The Falkirk Ward

The Falkirk Ward was designed by the Department of Health for Scotland in the 1960s. It was an experimental ward, a prototype to be tested for its efficiency and flexibility. If successful, it was to be rolled out in the new district general hospitals planned to be built across Scotland as promised by the Hospital Plan of 1962. In the 1990s it was selected by DoCoMoMo as one of Scotland’s key 20th Century Modern architectural monuments. It  was one of  60 post-war buildings which were deemed to be of particular significance in terms of their design or style.

Looking towards the Falkirk Ward Unit from the south, photographed in 1991 © RCAHMS

The ward block was erected at the existing Falkirk and District Royal Infirmary. The Infirmary had been built in 1926-31 to replace an older cottage hospital and was officially opened by Prince George, later Duke of Kent, in January 1932. It had been designed in a sparse Neo‑Georgian style by the local architect, W. J. Gibson, with advice from Dr D. J. Mackintosh, Medical Superintendent of Glasgow’s Western Infirmary. Mackintosh was an inveterate giver of advice to hospital boards of management, and author of Construction Equipment and Management of a General Hospital published in 1916. The architect, William Gibson, had a family connection with the infirmary as his mother, Harriette Hicks Gibson, had been the main force behind the foundation of the original cottage hospital. His father, John Edward Gibson, was managing partner of the Camelon Ironworks in Falkirk.

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Falkirk Royal Infirmary, photographed by in 2008. These buildings were demolished some time after 2010. © Copyright John Lord and licensed for reuse under this Creative Commons Licence.

Funds were raised to add a nurses’ home in the late 1930s and a competition held for the design, limited to architects practising in Scotland. First prize went to the firm of Rowand Anderson, Paul & Partners, Stuart R. Matthew came second and a local firm, T. M. Copland & Blakey were placed third by the assessor, C. G. Soutar. [AJ, 22 Dec 1938, p.1013.]  The outbreak of the Second World War resulted in the plans being postponed and eventually abandoned, instead nine Emergency Medical Scheme huts were built on the site (a further two were added later).

O.S. 1:1250 Map, Surveyed in 1951, showing the 1920s-30s infirmary at the top/north side of the site, and the EMS hutted annexe to the south. Reproduced by permission of the National Library of Scotland.

Falkirk Infirmary was one of eleven institutions in Scotland selected by the Department of Health for hutted annexes to provide for the anticipated air-raid casualties. The eleven sites comprised four local authority hospitals (Robroyston, and Mearnskirk, in Glasgow; Hairmyres, Lanarkshire; and Ashludie, Dundee) four voluntary hospitals (Astley Ainslie, Edinburgh; Victoria Infirmary Auxiliary Hospital, Busby, Glasgow; Falkirk Royal Infirmary; and Stirling Royal Infirmary), and three mental hospitals (Gartloch, Glasgow; Bangour, Edinburgh; and Larbert). The huts, measuring around 144ft by 24ft,  were each to contain 36 beds, and were to be built and maintained by the Office of Works. [The Lancet, 22 April 1939, p.943.]

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Extract from the OS Air Photo Mosaics, 1944-50. Reproduced by permission of the National Library of Scotland

The executive architects of the Falkirk Ward who worked in conjunction with the Scottish Home and Health Department and Western Regional Hospital Board were Keppie Henderson and Partners. The design was drawn up by the Hospital Planning Group of the Scottish Home and Health Department, comprising two architects – John Ogilvie and Mr Bruce, Dr Hunter and Miss McNaught on the medical and work-study side, Mr Rendle for administrative expertise, and Mr. Wotherspoon, engineer. Plans were finalised in October 1962 and work began in the following year. The new unit was officially opened by Bruce Millan M.P., Under Secretary of State for Scotland, on 4 November 1966, although one of the wards was brought into use towards the end of 1965. Patients were moved into it from two overcrowded wards in the old hospital. One of the consultant surgeons, Mr R. G. Main, noted that the old hospital’s surgical unit (which the new block replaced) had 65 beds consisting of one male ward and one female ward, but they sometimes added in as many as ten extra beds in the middle of each ward in order to cope with the waiting list. He recalled how ‘A ward round could be likened to a stroll through Glasgow Central Station on Fair Saturday!’ [SHHD, Hospital Design in Use 4 The Falkirk Ward, Edinburgh, HMSO 1969, p.39.]

