Gems or carbuncles? In the second of three articles, Ann Dix reports on the rise and fall of some of the pioneering hospital buildings of the 1960s and 1970s

When Greenwich District Hospital was opened in 1969, it was hailed as a Department of Health and Social Security model for reshaping hospital building. Today the hospital stands condemned - due to be sold and most likely demolished at the turn of the millennium in favour of a 93m redevelopment of a former military hospital under the private finance initiative.

Meanwhile, a very different fate has befallen another mould-breaking 1960s hospital. Wexham Park Hospital in Slough was the only post-war British hospital to be planned almost exclusively on one storey, setting the trend for modern low-rise hospitals. It is also has the distinction of being the only post-war hospital recommended for listing.

The irony is that both these hospitals were designed to change with the times and avoid obsolescence. Now, less than 30 years later, one has been written off in its prime (most hospital buildings last at least 100 years) and the other is in danger of being fossilised in the name of conservation.

Both buildings were among a handful of pioneering examples that revolutionised hospital design in the 1960s and early 1970s - and whose influence can still be seen in designs for hospitals today. And despite the current unpopularity of 1960s architecture, they were bold - and arguably largely successful - attempts to solve some of the intractable problems hospitals still face.

In the words of one of the leading lights of the period, architect John Weeks, these were the 'heroic years' of hospital design. After a decade of post-war stagnation when there was almost no health building but ideas were laid for the future, the 1960s heralded a building boom. As money became available, radical ideas could be put into practice and Britain developed a hospital building research and development programme that led the world.1

The trigger was the Hospital Plan, launched by health minister Enoch Powell in 1962, which proposed a massive hospital building programme (99 new and 134 upgraded hospitals) at a proposed cost of 500m over the next decade.2

Although this turned out to be a gross underestimate, and the plan had to be drastically cut back in 1966, the boom was largely sustained until the oil crisis of 1973-74.

The task facing hospital planners was mammoth, and experience and expertise were in short supply. But for many working in hospital design, it was a period of optimism and intellectual fervour.

The chair of Architects for Health, Professor Raymond Moss, worked for a year in the newly formed hospital design unit at the Ministry of Health in the early 1960s. 'If you were one of the 'blue-eyed boys' picked to join the unit, it was like being touched by a magic wand,' he recalls.

In the early days, the culture was one of 1960s radicalism - unlike the rest of the civil service. Professor Moss remembers people swapping the standard name badges on their office doors with badges giving their first names only.

Howard Goodman also worked in the unit, which was headed by chief architect William Tatton-Brown, whom he later succeeded. A tall, elegant man from the radical world of education, Mr Tatton-Brown was 'very avant-garde' and had a passion for industrialised and modular buildings, Mr Goodman recalls. He immediately set about building up a research and development team similar to that in the Ministry of Education. Its work ranged from painstakingly researched design and cost guidance to whole demonstration projects, such as Greenwich Hospital.

But not all the team were designers. The 1960s also saw the rise of the nurse planner (now more or less extinct), who advised on nursing and patient needs - in particular the ward plan.

Jean Heyward claims to have been 'the first nurse planner since Florence Nightingale'.

'The need for nurse planners came from a realisation that aside from the drains, nurses were the only consistent element running right through a hospital,' she laughs. 'You had to have a nurse who could speak up for herself in a multidisciplinary team and stand her ground against the doctors,' she adds. 'The doctors took it quite badly to start with.'

And doctors weren't the only ones nurse planners had to stand up to. Working in the Ministry of Health design unit, she recalls that 'Tatton- Brown always favoured the latest gimmicks' and it often fell to the nurse planners to inject a note of realism. 'To the architects we were often the fly in the ointment.'

At one stage Mr Tatton-Brown was hospitalised in London's St Thomas', where he came to see some of the advantages of the traditional Nightingale wards. 'We always used to say it was a shame it didn't happen earlier,' she laughs.

Among the myriad issues that planning teams had to grapple with were whether hospitals should be high or low-rise, how to stop them from becoming obsolete and, as time went on, how to control costs and build more quickly (made more difficult by increasingly cumbersome DHSS planning procedures, culminating in what became known as Capricode).

But the first problem was the sheer bulk and complexity of the buildings envisaged. The area per bed of a 19th century hospital had doubled in the inter-war period. Now designers were being asked to provide four times the space. Until the early 1970s, the trend was also for increasing bed numbers - while the Hospital Plan was based around hospitals of 600-800 beds, a DHSS report in 1969 suggested there should be 1,000-2,000 beds.3

In parts of Europe and in America, the initial response was to stack wards in a tower, rising from a wide-spreading podium containing all other accommodation. It was a design shaped by new lift technology and a desire for short walking distances, and it was nicknamed 'matchbox on a muffin'.

The classic shape of hospitals from the 1950s until the mid-1960s, it was adopted for a number of UK hospitals - including the Princess Margaret Hospital, Swindon, and the Western General in Hull. 'At first ideas were translated to the UK without much analysis of how it would work. It wasn't until we started to develop our own solutions that things changed,' Howard Goodman recalls.

The biggest drive for change was the need to design hospitals that would respond quickly and effectively to rapid medical advances. As architect Peter Stone wrote in a review of hospital design in 1976, high-rise hospitals had become 'physical coffins' because they could not be altered or expanded easily. The pace of change and the time taken to build hospitals meant that they were in danger of becoming obsolete before they opened.

