THE KING'S FUND BED PROJECT
In 1967, a Report entitled The Design of Hospital Bedsteads y^as published
by the King's Fund in London/ The Report, which contained a specification
for 'a bedstead suitable for general purposes', was the result of a four year
project which had cost in the region of £35,000.^ Many accounts of the
origins of the project, especially those provided by participants, begin with
a situation described in January 1964 by the then Minister of Health,
Anthony Barber, in a speech to the Doncaster Branch of the Royal College
of Nursing.^ Barber pronounced himself horrified to find that manufacturers
offered 'more than three hundred different patterns of hospital bed.'"^ Later
in the speech he went on to extol, cautiously, the virtues of a degree of
equipment standardisation within the NHS.
King Edward's Hospital Fund for London, Design of Hospital Bedsteads, 1967.
Figure compiled from 'Notes of a meeting at the Hospital Centre', Roberts, Hall and Archer,
For accounts of the project by participants, see Bruce Archer, 'Designing a hospital bed', SIA
Journal, 152/153, October/November 1965, pp.1 -7., Gillian Patterson, 'Hospital Design:
equipment and buildings'. Official Architecture and Planning, July 1968, pp. 905-908. For
other accounts, see James Cousins, 'A general purpose bedstead for hospitals'. Design,
195, March 1965, pp.53-59., David Crawford, 'What happened to the hospital bedstead?'.
Journal of tfie Society of Industrial Artists and Designers, January 1 968, 1 79, pp. 4-5, Irfon
Roberts, 'Design of Hospital Bedsteads', Hospital Management, Planning and Equipment,
May 1967, p. 244.
"^Transcript, speech by Anthony Barber, 17.1.64, AAD/1989/9, Job 7.
Although, as noted above, the 1960's was a decade of relative
buoyancy, with the £500 million Hospital Plan not only underway but to be
officially speeded up in 1965, attention to cost saving had increased
steadily from the outset of the Service.^ The Public Accounts Committee
for 1961-2 had turned its attention to the NHS, pointing out wide
discrepancies in the prices paid by different hospitals for similar goods: for
example, sums ranging from £16 to £50 had been paid for hospital beds,
and from £8 to £34 for bedside lockers.^ The Committee returned to the
subject the following year, noting that 'arrangements are now being made
to secure greater economy in the purchase of equipment by hospital
authorities . . . however . . . much remains to be done before these
arrangements will be fully effective; and in the meantime considerable
sums are being spent.' They regretted the delay in the preparation of
standard specifications and urged their introduction at 'the earliest possible
date'/ Large orders for hospital equipment of the same design would save
money, especially in the fit-out of ninety projected new hospitals in the Ten
Year Plan, which it was estimated would cost between £60 and £85 million.
Barber assured his audience that he had just set up 22 study groups,
comprising architects, engineers and quantity surveyors, working on
designs for hospital components to allow for bulk production.^
Webster points out that after the 1956 Guillebaud Committee (who commissioned an
economic analysis by Brian Abel-Smith and R.M. Titmuss) refuted claims of excessive
costs, 'no subsequent administration has dared to set up an independent enquiry into the
cost of health care in the UK', Webster, The National Health Service, p. 33. This did not of
course prevent scrutiny by the Public Accounts Committee.
^Civil Appropriation Accounts (Classes l-V) 1961-2, HMSO.
''civil Appropriation Accounts (Classes l-V) 1962-3, HMSO.
op. cit. note 4.
The choice of this episode in 1964 to open the narrative is in line
with a portrayal of the King's Fund Bed Project as a rational exercise in
variety reduction to permit the economies of large orders and large
production runs. In fact the MOH had been involved with the question of
hospital beds since at least 1962. And although it had been their policy
since 1949 to encourage joint and central contracting for NHS hospital
supplies because of the potential financial savings brought by bulk
ordering, this was not, in 1962, their only concern.^ A visit to the Royal
Hampshire Hospital that year had prompted the then Minister of Health,
Enoch Powell, to direct attention to what was dubbed 'the mechanization of
the nurse's task'. 'I should like to feel sure', Powell wrote to his Private
Secretary, 'that before we advance far on the hospital building programme,
the attempt has been made to envisage as boldly as possible the
mechanisation of nursing and patient care generally which may be possible
in the next decade or two'.^° Powell's immediate concern was not cost
saving, but labour shortage. The protracted and serious shortage of nurses
in the NHS, identified since the outset of the Service, showed no
immediate signs of improving. This was despite numerous initiatives during
the 1950's on issues of recruitment, training, pay and the high 'wastage'
rate of student nurses. In Parliament, Powell asserted there were more
nurses than ever before, which was true, but hardly the point.^^ In private
Supplies Division memo, 1 3.7.49 : 'HMCs and BGs are encouraged to consider tlie
advantages of joint contracting not only for food and common services eg laundry which
can be covered centrally by the Ministry, but also for equipment and stores which are not
for the present under central supply through the Ministry.', MH 1 36/1 7.