The Falkirk Ward Unit, photographed in 1991 © RCAHMS

The Falkirk ward was developed in order to provide greater ‘privacy, amenity and better facilities for caring for patients and so set standards for National Health Service hospitals which might be generally acceptable for many years to come’. [The Hospital, Feb 1968, p.65.] It was an experiment in design incorporating several features which were being contemplated or proposed for new hospitals but had not yet been tried out in Britain. It was a complete departure from the standard Nightingale ward, and involved a move towards much smaller ward units. It was not considered viable to provide only single and double rooms which were by then current in American hospitals. This would have created too many operational and staffing difficulties and greatly increased the running costs. For these reasons a combination of four‑bed wards and single rooms was selected, with a ward floor of 60 beds, including twelve for intensive care.

Falkirk Ward Unit, First-floor, reception © RCAHMS

In addition to the experimental ward block, a two-storey service building was constructed as part of a general scheme of reconstruction at the infirmary. This addition provided kitchen, staff dining-room, pharmacy and central stores, and was also completed in 1965. In that year work began to design a new out-patients’ department. This, too, was designed by members of the Hospital Planning Committee of the Scottish Home and Health Department. The team in this instance comprised one of the few female architects employed by the NHS in Scotland in the 1960s, M. Justin Blanco White, Dr Hunter and Miss McNaught were the medical advisers and Mr Rendle the administrative adviser.

Interior of the Falkirk Ward, with the nurses’ station on the left. Photographed in 1991. © RCAHMS

The new out-patients’ department was intended to be a demonstration building embodying the principles behind the Department’s Planning Note (the guidelines which were to be followed throughout the country for new out-patient departments). It was part of the wider strategy of devising standard hospital departments. In the mid-1960s the Department thought that the advantages of standardisation of departments would be increased if a standardised system of building and the use of common structural components were adopted. The model plan of the Falkirk out-patients’ department was also designed to illustrate the recommendations for A&E departments, especially regarding standard rooms for both diagnosis and treatment of either new or returning patients ‘walking, in wheel chairs or on a trolley’.  They were also trialling a short-stay ward and operating theatre shared between out-patients and A&E.

Design work on the out-patients’ department continued through 1966-9. In 1969, with the plans nearing completion, work began to clear the site for the new department. Construction began in 1970, and the department was completed in 1972, having cost £881,000. It was equipped and furnished ready for use the following year.

With the reorganisation of the National Health Service in 1974, the running of Falkirk and District Royal Infirmary passed from the Western Regional Hospitals Board to the newly established Forth Valley Health Board. One of the first schemes undertaken by the new Health Board was the upgrading of the war-time hospital huts, completed in 1976.

Windsor Unit, built in 1984-6. Photographed in 2008. © Tom Sargent (cc-by-sa/2.0)

The next major development took place in the 1980s with the addition of the Windsor Unit. This project was approved in 1979 and was intended to provide 176 maternity and geriatric beds. Work began in April 1984, on the scheme estimated to cost £8.7m and was scheduled for completion in 1986. The three storey block was very much of its time, the design made effective use of contrasting colours and materials, with the rich brown brick threaded with orange-red brick stripes. Despite being of relatively recent date, the unit had been decommissioned by October 2010, after the opening of Forth Valley Hospital, and was subsequently demolished.

 

 

 

The Western Isles Hospital, Stornoway, and its forebears

Memorial stained-glass panel in the Western Isles Hospital, depicting the Lewis Hospital on the right and the County Hospital to the left, both closed when the new general hospital opened. © H. Richardson

The Outer Hebrides are served by one general hospital in Stornoway on the Island of Lewis – the Western Isles Hospital. It was designed and built by the Common Services Agency and opened to patients in 1992. The hospital was designed to replace two much older hospitals: the Lewis Hospital and the County Hospital.

The Western Isles Hospital, photographed in January 2019, © H. Richardson

The County Hospital had been built by the Red Cross during the First World War as the Lewis Sanatorium, and after the war was transferred to the local authority. The Lewis Hospital was built in 1893-6 on Goathill Road. Before the advent of the National Health Service, there was also Mossend Fever Hospital, built by Stornoway Town Council in 1876, which contained 12 beds, and the Lewis Combination Poorhouse, opened in 1897, which took in sick paupers and manageable cases of the mentally infirm.

Memorial plaques from the Lewis Hospital preserved in the present hospital. © H. Richardson

In 1904 the Lewis Hospital also contained twelve beds, but its capacity was increased to twenty when the building was enlarged in 1912. A consultant surgeon was appointed in 1924, partly funded by the Scottish Board of Health under the Highlands and Islands Medical Service. A further grant from the Board helped to fund an extension to the hospital that opened in 1928. At the time, this was heralded as the first step in the realisation of a perfect hospital service for the Outer Hebrides as envisaged by the Dewar Commission of 1912, which first outlined the Highlands and Islands Medical Service. Seen by many as a precursor of the National Health Service itself, the Service extended state-funding of health care beyond the responsibilities for the care of the destitute sick, the mentally ill and the control of infectious diseases.

