Hewading 1Winners of the Sands Cox CHAAY pRIZE
A new hospital for Birmingham 1938
Keith Harding (M 1963)
I was sent a copy of the Souvenir programme for the opening of the Birmingham Hospitals Centre and the Medical School, 14th July 1938. After 70 years plans are already well in hand to open the replacement hospital. It seemed opportune therefore to investigate the background of the 1938 hospital.
Background
In the 1920s, hospitals were of two types. The Voluntary hospitals were administered by an independent committee and supported by contributions from individuals and organisations but usually had no subsidy from rates or taxes. The two general Voluntary hospitals at that time were the Queen’s hospital named after Queen Victoria and opened in 1841, and the other was the General hospital relocated in 1897. They were both teaching hospitals but were run separately. However they were well known to the general public and the hospitals had close liaison with general practitioners. Both had suffered from-under funding but had plans to increase their bed numbers. The other general hospitals, Municipal hospitals, were administered by the City Council and entirely supported from the rates. They were Dudley Road hospital, which had been a Military hospital in the Great War (1914-18), and Selly Oak hospital. Both had been Poor Law Infirmaries. Free treatment was provided and after the war they had equipment which was more up-to-date than that in the Voluntary hospitals.
The pre-clinical Medical School had been in the middle of the City at Edmund Street since 1892. Students had to visit both the Queen’s and General hospitals, but for their specialist training went to other hospitals scattered throughout the City. These included a number of disciplines: Mental, Fever, Eye, ENT, Skin, Midwifery, and Orthopaedic.
By the 1920s it became clear that a new scheme was required for the Voluntary Hospitals and for the Medical School. In 1922 Alderman Cadbury proposed the Queen’s and General hospitals should agree a scheme to cover the next 50 years and that all extensions should carried out on a new site, leaving the old buildings to deal with Casualties and Outpatients. If a site of 100 acres could be found it would not cost more than the proposed land purchase in the City for the extension of the existing hospitals.
As a result of the First World War, the cost of maintenance had increased and voluntary contributions had decreased so the Voluntary hospitals were getting into debt. The Government set aside half a million pounds to be distributed between them. A Commission was set up nationally in 1925 and a local Voluntary Hospitals Council set up. Any extension of the hospitals had to be notified to the Council and no public appeal for funds could be made without prior consent of the Council.
The Grant Robertson Committee
The Hospitals Council set up the Grant Robertson committee whose terms of reference were to meet and consider outlines for a scheme for a new hospital Centre, on the assumption that an adequate site adjacent to the University would be available. Sir Charles Grant Robertson was the Vice-Chancellor and Principal of the University and had been proposed by both the Queen’s and General hospitals. There were two lay and two medical members of each Governing Body together with both House Governors. The terms of reference were agreed, as was the proposal that the two hospitals should for all purposes should amalgamate. These resolutions were agreed by the Hospitals Council in 1926. Reservations were however expressed that the scheme might be too costly.
In 1926, 100 acres of land were purchased by Cadburys and donated to the City. This land was adjacent to but separated from the Science Faculty of the University by the railway to Bristol and the Worcester canal. There were certain conditions notably that no cases of insanity or infectious disease should be treated there and the City was barred from building houses on any part of the site. This generous gift produced a change in attitude of the Queen’s and General Hospitals.
In 1927, two years after schemes for extending the General and Queen’s hospitals had been halted an Executive Board was set up. It comprised the Lord Mayor, the chairman of the Hospitals Council, Alderman Cadbury, and four members from each of the General and Queen’s Hospitals. In addition members were nominated by the City Council, the University (its Vice-Chancellor) and by the Chamber of Commerce. Despite support for the scheme at the meeting, soon afterwards there was opposition to a suburban site, and the suggestion of amalgamation of the Queen’s and General Hospitals was felt unacceptable.
In 1931, two ‘Birmingham Medical Men’ wrote unsigned letters to the Birmingham Post making two main arguments for postponing the building, firstly that since the Grant Robertson report and 1930, 879 beds had been provided by Voluntary and Municipal Hospitals and the secondly they were concerned about the cost of maintenance of the proposed hospital. Several other letters were also published and Sir Charles Grant Robertson wrote a full statement of the position to the Birmingham Post, emphasising putting the interests of the patient first. A public meeting was held in 1932 at the Birmingham and Midland Institute with Sir John Burman, Lord Mayor in the chair. The policy of the Executive Board was carried and a meeting of the Executive Board suggested that the best plan was to start building in 1933. Opposition gradually died down.
Building costs had by now increased and the original plan had to be modified to exclude the whole of the West (Surgical) wing, all of the OP and Casualty blocks, the maid’s quarters, the Chapel, Refectory and rooms designated for Clinical teaching. In 1933 the Queens Hospital was handed over to a special committee. The world famous Accident hospital evolved at that site after the War.
