When Wexham Park Hospital (above) was proposed for grade two listing, hospital managers were not the only ones to react with horror. 'Gems or carbuncles?' screamed the Daily Express in February 1996 when the proposed post-war listings were announced: 'Concrete from 60s on list of treasures.' And under a photo of the hospital's administration tower: 'Sight for Sore Eyes?' Yet Wexham Park was widely regarded as one of the most pleasing and humanistic hospitals of the period. According to a 1966 article in British Hospital Journal and Social Service Review (now HSJ) it was designed to be like 'a village or small town - a community, not an imposing institution'. It was praised by the architectural press for the 'sheer humanity of its scale' and even featured in Country Life in 1967.

If the hospital is listed, managers will have to ensure that future changes are in keeping with the original design - the trust is fighting it tooth and nail. Managers even tried to enlist the support of the architect, Sir Philip Powell, on the grounds that the hospital was designed to change with the times. But Sir Philip believes the building is 'a victim of what I thought was a virtue of the design'. His finest hospital, he says, has been 'spoilt with dreadful additions' and its administration tower 'savagely ruined'.

Trust project manager John Marshall says alterations to the tower had to be made to meet modern fire safety standards. He claims that the hospital was not extended according to the original plan because people would have had too far to walk, but freely admits that some of the additions are 'dreadful'. 'The original building still has a lot to offer,' he says.

Frank Johnston, head of estates, agrees: 'The wards as a planning concept can't be beat.' This is why the trust is spending 6m to upgrade them. They are great for patients because every patient looks out on to a garden, he says. And according to Mr Marshall, while 'the public are aghast at the proposed listing of what to them is an old concrete building, the original building must have been quite a stunner, with its brilliant white walls and teak finishes'.