Her Majesty the Queen officially opened the Diana, Princess of Wales Children’s Hospital at Steelhouse Lane, Birmingham on 30 October 1998. During her extensive tour of the hospital, the Queen and the Duke of Edinburgh – escorted by Chairman and chief executive Colin Hough – unveiled a specially commissioned stained glass window, met staff, patients and their families and inspected state-of-the-art facilities and medical equipment.
Afterwards, Colin Hough proudly announced that the visit was a wonderful tribute to the reputation of the Trust and all those who work so hard to help the many sick children seen by the hospital each year. The historic hospital has a new site and a new name, but is determined to maintain its position as one of the world leading paediatric centres and a focal point for the local community.
On 20 May 1998, the West Midlands Ambulance Services shuttled the final few of a 100 or so young patients the several miles across town from the old Children’s Hospital on Ladywood Middleway to the new Children’s Hospital in Steelhouse Lane. Just over an hour after the gleaming new Accident and emergency Department opened, the first emergency patient was admitted – a six year old boy who had sprained his fingers while playing. After decades of hoping and waiting, years of planning and fundraising and building, the Birmingham Children’s Hospital had finally arrived in its new city-centre home.
The logistics of the move from Ladywood, home of the Childrenâ€™s Hospital since 1917, were dauntingly complex. Apart from the delicate business of transporting the patients â€“ some of them infants in incubators â€“ more than 30,000 items from the old building had to be packed into 11,000 removal crates and hauled across the city in some 500 truckloads, to be re-commissioned into 1,600 rooms. In addition, a further 6,000 newly purchased items were delivered to the site
. Nine thousand signs were installed to help people find their way around, 200 gallons of floor polish were applied to the splendidly refurbished wards and corridors of the new building, and tags attached to the best part of 10,000 keys.
As the content of the entire modern hospital were unpacked and installed, Chief Executive Colin Hough did the rounds with a trolley, offering cakes and cold drinks.
He says: “I thought my job was to keep their spirits up, keep them fed, keep them watered. Keep them supported while this huge move was going on. It’s hard to think of somewhere else up and down the country that’s actually done this. There are very few hospitals that lock, stock and barrel – have uprooted and moved from one location to another. We ended up with what I call a party on the park on 22 May where we all celebrated the move. Everybody was together. Doctors, nurses, porters, cleaners, managers, all the clinical support staff. There was a huge sense of occasion, coming together, celebrating an enormous task achieved. I think we’ve actually done something here that is quite special.”
Special is certainly the word to describe the new premises. The handsome redbrick building in Steelhouse Lane was originally completed in 1897 to house the Birmingham General Hospital. Although by the 1990s it had become little more than an accident centre, for most of the twentieth century the General has been a much loved Birmingham landmark. A total of £30 million of NHS cash had been spent on transforming this Victorian gem, which might have been knocked down had the Children’s not moved here, into a hitech modern hospital. The aim was to achieve the right blend between preserving the best of this Grade II Listed building and creating an uncompromisingly up-to-date facility capable of improving and developing health services for children well into the next future.
Within the outer Victorian shell, the big old “Nightingale wards” were converted into new cubicle wards, with 2-6 bed bays and some single bed areas. There is room for 300 inpatients – up from 270 at the old site. Ceilings have been lowered while brighter colours and patterned floors have been introduced to make the wads feel more child-friendly. The original out-patients department has been preserved, although heavy, brown Victorian tiles have been painted over. Elsewhere in the hospital, original tiling has been
preserved in corridors and stairwells. The marbled chapel on the first floor has been restored, as has the beautiful groundfloor conservatory, intended as a relaxation area and informal meeting place for staff.
While the old has been preserved as far as possible, many of the more hi-tech features of the new Childrenâ€™s Hospital have been housed in an entirely new purpose-built block, inserted into the middle of the Victorian complex. Here, for example, is the new Intensive Care Unit, with room for expansion to 20 beds â€“ a calm and spacious contrast to its cramped and often chaotic predecessor. In the old place
there were wires everywhere. Here each intensive care bed is fitted with state-of-the-art monitoring equipment, attached to specifically designed stands which can be suspended from ceiling to floor and neatly swivelled around the bed.
The new block also includes four operating theatres, making a total of seven in the hospital. One is dedicated to cardiac surgery, allowing the Children’s to further develop its pioneering work in sophisticated open-heart techniques. Another operating theatre, which will be used by the hospital’s neurosurgeons, is kitted out with a £250,000 “Surgiscope” – a device which guides doctors by laser through the complexities of a human brain. The radiology department is in the new block too, enhanced with both a new CT scanner to replace the ten-year-old model that was in use at Ladywood, and an MRSI scanner, the hospital’s first.
One of the many problems at the old site was the lack of accommodation for parents. Sometimes mothers and fathers wishing to comfort their children had to sleep on camp beds in the narrow spaces between beds. In the new hospital there is dedicated parent accommodation on the wards, and a residential house run in conjunction with the Edwards Trust
and capable of catering for up to 35 families. There are also vastly improved refreshment and waiting areas.
Spaciousness is in every way the key. At Ladywood, just about anywhere it had been possible to put a new building, theyâ€™d already dropped one in. World-class surgeons were working out of Portakabins. Where once there had been expansive gardens, there was just one last piece of grass left,
offering a single bench and a tree. If the move had been delayed any longer, this final haven would probably also have
disappeared. Now at Steelhouse Lane there are quiet corners, shady gardens, spaces for colleagues t meet and greet and keep in touch.
The staff of 2,000 surgeons, doctors and nurses, catering staff and clerical workers, physiotherapist and lab technicians – are all proud of this new home. And both the shared experience of all the move’s complexities, and the room to stretch out which the new site offers, have fostered a new sense of community within the hospital, brought them closer together than ever before.
Says Colin Hough: “We’ve built the platform here on which we can go on to achieve the opportunities of being a centre of excellence in terms of clinical care, research and development, teaching and education – all those kinds of things that we’re here to do. Now finally we’ve got the foundation that we need.”
The biggest irony of the move is that, in looking to the future, it has also brought the Childrenâ€™s very close to its past. For it was in the Steelhouse Lane, back in the mid-nineteenth century, where the story of the hospital began.
Thomas Pretious Heslop was by all accounts a man with the courage of his convictions. He was both a physician of great ability, who fought zealously to defend and improve the reputation of his profession, and an ardent reformer, who claimed to be compelled by a sense of justice. When the occasion demanded it, he was easily roused to righteous and eloquent anger. It was this man, more than any other, whose efforts led to the founding of the Birmingham and Midland Free Hospital for Children.
Heslop was born in 1823 in the West Indies, where his father was stationed as a Major in the Royal Artillery. Little is known of his life before he became apprenticed to a Dr
Thomas Underhill of Tipton, Staffordshire, the husband of Heslop’s aunt. Later he studied in Dublin under a Professor Stokes, who was both an outstanding physician and a distinguished man of letters. In Ireland Heslop also gained invaluable clinical experience, taking on the unpaid post of clinical clerk at Meath Hospital: “I had exclusively charge of the whole medical work of the institution, under the physicians. The gentleman who holds the office obtains clinical practice for nothing, in consequences of the labours imposed upon him.”
