Alida Baxter

Renowned London journalist and author

View from Soho

- New Hospitals

Verus Old

I've never been asked to design a building mercifully for anyone who might want one but I imagine, quite apart from any question of beauty or style, that the structure's use, its purpose, must be a vital consideration. Is it a simply a house (and if you watch Grand Designs you need to lie down, it's so far from simple!), an office block, an hotel, or something really complex?

When it comes to complexity, surely a hospital must go right off the scale. Operating theatres, day surgery units, scanners, X-Ray departments, wards all these and more have to be incorporated. Every technological advance adds to the jigsaw. You don't just need a designer for this, you need Harry Potter! So when a hospital comprises all these and manages to be visually striking, it must be a matter for congratulation. Mustn't it?

The huge new University College Hospital building, spread over the entire North West corner of Tottenham Court Road and the Euston Road , looks quite stunning. It is white (so dazzlingly white that it makes all the other buildings around it seem grubby), with acres of pale green glass, and, seeing this flagship's towering bulk from the height and distance of my bedroom window, it really does remind me of a great liner. Unfortunately, the Titanic, when it had tipped to a vertical position, the funnels already submerged, and the enormous ship poised to plunge beneath the waves. Or in this case the pavement.

That fateful image is just an illusion - if I only passed it in taxis, I'd think, at the very least, it was impressive.

So why, attending it as an Outpatient, do I desperately wish I could scoop up its medical staff, resurrect an ageing building in Mortimer Street, now sadly demolished, put them in it and see them there instead? The Middlesex Hospital was closed in 2005, and its patients (including me), its doctors and clinics were transferred to the new building in an amalgamation with UCH. Whatever sense this may have seemed to make, I believe it was a tragedy.

The last few decades have seen the closure of several hospitals in the West End , some of which were absorbed by the Middlesex. When that in turn was closed and integrated with UCH, which was already very big and very busy, a Hell of a lot was being asked. Was there ever going to be sufficient capacity to compensate for the loss of all the old hospitals? I'm not sure the answer is yes.

And that isn't the only problem far from it. The London Evening Standard has reported that, a mere four years after its opening, the £422 million flagship is already in need of repairs. (If it were the Titanic, it would at least have the excuse of an iceberg!) Worst and most inexplicable of all, though, is the obstacle course of the internal design.

Let's start with the Outpatient Clinics. At the Middlesex these were held in undistinguished premises in Tottenham and Cleveland Streets, but oh, the bliss of the convenience if, like me, walking any distance increases your pain. From the smallest of foyers you took a lift, and were then only paces from a Clinic, or actually in a Clinic itself.

But reaching a Clinic now, in the new UCH, is, for me, like scaling the North Wall of the Eiger. Whilst, inside and out, the Euston Road edifice is a state of the art building, it's also a hospital you can only attend easily if you're physically fit!

I'm not fit, that's why I attend hospital, and surely to Heaven I'm not alone. A veteran of two spinal operations, I'm in constant, excruciating pain. Raw sciatica makes walking agonising, I can't sit on or in anything low, even wheelchairs are out, and a lot of boring gastric problems make it incredibly difficult for doctors to help: if you can't eat most ordinary food, your guts go mad when you swallow pain-killing drugs.

So, hideously unfit, I don't appreciate the front entrance, because it's so far from the pavement, or the vast, imposing foyer. I don't absorb the beauty of the glass-sided bridge above it that I have to hike across (and God help anybody with vertigo), or like the double doors I have to fight through, to reach a corridor as long as a street where the Outpatient Clinics are located. It's all elegant, it's all spotless, and it's all agony.

And these Outpatient Clinics are there to help people who need new hips, new knees, who have arthritis, who, like me, are in pain. The Clinics themselves do help (the doctors and nurses are second to none) but I don't know how even the staff manage the walking their legs must be worn down to stumps! (And, by the way, if it weren't for the nurses I wouldn't be able to attend the hospital at all they arrange that when I attend a Clinic I am found somewhere to lie down while I wait to be seen.) But it's not the staff I have a problem with, it's purely the building. For me, this is Total Wipeout on dry land!