The answer in Britain was a return to the low-rise hospital: 'The Victorian corridor and pavilion designs... extolled by Florence Nightingale... began to reappear in 20th century dress.'

The first modern building to explore the idea of taking 'horizontal' hospitals to the limit - providing the stimulus for designing for growth and change - was Wexham Park Hospital in Slough. It was originally intended to be high-rise, but architects Powell & Moya showed that most of the important journeys would be quicker in a one-storey design, dispelling the myth that tall hospitals were more efficient. Opened in 1966, the hospital had 300 beds and was built along a central spine or hospital 'street', with single-storey pavilion wards projecting from it. Each ward is L-shaped, planned around its own garden.

The theory was that the hospital streets could be lengthened, the buildings off them extended, and fresh buildings added. In the event, it never happened (see box, previous page). But the idea was taken further by architectural consultants on the scheme, Llewelyn-Davies Weeks, in another landmark building.

This was Britain's first combined district general hospital and medical research centre, at Northwick Park in Harrow. With 800 beds, it was the first example of 'indeterminate architecture', in which no attempt was made to construct a finite form - much to architects' horror.

'The idea is that you can't predict how a hospital will change, and you shouldn't try to. But if you don't make provision for it, then you are dead,' John Weeks explains. 'My idea was that hospitals should be planned along a street, like in a town or village, around which buildings can be added of any shape.'

The result, as Peter Stone described it in 1976, was a collection of buildings offering 'as many surfaces as the human lung, each capable of independent extension, yet each linked to an artery system of corridors', which could be extended, with new buildings added. Buildings were also adjustable internally within a loose-fitting shell (known as 'duffel-coat' planning).

'The top floors on some buildings reach only halfway across the roofs. Demountable steel escape stairs were pinned to corrugated expanding ends of buildings, and pipes were teed off to await further expansion. Today the creeping extension of the building continues, and the interior is subject to endless small alterations.'

Northwick Park had a direct successor in York Hospital, and both were very influential. But meanwhile, a very different way of planning for change had been devised in the DHSS prototype hospital at Greenwich.

This was the first low-rise hospital to be built on a tight inner-city site. Designed as a three-storey rectangular block, with wards in a band round the outside, it had a revolutionary structure offering total internal flexibility (known as 'universal space').

The use of bridge technology left floors free of supporting columns, while services were in an 'engineering sandwich' between floors, where engineers could walk about and do their work. It was totally air conditioned, enabling departments to be located wherever logistically convenient.

Social services secretary Richard Crossman, who opened the hospital in 1969, was widely reported as likening it to 'a Dutch barn. The building is permanent, but its uses are constantly changing'. Mr Goodman recalls that it generated so much interest worldwide that a full-time public relations officer was needed.

However, despite being extensively copied abroad, the Greenwich design was never repeated in Britain. This was possibly because the engineering floor 'sandwich principle' was perceived as too expensive (although Mr Goodman claims it only added 2-3 per cent to the capital cost), and possibly because it was seen as too energy-guzzling (British hospitals have since adopted air conditioning only for high-tech areas).

According to Professor Moss, the idea of total air conditioning was also alien to the British culture: 'People felt there something evil about it.' Certainly at the Greenwich launch in 1964, health minister Anthony Barber (later Lord Barber) was reported in The Times as admitting 'my own preference is for the open window'.

However, Greenwich did influence subsequent developments - including the two DHSS 'Best-Buy' hospitals at Bury St Edmunds, Suffolk, and Frimley, Surrey, opened in 1974. These were virtually identical hospitals, which borrowed aspects of the Greenwich plan, but were naturally lit and ventilated and omitted the engineering 'sandwich' floors. They were also a highly successful attempt to build hospitals smaller, more quickly and more cheaply, costing two-thirds of the price of the average hospital built at that time.

These hospitals were the first real attempt to co-ordinate hospital and community services, significantly reducing the number of beds - the first two Best Buy hospitals each had 550 beds compared with 800 for Greenwich, which served a similar population. They also dovetailed accommodation and operational policies to maximise the use of space to an extent that had never been attempted before - saving on building and running costs.

According to architect Paul James, who was on the project team, completion took around five years - half that of most hospitals.

This was partly achieved using a prefabrication method borrowed from two hospitals at Airedale and Eastburn in Yorkshire. Interestingly, these were built by John Poulson - who in 1974 was jailed for five years, convicted of corruption. Mr Goodman recalls that it was Poulson's boast that he could build 'two hospitals for the price of one' which caused health minister David Owen to call for an investigation of the two hospitals, as money got tight in the early 1970s. 'He said, if he can do it, why aren't we,' Mr Goodman recalls. 'A lot of Poulson's claims didn't stand up, but a lot did.'

A few more Best Buy hospitals followed, but the snag was that they weren't designed to be extendable or built in phases.

They were followed by the DHSS Harness system - described by John Weeks as 'a rather megalomaniac attempt to standardise planning and building'. The idea was that standard building 'envelopes', housing different departments, could be assembled around a 'harness' of services and communications as required, producing hospitals of 500-1,100 beds.

But before the Harness programme could take off, the economic crisis of 1973-74 intervened, threatening to halt hospital building. The need to find a cheap and politically expedient solution was to pave the way for a standardised system that would endure for the next 15 years - the Nucleus planning system.

The 'heroic' years of hospital design were well and truly over.