From Dublin, Heslop moved on to Edinburgh. There he took his M.D. in 1848, while also leaping at the opportunity to work briefly in the Royal Edinburgh Infirmary. His courage and enthusiasm are self-evident. “Three times, owing mainly to the frightful number of deaths, and because no resident medical man would go in at a particular moment in 1848, I had the great good fortune to go in to reside for several weeks as a substitute.”
Later that year he returned to the Midlands, where he spent three years as resident medical officer and tutor to the Birmingham General Hospital. His duties might have daunted
a lesser man. For a salary of £100 a year, Heslop had to attend to the physicians’ out-patients, do the rounds of the in-patients, and then write up all their case notes every day. He also had responsibility for the studies of the three or four resident pupils This meant not only talking them through clinical experience and instructing them on medical matters, but also supervising their reading – scientific tomes as well as general literature – tutoring them in Latin, French and German, and making sure they all went to church on Sunday. Arduous this all might have been, but the post provided great experience of the workings of a hospital – experience Heslop would later put to use when setting up the Children’s Hospital.
He eventually resigned on a matter of principle and set up in private practice on Temple Row – in those days Birmingham’s equivalent of Harley Street. But patients failed to turn up in droves and in 1852 he took an appointment as Professor of Physiology at Queen’s Hospital. For a while this offered Heslop scope to develop both his clinical and educational abilities. But in 1858 he again resigned on a point of principle. The immediate cause seems to have been the critism of irregulaties in the wards. What these may have
been has not been recovered, but an earlier letter he wrote to the Weekly Board perhaps provides some indication.
“On Tuesday last I was informed by Mr John Davis, now residing in this hospital, that on the evening previously he had seen a patient of mine, a young girl, aged 13, labouring under St Vitus Dance, scrubbing the upper large Female Ward at half past eleven o’clock. This appeared to be no very uncommon circumstance and from what I have observed myself I judge that cleaning or rather wetting the wards in the evening is very frequent... I entreat the Committee of Council to call before them the whole body of Nurse, and I will then aske them if they believe that such persons are competent to carry out the orders of the Medical Staffs.”
Heslop was by this time convinced that children could not be adequately treated in general hospitals. Indeed, they were rarely admitted to the wards. Without a hospital appointment, he now found time to think through his arguments for a children’s hospital and to start shaping his plans for its foundation. Certainly, reading medical literature
or even just looking around the city in which he lived, he was aware of the shockingly high level of childhood mortality.
Squalor and malnutrition
In British cities in the mid-nineteenth century, two out of ten babies would not live to see their first birthday, and only four might survive until age five. The Industrial Revolution had meant the concentration of work in factories, and of factories in towns. Employers and speculators threw up row upon row of cheap brick houses â€“ poorly ventilated
and cramped – accommodate those who had flocked into the cities to work. Conditions were appalling: lack of pure water, outside toilets shared between several families, insufficient drainage and an overcrowding so severe that some surveys put average bed occupancy at 2.8 persons per bed. In 1875 the death rate in the centre of Birmingham was 26.82 per 1,000 – fully twice that of leafy Edgebaston nearby.
I have penetrated court behind court, in which the space between a high wall on one side and the doors of the houses on the other was so narrow that it would not permit my umbrella being placed horizontally between them. In this very place were two cases of smallpox and one of scarlet fever, and noxious odours were its prevailing atmosphere. The infant mortality in such areas is frightful. If we had accurate statistics, the testimonies of the people themselves would be sufficient on this point. In one court of five houses I got such replies as “Buried four, only this one left”; “Buried six, been married twelve years”; “Buried two”, and so on ad infinitum. William White, chairman of the Improvement Committee, on conditions near the hospital before
slum clearance programmes. (Improvement Scheme, 1875)
Children had no rights whatsoever. There was barely even a concept of childhood and its specific needs. The Royal Society for the Prevention of Cruelty to Animals had been established in 1823; the National Society for the Prevention of Cruelty to Children was no founded until 1883. Growing up in insanitary squalor, children had no schooling and were sent out to work at the age of five or six â€“ bringing an important 3d or 4d a day back to their families. The diet of most working â€“class families comprised bread and weak teas with cheese, beer, potatoes, sugar and fat when they could afford it. Meat was a luxury, enjoyed perhaps once a week, and milk, when available, was unpasteurised and of poor quality. Babies were suckled for at least a year.
Not only was this cheap and natural, but it was also commonly believed that a woman could not conceive while still breast-feeding. Otherwise babies were fed pap-a bread and water paste flavoured with sugar or treacle. It was common for mothers to chew the crusts before dropping them into the bowl.
Under-nourishment and bad feeding inevitably took their toll, causing many babies to become restless and bad tempered. Often they succumbed to diarrhoea. Difficult infants were dosed with patent remedies such as Godfrey’s Cordial, Atkinson’s Infant Preservative or Street’s Infant Quietener. These did the job very effectively – mainly because they all contained opium.
Many babies died from opium poisoning, or one answer: starved from resultant lack of appetite. Suffocation by overlaying in a crowded bed was another widespread cause of infant mortality. The commonest time for this to happen was on the Sunday morning following a Saturday night of drinking down the weekly wages in jugs of chip gin.
Working-class children were rarely taken to see a doctor. A private practitioner was simply too expensive. Applying to see the parish doctor carried the stigma of pauperism. There were sick-club doctors, but these were grossly overworked and seriously underpaid. To the philanthropic middle-classes, appalled by city-centre squalor and motivated by both compassion and concern for social control, there seemed to be one answer: childrenâ€™s hospitals. These could supply care in the outpatient department, home visits, and the temporary removal of the seriously ill child into a more wholesome environment as an in-patient. In the age of Florence Nightingale, the training of nurses had also become attractive. Not only could they tend sick children in hospital and at home, but they could also play a part in spreading the right ideas about feeding, clothing, ventilation and the general care of children.
The Big New Thing Largely because of advances in medical knowledge, children’s hospitals had already become fashionable on the Continent. The first had been established in Paris in 1802, based on the foundling hospital of Maison de l’enfant Jesu. In the following decades, it’s physicians published an extensive and pioneering literature on the diseases of children. Decades later, an epidemic of children’s hospitals began to
spread across Europe: St Petersburg (1834), Vienna (1837), Pest (1839), Prague (1842), Moscow (1842), Berlin (1843), Turin (1843), Copenhagen (1845), Munich (1846) and Stockholm (1854). Many of these had royal of imperial patronage. Several were integrated with medical schools.
Great Ormond Street Hospital in London, Britain’s first children’s hospital, was opened in 1851 in the wake of this international development. Similar children’s hospitals were shortly founded in Liverpool, Manchester and Edinburgh. It was only to be expected that Birmingham should soon follow where these other great cities had led. At a meeting in his house on 25 June 1861, Thomas Heslop presented his proposal for a hospital to a carefully chosen group of leading citizens.