The former County Hospital, photographed in September 1993, reproduced by permission of Kathryn Morrison © K. Morrison

The works done in the 1920s included improvements to the water and electricity supplies, the installation of central heating to replace peat and coal fires, X-ray plant, a new operating theatre, light treatment – including artificial sunlight treatment – enlarged kitchens and improvements to staff accommodation.

With a population of over 32,000 on Lewis and Harris, scattered over a wide area, the difficulties of communications and the different way of life of the people presented the singular circumstances necessitating state intervention. According to the reporter for The Scotsman:

 ‘Until the advent of the motor car, medical practice in these parts was on a very limited scale, and to this day the superstitious practices of former generations still linger in the hereditary healers and village bone-setters. Until quite recent days the idea of an hospital universally held was that of a place where people went only to die. As a result, the mere suggestion of hospital treatment was opposed with the same vigour that city patients resist the poorhouse.’ [1]

This may have been true, but the annual report of the hospital back in 1899 painted a rather different picture; 70 patients had been treated during the past year, of whom only three died. The yearly number of admittances was increasing, most being from the island, but 18 patients were ‘strangers … whose home residence extended from Reikjavik, in Iceland, to Sidmouth, on the Devonshire coast’. Nearly all of these were fishermen or sailors. In 1923 fewer than 100 cases were admitted to hospital, but in the following year, after the appointment of the consultant surgeon, 375 patients were treated and 350 operations performed.

The former Lewis Hospital, photographed in September 1993, reproduced by permission of Kathryn Morrison © K. Morrison

In 1964 the Secretary of State for Scotland appointed a committee to review the general medical services in the Highlands and Islands. Under the NHS the areas formerly covered by the Highlands and Islands Medical Scheme were now administered by three separate regional hospital boards: the North Eastern, based on Aberdeen, took care of Orkney and Shetland; the Western, based in Glasgow, oversaw the counties of Argyll and Bute; and the Northern, centred on Inverness, took care of everywhere else. The Regional Hospital Boards appointed boards of management to run groups of hospitals (or, in some cases, individual hospitals). The Lews and Harris board of management was responsible for the Lewis and County Hospitals in Stornoway.

The County Hospital,  from the 1:1,250 OS Map revised in 1964. Reproduced by permission of the National Library of Scotland

Then, as now, one of the biggest challenges to the health service was providing for the elderly, and one of the inherent flaws of the NHS was (and still is) the division of responsibility between the NHS and local authorities. In 1966 the Chairman of the Northern Regional Hospital Board commented on ‘the nebulous boundary’ between the two, noting that where responsibility is shared between two types of authority ‘each of whom would have no difficulty in finding good alternative uses for any resources currently required for care of the elderly, there is a natural inclination for each to feel that the other ought to carry more of the burden’. [2]

The Lewis Hospital as extended, from the 1:1,250 OS Map revised in 1964. Reproduced by permission of the National Library of Scotland

Between 1948 and 1960 around £100,000 was spent on additions to the Lewis Hospital. In 1950 work had begun on a new maternity unit, nursing staff quarters and an out-patient department. In the mid-1960s Lewis Hospital had 83 beds, 46 for general surgery, 24 for general medicine and 13 for maternity cases. the County Hospital had 89 beds, 50 for the chronic sick, 35 for respiratory tuberculosis and four for infectious diseases.

Following the re-orgnisation of the NHS in 1974  which abolished the old regions and introduced a larger number of new area health boards, the islands of Harris and Lewis were managed by the Western Isles Health Board. In 1978 the Board outlined the need for a new district general hospital, on the site of the Lewis Hospital, but recognising that this was likely to be a long-term goal, it proposed that in the mean time a new operating theatre should be built. The Common Services Agency (CSA) had by then already drawn up a development plan for the Lewis Hospital, but the medical staff in Lewis criticised some of its elements: the theatre was not on the same level as the main surgical ward, the out-patient department was too small, and generally the plans left no room for further expansion. The Aberdeen Press & Journal reported that the CSA apologised for the plans, explaining they were only basic block plans aimed at demonstrating that it was possible to add the required facilities to the existing site, incurring as little interference to the ongoing work of the hospital as possible. The CSA ‘were not proud of the plans but were open to suggestions’. [3]

By May 1980 the Health Board had drawn up a list of their requirements for the new hospital, suggesting at least 280 beds be provided, comprising 30 medical beds – including provision for infectious diseases and intensive nursing; 48 surgical beds, including 8 for orthopaedic cases, 10 gynaecological beds, 8 for children plus four cots, two for the staff sick bay, 14 maternity, 90 geriatric beds and 30 beds for acute psychiatric patients.