Thankfully, some of the Outpatient Clinics have been transferred to an elderly building in Grafton Way , which belongs to the UCH complex. It's not stunning, it's not glamorous, but I could kiss it, because from the pavement there's so much less walking required. And why the transfer? It seems there isn't sufficient capacity for all the Clinics in the new edifice already . But anyone seeing how staggeringly busy the Clinics are cannot be surprised: they heave with patients.

And pity the patient, because the majority of the facilities are in the new building. If you need an X-Ray it's an Iron Man event. The X-Ray Department is in the Lower Ground floor, at the end of relentless corridors. Far worse, the way is repeatedly barred by sets of double doors. I've seen large men with their arms in plaster, or people on crutches, attempting helplessly to heave those doors open, and the sight has made me impotently angry. Just as angry as someone I know who took a wheelchair-bound friend for an X-Ray and found it impossible to hold the doors open and get the chair through them at the same time.

What, in Heaven's name, is going on in modern hospitals? Because UCH is far from being the only culprit in another spanking new hospital someone I know of had to sit down and rest half way to the ward where she was visiting a friend! The distance to walk was just impossible for her, and she was well. Why have we lost so many of the virtues that existed in far older buildings, which, long before even the advent of antibiotics, were immeasurably more user-friendly for the patient and, I suspect, possibly for the staff as well?

Let's start with the basic design of the lost and gone Middlesex (founded in the eighteenth century, but undergoing various alterations and incarnations until it was last rebuilt between 1928 and 1935). At the front was a courtyard where cars and ambulances could drive in off the street, whilst the main building behind that was a hollow square, enclosing a large paved open space, utterly quiet. It was the perfect place to take anyone who, whilst still too ill to return home, yet needed a breath of air. Not long ago, outside UCH, I have seen an unattended man in a wheelchair, his leg in plaster stretched straight out before him, teetering terrifyingly on the area above the Euston Road pavement, an accident waiting to happen, but obviously desperate to get outside on a hot day. Nothing as civilised as a safe, open space is available here.

At the Middlesex, staff too used to take a break and perhaps eat a sandwich in the peaceful open area, and they needed it, considering how hard they work. For everyone, it was a wonderful place of escape.

Everything about the building was user-friendly, because of its size. The X-Ray Department was easily reached: no double doors to heave and haul on, no endless corridors. None of the wards were an horrendous distance away, there were no long overhead bridges to dread. It may have needed modernisation, (although it was already housing every kind of scanning and imaging facility, plus a day surgery unit) but demolishing it was appalling. A pitched battle was fought over the fate of the paintings which had decorated its foyer, and which were on display at the National Gallery this year, and now only its exquisite chapel, a listed building, is left on the demolition site where a great teaching hospital once stood.

And whilst it's a mistake to be too nostalgic, I had a soft spot for the design of its old-style wards. Bob Hope put it best: I don't say a woman's dress should be tight, but when she puts it on, I want to know where she is. Well, I'm like that with nurses. If I'm lying in bed in agony, I don't say a nurse should be chained to my locker, but I would like to know where she is. When the nurses' station was in the ward with you, it could be an enormous comfort.

On one of my stays as an in-patient, I couldn't eat or drink and was attached to a drip that accompanied me everywhere like a skinny dance partner. Despite pethidine injections I was in too much pain to sleep, and it was incredibly comforting to see the small light at the nurses' desk as the night hours passed, and to hear the soft murmur of a voice, or be approached just when I most needed a friendly word.

Mind you, even when people are nearby, they're still fallible. One night a staff nurse asked me whether I was playing patience, as I laid cards across my lap. No, I said, I'm telling my fortune. I told her fortune, too, and her colleague's, and as the nights passed and the word spread nurses came from other wards all over the hospital to have their fortunes told. This was all right till I started getting better and managed to drop off. Then it wasn't quite so comforting to be shaken awake by a gentle hand and to hear an excited whisper, Are you the patient who tells fortunes? as someone from orthopaedics or obstetrics dropped in.

But dropping in can transform a hospital and make it a less intimidating place.

A receptionist at the Middlesex once told me that an elderly gentleman who lived nearby used the foyer as a club. He would sit and chat to people waiting, go off to have a coffee, buy a newspaper at the kiosk, sit in the central square if the weather was good, and finally return home having spent a companionable day.

And somehow I can't imagine anything like that ever happening in the dazzling, daunting structure on the Euston Road .

© Alida Baxter

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