A Town’s Meeting to further discuss the project was held on 12 July in the Public Office. There was a letter from the governors of the Queen’s Hospital setting out their view that no further provision for children was necessary beyond their hastily cobbled-together plans to open a new children’s ward. Clearly they were worried about a potential loss of funds. Criticism came also from S.S. Lloyd, who noted the
Queen’s and General Hospitals habitual state of indebtedness. Heslop, however, maintained that the new foundation would not divert monies from existing charities. “It would be another rill in the stream of charity; persons would give to this who would give to no other, and subscribers to existing charities would not withdraw their subscriptions to give to the new institution.” History would prove him to be correct.
The Town’s Meeting unanimously passed a resolution “that it was desirable to establish a Hospital for Sick Children in Birmingham having for its objects: 1. The medical and surgical treatment of poor children. 2. The attainment and diffusion of knowledge regarding the diseases of children 3. The training of nurses for children.” A provisional committee was appointed, charged with the tasks of finding a building and drafting a constitution. C.E. Mathews, then a young man of 27, was appointed Honorary Secretary responsible for much of the project’s administrative and legal work. A passionate reformer and a lifelong friend of Joseph Chamberlain, he formed a highly
effective partnership with Heslop and can in many ways be regarded as the co-founder of the Children’s Hospital.
Mathews set about raising funds, circulating 400 letters of appeal and publishing the receipts in the “Birmingham Daily Post” and other papers. Committee members canvassed friends and acquaintances. By September donations totalled £685 with a further £134 in subscriptions. Meanwhile, Thomas Lloyd chaired the Buildings Sub-Committee. Lloyd was also chairman of the Eye Infirmary and knew that it was about to move from its premises at 138-139 Steelhouse Lane, which soon became the favourite out of several possible sites. The eighteen-century building had previously been a private house, a bank and a polytechnic. It could be used immediately without extensive alternations, had a central location that was convenient for out-patients, could accommodate 16 in-patient beds, and was “situated amongst that portion of the population by whom its benefits will be most readily appreciated”. In other words, the poor.
Not everyone saw it this way, though, as exemplified by a letter to the Mayor believed to have been written by Queen’s Hospital Surgeon Sampson Gamgee:
“How can one conceive of a place less fitted for a child’s infirmary than the one named in Steelhouse Lane, with its crowded neighbourhood, with Weaman Street and its thronged garrets and workshops on one side, and that nest of filth and worse abominations, Slaney Street, on the other, and last, but very assuredly not least, with the tannery in its immediate rear?”
Nevertheless, a mortgage on the Steelhouse Lane premises was taken out, the first medical staff were appointed, and an appeal was launched for furnishings and equipment. Within five days the manufacturers and trades people of
Birmingham had contributed everything that was needed. The list of gits included cots, beds, tables, chairs, inkstands, hatstands, brooms, mops, crockery, needles, bottles for the dispensary, clocks, sponges, thermometers, toys, dolls, instruments, drugs, papier-mâché prescription boards and – showing that some traditions never change – a bunch of grapes.
The Out-patients Department was finally ready to open its door on New Year’s Day, 1862. The In-patient Department followed a fortnight later. The Birmingham and Midland Free Hospital for Sick Children had finally become a reality.
A Free Hospital Then as now, the healthcare of children was at the heart of the new hospital’s concerns. But Heslop and Mathews had always intended the Children’s to be something more than an institution for the treatment of sick youngsters. With a number of far-sighted reforms, they founded the hospital also to be both a working model of good management and a
beacon in the struggle against privilege. There can be no better tribute to their work than to note that so many of their objectives today seem obvious and commonplace. At the same they were no such thing.
They separated the business of administration from the practice of medicine, thus challenging one of the main obstacles to reform: the domination of hospital policy by ageing medical men with inflexible views. They also reformed the process by which honorary surgeons and physicians were elected. This was to ensure that medical officers were chosen
for their professional qualifications rather than the extent of their local contacts, or the amount of money they could splash out on a campaign. One contemporary estimate if the bill for election to a position at the Birmingham General Hospital was the then staggering sum of £1,000. Professional canvassers had been employed to remind subscribers of their duties. Carts had trundles through the city streets with placards pleading “Vote for Doctor X” or “Vote for Doctor Y”. In place of this ridiculous process, Heslop created a Special Committee of Election that was broad in its composition and competent to judge medical credentials, while also small enough to render expensive electioneering unnecessary.
But the most important reforms were in the systems of admission. In the mid-nineteenth century, general hospitals were still part of a wide though increasingly outmoded system of patronage. Wealthy subscribers to local hospitals expected to receive the right to recommend for admission, and would pass out ‘tickets’ as favours to servants and dependants. This might have worked more efficiently –and for the hospitals at least it was some kind of guarantee that an applicant was genuinely in need of treatment – but for the fact that they were also expected to admit accident victims and emergencies for free, thus upsetting any financial
calculations based on subscribers’ privileges. Meanwhile, anxious parents of sick children would end up traipsing from door to door trying to find someone with a ticket to spare.
In London this system was already being challenged – the Royal Free Hospital had been founded in 1828 – But Heslop was also influenced by his experiences at the Edinburgh Infirmary, where the admission of patients depended only on their need for treatment. Heslop and Mathews intended the new hospital to be a practical demonstration of the free principle. The Birmingham and Midland Free Hospital for Sick Children was the first free hospital in town. Subscribers were given no tickets of recommendation to distribute. Instead Heslop sought safeguards to reassure supporters of the charity that their money was being properly spent, and on the right people. The hospital’s constituency was defined as “that class of sick persons, suffering from whatever serious ailment, who are above pauperism, and yet below the capacity of paying for a medical man.” Paupers living on a parochial relief were to be dealt with by the parish doctor or the workhouse infirmary.
It took some tinkering to get these safeguards right, but Heslop and Mathews had created a system of management sufficiently flexible to respond to changing circumstances, and the Children’s has remained a free hospital ever since. In the words of Rachel Waterhouse, author of ‘Children in Hospital: A hundred years of child care in Birmingham’;”Unfettered by bonds of tradition and custom, the Children’s Hospital was able to adapt itself readily to new conditions. Far from being petrified at birth it was, like the children now flocking to its doors, a growing, living organism.”
Trivial Complaints? And flock they did, although it had proved usual wherever a children’s hospital opened that parents would at first be reluctant to leave their children behind for treatment. In Birmingham too the number of in-patients built up very slowly. Just two were admitted in January 1862, followed by 16 in February. There were in any case at the beginning only 16 beds.
It was different with out-patients. Almost from the off, the waiting room would be filled with mothers and their ailing offspring, 762 of whom had been seen by the end of March. The initial system required parents to bring along, not a subscriber’s ticket, but a certificate of eligibility signed by two ‘respectable householders’. This quickly proved useless as people living in the vicinity of Steelhouse Lane were only too happy to endorse anyone who asked for their signature. Crowds in the waiting room swelled until the annual onset of summer diarrhoea caused such out-patient chaos that the hospital tried limiting the issue of tickets to 30 a day, served out to the first-comers. The injustice of this soon became apparent – those who fought their way to the front of the
queue were invariably the strongest, roughest and rudest and often the least deserving.
