I first visited the Orkney islands in 1989 when I was working on a survey of Scottish hospitals. I had not been back until June this year. This post provides a short account of the surviving historic hospital buildings in Kirkwall and how the hospital service has developed since the first general hospital opened there 200 years ago.
As far as the hospitals on Orkney are concerned, the biggest change since the 1980s has been the opening of a new Balfour Hospital on the outskirts of Kirkwall for NHS Orkney. It was built in 2015-19 and officially opened in May 2021. The architects were Keppie Design.
The new Balfour is the third iteration of the hospital which first opened in a converted house in Main Street, Kirkwall, in 1845. It was named after John Balfour, local landowner and former MP for Orkney and Shetland, much of whose fortune was derived from India as an official in the East India Company. In 1836, Balfour had appointed a board of trustees with instructions to use dividends from Mexican Government Bonds for ‘building, furnishing and endowing a hospital or infirmary with a dispensary … for the reception of such sick and wounded persons as may be recommended by those appointed by my said Trustees for that purpose.’ 1
The house in main street that was acquired for the hospital was built in 1824 by William Richan of Rapness, at least in part to satisfy the extravagant tastes of his wife, Esther. Richan had borrowed heavily, and put his affairs in the hands of trustees before his death in the Kirkwall house in 1830 after which it was sold to a merchant, James Shearer from whom it was purchased by Balfour’s trustees as a hospital. The house was listed in 1971 at Category B. The list description mentions an anecdote about Richan’s wife Esther, who was reputed to have won a wager that she could eat the most expensive breakfast by putting a £50 note inside a sandwich.2
Originally the Balfour was called the ‘Orkney Hospital’. This was suggested by John Balfour, the founder, in preference to the proposed ‘Trenaby’s Orkney Infirmary’. The first resident matron was a Mrs Dearness, appointed in May 1845, and the first patient was admitted on 6 October that year on the recommendation of the surgeon, Peter Flett. In 1853 the name was changed to the Balfour Orkney Hospital, which was soon shortened to the familiar Balfour Hospital.
Patients suffering from infectious diseases were admitted from the start, initially within the main building but in the 1870s one of the neighbouring houses was acquired and an additional nurse appointed specifically to care for the fever patients. Additional accommodation near by was acquired in the early 1880s. These ad hoc and not altogether satisfactory arrangements were remedied in 1890-1 when a new purpose-built fever hospital was constructed on the adjoining ground. The plans were drawn up by the local architect, Thomas Smith Peace senior. The new fever hospital had three wards and 14 beds together with staff accommodation.3
The second Balfour Hospital was built in the 1920s following a proposal first made in March 1914 when the widow and family of Robert Garden offered funding for the purpose. Robert Garden had made his fortune in retail, with a fleet of cargo vessels and floating shops serving the islands. His widow, Margaret Garden, wrote to inform the Balfour Hospital Trustees of her family’s wish to present a hospital of ‘up-to-date design’ as a gift to Orkney, adding that details regarding the building, accommodation and site were already under consideration.4
The outbreak of the First World War a few months later meant that the project was put on hold and seemingly not taken up again until 1926. The new hospital became known as the Garden Memorial Building and provided 19 beds in two six-bed wards, single rooms and a bed for maternity cases, as well as the usual offices, staff accommodation, out-patients department and operating theatre. The old Balfour and fever block seem to have continued in use for some years after the opening of the new hospital, but had closed by 1938 and was sold in 1940. In 1943 the original hospital became the West End Hotel, which is remains to this day, while the former fever hospital has been converted to housing.
During the Second World War two hutted ward blocks were added to the rear of the Garden Memorial Building as part of the war-time Emergency Medical Scheme. These provided 84 beds on war-time standards – the beds more densely packed than in peace time. Another temporary ward block of timber was added, but was used for staff accommodation in addition to the nurses’ home. Post-war additions included a maternity unit in 1966 and a health centre in the early 1970s. The latter was officially opened in April 1973 by Sir John Brotherton, the Chief Medical Officer for Scotland.
There are also some later blocks to the rear of the site, possibly a laundry and/or boiler house that look to have been added in the 1980s-90s. All the buildings are low-rise, mostly single storey, and a good example of the incremental expansion of a small general hospital in the twentieth century. The site is currently (June 2025) surrounded by security fencing and the buildings mostly empty.
Apart from the Balfour, there are two other surviving former hospitals in Kirkwall: Eastbank, a sanatorium and infectious diseases hospital established by Orkney County Council in 1936-7, and the Orkney County Home, built as a poorhouse in 1883 but which had some maternity beds and beds for the chronic sick in the mid-twentieth century.
