CONTENTS Preface ........ .......... .. ............... .......... ... ... ... ..... " ... ................... ..... .. 5 Acknowledgements ........... 6 Chapter 1 Introduction .................. .. ................. ...... .................... 7 Chapter 2 Pre 1948: The legacy of the Past ........................ ... .. ..... 9-35 THE HISTORICAL PERSPECTIVE Voluntary Hospitals ..... .. ................ ....... .. 10 Municipal Hospitals .. 11 11 .,' Mr Delme Griffiths and Welsh Health Esrares, 1998 Poor Law Institutions ................... Isolation Hospitals: the spectre of epidemics ................... ... ...... 13 From Lunatic Asylums to Mental Hospitals .......... ........... ..... .. 14 THE GENESIS OF HOSPITALS IN WALES Firsr Published 1998 by Welsh Health Esrares A Tradition of Care ............... ................. ................. ........ ... .... 16 Voluntary Hospitals Take the Lead .... ........................... ... ... ... 16 All Rights Reserved. No parr of this publicarion may be reproduced, srored in a Municipal Hospitals Follow On ....... .. .... ... ........ .... .. ........... .... 19 retrieval sysrem, or transmirred, in any fonn or by any means, electronic, General Acute Hospitals .. .......... ........ ............. .... .... .. ... ....... 19 mechanical, phorocopying, recording or otherwise without the prior pennission of Infectious Diseases Hospitals .............. .................. ..... ......... 24 Mental Health Hospitals . .... ..... .................... .... ....... ... 27 the copyright owner. The Role of the Welsh National Memorial Association .. ...... .. .. 30 The Fight Against Tuberculosis 30 This book is an NHS internal document and has therefore been produced in The NHS Legacy ................ .......... ................... .. 35 English only. Chapter 3 1948: The NHS Estate in Wales - The Early Years 36-50 Phorographs by Welsh Health Estates and Capita EC Ltd. Chapter 4 Development of the Estate - New Hospitals .............. 51-6 9 The District General Hospital .. .. .................... .... ......... .. ..... .... 51 Designed and produced by Keith James Design Associares. Hospitals for Mental Health ....... .. ...... ... ....... .. ............. .. .......... 59 The Improvement of Existing Hospitals ......... .. .... 62 Printed by Bigwood and Sraple. The Restructuring of Hospital Management Committees 65 Changes in Health Care Requirements ......... 6 7 Cover photographs: J West Wales General Hospital, Glangwit.; Carmarzhen 2 Singlelo n. Di:uricl General Hospital, Swansea Chapter 5 1974: The Restructuring of the NHS ­ ng 3 Royal Glamorgan District Gmeral Hospital, Llantnsa'lI Effect on the Estate .. ...................... .... ....................... 70-79 (Courzesy of Capita EC Ltd). PREFACE he creation of the National Health Service in 1948 was to change T fundamentally the whole concept of hospital provision in the Chapter 6 Consolidation of the Estate .... 80-106 United Kingdom. This book attempts to record how the estate of health Under New Management ................ 80 care buildings in Wales has evolved over the fifty year existence of the Progress in Hospital Building .... ........... .. ......... ........... 82 National Health Service. Due consideration is given to those aspects of The Nucleus Hospital ............................ .. 86 history that largely determined the origins of the hospital buildings Further Organisational Change 87 inherited by the NHS in 1948. Constructional Difficulties 88 The book describes many of the various factors that have The Agency Agreement ........................... .. .. .......... .......... ... 93 influenced the formation of the hospital estate in Wales to the present Uniform Hospital Design 97 day. It is not intended to be other than a superficial history of health care The Community Hospital 99 development within the NHS. Likewise it describes those changes in the Improvements to the Estate ... 103 structure and organisation of the NHS in the Principality over the fifty years inasmuch as they have affected the estate. A chapter is devoted to Chapter 7 Approaching Fifty Years: Reforms and Changes 107-114 representative examples of specialised estate work inherent in hospitals. Chapter 8 Specialised Aspects of the Estate 115-147 The Welsh health estate is considered as a whole. Many hospitals National Estate Standards 115 are listed as buildings of special historical or architectural interest and a Landscape Architecture ..... 116 number have an association with notable and interesting personalities Interior Design 118 from the past. For example, the connection of the explorer and journalist Site Supervision 118 Sir Henry Morton Stanley with the hospital which bears his name in St Commissioning of Engineering Services 119 Asaph is relatively well known. Perhaps less so is the fact that Florence X-Ray and Diagnostic Imaging Engineering 120 Nightingale once failed to obtain a post at Swansea General Hospital. Land and Property Management ............. 