war pavilion planning in its arrangement, if not its internal layout, comprising a three-storey T-plan building divided into three ward wings with the main entrance hall and stair at their meeting point. A single storey range on the north side contained the main out-patients’ department, and another at north-west corner housed a chest clinic. The entire building is flat-roofed, steel framed, and faced in buff-coloured brick and glass curtain walling. The flat roof of the north-east wing had a solarium and roof garden, its reinforced concrete pergola remains a distinctive feature of the building. Roof terraces and solaria were more common in the interwar period, and even then roof gardens were a rare feature in a Scottish hospital. 

Inside, clinics, offices and the children’s ward were on the ground floor, wards and accommodation for medical staff on the first floor, and further wards and twin operating theatres on the second floor. According to Holt, ward planning was based ‘on the continental practice’ of having wards sited on one side of a central corridor and ancillary rooms on the other. This was known as the Rigs model (referring to the Rigs Hospital, Copenhagen), and was also the basis of the Nuffield Provincial Hospitals Trust’s widely publicised experimental ward built at Greenock in the early 50s. 

Unusually, the operating theatres faced south. This met with surprise from the Board of Management committee, as it was traditional for theatres to be on the north side to benefit from even northern light. Holt explained that the trend was now against providing large theatre windows, rendering their position unimportant, and the theatres here would be air-conditioned, combatting heat from direct sunlight and providing effective bacteriological control. 

When work on the surgical block was nearing completion in 1959, it was discovered that the ward doorways were too narrow to allow beds to be wheeled through easily. The standard hospital bed, without mattress, sheets and blankets, was 36 inches wide, and the new ward doorways were fractionally under 40 inches wide. Various suggestions were made for easing the beds through the doorways, but widening them was dismissed as too costly. Metal strips were proposed to be added to the door frames to protect the woodwork, narrower beds were rejected, but narrower mattresses would be used. The matter was also to be ‘kept in mind’ when plans were drawn up for the phase two ward block.

Nurses’ Home, Hayfield House

The nurses’ home, now Hayfield House, has some more overtly modernist features: its upper floors resting on slender pilotis, originally with an open space in the centre. It was constructed in a novel way, using a method that until that time was only used on tall silos. The concrete frame of the building was constructed from shuttered concrete made using continuously sliding forms operated by hydraulic jacks. The timber forms were constructed in situ on the first floor, and given a slight batter to ensure that they were self-clearing. Work was carried out continuously for four days, with 54 men on the day shift and 51 on the night shift.  This experimental construction method was recommended by the consultant engineers, Blyth and Blyth, because of the ground conditions. The presence of historic mine workings favoured a concrete frame, being lighter than steel, particularly for a building of this height. Nevertheless, the modernist aesthetic was tempered by the warm tones of the brick facing, pale blue tiles and random-rubble stonework at the entrance. 

Phase II

In 1958 the Department of Health approved a second extension at the Victoria Hospital. Trial borings had to be made on the site once more, to check for underground mine workings, but as soon as the site was deemed suitable detailed planning was begun in the hopes that building work might start in 1961. The architect in charge of phase two was Eric Dalgleish Davidson, who had taken over from Walter Scott on phase one when Scott had left to set up in private practice late in 1957.

A model of phase two was made in 1962, and plans had been finalised by November that year. The annual report of the Scottish Home and Health Department recorded that the second extension to the Victoria was in progress at the end of the year. Officially opened in 1967, phase two is in marked contrast to phase one in style and scale: high rise rather than low rise, uncompromisingly modernist, and adopting a deeper, double-corridor ward plan.

An eleven-storey tower sits atop a two-storey podium – in the matchbox-on-a-muffin manner, demonstrated clearly in the model pictured above. The extension housed twice the number of beds as phase one (240), three operating theatres, a new out-patients’ department, A&E, X-ray, sterile supply, physiotherapy and occupational therapy departments, as well as a conference hall, and libraries for patients and medical staff. Eight ward units, each with 30 beds, were located in the tower; the beds were mostly in four-bedded bays, supplemented by single rooms. Various labour-saving devices were introduced making the most of technical innovations. 

In addition to the main ward tower, some of the phase one buildings were extended to meet the demands of the large increase in patients and staff. The kitchen and dining-room building was one that had to be enlarged, but the Board of Management’s hopes for greatly expanded staff recreation facilities (including a swimming pool) proved too expensive. 

With the shift from Cameron Hospital to the Victoria as the new general hospital for East Fife, the central laboratory which had been established at Cameron was now in the wrong place. A new laboratory was therefore included in the phase two scheme. Different in style again from either phase one or the ward tower, this distinctly industrial-looking building occupies the north-east corner of the site. The laboratory is square in plan, arranged around an internal courtyard. 

The phase two extension of the Victoria Hospital is particularly significant in Scottish hospital history because of the involvement of Eric Davidson in its design. Whilst it is difficult to ascribe a single designer to the phase two buildings, Davidson was the architect in charge.  In 1960 he had been made Assistant Regional Architect to the South Eastern Regional Hospital Board and also Chairman of the Scottish Hospitals Study Group (1960-4). Following the re-organisation of the NHS in 1974 he became Assistant Director and Chief Architect of the Scottish Health Service Building Division (from 1974 until he retired in 1989). John Holt, likewise, is a key figure in the earlier decades of Scottish hospital design. As the chief architect to the Regional Board, he headed up a department that designed many remarkable buildings extending from hospitals in the Borders, across the Lothians and into Fife. 

In the more recent additions to the Victoria Hospital, major architects or architectural firms are also present, with Building Design Partnership for the newest development (completed 2012) and Zaha Hadid for the Maggie’s Centre (2006). Each phase, from the 1890s onwards, encapsulates in built form the ideas, hopes and aspirations of the different times in which they were designed. 

The view above looks south across the double-curved front of the new wing, with its paired entrances sheltered by distinctive, up-turned, curved canopies. The nearer entrance leads to the out-patients’ department and main wards, the farther entrance to the maternity wing. Just visible on the right is the corner of the diminutive Maggie’s Centre. 

Sources 

National Records of Scotland, Department of Health files: Fife Archives, East Fife Hospitals Board of Management, Minutes; Plans, DG/K/5/121: Department of Health for Scotland,  Scottish Hospitals Survey, Report on the South-Eastern Region, 1946: PP, Scottish Home and Health Department, Annual Report for 1967, p.76: The Hospital, Jan. 1960 p.67; December 1960, pp 995-1004; Jan. 1961, p.54; July 1961, p.474; May 1962, pp 303-4; March 1964, p.163; Sept 1967, p.353: AJ, 22 Nov 1956, pp 746-7: Urban Realm, 24 Aug 2012.