Nuffield Provincial Hospitals Trust Research Articles

‘In line with the modern conception of much mental illness’: psychiatric reforms and architectural design contributions in post-war England

This article examines the history of, and specialist design principles behind, two Admission Units that were added to two existing mental health hospitals in post-war England: Fair Mile Hospital, in Cholsey, near Wallingford, Berkshire (now Oxfordshire) and Fulbourn Hospital, near Cambridge, Cambridgeshire, completed in 1956 and 1964 respectively. Their commission and realisation fell within a period of critical psychiatric reforms, some of which first emerged in the first half of the twentieth century with further developments peaking after the Second World War. Although the two buildings preceded subsequent interdisciplinary advancements that specifically fed into the correlation between buildings and healthcare, namely, environmental psychology and evidence-based design, they emerged at a time when prominent hospital architecture studies were embracing a research culture and aimed at merging an interdisciplinary approach with modernist architectural principles. Yet these two buildings, and numerous other similar units, have been virtually absent from existing scholarship, both general architectural historiography and studies of specialist healthcare architecture. The study here uses literature review of architectural historiography, historic policy and guidance documents, and archival material, as well as review of graphic material comprising photographs, architectural drawings and diagrams. The discussion opens with a brief overview of the general policy and psychiatric context within which the two units were commissioned and erected. This is then followed by a closer inspection of the two buildings, which brings to light both similarities and differences. Discussed in parallel to principles outlined in healthcare architecture guidance published at the time, this comparison highlights the complex and nuanced associations between architectural design and mental healthcare, as well as the way these evolved in this particular time period. Specifically, by looking closely at national and international guidance on healthcare architecture developed by the Nuffield Provincial Hospitals Trust, the World Health Organization and the Ministry of Health, key shifts in the role that architecture could play beyond a medical model of mental healthcare and in support of a psychosocial approach are discerned. Finally, the article also makes the case for further research that broadens and deepens studies of the post-war history of this field as well as comparisons both to the inter-war and to the contemporary periods.

An Australian reflects on the Collings report 70 years on.

The publication of ‘General Practice in England Today — a Reconnaissance’ in the Lancet of 25 March 1950 made its Australian author, Dr Joseph Silver Collings, the National Health Scheme’s first whistleblower.1 It also ruined any chance of an academic or administrative career in the UK. Its unflattering description of English general practice angered the medical profession, particularly the British Medical Association (BMA). The Nuffield Provincial Hospital Trust who had funded it were not prepared to have their name associated with it. The Ministry of Health and the Chief Medical Officer who had directed the research underlying it remained silent. Joe Collings, as he preferred to be called, conducted the first evaluative research on general practice published in the English world.2 Challenging the smugness of British medicine, Collings was denied due recognition with his approach labelled unorthodox, and his sampling of English general practice considered fatally skewed. Joe was portrayed as a brash, inexperienced Australian influenced by American concepts with limited experience of British medicine. All those with direct knowledge of those times are now dead, so we must rely on records to ascertain what happened. Joe was a meticulous archivist and his wife Bett preserved his papers in the National Library of Australia.3 Extensive Rockefeller Foundation archive documents add to our knowledge of his activities.4 Joe had experienced general practice in two pioneering universal healthcare insurance systems, New Zealand and Manitoba, Canada, where the reformers sought his opinions. The Rockefeller Foundation funded him for 3 months in 1948 to explore medical educational developments in …

Treating architectural research: the Nuffield Trust and the post-war hospital

This paper explores the influence of medicine on architectural research after the Second World War. I look at the funding of research into hospital design by the Nuffield Provincial Hospitals Trust as a case study. This charitable foundation was set up in 1939 by the industrialist Lord Nuffield, William Morris, founder of Morris Motors. In 1949 the Trust partnered with the University of Bristol to investigate the functions and design of hospitals, triggering one of the most influential architectural research programmes in post-war Britain. I argue that the Trust’s interest in the hospital as a building type initiated a new understanding of architectural research on the model of medical research, triangulating a profession, post-graduate university training, and private philanthropy. I focus on the writings of Richard Llewelyn Davies (later Baron Llewelyn-Davies of Hastoe), the Director of the Trust’s investigation into hospitals from 1949–1960. His contributions to research as Chair at the Bartlett School of Architecture (1960–1969) are well known. Scholars including Reyner Banham, Anthony Vidler, and Alise Upitis have explored how he pioneered the techno-scientific turn in architectural pedagogy. However, the structural change for the profession he envisioned and its basis in the Nuffield Trust model remains unexamined. Looking at his work as an extension of the history and agenda of the Nuffield Trust allows us to move away from the disciplinary assessment of architectural research as a problem in pedagogy and re-centre it as a question of how architecture might participate in improving social welfare.

