Designing our hospitals

Update

Model of new hospital design now shown in local press

It’s important what they look like. It matters how they feel. Because hospitals are for humans. To work in, to be born in, to visit, to get fixed in, to recover in, to die in. So we get emotional about them.

The planned new Royal Liverpool Hospital.

The planned new Royal Liverpool Hospital.

You probably know how it is. Parking in the multi-storey, across the road, through the smokers outside the door under the No Smoking sign, past the Reception no one uses, along the corridors, past the Staff of the Year pictures, up the stairs, along to the clinic or maybe the ward this time, hours of waiting, then suddenly into the ‘How are you doing?’ or ‘What’s the diagnosis?’ – those moments the whole room goes real. Then back out along the corridors, past the smokers, leaving the loved one behind, worrying. And that’s just being the carer, being the visitor. We get emotional. About the place, how it is and how it feels, as well as what happens there.

I was reminded of all this. Not just what hospitals do, but the importance of how they are, by two things this week. Photographs of an old hospital and architectural images of a new one.

First the old one, the David Lewis Northern Hospital in Leeds Street, Liverpool. A philanthropist funded replacement for an earlier, Victorian, Northern.Northern 1 Northern 2 Northern 3

These were sent to me by blog reader Stan Cotter who took them while the hospital was being demolished around 1980. Taken from the top floor of the Telephone Exchange where Stan was working.

This was one of the mixed variety of ageing hospitals gathered up into the National Health Service when it was founded, and you can read more about it on the lovely ‘Streets of Liverpool’ blog, where you’ll also see a very evocative 1963 photograph of a hospital with hardly any cars parked outside it. What you’ll also see there is a deal of emotion about the place:

“My mother spoke of it fondly…Met my future husband here…happy memories…I remember the circular wards…such happy days…love to hear from the Northern Girls…Sister O’Leary was a great teacher.”

The Northern closed in 1978 when Liverpool NHS finally replaced the smallish local hospitals it happened to inherit, with a big one it designed for itself.

A place of constant clinical excellence.

A place of constant clinical excellence.

That unfortunately looks like this.

That unfortunately looks like this. A grim example of 1970s slab architecture. Poor working and waiting conditions and lots of rooms with no natural light.

Though with some good views beyond the concrete. It is Liverpool after all.

Though with some good views beyond the concrete. It is Liverpool after all.

This is the place we’ve all endured rather than celebrated these last 30 odd years. And I doubt that many will mourn the fact that it is soon to be replaced. Which brings me to this week’s second hospital. The new Royal Liverpool.

You can read about it and what will happen there in these BBC and Liverpool Echo articles.

“Once services transfer into the new Royal, the current Royal will be demolished and the surrounding area will be landscaped.

The planned research facility, called Liverpool BioCampus, will then be built on the site of the old hospital.

The new hospital will cost about £335m, with funds coming from the government and the private sector.

Cutting edge

Royal Liverpool and Broadgreen University Hospitals NHS Trust said it would be the largest hospital in the country, providing all single en-suite bedrooms for patients.

There will be 18 theatres and 23 wards, with the emergency department being one of the biggest in the North West.”

In amongst the architectural images of what the new place will look like, there is a fly-through of the new design which won’t link to here yet (but is fine on the Liverpool Echo link above).

But here’s a fly-through from earlier in the design process of some early imaginings.

Then here are the architectural images:New Royal 2New Royal 4New Royal 3

All of which was looking whizzy, spacious, modern and light filled until I got to this last picture. ‘Looks a bit like the existing Royal’ I said on Twitter. ‘With a glass front glued on top of it’ said a friend. At which point the Royal Liverpool themselves got involved in our discussion, pointing us here in response to my suggestion I’d need to see some more detailed plans to get a real handle on the place.New Royal site layout

Well they’re not all that detailed and there are a lot of unlabelled, unexplained spaces on there.

So I remain uninformed and unconvinced on the new design. And I decided to write this blog piece to raise my personal concern that this light touch, P.R. way of ‘announcing’ our major new hospital design isn’t good enough.

I’m not against it, I don’t know enough to be against it. And I accept that all opinions on new buildings are subjective. But here, like in all cities, we are expert users of our hospitals and I believe we deserve to be better informed and better engaged in the design of our new place than this week’s experience would suggest is planned.

Because it’s our NHS which we love and treasure so much, and because the current Royal, which we’ve put up with since 1978, has been one of the ugliest buildings in Liverpool since the moment it was built. And we deserve better this time around.

When David Lewis funded the old Northern no one will have expected to be asked about its design. When the state funded its replacement in the 1970s I have no memory of any of us being asked either, and look what happened.

So until this new hospital’s built it’s not too late to get it as right as possible this time round. So come on Royal Liverpool, let’s hear how you’re going to let your supporters support you?