The inclusion of beds for psychiatric patients reflected current NHS policy and the terms of the Mental Health (Scotland) Act of 1960 (and the Mental Health Act of 1959 covering England and Wales), . The new network of district general hospitals were to cater for general medical, surgical and psychiatric patients. This policy had evolved from a recognition that the existing mental hospitals did not provide the best environment for new cases. This was in part due to the institutional character of the large Victorian mental hospitals, but also the difficulties of attracting good mental health nursing staff, together with the stigma attached to mental illness in general and the old ‘lunatic asylums’ in particular. In the Western Isles the problems were exacerbated by the distance to the only psychiatric hospital serving the whole of the Highlands and Islands: Craig Dunain Hospital at Inverness. In 1979 more than 100 patients from the islands were in care at Craig Dunain. The new hospital in Stornoway was therefore to include a psychiatric unit, though links to Craig Dunain were to be retained given the number of specialist psychiatric fields.

Main entrance of the Western Isles Hospital, photographed in January 2019 © H. Richardson

Formal approval to build the new hospital complex was granted in 1986, and work was underway by 1991. It took two years to build and cost £32m.  Although the first patients were admitted in September 1992, the official opening took place the following March, performed by Prince Charles (as Lord of the Isles). The Prince was welcomed to the hospital by the chairman of the Western Isles Health Board, Marie MacMillan, and was given a comprehensive tour of the facilties and chatted to staff and patients. He then unveiled a plaque in the main concourse area. [4]

References:

  1. The Scotsman, 4 May 1928, p.8
  2. Parliamentary Papers: Scottish Home and Health Department, General Medical Services in the Highlands and Islands, Report of a committee appointed by the secretary of State for Scotland, June 1967. Cmnd. 3257
  3. Aberdeen Press & Journal, 24 May 1978, p.26
  4. Slàinte, NHS Western Isles Staff Magazine, Winter 2012, p.4

Sources:

North Star and Farmers’ Chronicle, 23 Feb 1899, p.6: Dundee Courier, 3 Feb 1904, p.1:: Department of Health for Scotland, Annual Reports:Aberdeen Press & Journal, 21 Feb 1979, p.27; 16 May 1979: The Guardian, 15 Oct 1986, p.31: Nicola MacArthur,  ‘The origins and development of the Lewis Hospitals’, Hektoen International, A journal of Medical Humanities, Spring 2017: NHS Eileanan Siar Western Isles 70 Years

Vale of Leven Hospital, the first new NHS hospital in Britain

Postcard of Vale of Leven Hospital from the 1970s

Vale of Leven Hospital, at Alexandria in Dunbartonshire, Scotland, was the first new hospital to be completed in Britain under the National Health Service at a cost of  around £1 million. It was built in 1951-5 on the site adjacent to the Henry Brock Cottage Hospital to designs by John Keppie and Henderson and J. L. Gleave. Joseph Gleave was the lead architect on the project, carrying out extensive planning and constructional research.

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Vale of Leven Hospital, photographed in 2006 © Copyright wfmillar and licensed for reuse under this Creative Commons Licence

The hospital was to accommodate 150 patients, and comprised eight standard units, built of pre-cast concrete on a modular system. Six of the units housed wards the other two ancillary services.  General medical and surgical wards were provided, together with theatres, radiological department and laboratories, out-patient, casualty department, nurses’ teaching school and pharmacy. The general wards were designed on a standard pattern but adaptable for specialisms such as ENT or eye diseases. It was also designed with adaptability in mind: the original flat-roofed, two storey ward units were intended to allow for the addition of a third storey. [1]

Vale of Leven Hospital, photographed in 2013  © Copyright Barbara Carr and licensed for reuse under this Creative Commons Licence

After the Second World War, although there was a desperate need for new accommodation and to overhaul existing hospital buildings which had suffered from a lack of maintenance during the war, restrictions on capital expenditure meant that it was many years before much new building could take place. The original allocation of funds had to be curtailed in 1949, and then cut almost completely the following year. Thus is 1950 most building work was limited to essential maintenance and to the adaptation of existing buildings, despite the recognition that many of the buildings taken over at the inauguration of the National Health Service fell far short of hospital standards for that time. Limited funding was compounded by scarcity of materials, and a ban on new, non-residential building imposed in November 1951.

