Saving the past: where do we stop?

BMJ 2004; 328 doi: (Published 18 March 2004) Cite this as: BMJ 2004;328:717
  1. Andrew Bamji, consultant in rheumatology1
  1. 1Queen Mary's Hospital, Sidcup, Kent

    I have just saved a historic building. I am now racked with self doubt—not because I have caused considerable trouble with a new proposal but because I wonder whether I went far enough.

    Erith and District Hospital was built on its present site in 1928—a pair of wards and surgical facilities in typical cottage hospital style. A small outpatient department and a radiography department were provided originally, but these outgrew their space. In 1938 the threat of war led to the construction of an underground hospital, to serve the locality as a clearing station for bomb (and gas) victims. Half sunk into the ground and covered with a mound of earth, the bunker survived the war unscathed and, as far as we can gather, virtually unused. As life returned to normal the main hospital's radiography equipment was moved to the bunker and has remained there ever since.

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    Listed: the Erith bunker

    The need for a new outpatient department after the war resulted in the construction of a purpose built, single storey building that would be familiar to anyone who practised in a cottage hospital in the 1950s or 1960s. Designed by the NHS Estates department and solidly finished, the clinic suites and examination areas provided a quiet haven from the bustle of the major hospitals around, and several generations of doctors and nurses have worked there happily. Postcards were made of the building. It has a large physiotherapy department with a gym, a well ordered reception and records area, a secretaries' office, a small pharmacy, and a delightful canteen run by the Women's Royal Voluntary Service. The decor is tired but serviceable; the space is slightly quirky, but it works well. The patients love it.

    Meanwhile the main hospital block had ceased functioning as a mini-hospital because in the 1980s such cottage hospitals were deemed uneconomical. The site was made over to a different trust, and later to a private finance initiative partner, with our main hospital retaining a lease on the outpatient areas.

    Suddenly there was a drive to modernise. The powers that be decided they wished to consolidate all their child development services on one site, and Erith Hospital was it. Plans suddenly appeared for a new centre, which would incorporate the present out-patient provision but which required the razing of the current outpatient building and the radiography bunker—the latter to accommodate extra parking needed for the hordes of new staff and perhaps some patients.

    Underground hospitals are not common. Indeed our bunker at Erith is the only one on the British mainland, apart from that in the tunnels under Dover Castle. It is recognised as a heritage building and is opened yearly under the auspices of the London open house scheme ( I thought the building must be listed. I discovered it was not. So I wrote to the Department of Culture, Media and Sport suggesting it was worthy of listed building status, that it was under threat and should therefore be spot listed. It was. End of car park plan—and, amusingly, the start of much excited discussion on how to make the most of the listing.

    My efforts seem to have been regarded as most praiseworthy by local residents and his Indeed, a rumour went round that the health department tried to block the listing, although I have no idea if that was true. But although I drafted a proposal to spot list the out-patients department too (which would have killed off the child development centre outright) I didn't send it off. Why not?

    A new building was needed to improve a poorly coordinated and widely dispersed children's service. To put it on the Erith Hospital site (the cheapest option) required the demolition of the outpatients department, which was “tired and old.” A brand new outpatients' facility would be incorporated in the new building. So to stand in its way would be wrong. On the other hand the present building is a classic design of the 1950s that continues to function perfectly. How many purpose built outpatients buildings of that era still survive? If we knock them all down how will we judge the facilities and practices of the past? Is there any less reason to save our out-patients building than the radiography bunker? Should we not preserve some of our better NHS buildings, not least if they can be working museums?

    So I appeal to readers to tell me what to do. Apply for the Erith outpatients building to be saved, or do nothing? Go boldly but blinkered into the future, or allow tomorrow to be informed by yesterday?


    • Competing interests Over the years I have protested against various local proposals that would despoil the neighbourhood, so I might be described as a serial “nimby.” Results: five won, four lost, one being replayed

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