In November 1863 a form of means test was introduced. This proved so successful in managing patient numbers and preventing â€˜abuse of the charityâ€™ that it was to remain in force for over half a century. The House Surgeon, before handing out tickets, would enquire into the earnings and number in a family, the nature of the illness, and whether the applicant was on parochial relief. For a family with three or fewer children, their total earnings were not to exceed 25 shillings; for those with four or more children, 30 shillings. The regulations were waived only in cases of unusual severity, for those requiring delicate surgery, or anticipating a jet feature of the modern health system â€“ for those who had brought a certificate from a medical attendant who had already been treating the case.
This system worked, but still failed to stem the steady increase in the number of out-patients. “All the gossips of the neighbourhood were reputed to foregather to exchange news and to waste the time of medical officers with their children’s trivial complaints.” Meanwhile, paupers denying that they were on parish relief still flocked into the Outpatient Department. With the Children’s limited facilities in danger of being swamped, Heslop proposed a remedy. A charge of sixpence, he considered, would exclude paupers but be affordable for the working poor who were the intended objects of the charity. With this amendment, established in 1871, the rules of admission were to remain the same up until World War 1 and the move to Ladywood.
I write to inform you of an evil which increases every visiting day, viz: that of the parents and friends of the children bringing cakes, apples, and other indigestible foot to the children. Every available means are taken to prevent it, the housemaid stands at the entrance door, questions and examines everyone as they enter â€“ a nurse is continually in each ward and the beds are searched when the friends leave; not withstanding all these precautions such things are continually being given to the children which are not detected until they show signs of being worse some hours afterwards, this happens almost every visiting day and although a great deal is attributable to the excitement of seeing their parents and friends very much is owing to indigestible food given surreptitiously. Dr Underhill, House Medical Surgeon, writing in 1870
A nightmare upon the soul Though it was considered sociologically beneficial or the poor to contribute to the cost of their own treatment, all those sixpences were even then but a drop in the stream of the hospital’s finances. Like other hospitals at the time, the Children’s was supported by subscriptions, donations and legacies. Bigger hospitals employed professional collectors and canvassers to chase up cash, but most of them lived up to or beyond the limits of their income. Until the NHS came along, hospital governors were as preoccupied with raising money as they were with spending it.
The Children’s was no different, except in offering no privileges to subscribers, and in the principle of spending no more money than they had at their disposal at any given time. The hospital practised careful economies, scrutinising the prices of equipment, food and drugs and keeping the prescription of alcohol to a minimum. Legacies were invested and only the interest was used. Though sensible enough, this policy also explains the slow growth of the hospital in the last quarter of the nineteenth century. The only expansion that took place was financed by appeals.
In 1865 the list of donations to a Children’s Hospital appeal includes £25 from one Joseph Chamberlain. That same year he had been elected to the Committee. Just 28 years old and yet to rise to national prominence, Chamberlain was already a widower with two young children. He brought to the hospital his own brand of hard-headed financial ability – that first appeal successfully raised a sum sufficient to pay off the remaining mortgage debt on the Steelhouse Lane building. It also allowed Chamberlain and Mathews to look towards expanding services for the ever-increasing number of outpatients.
The Children’s soon acquired a lease on a 585-squareyard site at the corner of Upper Priory and Steelhouse Lane, and set about constructing a new Out-patients Department. John Henry Chamberlain, a devotee of Ruskin, drew up the plans and eventual building, opened at the Annual General Meeting of 1869, attracted much praise. George Dawson, a prominent supporter of the project, was minuted to have said that:
“Birmingham was filled with architecture which – especially on a foggy morning – lay like a nightmare upon the soul, and he was delighted that there was in this town one committee wise enough to understand that a little beauty cost a little money but gave great joy. He congratulated the Children’s Hospital upon having done something to relieve that sad disease: deformity, hideousness, misconstruction, rickets and ugliness in architecture ugliness in architecture."
The new building also showed up the fundamental inadequacies of the original Steelhouse Lane premises, now expanded to include 33 beds for in-patients. The lack of an isolation ward had created great difficulties in handling patients with infectious diseases such as scarlet fever, diphtheria or measles. Scarlet fever was particularly widespread and virulent throughout England and Wales in the i86os, and many patients admitted to the hospital were suffering from its after-effects and complications.
Hospital regulations insisted that parents not bring in any patient suffering from scarlet fever or measles. Instead they should apply for a home visit. Some patients, however,
were admitted to the wards only to develop one of these infections later. The rules said they were to be sent home, often when they were most in need of medical care, proper food and a sanitary environment. This problem was eased by Heslop, who had been able to obtain, out of his own pocket, a seven-year lease on the property next door. In November 1862 he transferred it to the hospital to be used as a contagious ward. The facility was inadequate, however, and the lack of isolation beds was a big factor in spurring a move out of the original premises.
Moving out to Broad Street
In March 1869, the opportunity arose to acquire a building in Broad Street then occupied by a more-or-less obsolete Lying-in Hospital.
Reports were favourable: the building was "far enough from the centre of town to secure abundance of light and air, and near enough to be readily accessible by patients... It possesses an ample space of ground more than sufficient to provide an admirable playground for convalescent children. The central department, built for a private house, is everything that could be desired for Hospital administration."
The Committee acquired a 5O-year lease on the Broad Street buildings. Improvements and alterations were to cost ÂŁ248, while Heslop and Mathews personally forked out for a new set of railings and gates and for laying out the garden around the building with shrubbery and lawns. Particular care was taken with the construction of an isolation block, finally completed in 1877, consisting of two six-bedded scarlet fever wards, a quarantine ward, and a four-bedded diphtheria ward. They incorporated every improvement then known to sanitary science, including glazed tiles for the walls and floors of closely grained oak. There was separate accommodation for the nurses and a dedicated laundry.
On the main road into town from Edgbaston, the Children's was now in a position-both geographically and in terms of facilities-to impress its existence upon the life of the city. No longer pushed for space or endeavouring to treat patients under impossible conditions, the hospital was now able properly to begin tackling some of its original objectives and to begin extending its influence beyond Birmingham to the Midlands, the rest of the UK, and the world at large.
Her babby had to go in. There was no other option. She had to have the op, the doctors had said so and these were the doctors that the whole of Brum trusted. The pair of them reached Five Ways, turned right down Lady wood Road and crossed over to mount the steps of the Children's Hospital. Inside, as if in a daze, the mother instructed her daughter to 'Be good. Do as you're told. And say your prayers each night'-and then watched as a kindly nurse led the babby off to the ward. No one saw the tears well up in the mom's face and no one heard her calls to God to mind her child-no one bar that nurse who turned her head and mouthed: 'Don't worry. We'll look after her.'
Dr Carl Chinn,from his Yesterday's World column in the Evening Mail
Raising funds Heslop and Mathews stood back from the day-to-day running of the hospital in 1872, but the work of the Children's continued. As services were developed, the number of patients continued to rise. The year 1881 saw the total number of patients treated since the hospital opened reach 250,000. But subscriptions, the hospital's mainstay from the beginning, were by this time in decline. The year the isolation wards were built also marked the start of the depression that ended the great era of Victorian free trade. In 1878 the Children's registered an annual loss for the first time, and began to face a recurring cycle of increasing expenditure, insufficient funding to admit every deserving patient and the consequent development of waiting lists.
