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

Children’s Hospital since 1917, were dauntingly complex.

Apart from the delicate business of transporting the patients

– some of them infants in incubators – 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 hi-

tech 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 in-

patients – 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 ground-

floor 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 Children’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 – 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,

they’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 Children’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 – 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 – bringing an

important 3d or 4d a day back to their families. The diet of

most working –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 over-

laying 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: children’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 ‘abuse of the charity’ 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 –

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 Out-

patient 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 – 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 out-

patients.

The Children’s soon acquired a lease on a 585-square-

yard 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

£248, 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 £620, money

that helped establish the new Out-patient Department. In

1870 the £835 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 £390 in 1873

to a regular £800 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.

Building Ladywood

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 Leedham-

Green 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

Children’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 research-

painstaking 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 home—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 ultra-

violet 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 Children’s has been a

matter of teamwork rather than individuals. Specialists from

all medical fields have contributed to make the hospital one

of the world’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 £40,000 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 heart-

lung 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 year-

takes 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.

“We'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 Children’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 child-centred 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

Integrated care

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 much-

loved 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 in-

patient 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.