Sound medicine: studying the acoustic environment of the modern hospital, 1870–1970

The twentieth-century hospital encountered two categories of sound that appeared troublesome. First was a kind of noise generated by city life, and second was a kind of soundscape generated by hospital life. In both cases, the acoustic environment was described and notated as an effect on patients, who, ill and immobile, were subject to sounds in a way that put their health and recovery at risk. In both cases, the solution to sound problems in the hospital was seen to be cultural and material, not medical. The difficulty was that physicians had no especial training to address the effect of sound on patients’ bodies. Sound and noise escaped the remit of medical expertise, and hospitals instead relied on a weak disciplinary injunction to silent comportment. This left sound as a matter for the medical environment rather than for medical intervention. In short, sound medicine was architectural.This paper looks at the twentieth-century modern hospital as an institution with particular acoustic environments, modified and shaped by architectural responses to the perceived problem of sound. I explore the emergence of noise on the inpatient ward as an architectural research topic, especially in the ground-breaking studies of the Nuffield Provincial Hospitals Trust (ca. 1955), and the identification of the emergency ward as the hospital’s signature acoustic environment. Using published studies of architectural acoustics, prescriptive advice from hospital specialist architects, and evidence from documentary films, I argue that the engagement with sound is an underemphasised yet key architectural characteristic of the modern hospital.

Workplace culture that promotes health and wellbeing for all: an imperative for health care managers and others.

In 1996, the Nuffield Provincial Hospitals Trust published a report on protecting and promoting doctors' health and the work environment.1 In the light of the seriousness of the evidence of ill health among doctors, other reports on the health of those working in the National Health Service (NHS) and the profound implications for individuals, communities and the nation at large, the Trust established a Partnership on the Health of the NHS Workforce. Many reports had been published on the health of those working in the NHS, but none was sufficiently extensive or robust to draw general conclusions for action and none covered all staff groups working in the NHS. The Nuffield Trust convened a Partnership of the key organisations with a stake holding in the NHS to assess all available evidence and make recommendations for action. The importance of addressing the challenge lay not just in the concern for the welfare of the staff of the NHS but also in the implications for the quality of patient care and the findings revealing the important influence of management culture, style and skills. The Partnership report2 contained a submission to the Secretary of State stating 'these very uncomfortable findings about the health of the NHS workforce will create challenges for all of us but the next stage must be a matter for those responsible for the NHS workforce'. Following publication of the report and its acceptance by Government, significant progress was made over the years in implementing its recommendations in the NHS.The publication in June 2015 by National Institute of Clinical and Health Excellence (NICE)3 brings the issue once more to the fore about what managers need to do to create a happy and healthy workplace. Simon Stevens, NHS England's CEO, said on the publication of the report, 'health-promoting workplaces are obviously good for millions of employees and ultimately for taxpayers too, so the time is right for all employers - including the NHS - to raise our game'.Work and the quality of work experience are key determinants of health. We spend about one-third of our life at work, and the quality of the workplace experience is key to our health and wellbeing and that of the employing organisation. In the UK, 27 million workdays are lost each year to work-related illness. The cost to the UK economy is around £13 billion per annum.The new NICE guidance proposes that promoting health and wellbeing is recognised as an essential management and organisational competence.A healthy workplace results in multiple benefits such as reducing sickness absence and presentism (being ill but not taking time at home to recover), increased safety and work satisfaction, greater loyalty to the organisation and enhanced reputation - all associated with greater productivity.People are any organisation's most valuable asset, and employers have a duty to look after and effectively care about the wellbeing of their employees. This is as, and arguably more, important in times of recession as well as boom periods. This is especially important given the increasingly less stable and secure nature of work for many in our society.Organisations' are essentially abstract entities; it's the people and the relationships between them that define the nature and culture of the organisation and its health and thus productivity and sustainability.NICE have produced (June 2015) generic guidance for the first time on workplace policy and management practices to improve the health and wellbeing of employees. The guidance confirms what good leaders and managers already know and what many may describe as self-evident truths. The guidance provides the underpinning evidence base and solid recommendations for practical leadership and management action at all levels of the organisation. …