Two innovative funding streams were developed in Birmingham. The first was the Hospital Sunday Fund, the inspiration of Dr J.C. Miller, Rector of St Martin's. He organised a simultaneous collection at all places of worship in Birmingham to be devoted to local hospital charities.
The Christian world has offered no greater spectacle than that of our clergy, rhe last two autumns, forgetting all differences, in the Name of One God, labouring lor one suffering people. The stern Calvinist relaxed to do good cheerfully, as with a brother, with the Romanist, the high Churchman descended, and the low one rose, to the conviction that charity has no sect; while the faithful Israelite made the largest concession, bowing in his temple on the Christian Sabbath, that his prayers might be one not only in thought and word but in the very instant of expression.
Sampson (jamgee, writing as 'Hospital Surgeon'on the pan-denominational Hospital Sunday Fund
From 1865, the Children's received a more than useful lump sum every three years. Its 1868 share was ÂŁ620, money that helped establish the new Out-patient Department. In 1870 the ÂŁ835 provided by the Sunday Fund was a great help in the costs of moving to Broad Street. By this time, another fund was being inaugurated: the Hospital Saturday Fund.
Originally based on a simultaneous appeal in the various working places of the city, it developed into weekly contributions paid by workers and given over annually to the Fund. It was a revolutionary step. Until now hospitals had been financed by the rich. For the first time they were partly funded by the working classes they were intended to serve. The share paid over to the Children's grew from ÂŁ390 in 1873 to a regular ÂŁ800 a year in the run-up to World War I.
These were funds to benefit all local charities, but the Children's also developed its own special support. An annual Sunday Schools collection-like a junior version of the Hospital Sunday Fund-was the first successful initiative to involve the children of the city in the well-being of the hospital. From 1880 onwards, it brought in a steady £2OO-£3OO a year. A Private and Public Schools Hospital Cot Fund was also created schools would maintain a cot named after them. The Jewish Children's League of Kindness also supplied £45 a year to maintain a cot.
Ridiculously, women were barred from sitting on the Committee for the first 50 years of the hospital's existence, but from 1862 a separate Ladies' Committee had been formed. In a typically Victorian mix of practicality and sentiment, the duties of lady visitors were "to go through the whole House; to take notice of its general cleanliness, regularity and economy; to report in the Visitors' Book any observations which may suggest themselves after inspection; and to take some convenient time for conversing with and contributing to the amusement of the children."
In 1874 some of the Ladies' Committee saw that there was a need for practical help among the poorer out-patients, and founded the Hospital Samaritan Fund with the object of providing "such articles as may be necessary to promote their recovery or contribute to their comfort - such as water beds, Macintosh sheeting, old linen, warm clothing and food, and to assist in sending them to the country for a change of air." This last end led to the establishment of a convalescent home at Arrowfield Top. Parents who could afford it paid two shillings a week and the seven-bed cottage was kitted out with gifts from supporters of the hospital. In 1883 Richard
and George Tangye presented it with a donkey and carriage. "This is of the greatest service to us, enabling those who cannot walk to get out more than they otherwise could, and fetching from the station the delicate children who arrive. It is besides a source of unfailing delight to the little patients." Over 1,300 children passed through Arrowfield Top before in 1890 it was rendered obsolete when Richard Cadbury presented Moseley Hall for use as a children's convalescent home, 20 beds of which were reserved for the use of the Children's Hospital.
Long before the lease ran out on Broad Street, it was apparent that the Children's was outgrowing its premises. The number of patients continued to rise as surely as subscriptions dwindled. The MP Henry Wiggin pointed this out at the 1892 AGM. In 1899, C.E. Mathews reminded everyone that the lease now had only 20 years to run. But lack of funding meant the matter was left in limbo. There were too few beds, too many buildings crowded on to the site and no accommodation for nurses. In 1906 senior surgeon LeedhamGreen declared at that year's AGM:
"The attention of the public should be drawn to the great difficulties and disadvantages under which the staff laboured in endeavouring to treat the sick children of the city in a building which could no longer
be described as either adequate or suitable for the purpose."
In 1907 the governors resolved to build a completely new hospital and a promising two-and-a-half-acre site was found in Ladywood Road. But the following year an appeal to raise the necessary £90,000 shook up only £19,904. After the cost of the freehold this left only £6,500 and the Committee refused to proceed with so small a sum. The project was shelved until 1910 when the death of King Edward VII evoked a wave of patriotic emotion that was channelled into support for the nation's hospitals. The 'Birmingham Daily Mail' inaugurated the local memorial fund. After a statue of the late monarch had been erected in the centre of town, the balance of the proceeds -just under £30,000-was placed at the disposal of the Children's Hospital. Extra cash was raised through bazaars, concerts and other charitable events. On St George's Day 1913, the foundation stone at the Ladywood site was laid by Her Royal Highness the Princess Louise, Duchess of Argyll.
In the same year, Mrs F.E. Player, one of the first two women appointed to the Committee of Management two
years earlier, inaugurated the Children's Hospital Brick League. Any child contributing one guinea to the Building Fund would have his or her initials cut on a brick to be laid at a grand ceremony in July 1913. On the appointed day 476 children, using special souvenir trowels, laid their own initialled bricks. The new Children's Hospital at Ladywood was well under way.
The Paediatric Pioneers Breakthroughs in medical and scientific research had a profound effect on the development of the Birmingham Childrenâ€™s Hospital during the first half of the twentieth century. It was to become one of the most forward-looking institutions of its kind.
Just as Thomas Heslop dominated the story of the Children's Hospital in its earlier years, so Leonard Parsons was to prove its guiding light in the first half of the twentieth century. Born in Aston in 1879, Leonard Gregory Parsons was educated at the local branch of King Edward's Grammar School (where Heslop had been Bailiff and chairman of the School Committee) and then at Mason's College (where Heslop had been Bailiff and chairman of the Education Committee). At Mason's, Parsons was highly successful in zoology and anatomy, qualifying with flying colours and bagging four prizes-including the Heslop Gold Medal. Thus was the baton passed from one innovator to the next. But though both men were gifted physicians and intimately concerned with child healthcare in Birmingham, it
is the differences between the two which illustrate the changes that were now taking place. For Heslop the battleground had been hospital reform, administrative improvement, and an attack on privilege. For Parsons, arriving on the scene after the work of Pasteur had completely changed the landscape of infectious diseases, the new high ground was in medical and scientific researchpainstaking clinical observations backed up by a new sense of experimental method and all the advances then taking place in technology and medicine.
After finishing his studies, Parsons worked for some years in general practice but then took the post of casualty officer at Great Ormond Street. In 1910 he moved back to Birmingham to become Physician to Out-patients at the Children's Hospital. Just five years later he'd already gained sufficient reputation in paediatrics to be appointed Lecturer in the Diseases of Childhood at Birmingham University. By 1928, the Medical Faculty had created a personal chair for him, making Parsons England's first Professor in the Diseases of Childhood. A gifted teacher who played a leading role in the establishment of both the British Medical Association and the British Paediatric Association, he introduced a strong research philosophy into the hospital and conducted pioneering work into paediatric problems of his day, such as anaemia, rickets, scurvy and skeletal disorders. His first success came at the Children's in 1912 with a series of lectures he delivered at the Royal College of Surgeons 'On The Mechanism and Treatment of Shock'. The work that had led up to this was an object lesson in teamwork and careful planning-the hallmarks of all Parsons' later successes. But at the Broad Street site possibilities for progress were limited and then in 1914 the Great War broke out. Parsons ended up in faraway Salonika, Officer-in-Charge
of the Medical Division of the Birmingham Territorial Hospital.