121 The many former mansion houses that later became hospitals have Sterilizer Engineering 122 similar associations. Craig-y-Nos Castle in the upper Swansea Valley, Building Regulations and Fire Precautions .. 127 once home to the operatic diva Adelina Patti, was to become a hospital Energy ............. ............................................... ............... 129 bearing her name. A lesser known example is Garth Angharad Hospital Care of the Environment .. ............ .. 140 near Dolgellau, at one time home to Admiral Sir James Saumarez, one of Aspects of Maintenance and Training 143 Nelson's captains at the battle of the Nile. Felix Mendelssohn Bartholdy is said to have composed "The Rivulet" on his visit in 1829 to Coed Du Chapter 9 The Next Fifty Years 148-149 Hall near Mold, a house that was also visited many years later by the Appendix A 150 author Charles Kingsley, where he frequently walked along the leet and, Appendix B 151 perhaps, found inspiration for "The Water Babies". It is outside the Appendix C 151 scope of this book to record the history of individual hospitals but such Select Bibliography .. 152 instances are typical of the many that illustrate the historic interest intrinsic to a number of buildings that were eventually to be used for health care and have passed into and in some cases subsequently out of the NHS estate. W ELSH HE A LTH E S TATES .n-nIU:Jj1 ACKNOWLEDGEMENTS INTRODUCTION o book of this nature can be written without the assistance of a n the 5th July 1998, fifty years elapsed since the inception of the N number of persons and it is my wish to acknowledge all the help O National Health Service. Conceived at a time of severe economic that has been willingly given. depression, gestated in the dark days of total war, and born in the A special word of thanks is due to Jim Cook who first had the idea austerity of the post war years, the NHS was unquestionably a major for such a book. Without his encouragement and support it would not social reform. The concept of a comprehensive all-embracing health have been written. When the proposal was first discussed little did we service under the direct control of Central Government and paid for by visualise the extent of the eventual outcome. Indeed it was only due to taxation, was visionary and deeply rooted in the social failings his conviction that my efforts would not be too presumptuous, that I was increasingly evident during the first four decades of the twentieth persuaded to proceed. century. In an era that has seen many changes in social policy, the In the shaping of the book I have amassed more debts of gratitude National Health Act of 1946 must rank as one of the most important than can be adequately expressed here. Particular thanks are due to items of social legislation, .comparable with such examples as universal David Wade for his indefatigable work in locating documents and suffrage, National Insurance legislation and the 1944 Education Act. photographs, to Peter Wiles for his tireless work in preparing the text for The National Health Act aroused considerable opposition, partly publication and to Gary Hyatt for providing access to a number of because ofthe medical profession's deep suspicion that it would become, to historic health service documents. Collectively they have also been of some extent, servant of the state and partly due to the vigorous political will immense help in providing suggestions for improving and editing the of the government of the day, epitomised by Aneurin Bevan as Minister of text. Thanks are also due to Joanne Westall for her initial typing of the Health in driving the bill through Parliament. manuscript. The impact of the reform was immense and immediate. Many of the aged and children in particular, obtained much needed treatment I wish to record gratitude to the Librarian of the Bro Taf Health which previously they had not been able to afford. The immediate cost Authority for providing access to those records remaining at the Temple of the NHS was far greater than anticipated and this was to have of PeaceandJ:Iealth in Cardiff, and to the Librarian of the Institute of a significant impact during the early years of the service. In the Health Service Administration for access to their library collection. long term, however, the NHS was to improve greatly the Thanks are also due to many former colleagues of Welsh Health Estates general health of the popUlation. who have provided information and photographs, and to the Directors of The principles of the NHS are manifested