Vale of Leven Hospital, photographed in 2006 © Copyright wfmillar and licensed for reuse under this Creative Commons Licence

The Henry Brock Hospital had opened in 1924 on the outskirts of Alexandria in a converted private house, with a large area of open ground to its west – where the new general hospital was eventually built. Beyond the original bequest of £15,000 to establish the cottage hospital, further funds were gifted by Hugh Brock, brother of the founder, who left a legacy of £2,000, and John Somerville, of Camstradden, Luss, Loch Lomondside, who bequeathed a further £1,000 to the hospital in 1929.[2] Dunbartonshire County Council, with Dumbarton and Clydebank Town Councils, had resolved to build a new 150-bed general hospital in the 1930s and were considering possible sites towards the end of 1937.

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Aerial photograph of Vale of Leven Hospital taken in 2015 by RCAHMS

The outbreak of war in 1939 called a halt to most building projects in Britain that were not related to the war effort. When the prospect of war had become apparent, plans were made for the organisation of emergency hospital accommodation. In 1944, as the end of the war was coming into sight, the Department of Health for Scotland commissioned a survey of the existing hospital resources, covering all local authority and voluntary hospitals, and public assistance institutions. Mental hospitals came under the Board of Control which conducted a similar but separate survey. The Scottish Hospitals Survey was published after the war, and many of its recommendations formed the basis of post-war planning. .[3]

The priorities in the early years of the NHS in Scotland were to increase the number of maternity beds and improve staff quarters and radiology departments.  One of the first new maternity blocks built under the NHS was at Seafield Hospital, Buckie, which opened in 1950 providing a much needed additional 14 beds. Plans were also in hand for a new maternity hospital at Hawkhead, Paisley. Out-patients’ clinics and health centres were also some of the earliest new buildings built by the NHS in Scotland. In Dumbarton a new TB clinic and x-ray department were built at the existing Infectious Diseases Hospital. The first health centres were at Sighthill, Edinburgh built in 1951-3, and Stranraer in 1954-5. [4]

Aerial perspective of the proposed new hospital, 1954

Vale of Leven Hospital was built in the face of post-war financial constraints because it formed a part of the Civil Defence Programme, initiated in response to the Cold War. Glasgow was considered likely to be a prime target once again. Plans were made for the potential evacuation of all hospitals in Glasgow and the surrounding area. Existing hospitals could serve as cushion hospitals, but there was nothing available for the area to the north-west of Glasgow. Alexandria was the ideal location.

Aerial photograph of Vale of Leven Hospital from the 1960s. Henry Brock cottage hospital in foreground to the left.

Taking a virtual tour of Vale of Leven Hospital in 2016 via Google street view, some of the outlying parts of the original buildings were in a poor state of repair, particularly around the out-patients’ department. Other areas have been refurbished and modernised, yet retain a sense of their original appearance. Despite its historic and architectural importance the hospital has not been designated as a listed building.

 The Vale Centre for Health and Care, photographed after it opened in 2013 © Copyright Lairich Rig and licensed for reuse under this Creative Commons Licence

Just to the east of the hospital a new health centre opened in 2013, the Vale Centre for Health and Care. It is a two-storey building, containing GP and dental surgeries, child and mental health clinics. Constructed on a steel frame, it has timber and zinc cladding and glass curtain walls. Once Vale of Leven Hospital looked just as sparkling as the new health centre, and might have fared better over the last sixty years had money been spent more consistently on its maintenance. The same could be said of the Finsbury Health Centre, another seminal health care building, designed by Lubetkin and Tecton and built in 1937-8 for the London Borough of Finsbury. There too a lack of funding for a full restoration has left parts of the building in a sorry state.

Finsbury Health Centre, centre block with main entrance photographed in 2014 © Copyright Julian Osley and licensed for reuse under this Creative Commons Licence

Sources

  1. Fiona Sinclair, Scotstyle, p.98: PP, Report of the Department of Health for Scotland… 1951, c.7921, p.32.
  2. Dundee Evening Telegraph, 6 Nov 1929, p.4: Sunday Post, 10 August 1924, p.3: Western Daily Press, 12 June 1924, p.3
  3. 10th Annual Report of the Department of Health for Scotland, 1938 PP Cmd.5969
  4. Miles Glendinning, Ranald MacInnes, Aonghus MacKecknie, A History of Scottish Architecture…, : Alistair G. F. Gibb, Off-site Fabrication Pre-assembly and Modularisation, 1999, p.13: David Stark, Charlies Rennie Mackintosh and Co., 1854 to 2004, 2004