Sunshine and fresh air
World War I had also frustrated plans for the new building at Ladywood. Not only were labour and materials hard to come by, but there was also a year-long strike by the Plumbers' and Heating Engineers' Unions. Meanwhile the lease on Broad Street was running out fast, so the first patients finally arrived on Christmas Eve 1917 to take occupancy of an only partially completed building. There was little in the way of a formal opening, although the Mayor and the Bishop both showed up. Two years later, on 21 May 1919, King George V and Queen Mary visited the new hospital and toured the wards for an hour. The wards had been built in a gentle curve facing from the north-west to the south-east to provide the optimum amount of sunshine. Each of the eight main wards also had south-facing windows and balconies with easy access to fresh
air. When the hospital was first opened, they overlooked pleasant lawns and gardens. Their Majesties, by all accounts, were most impressed. Some of these wards, however, remained closed for several years after the Armistice. The problem was lack of funds, exacerbated by the increasing costs of equipment and maintenance, and the need for new laboratories, theatres and other special departments. Meanwhile, members of the burgeoning lower middle-class-neither poor enough for the hospitals nor rich enough for private nursing homeâ€”were being squeezed out of the healthcare equation. The Children's decided to open one of the wards for fee-paying patients-in 1921 it cost three guineas a week to cover maintenance, dressings and medicines, plus a further fee for the attendant physician or surgeon. This was an important development. No longer was the Children's solely a charitable institution. But it was a change that went hand in hand with completely new conditions in medical treatment. From the first we had lectures and classes and wonderfulbedside reaching by .sisters, the Final Examination took place and they were very thorough:medical and surgical nursing papers; viva voce examinations taken by a Physician and Surgeon in
their respective wards at the bedside; and very practical tests by Matron. After gaining my certificate, together with a certain nurse also certificated, I started studying for the examination then held by the Incorporated Society of Trained Masseuses. We had to do a great deal of study in off-duty times and attended lectures at the Queen's and did a great deal of the practical training there. I am glad to say that we both passed the examination, and I was put in charge of the Out-patient Department at Steelhouse Lane and with d very early type of apparatus gave the Massage and Electrical Treatment in the Hospital. Edith Lockeram, Later a Matron of the Children's, recalling her training after arriving us a young trainee nurse in July 1902.
A flame of anger The end of the war brought back Parsons and other staff. Full of new ideas and catching the mood of national optimism, they arrived at the new Children's Hospital with its state-of-the-art buildings, open-air wards and modern theatres, and set about transforming it into one of the most forward-looking institutions of its kind. This meant introducing new scientific departments and increasing specialisation. In 1920 the Children's began setting up an X-Ray Department. Radiology in those days covered pretty well anything electrical, so in 1924 it was this department that established the so-called Sunlight Clinic to administer ultraviolet rays, a fashionable treatment that reached its peak in the late 19205. The first Massage and Therapeutical Department-offering three masseuses, four electrical baths and lots of Swedish exercises-opened in 1925, expanding into the space left behind when the Children's finally opened a new Out-patients Department. The Department of Bacteriology and Pathology was opened in 1919. The facility was small, but it enabled the hospital to meet its own needs in these fields and no longer
have to rely on the University laboratories. The new biochemistry lab was even smaller, but from 1923 under Evelyn Hickmans did important clinical and research work, partly supported by grants from the University and Medical Research Council. Also during the 19205, the Dental Department was re-equipped, the Ophthalmic Department was reorganised, anaesthetics and orthopaedics were enhanced with extra appointments, and for the first time the Children's established a department for Ear Nose and Throat. From 1923 the hospital boasted a Tonsil and Adenoid Detention Ward. But despite all the up-to-date facilities, the Children's still had a long way to go if it was to establish more than a regional reputation. Ever since the war, the hospital had been engaged in a friendly rivalry with the Glasgow Children's Hospital. Later, Parsons wrote of a trip he had made to the USA:
Glass cubicles Changes in medicine also meant a growing demand for trained nurses. True to one of the original aims of the hospital, the Children's set up its own Training School for Nurses in 1920. Around the same time it became apparent that a Nurses' Home would be needed. It took until 1929 for the Hospital to buy up, one by one, eleven houses in adjacent Frances Road. These were demolished and in their place arose a block with no bedrooms, while the remaining space was used to lay out an attractive oasis of greenery in the centre of the hospital site.
The other major building project of the period was a new Babies' Block. Throughout the 19305, the hospital conducted a prolonged study of childhood anaemias, involving close co-operation between physicians, biochemists and pathologists. Apart from all the information that was published, this research had the result of focusing attention on younger children and infants. As babies could not be taken into the main wards for risk of infection, the Babies' Block was a necessity. The first stone was laid in 1937, but World War II slowed construction and the block was not completed until 1941. Soon after it was finally opened, with 66 cots and a system of separating babies in glass cubicles to prevent cross-infection, it was officially christened The Leonard Parsons Block. After decades in which, under his inspiration, the Children's Hospital had won fame and recognition at home and abroad, Leonard Parsons retired in 1946. He was knighted that year and elected to the Fellowship of the Royal Society in 1948, a final tribute to a brilliant career. As H.C. Cameron wrote in 'The British Paediatric Association 1928-1952': "The contributions of Parsons to our knowledge of disease in childhood were, without doubt, the most notable of his time."
Teamwork in a Special Place The latterday success of the Childrenâ€™s has been a matter of teamwork rather than individuals. Specialists from all medical fields have contributed to make the hospital one of the worldâ€™s leading treatment centres for heart and liver disease.
It has been a paradox of medicine in the twentieth century that the more efficient and advanced it has become, the deeper it has sunk into financial deficiency and funding problems. Pioneering new healthcare services often go hand in hand with shortages of staff and facilities and ever-longer waiting lists for specialised treatment. Arguments for and against public provision of healthcare, at both national and local level, were a persistent theme at the Children's Hospital, just as they were in hospitals all over the country.
Up until the inception of the NHS, subscriptions, legacies, appeals and donations continued to fund the Children's Hospital. From the late 19208, the hospital also received income from the Birmingham Contributory Fund. After its initial successes, the Brick League turned its attention to raising money for the new Out-patient Department which was opened in 1925. A second brick-laying ceremony was held on 24 November 1923, attended by over 300 children. In the post-war era the Brick League evolved into the Children's Hospital League of Friends, and continued valuable fundraising efforts that equipped Physiotherapy and Occupational Therapy Departments, furnished accommodation for the parents of patients, upgraded all the baby wards, sent nurses on courses and refurbished the Nurses' Home from time to time.