If the cap fits…

Journal of Wound CareVol. 22, No. 8 EditorialIf the cap fits…Daniel ShanahanDaniel ShanahanSearch for more papers by this authorDaniel ShanahanPublished Online:29 Sep 2013https://doi.org/10.12968/jowc.2013.22.8.387AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View articleReferences1 Cochrane, A.L. Effectivenes: and Efficiency: Random Reflections on Health Services. Nuffield Provincial Hospitals Trust, 1972. Google Scholar2 Evidence-Based Medicine Working Group. Evidence-based medicine: a new approach to teaching the practice of medicine. JAMA. 1992; 268: 2420–2425. Crossref, Medline, Google Scholar3 Sonnad, S.S., Goldsack, J.C., Mohr, P., Tunis, S. Methodological recommendations for comparative effectiveness research on the treatment of chronic wounds. J Wound Care. 2013; 22: 9: In press. Link, Google Scholar FiguresReferencesRelatedDetails 1 August 2013Volume 22Issue 8ISSN (print): 0969-0700ISSN (online): 2052-2916 Metrics History Published online 29 September 2013 Published in print 1 August 2013 Information© MA Healthcare LimitedPDF download

Conversation with Bruce Ritson

In this occasional series we record the views and personal experience of people who have especially contributed to the evolution of ideas in the journal's field of interest. Dr Bruce Ritson was formerly Consultant Psychiatrist at the Royal Edinburgh Hospital and Senior Lecturer at Edinburgh University. He currently chairs the medical campaign group, Scottish Health Action on Alcohol Problems (SHAAP), which is hosted by the Royal College of Physicians of Edinburgh. He has had a long and fruitful research career.

Patients seeking care from acupuncture practitioners in the UK: A national survey

The primary aim was to describe the characteristics of acupuncture patients and in particular the main problem or symptom for which they were seeking treatment. Our secondary aim was to compare the profiles of acupuncture patients with those of a patient survey undertaken in 1988. We used the data from a recent prospective adverse event survey of a representative sample of 9408 acupuncture patients who were consulting members of the British Acupuncture Council. We analysed patient reports of demographic details, pathways to care, whether the National Health Service paid for their treatment, whether they had previously consulted a GP or hospital specialist for their main problem and whether they were consulting an acupuncturist for the first time. We separately analysed equivalent data from a survey funded by the Nuffield Provincial Hospital Trust undertaken in 1988. Seventy-four percent of patients were female, and with an average age of 51 years. Most commonly, patients had self-referred (39%), had previously consulted their doctor about their problem or symptom (78%), were paying for their own treatment (95%), and had received acupuncture before (87%). The most common main problem or symptom reported by patients was musculo-skeletal (38%), followed by psychological (11%), general (9%), neurological (8%) and gynaecological/obstetric (8%), while 5% of patients were seeking treatment for their general well-being. In comparing our data with that of the 1988 survey, we found a number of changes over time, in particular the proportion of musculo-skeletal conditions had dropped significantly (chi(2) = 17.36, d.f. = 1, p < 0.001), indicating a wider case mix amongst patients compared with those seeking care in 1988. This evidence from acupuncture patients' reports shows that musculo-skeletal problems provide the main reason for seeking treatment. The large dataset from this study provides a wealth of information and a fresh raft of questions which will inform future research and policy-making.

