The “matchbox on a muffin”: the design of hospitals in the early NHS

Abstract

Although I am not myself a devotee of bigness for bigness sake, I would rather be kept alive in the efficient if cold altruism of a large hospital than expire in a gush of warm sympathy in a small one.'The role of architecture within Britain's National Health Service has received little attention beyond the discussion of technical matters.Yet architectural design is not a neutral, value-free resource from which architects draw as desired.The layout, design and styling of buildings can manifest the geographically-and temporally- localized thinking, aspirations and prejudices of their designers and clients.This was especially so during the early years of the NHS when, in the late-1950s and early-1960s, significant capital expenditure was once again channelled towards major healthcare schemes.And, since this state funding was largely directed towards general hospital schemes, architects were forced to re-engage with hospital design after a gap of almost two decades, to update inter-war thinking with contemporary continental European and North American ideas.This article seeks to trace the conflation of clinical, social and architectural ideas which justified, in the early post-war period, the development of a particularly influential architectural solution for the modern hospital: the ward tower set on a wider, lower block of accommodation.Whilst not the only possible solution to the architectural needs of the modern hospital, this model-known as the "matchbox on a muffin"2-was certainly the most influential during the early years of the NHS, and underwrote schemes both on tight inner-city sites and more expansive greenfield locations.This article reconsiders the development of this model, and marshals two case studies to provide accounts of the ways in which architects came to terms with the changing demands of the modern hospital in the late 1950s.What emerges is the desire to provide hospital architecture with a symbolic form expressive of the modernity of the healthcare to be found within.Moreover, the reactions to these buildings highlight the extent to which such designs could equally be aligned by critics with a crude Taylorist functionalism.Far from being a neutral statement of

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