Local business people made many contributions, notably the Swiss-born confectioner Christian Kunzel. After a spell as chef for the House of Commons he had moved to Birmingham in 1903, opening a bakery at Snow Hill and a cafe and shop in the Midland Arcade. His cakes were popular and the business expanded to include premises in Leicester and London, but Kunzel's base remained a factory at Five Ways. In 1932 he was elected chairman of the Children's and opened up his family home in Davos to some of its patients. The Chateau Brusselle was surrounded by 200 acres of mountain woodland, and was used for the care of "debilitated and pre-tuberculous children". The hospital maintained a small nursing staff there,
and hundreds of Birmingham children enjoyed some Alpine fresh air in the years before World War II.
Wartime roots of the NHS
In the early years of World War II, the Children's set aside two-thirds of its bed capacity at the behest of the Emergency Medical Service. These beds were paid for even if unoccupied, allowing the hospital to reduce its deficit to almost nothing in 1939. But as casualties proved fewer than at first anticipated, later in the war some of these wards opened again. The Children's also contributed Leonard Parsons to the war effort-in 1940 he was made Regional Hospital Officer. These were the years when the NHS was being planned and discussed. The voluntary hospitals were at first jealous of their independence, but the war years
had also introduced healthcare professionals to a necessary pooling of skills and resources. In the wartime Emergency Medical Services were the seeds of a homogenous hospital system, and it was in any case becoming clear that few voluntary institutions would survive without state assistance. When the NHS was finally established in 1948, it was to Leonard Parsons' credit that the Children's became part of the Teaching Group of Birmingham United Hospitals. He had long insisted that paediatrics should be a compulsory subject in the medical curriculum. By the end of the war this argument had been won and it was logical that the Children's, by this time a vital teaching centre for undergraduates and nurses and with a full-time unit tying it to the University, should continue and develop its educational activities along with the other major hospitals of the city. At the same time, the improvement in salary scales encouraged more doctors to take up paediatrics and contributed to the closer integration of child healthcare in its various aspects.
Bringing professionals together Parsons' other great legacy was the Institute of Child Health, established as a department of the University of Birmingham. From the' earliest days of the hospital there had been personal links with the local authority. Later Parsons was involved with some of the city's child welfare clinics. The point of the ICH was to formalise direct cooperation between the Children's Hospital, the University and the city's Child Welfare and School Medical Services. This would provide a forum for discussion, collaborative research, and both undergraduate and postgraduate education. Parsons had been thinking about this all through the 19308, and in 1945 it finally became a reality
By connecting the hospital with public welfare clinics the ICH finally brought together the preventative and curative aspects of paediatrics. Registrars from the Children's went to the welfare clinics, and staff from the Child Welfare Service came to the hospital. Arrangements were made for students to study the clinical aspects of the Health Department, visit child welfare and antenatal clinics, learn about the School Medical Services, and receive some training in midwifery and home nursing. It was also a centre for postgraduates specialising in paediatrics, for GPs on refresher courses, and for public authority medical officers concerned with child welfare. The ICH had no home of its own until 1961, when the Nuffield Provincial Hospitals Trust provided ÂŁ40,000 to complete a two-storey building fronting Francis Road and with direct access to the hospital at the rear. This contained offices, conference rooms, a library and laboratories. Under the guidance and inspiration of Sir Douglas Hubble the ICH proved an effective catalyst for research and collaboration and nurtured many of the new clinical services for which the Children's was to become well-known: clinical genetics, nephrology, nutritional disorders, neurology and neurological handicap, haematology and oncology.
Britain's first If much of our story so far could be told through the achievements of great individuals such as Heslop and Parsons, in the post-war decades it has been mostly a tale of teamwork. Take cardiology, for example, a field in which the Children's has participated in tremendous advances. Heart surgery was only made possible by corresponding advances in various fields including anaesthesia, haematology, radiology and the heartlung machine. The task of developing surgical treatments for
congenital heart diseases therefore exemplifies the close interdependence between the various branches of medical knowledge which are represented at the hospital. It was at the Children's in 1951 that Leon D'Abreu performed Britain's first successful hole-in-the-heart operation. These days holes in the heart can be repaired without open-heart surgery, using a technique known as cardiac catheterisation. In 1995 the Children's became Britain's first hospital to use this technique, in which a tube is inserted through the groin and manipulated through blood vessels into the heart. The hole in the heart is thus plugged with a device made from a metal invented for American submarines. Cardiac catheterisation is also useful in treating cases of abnormal heart rhythm, a condition which can now be treated as a day case. The Heart Unit at the Children's-one of the largest in Europe, performing over 400 serious operations every yeartakes referrals from all over the UK and abroad. This is partly the result of its specialist expertise in hypoplastic left heart syndrome, a rare condition in which only half of the heart is properly formed, causing babies to die from low blood pressure and Jack of oxygen. The pioneering operation, with which the Children's has the highest success rate in Europe,
involves the complete reorganisati on of a series of arteries connecting the heart and lungs.
The aim of the Heart Unit is to mend hearts as early as possible -preferably within the first year of life. The sooner conditions are identified the better and to this end the Unit has developed an ultrasound ante-natal diagnosis service, which can pick up signs of certain congenital heart diseases while a baby is still in the mother's womb. Clearly, heart surgery involves a big team effort: medical and surgical consultants, laboratory services, dietitians, the Intensive Care Unit and nurses all play an important part. The Children's also has a Cardiac Liaison Service which acts as the interface between the hospital, wider community services, the parents and patients, making sure that their needs are met and that they get the right support.
Teamwork is also the key in the Liver Unit, another area in which the special expertise of the Children's draws patients from beyond the region. In this field too there has been pioneering surgery. The first British operation to give a child a cut-down liver, in which a portion of an adult liver is transplanted, was performed in Birmingham in 1989. Since then the Liver Unit has pioneered 'split-liver' operations, in which a chronic shortage of donors is ameliorated by dividing livers between transplant patients. In 1993 the Unit performed Europe's first combined liver and bowel transplant operation and in 1998 Britain's first triple-transplant of small bowel, liver and pancreas. The team responsible for this extraordinary work includes not just doctors and surgeons, nursing staff and intensive care personnel but also dietitians, social workers, psychologists and physiotherapists. The Liver Unit is committed to family-centred care and a holistic approach in which the child's entire needs are taken into account, thus involving teamwork right across the hospital. This aspect of care has even been the subject of considerable research, with a major investigation into the quality of life for children and families following transplantation.
Teamwork, collaboration, multi-disciplinary care and a holistic approach are also a feature of the oncology department, one of the largest such units in Europe. Twenty years ago, there was little hope for victims of the commonest children's cancers-leukaemias, brain tumours and other "rare tumours of childhood". But now the Children's achieves cure rates of 60-70 per cent from acute lymphoblastic leukaemia (formerly less than i per cent); 85-90 per cent from Wilm's Tumour (cancer of the kidney); and 80-90 per cent from Hodgkin's Disease. The dramatic improvement in the odds is due to better management of chemotherapy and surgical techniques, as well as new screening methods to detect childhood cancers as early as possible.