Some Origins of Operations Research in the Health Services

1055 W. Joppa Road, 203, Towson, Maryland 21204, cflagle@jhsph.edu INTRODUCTION Closer to home, and also in 1952, Dr. Ellis Johnson, Several apparently independent events around the year director of the Operations Research Office of the Johns 1952 formed the nucleus of what is now almost half a Hopkins University (ORO)-actually the program and staff century of operations research in the health services as of the U.S. Army Operations Research Office, administered I have known it. In England, Norman Bailey published by the University under contract-authorized the creation \Operational Research in Medicine in the June 1952 issue of an informal seminar in operations research, conducted of Operational Research Quarterly (Bailey 1952), and on the University campus and organized by an ORO histo- almost simultaneously in the Lancet, a paper on appoint- rian, Joseph McCloskey, who edited the collected seminar ment systems in outpatient departments (Welch and Bailey papers into two volumes entitled Operations Research for 1952). His work was part of an operational research effort Management (McCloskey and Trefethen 1954, McCloskey supported by the Nuffield Provincial Hospitals Trust that and Coppinger 1956). The seminar had a dual purpose, first was influential in the development of Britain\'s National the enlightening of the faculty and students about opera- Health Service. In that same year publication of the Jour- tions research, which was not a well-known topic in civil- nal of the Operations Research Society was launched, and ian life at that time, and second, searching for an academic would soon provide an outlet for communication of similar home for OR in the departmental structure and curricu- work in America. lum of the University. I recall that a place in engineering In the United States the Hill-Burton legislation of 1945 was not the first choice of an academic home for much of to fund innovation, construction, and renovation of hospi- the ORO staff, with its mix of educational backgrounds- tals created an extramural research and development pro- something in the humanities would have been preferable- gram aimed at the provision of technical assistance and but it was fortunate that the Dean of Engineering, Robert guidelines for design, construction, and management of H. Roy, an articulate and experienced manager, a student hospitals and health facilities. This created the opportunity of organizational behavior and author of several books on for operations research to participate in a multidisciplinary administration, saw in the substance of operations research effort that became the nucleus for the soon-to-emerge a complementary element in his already multidisciplinary field of health services research. The development in both Department of Industrial Engineering. The relationship intragovernmental and extramural research was led by the between ORO and the School of Engineering was formal- Assistant Surgeon General for Hospital and Medical Facil- ized, and in time the name of the department would become ities, Dr. J. R. Haldeman. His vision extended beyond the Operations Research and Industrial Engineering. design and management of the physical infrastructure of In the Johns Hopkins Medical Institutions in 1952, facilities to the determination of community needs and Russell A. Nelson, M.D., a skilled clinician and adminis- resources and the integration of services, concerns that trator, was appointed Director of the Johns Hopkins Hos- would in time dominate the directions of health services pital while maintaining for a while his position as adjunct and research centered on them. lecturer in the Department of Public Health Administration These events are indicative of the post World War II in the School of Hygiene and Public Health, where he had changes in the role of government in the health services: in been developing an educational program in hospital admin- Britain the commitment to universal coverage of care, and istration. In a few years he would become president of the in America a responsibility for funding of needed medical American Hospital Association and would chair the Advi- care facilities in the aftermath of the war and the years of sory Committee on Hospital Facilities and Services of the economic depression that preceded it. In both countries the U.S. Public Health Service. need for support of research and education was recognized At the time all this was taking place, I was a gradu- and implemented, opening the door to forms of inquiry not ate student in Dean Roy\'s department, and was one of his widely accessible to the health services in the past. advisees. I was in the throes of doctoral research and some Subject classification: Professional: comments on. Area of review: Anniversary Issue (Special). Operations Research © 2002 INFORMS 0030-364X/02/5001-0052 $05.00 Vol. 50, No. 1, January-February 2002, pp. -60 52 1526-5463 electronic ISSN

Persuading the sick or impaired doctor to seek treatment

A recent working party report published by the Nuffield Provincial Hospitals Trust (1996) made a series of recommendations for the improvement and better coordination of existing services. This comes at a time when new and expensive counselling services are springing up everywhere, the most ambitious being the British Medical Association's 24-hour counselling service for doctors and their relatives.

The Mystery of General Practice

Iona Heath Nuffield Provincial Hospitals Trust, pounds sterling8, pp 53 ISBN 0 900574 93 3 The role of the general practitioner is changing rapidly on both sides of the Atlantic. In the United Kingdom general practitioners enter into fund holding arrangements with the National Health Service. In the United States family physicians accept capitated contracts with managed care organisations. Both arrangements require doctors to balance the competing needs of the patient, the practice, and the larger system. The opportunity is to provide services to …

Communication Skills for Medicine

Margaret Lloyd, Robert Bor Churchill Livingstone, £15, pp 180 ISBN 0 443 05168 2 In 1978 the late Charles Fletcher wrote a superb book entitled Talking with Patients: A Teaching Approach. This was distributed to medical schools by the Nuffield Provincial Hospitals Trust and it made a lasting impression on many doctors. Communication training has subsequently been introduced into all undergraduate curriculums. Lloyd and Bor have produced a text to go with these courses, but the content is not specific to medical students and is aimed at all who wish to improve their communication skills. The book uses a combination of factual …

British Doctors' and Dentists' Group will provide an intervention service from 1 July

EDITOR,—Martin S Wolfson's letter about his attempt to take action over a doctor with alcohol problems comes as no surprise,1 A report of the Nuffield Provincial Hospitals Trust clearly outlines the failure of systems that purport to be in place.2 The British Doctors' and Dentists' Group, which has existed for over 20 years, provides confidential help for chemically dependent doctors. …

Primary Health Care in an International Context

John Fry, John Horder Nuffield Provincial Hospitals Trust, pounds sterling16, pp 166 ISBN 0 900574 90 9 The fascination of Primary Health Care in an International Context is tinged with sadness. We will no longer be enlightened, entertained, sometimes infuriated, but always stimulated by the writing of the late John Fry. General practice and patient care will be the losers. For a medical travel addict, this account of countries visited by John Fry and John Horder rings true, bringing to light problems and aspirations concerning patient care …

Keep, John and Clarkson, Jill, Disabled people have rights: final report on a two year project funded by the Nuffield Provincial Hospitals Trust. The Royal Association for Disability and Rehabilitation (RADAR), 1994, 66pp, E5.00. Available from RADAR, 12 City Forum, 250 City Road, London EC1V 8AF

Keep, John and Clarkson, Jill, Disabled people have rights: final report on a two year project funded by the Nuffield Provincial Hospitals Trust. The Royal Association for Disability and Rehabilitation (RADAR), 1994, 66pp, E5.00. Available from RADAR, 12 City Forum, 250 City Road, London EC1V 8AF

The end of the outpatient problem?

