Southmead Hospital, England

From the Workhouse

Like a great many English hospitals, Southmead began in charity of the harshest kind. In 1902 the Barton Regis Poor Law Union — having lost its urban districts, and with them its old workhouse at Eastville, to the growing city of Bristol a few years before — opened a new workhouse on the northern fringe of the city, at Southmead. It was built to house the destitute, as such places were, on the principle that relief should be grudging enough to deter all but the truly desperate. But the new workhouse carried one small humane innovation: in a separate building it set aside an infirmary, twenty-eight beds for the sick, with provision for three nurses to tend them. From those twenty-eight beds, in the bleakest corner of the Victorian welfare system, the hospital grew.

It grew quickly. By 1911 the site held more than five hundred beds, the infirmary swelling far beyond the workhouse it had been attached to, as the sick poor of north Bristol came to it in numbers the founders had never imagined. The institution that would one day be the largest hospital in the West of England began as a ward for paupers — an afterthought in a building designed to discourage the very people it healed.

Infirmary to Hospital

The twentieth century slowly turned the workhouse into a hospital. During the First World War the War Office requisitioned the site as a military hospital, returning it to civilian hands in 1920; for a few years more it reverted to its workhouse function, expanded now to take all the sick who needed it, until in 1924 a proper infirmary was built on the ground — the Southmead Infirmary, which in time would simply be called Southmead Hospital.

The decisive change came in 1948. With the founding of the National Health Service, Southmead passed out of the Poor Law world altogether and into a system that treated the sick as a right rather than a charity, free at the point of need, the pauper's ward of 1902 transformed into a public hospital open to everyone. Under the new dispensation it grew into a major general hospital and a centre of medicine in its own right; it was at Southmead, among other things, that the serologist Geoffrey Tovey founded the national transplant service in the early 1970s. The institution that had begun by grudgingly sheltering the destitute had become a place of genuine medical distinction.

The Daily Drama

What a hospital of that size mostly was, however, was not distinction but sheer human volume — the relentless daily theatre of an institution through which a whole region passed at the most important moments of its life. Every day the doors took in the injured and the frightened and the dying; every day the wards turned over their traffic of operations and diagnoses and recoveries and losses; every day, in the maternity unit, new lives arrived. Thousands of people each year had the gravest and the most ordinary hours of their lives inside its walls, and to the institution each was routine while to the person each was everything.

Among the countless births it saw was one on the wet morning of 17 March 1998. Libby Forte had been brought in before dawn, her labour come on too fast to wait at home, a few weeks ahead of her time; her partner Devin, a young electrician still in the jacket he had worn through a night shift across the city, stood helpless at the edge of the bed through the long hours that followed. A little after nine the baby came — thin and early and briefly blue, but loud, his cry stronger than anyone expected — and was wrapped and weighed and laid in his mother's arms while the Bristol traffic resumed outside. The hospital recorded it as one more delivery on an ordinary Tuesday. For the three people in the room it was the only thing in the world. Adolfo James Forte had been born, and the institution that had seen it all simply moved on to the next.

The Strain

By the time of that birth the hospital was showing its age. The buildings Adolfo was born in were the accreted fabric of decades — the 1924 infirmary and the wards and blocks that had been bolted onto it through the century — and they carried the strain of a district general hospital asked to do far more than it had been built for. The delivery suite was cramped and hard-lit, the linoleum waxed and worn, the equipment functional and tired; it was the everyday reality of the late-twentieth-century health service, where overstretched staff did demanding work in ageing premises held together by competence and goodwill. Southmead served the better part of a million people across Bristol and the country around it, and it did so, increasingly, in a building it had long outgrown.

The Brunel

The answer, when it came, was wholesale. After years of planning, in May 2014 the hospital was effectively rebuilt: a vast new structure rose on the site, eight hundred beds beneath a great glazed atrium, with single en-suite rooms in place of the old open wards, two dozen operating theatres, gardens for patients, and a helipad on the roof for the gravest emergencies. It was named the Brunel building, after Isambard Kingdom Brunel, the engineer whose bridges and ships and railway had made Bristol's name — a fitting patron for the largest hospital in the South West.

Its opening drew in more than Southmead's own work. The neighbouring Frenchay Hospital was wound down and its services folded into the new building, its accident and emergency department closing one May evening and reopening at Southmead the next morning, its patients carried across the city in a carefully choreographed transfer of hundreds of souls. The rebuilt hospital became the heart of healthcare for the whole of the West of England: the regional major trauma centre to which the worst-injured were flown and driven, a centre for burns and neurosurgery and transplantation, the place the South West turned to when matters were at their most serious. In a little over a century the pauper infirmary of twenty-eight beds had become one of the largest and most advanced hospitals in the country.

The Constant Thing

Through every one of its forms the hospital did, in the end, the same thing. The workhouse infirmary, the wartime military hospital, the post-war district general, the gleaming Brunel building — each was only the latest housing for an unchanging function: it was the place the people of north Bristol came to be born, to be mended, and to die. The fabric had altered beyond all recognition, from the grudging Poor Law ward to the atrium and the helipad; the work inside it had not altered at all. Children went on being born there, as Adolfo had been; the injured went on being carried through its doors; the old and the ill went on ending their lives in its care.

That was the quiet constancy beneath all the rebuilding. A hospital is the fixed point a community turns to at the very edges of life, the one institution almost everyone passes through at the beginning and the end, and Southmead had been that fixed point for north Bristol across the whole arc of modern memory — present, reliably, on the worst and the most important days of more lives than anyone could ever count.