Souvenir Programme
The opening off the Hospitals Centre was on the 14th July 1938. The King and Queen were invited but unfortunately the King had bronchitis so the opening was performed by the Duke and Duchess of Gloucester on their behalf. Subsequently King George VI and Queen visited the hospital in March 1939 and the Queen ‘named this hospital the Queen Elizabeth Hospital’. This was indeed an honour but all of the stationery had to be reprinted!
The Souvenir programme pointed out that piecemeal development into the crowded and noisy parts of the City was not easy nor economical and would, even if completed, fall short of what was possible with an alternative and more comprehensive scheme. For the best interests of the City this required ‘an organic and integral connection between the and the clinician’. This would also secure the best treatment of patients and training of medical students and nurses. Links between science and treatment, laboratory and ward were difficult because of the separation of the teaching hospitals and the University of Birmingham. A Hospitals Centre was explained as an economic and logical co-operation of effort and coordination of hospital and health facilities.
The Hospitals Centre was planned with four functions:
• Treatment of the sick (Medical function)
• Training of medical students and nurses (Training)
• Investigative (Research)
• Constructive Health Building (Social)
It was stated that one or more of the scattered hospitals could not accept this four-fold responsibility. A Hospitals Centre would get team-work organised as opposed to isolated effort.
With Specialisation the specialists became isolated into groups. In a Centre the specialists would be accommodated together. Research and the training of medical students and nurses together would go concurrently with the treatment of the patient.
General medical and surgical beds would form stage 1 of the scheme. The Special hospitals would in due course be given the opportunity of working with the Executive Board of the Centre to plan their future development on the site reserved for them. It emphasised that in doing so these hospitals would not lose their identity, but become stronger and more permanent in position. They would also be by the adjacent Medical School of the University of Birmingham
The accommodation
The Foundation stone for the Centre had been laid in Sept 1933 by Edward, the Prince of Wales and he also cut the first sod for the Medical School. The first phase of the scheme comprised a general hospital of 500 beds, the Nurses Home and the Medical School. When complete the General hospital of the centre would contain 740 beds: Medical 240,Surgical 300,Children 60, OandG 60, Special (ENT, Ophthalmic, Skin etc) 60, Casualty 20. The beds would be organised in Units of 60. Of these sixty, 30 would be for men and 30 for women. There would be one ward of 16 beds, two wards of 4 beds and 3 wards of 2 beds. Provision was made for one-fifth of the patients to receive the additional benefits of open air treatment in the space between the Medical School and the hospital. There would be eight operating theatres with all known methods of special treatments. Regarding individuals it was emphasised that they would be patients, not cases.
Medical School
The Medical School would occupy the South part of the site and be moved from Edmund street to contain all the essential departments and facilities essential to conduct a Medical School on the most modern lines. The maintenance of the School would be the responsibility of the University and not entail any expenditure on the part of the hospital authorities.
The Site
The Hospital Centre had received a munificent gift of 150 acres, 100 of which were for hospital purposes. This land was practically free from all disturbing factors such as smoke, noise, fumes, dust and its high and open position would ensure abundance of pure air and all available sunshine for patients. Through the foresight of the donors the site was sufficient to provide ample scope for all hospital developments for the City for a period of upwards of 50 years.
The appeal had raised £979,000 and the cost of raising this money had been less that 1% of the amount. Another £30,000 would be required to complete the First phase and everyone was asked to donate.
Further developments towards the Centre
Little progress was made initially because of the Second World War (1939-1945). Because the Hospitals Centre was away from the Industrial area of the City it suffered little from the extensive bomb damage inflicted on Birmingham. In1940 the bed numbers had almost doubled as a result of the war effort and comprised: 384 normal beds, 32 Emergency, and 620 Special Government beds. By 1945 the wards had reverted to their normal bed complement. Sun balconies on the end of the main wards were later enclosed and used as patients’ day rooms. The third floor of the Administrative Block became N3A and N3B and was used for treatment of patients with malignant disease. The Nurses’ Home was named Nuffield House in honour of Lord Nuffield of Morris Motors, who had endowed the building. The Birmingham Maternity hospital opened on the hospitals site in 1968 and the Loveday Street and Sorrento hospitals were eventually closed.
Acknowledgements
Prof Robert Arnott helped considerably in discussions and suggestions for the article. Dr Alex Wright sent me the Souvenir programme. Two books were very useful:
The Birmingham Hospitals Centre. Stanley Barnes. Stanford and Mann: Birmingham 1952.
QE Nurse 1938-1957. Ed Collette Clifford. Brewin Books: Warwickshire