Now a model of the new hospital has been shown in the local press, it begins to look as if the hospital design is done and the opinions of potential hospital users will not be sought. Or am I wrong?

8 thoughts on “Designing our hospitals

  1. Sarah Jones

    A fantastic piece of writing Ronnie! My response couldn’t do it justice in a tweet.

    It’s really important we get this right.

    It got me wondering how the existing building was described to the public back in 1978 when it was built back to front? It hasn’t stood the test of time and I’m keen to see that this £335million investment doesn’t repeat any of these mistakes in its planning and design.

    Your description of the grim arrival into the hospital is spot on and it’s this first impression that patients and relatives have. It heightens any emotional response of fear or worry when loved ones are being treated in the hospital. There are many people who have been affected by the Royal’s poor design over the last 30 years and it is because of this that the plans for the new hospital must be communicated clearly and rationally.

    People are rightly sensitive, I’m one of them, and with good reason.

    Four years ago, my Mum was admitted to the Royal, critically ill. She had a dangerously high temperature. The ward was hot and we needed to open a window quickly. We were informed by the nursing staff that we needed to find the ward spoon to lever the window open!

    It’s because of these dreadful conditions, poor planning and my personal experience of this building that, like you, I’m keen to see some better laid out plans.

    Reply
    1. Ronnie Hughes Post author

      I don’t remember getting any explanation about the existing building back in the 70s. I have a memory of it taking a very long time to get built and wondering whether it would ever be finished. When it was first being built I was working up in Everton for the City Council and would often walk past the evolving towers of grey concrete telling myself ‘I’m sure it’ll look ok when it’s finished.’ Ha.

      Times and expectations have changed since then of course. Then we had little expectation of being involved in large public projects and so we weren’t. That’s why, this time round, like you, I expect us to do better and am worried that this week’s PR exercise plus some more cooing over pretty pictures might be all we’re going to get.

      You going in to see your Mum, me going in to see Sarah, all of us going in to see someone. Then sometimes being the person in there. The Royal is one of the places that binds us all. So let’s do our joint bests to make this new one a place that’s fit for us all.

      Reply
  2. cheethamlib

    The 1970’s Royal Liverpool looks as though it was designed to provide space for some terrifying alien invaders to launch their reign of terror on a hapless Earth.

    Seriously, modern hospitals are not generally aesthetically pleasing buildings. You should see the skeleton of the vast new hospital that is going up here in on the other side of the world. You’d think by now hospital building design might have improved since the dreadful faceless rectangular boxes of the 60’s and 70’s. Many people spend sorely trying times inside those places.

    Reply
    1. Ronnie Hughes Post author

      How did you guess?

      I think many organisations design their buildings and services from the inside looking out, principally for the convenience of just some of the people (senior managers and admins often the main culprits) who work in there. They rarely seem to do anything so radical as to ask the main users of the buildings what might work best for them. Hospitals being no exception.

      Except you can just leave a badly designed shop, or never go into a forbidding restaurant. Hospitals are different in that, mostly, when it’s time for us or our loved ones to go into one, its design is the last thing that concerns us. But it does affect us and our mental and physical health in many ways. And it affects the front line nurses and surgeons who are trying to help us.

      So that’s why us lot, the public, the nurses and the surgeons should be intensely involved in the design of a new hospital. Peacefully and creatively at its conception stage, before it turns into a monster (like the current Royal) that we all have to cope with to survive it. Doesn’t look like we’re going to be though.

      From Liverpool to Australia, officious bean counters rule the world.

      Reply
  3. lindsay53

    Hi Ronnie. Doing my very late ‘reading your blogs’ catch up.

    It is so essential that users, potential users, people who might not be users but may be interested should get a chance to comment on, input to the designs of public buildings. It is not always the grand design where the input is needed. It is, like you say, in the minutiae of its daily use. All that emotional stuff that is going on when you enter a public building. In this case, a hospital. The walk up to it, the entrance, the reception area, the navigation of corridors, floors, treatment rooms, the signage, the colour, the light….Do these really have the users in mind? If the answer is ‘don’t know’ then there should be a major consultation, however, difficult, complicated & awkward that is to organise. It SHOULD be done.

    New ideas and new takes come from unexpected places. Ronnie, you & Sarah should be offer to facilitate consultation sessions. The resulting designs would be quite different, stunning, amazing & cutting edge, I suspect! Lindsayx

    Reply
    1. Ronnie Hughes Post author

      Well said Lindsay,
      Though I fear in this case the ‘finished article’ approach to public consultation is being taken. For which we are all supposed to be fawningly grateful.

      But I’ve had some contact from the hospital on Twitter, and so know someone there is following this post, so who knows. We may yet get a collective chance to get our hospital right this time?

      Reply

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