Eastbank Hospital comprised two ward blocks built to either side of a substantial private house of twenty rooms, with cottage and outhouses standing on two acres of ground. The Council had previously acquired the seaplane station at Scapa after the First World War, first used as a temporary isolation hospital in 1920 and later adapted as a tuberculosis hospital opening in 1924. The new hospital at Eastbank opened in 1937 with 40 beds: 24 in the infectious diseases block on the north side of Eastbank house, and 16 in the TB block to the south, where most rooms opened out onto a veranda that faced south-west.
The poorhouse opened in 1883 with accommodation for 50 paupers, the plans having been drawn up by Thomas Smith Peace senior. There had been a few small poorhouses dotted about the islands previously, while some paupers were boarded out with families or were able to gain ‘out-door relief’ (money from the Guardians to enable the poor to remain in their own homes). Birsay and Harray on the Mainland were operating a poorhouse by 1861 near Douby. At the south of Kirbister there was a parish poorhouse for Orphir, and Deerness parish had a poorhouse near Grindigar. On Westray there was a poorhouse at Kirkbrae, established in the same year as the Kirkwall poorhouse. This was also intended to provide isolation for infectious cases. It was a small building of four rooms. There were similarly small poorhouses on Papa Westry and Sanday.5
The Kirkwall poorhouse became known as the County Home by the early 1940s when it had 52 beds and accommodated a mix of the elderly, infirm, chronic sick, ‘mentally impaired’, and neglected children as well as two maternity beds. The building had outwardly changed little in the later 1980s, but within the last twenty years has been converted to flats, raising the single storey side and rear wings to the same height as the central two-storey range. New sheltered housing has been built to the rear of the old poorhouse.
During the twentieth century there were various moves to reform medical care in Britain. One that addressed the particular problems of caring for the sick in the remoter parts of Scotland was the Highlands and Islands Medical Service, established during the First World War. This scheme had released government funding to improve the health services in remote areas where it was difficult to recruit medical staff. The resident surgeon at the Balfour Hospital in Kirkwall had been appointed through the scheme. The most radical reform, of course, was the establishment of the National Health Service in 1948. In order to provide a free and equitable service to the entire population it was first necessary to understand the nature and extent of the existing health services. Even before the exact form of the NHS had been decided upon, steps had been taken to establish the condition and function of existing hospitals. A national survey had been carried out during the Second World War, begun in 1942. The results of the survey were published in 1946. The reports on Orkney and Shetland form an appendix to the volume covering the North-Eastern Region of Scotland.
The Survey acknowledged that the main problem on Orkney was its isolation from the larger medical centres and recommended that a re-organised hospital service should link Orkney more closely with one of the mainland regions. The traditional link had been with Edinburgh, largely because many Orkney doctors were Edinburgh graduates and many Orkney families had relatives in Edinburgh. Some patients were sent to Aberdeen, and Orkney County Council had an agreement with Aberdeen Town Council to use the pathology service based at the Aberdeen City Hospital. As a result of the recommendations in the Survey, when the NHS was established Orkney became part of the North-Eastern Regional Hospital Board centred on Aberdeen. This set up a formal connection with the Aberdeen hospitals to provide a much fuller service for the islands, including regular visits by specialists from Aberdeen to Kirkwall, and access to specialist hospitals in and around Aberdeen for patients from Orkney.
The administrative structure established in 1948 remained in place until the mid-1970s NHS reforms which abolished the regional boards, replacing them with smaller health boards. The Orkney Health Board was the smallest of all with just two hospitals: the Balfour and Eastbank (Shetland Health Board administered three hospitals, while the Western Isles Health Board covered five hospitals.) When Eastbank Hospital closed in March 2000, the Health Board administered just the one hospital. In 2004 Orkney Health Board became NHS Orkney, but remains the smallest territorial health board in Scotland.
Notes – see also the Orkney page of the website
- History of Parliament online: Orkney Herald, 21 March 1914, p.4 ↩︎
- Historic Environment Scotland, List Description; R. H. Hossack, Kirkwall in the Orkneys, Kirkwall, 1900, pp 348-58. ↩︎
- Orkney Herald, 19 June 1889, p.5; 25 Sept 1889, p.4; 6 Aug. 1890. ↩︎
- Orkney Herald, 18 March 1914, p.4. ↩︎
- see workhouses.org for more information on the former poorhouses on the Orkney islands ↩︎