â€œWe've loved you, we've hated you" These achievements are all the more extraordinary given deteriorating conditions at Ladywood. The oncology unit was operating out of a Portakabin in the hospital grounds. Patients were camping out on chairs and makeshift beds in the narrow corridors of overcrowded Ward 6. The increasing costs and complexity of modern medicine (in 1961, to give one stark example, the hospital performed 9,785 biochemical tests; by 1996 that annual figure had mushroomed to 272,084) and its demands for more and more personnel, were creating a similarly intolerable situation in most of the hospital's departments. Demands for a new hospital had begun way back in 1957, when it was decided that a
sanatorium-type hospital was no longer suitable for the complex medical services of the late-twentieth century. In the subsequent decades, plan after plan was mooted and shelved as conditions at Ladywood deteriorated. Small amounts of cash, much of it raised by dedicated volunteers and often with celebrity aid, helped to allay the dilapidation. One problem was that the site had become an essentially unconnected collection of buildings. In 1986 a special appeal, helped by a Paul McCartney concert, funded 'The Covered Way'-a plastic corridor that saved patients from being pushed out into the snow and rain to get from one place to another. But every time it rained, the water would collect underneath. In the course of their daily duties, hospital staff had to paddle through a small river. Despite its worldwide reputation for excellence, the Children's had become very run down. Even so, the work of the hospital had always inspired a certain affection. When the staff finally left for Steelhouse Lane - some of them after waiting 40 years for the move many left behind graffiti on the walls:
"Thank you for sharing your final moments with us this was a special place!"; "For all those babbies we've looked after, the memories will linger forever"; "We've loved you, we've hated you, but we'll never forget you."
Our New Home Birmingham Childrenâ€™s Hospital, Birmingham is hi-tech, comfortable and friendly; the sort of place that staff can bring their colleagues from all over the world and feel proud to show them around.
"As the principal provider of children's services in Britain's second city and the only centre for specialist children's care in England's largest health region,
Birmingham Children's Hospital NHS Trust has a vision for its future role-locally, nationally and internationally," says Dr Mike Stevens, Medical Director. "It sees its place not only in providing excellence in care, but also in teaching and research. Such a position offers a mandate for wider advocacy of the health of children and the Trust intends to develop its relationships with other agencies in education and social services, in public health and the research community. Leadership in local strategies for children's health care; the development of a new national children's clinical trials unit; and links with children's hospitals overseas are all examples of the way this vision is being implemented. The future is as exciting as the past and Birmingham Children's Hospital NHS Trust plans to lead the way."
"What we've got here" says Colin Hough, sitting in his new office in Steelhouse Lane, "is a modern classic which provides the necessary accommodation to deliver the highest quality patient care. Outside it's a lovely old building, but inside it's modern and hi-tech as if it was built today."
No longer do world-class physicians and surgeons work out of rickety Portakabins, or traipse along waterlogged corridors. Quite the reverse. Now they have a facility they can be proud of. "It's a different world," says Hough. "This is the sort of place where staff can bring their colleagues from all over the world and feel proud to show them around."
There is not an area of the hospital's work that has not been greatly enhanced by the move. The several dozen departments now have decent office space, modern facilities, room to work and breathe. There is space for children to play, for parents to stay. Space for staff to meet and mingle and keep in touch with each other's work.
Whereas at Ladywood, the buildings were only connected by the leaky plastic "Covered Way", the Children's new home is run through by a proper corridor. "It probably sounds like a daft thing to say," shrugs Hough, "but corridors are the lifeblood of a hospital. They're places where people meet, have a chat. Here you can get from anywhere to anywhere and it's all under cover. It's all in a modern, clean, heated, lit sort of area. We shouldn't be saying things like this in the iggos, really, but that's where we've just moved from."
Individualised care will be planned and negotiated
with the child and family. They will be supported to participate in all aspects of care, as they feel able. In each case setting the child and family will be introduced to a named person who will be responsible for planning and coordinating their care, respecting and valuing the contribution of the healthcare team. Care will be provided within a safe and friendly childcentred environment. Each child and family will be listened to, their wishes and feelings acknowledged and their right to privacy, dignity and worth respected. To enable participation in decision-making, the child will have access to information through education and play, relevant to their age and understanding. The cultural, spiritual and religious needs of the child and family will be met in a sensitive and respectful manner. Play and education will be part of each child's planned care. Birmingham Children's Hospital's Philosophy of care for the Child and Family, 1998
The move to Steelhouse Lane has been not only a physical shift, but also a move in mind-set. The new city-centre location in a muchloved old building is important in emphasising the Children's role and history in the community. Unlike the better-known Great Ormond Street, which takes only specialist referrals, the Diana Princess of Wales Children's Hospital is very much part of the life of the city where it operates, and in the future is aiming to become more so. As an NHS Trust, says Hough, the Children's "is committed to providing truly integrated care and we are putting a renewed emphasis on working in partnership with other Trusts,
primary care groups, statutory and voluntary agencies and, of course, the children and the carers."
A number of innovative schemes are being set up in conjunction with the Departments of Education and Social Services in Birmingham. These are intended to give the children and young people of Birmingham an opportunity to have a say in the strategic direction of the hospital, particularly in the areas of research and development. Efforts will be made to further improve the quality of life for children at the hospital, and to minimise the duration of inpatient stay.
Ongoing community-based schemes and initiatives include speech and language therapy, audiology, eye screening, occupational therapy, social work, respite care, community and schools nursing, interpreting services, child and family care, diabetes home care and psychotherapy.
Child health in the community is also one of the central themes of the extensive research going on at the Children's. New facilities allow this research to be better coordinated
than it ever was before. Given the importance of cooperation between the Children's Hospital Research & Development Directorate and the Institute of Child Health, perhaps the only drawback of the move has been a greater distance from the University campus. New communications media and sophisticated data links have compensated for this, however, and the Children's is developing both an extensive website tapping into skills around the Trust, and an intranet to enable front-line staff to access national and international data about conditions and treatments. The hospital's Education Department is also working on and, through its school and expanded play centre, testing computer programmes that will help children learn about their own diseases.
Hope for the next century All hospital staff are involved in ongoing training schemes, aimed at maintaining and improving the quality of healthcare for children. These initiatives are multi-disciplinary in scope, and will increasingly involve the various universities surrounding the hospital. In addition, a patient and family health centre has been established specifically to cater for the
needs of the wider ethnic community in the Birmingham and West Midlands area.
Other areas for future research include clinical trials and work on diseases that affect specific organs and systems. Over the next half-century significant developments can be expected in transplantation, neurosurgery and cardiac surgery. But Ian Booth, the current Leonard Parsons Professor of Child Health, stresses that the vision for paediatrics is also one of increased care in the community, and of treating the child as a whole person, rather than merely as a disease. "I think we can say," smiles Ian Booth, "that the research future is extremely bright."
Ever since the Children's first opened in 1862, it has been an innovator. The infectious diseases that were originally one of its main concerns-scarlet fever, typhoid, whooping cough, polio, cholera, summer diarrhoea, smallpox, measles-have all now been eradicated or are under control. Now, in the age of high-tech medicine and intricate treatments, the hospital is equipped to look ahead and meet the challenges of the future.
"We're looking forward," says Colin Hough, "to designing services which will deliver consistently high standards in the full range of hospital and community child health services."
As a hospital, and as a centre for education, research and community services, the Birmingham Children's Hospital NHS Trust is now equipped to offer hope for the next century, not just for the people of Birmingham, but for children all over the world.
A history of Birmingham Children's Hospital