The nineteenth century hospital accommodated the urban and rural poor – wealthier citizens were treated at home. Hospitals were funded through the public purse or by charitable subscription and were often part of larger workhouse developments.
Their patients were recipients of welfare under the direction of the staff and the design of many of these early hospitals had much in common with prison and asylum building typologies where control is a key driver.
As the century progressed a model developed. It was essentially residential in nature composed of sets of nightingale wards arranged in slender pavilion buildings which were linked by a single circulation spine in often very formal and ordered configurations.
Diagnostic, treatment and outpatient accommodation made up a small proportion of the overall floor area. Despite their humble origin the architecture of most of these hospitals recognised their public and civic responsibilities and made positive additions to their urban fabric.
During the twentieth century this generic model changed as diagnostic and treatment areas grew and specialised. The percentage of residential accommodation decreased as the hospital developed into an ever increasing number of specialist departments with complex inter-relationships and highly specific technical requirements.
Insurance and tax based systems were developed after 1945 to provide universal access to hospital care. Yet despite this becoming a right rather than a charitable dispensation the definition of functionality became increasingly focussed on clinical process rather than the patient experience. As a consequence health care design became somewhat mechanistic, providing a technical response to this narrow definition and retreated from the architectural mainstream to become a specialist and isolated sub-set. Many of these buildings lost any sense of public responsibility or having a wider social purpose.
John Cooper has been engaged in changing this approach since the design of ACaD and was an active participant in the design of the recent generation of NHS hospitals to acknowledge their public responsibilities and place the patient at the centre of the design.
However, there hospital typologies are changing. JCA is currently looking at new models of care which will replace outdated district general hospitals. We are also looking at ways in which ageing estates can be redeveloped by intervention and conversion in this time of austerity.