The outpatient problem in Britain has had a long and troubled history, but at last a solution seems to be in sight. This is happening by default rather than by design, not by tackling head on problems of delayed access to consultation for patients suffering from pain, anxiety, or illness, nor by substantially reducing unnecessary reattendances by patients, but by redefining the problem out of existence. The main problem has always remained constant: too many patients being seen in a system of care in which responsibility for outpatients is disputed by different sectors of the medical profession. Towards the end of the 19th century general practitioners believed that too many people were gaining access to voluntary hospitals too easily. In 1887 one and a half million visits were recorded for the total London population of four million. General practitioners became reluctant to refer patients to hospital in case they were poached by consultants and they formed an association to try to stop abuse of the system. The inauguration of the NHS and the formalisation of the referral system unified the profession to a certain extent, but outpatients have remained in a contested terrain. The problem of repeat attendances by outpatients was revived in the 1960s and 1970s with the publication of a survey funded by the Nuffield Provincial Hospitals Trust. Articles in the medical press deplored the thousands of season ticket holders. Through no fault of their own these patients were …

British study highlights stigma of sick doctors

Doctors who are sick do not seek help because of the stigma of illness and because of peer pressure and professional loyalty, according to a new study. The study found that attitudes of denial learnt in medical training and lack of insight into personal illness also played their part (see editorial on page 557). Eight health authority districts were studied by the department of public health medicine at the United Medical and Dental Schools at St Thomas's Hospital in London. The report, which was funded by the Nuffield Provincial Hospitals Trust, concludes that there …

Effect of NHS and Community Care Act Problem with interpretation

EDITOR, - We believe that the simple approach and methodology of Peter A Lewis and colleagues' study fail to recognise the complexity of the changes brought about by the NHS and Community Care Act 1990.1 With the support of the Nuffield Provincial Hospitals Trust, we are undertaking a detailed comparison of the discharges from five elderly care units in South East Tha mes region for the first six months of 1992 and 1994. Our preliminary findings lead us to suggest that the paper does not take account of several issues. Period of data collection - In many districts it took a few months for the new systems to be fully operational. Therefore changes in the numbers of patients going to institutions or in their lengths of stay in hospital might not be apparent from information collected in the first few months after the introduction of the act. Changes in procedures brought about by the act - The paper fails to discuss the changes in hospital and social work procedures that occurred on 1 April 1993. The impact of the act was different in different districts, depending on, for example, the previous style of administration in social services, the type of community services provided before the introduction of the act, and the availability and range of places in institutions. Other NHS changes - Any other changes in the operational policies of the department are not discussed. In our region changes in catchment areas and admission and other NHS trust policies have occurred in some districts, which affected the process of discharge from hospital. Placements not arranged by the local authority - In one district in our study all …

Diagnosis in General Practice. Art or Science? by David Cameron Morrell. Nuffield Provincial Hospitals Trust, 1993. No. of pages: 73. ISBN 0-900574-85-2

Health EconomicsVolume 3, Issue 4 p. 296-296 Book Review Diagnosis in General Practice. Art or Science? by David Cameron Morrell. Nuffield Provincial Hospitals Trust, 1993. No. of pages: 73. ISBN 0-900574-85-2 Nick Bosanquet, Nick Bosanquet St Mary's Hospital Medical School/Imperial CollegeSearch for more papers by this author Nick Bosanquet, Nick Bosanquet St Mary's Hospital Medical School/Imperial CollegeSearch for more papers by this author First published: July/August 1994 https://doi.org/10.1002/hec.4730030413AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume3, Issue4July/August 1994Pages 296-296 RelatedInformation

Postgraduate Medical Education

John Lister Nuffield Provincial Hospitals Trust, pounds sterling 15, pp 118 ISBN 0-900574-84-4 The trouble with medicine in Britain is that training often seems never ending. The inherent danger in such a system is that eventually for many learning becomes a great effort. Reconciling educational requirements within service needs has proved a planning nightmare in the hospital sector. General practice has fared better, but there is still much to be done. A book that tackles the history of postgraduate …