^°Powell to Brandes, 5.10.62, MH. 136/12.
^^Rivett, From Cradle to Grave, p. 189. See also Webster, The Health Services since the War,
pp.1 70-1 77.
he was deeply concerned and insisted that the IVIinistry consider other
ways of alleviating the situation. 'Should we not ask,' he continued to his
Private Secretary,' . . . what mechanical and powered assistance would be
necessary if the same quantity of care and attention had to be given with
half the present quantity of woman-hours?'^^ Powell called a meeting which
included the Chief Nursing Officer, a Principal Medical Officer, the
Controller of Supplies and the Chief Architect at the Ministry 'to discuss
ways of conserving nursing time' in July 1962. At this he decided that five
reviews should be initiated. They were: 'methods of disposing of waste
products of the human body, methods of handling the immobile patient (to
include the bed), feeding procedures, ward supply and replenishment
systems and the documentation of patients. '.^^
According to the Controller of Supplies, the Minister 'made it plain that he
thought it was quite possible to apply to the hospital modern technological
advances which had transformed industry in the last ten years'. He felt that
'without any loss of human touch it was possible and sensible to regard the
seriously ill patient as a 1501b. job passing through a planned series of
modern processes.' When it was pointed out that some of the proposed
ways of saving nurses' time, such as the use of disposables, were unlikely
to save money, the Minister told the meeting that this should not be of
undue influence in considering the introduction of new methods. 'The most
precious commodity to be saved was manpower and particularly nursing
As a result of this meeting it was clear to the Controller of Supplies
^^op. cit. note 10.
^^Davies to Hollens, 13.10.62, MH136/12.
that 'among the various assignments we are likely to secure . . . will
certainly be a study of hospital beds'. The head of the equipment section,
F.R. Howes, was deputed to run this. It was suggested that:
Faced with the bewildering range of beds now on the market a useful way
of proceeding would be to ask the various experts in the office for
their opinions on what functions a bed should discharge and the
features which it should contain. It may be that we will find the need
for, say three beds ranging from a simple apparatus for lying and
sleeping on, to a fully motorised suspension equipment with a wide
range of devices for diagnosis and therapy. The idea might then be
to draw up user specifications for each of the types of bed and if we
are not satisfied that an adequate bed is already commercially
available, then to consider letting a development contract to a
suitable firm - Vickers? I would be glad if you would commence
thinking about this in advance of our receiving further direction. ^"^
It was somewhat fortuitous for the Ministry, therefore, that the King's Fund
was on the point of setting up a working party to look into the design of
hospital beds.^^ In January 1963 the MOH asked the Fund to act on their
behalf, thereby relieving themselves of at least one part of the huge task
which Powell's review potentially involved. The King's Fund working party in
question, however, was shortly to come under the influence of a
researcher, Bruce Archer, whose interest in standardising hospital beds
was not, primarily, saving the NHS money, alleviating the nursing crisis, or
even increasing patient comfort, though all these factors would later be
invoked in support of the concept of a 'bedstead suitable for the majority
(say 60%) of patients being nursed in the ordinary wards of general
^"^Davies to Howes, 13.10.62, MH/136
^^The Working Party on Hospital Beds first met on 19 February 1963. A/KE/PJ/1 7/1 9 KFWPHB
^^Royal College of Art, Studies in the function and design of non-surgical hospital equipment,
Report No 12, General purpose hospital bedstead, user specification, April 1964.
The origins of Archer's project predated any IVIinisterial initiative to
the King's Fund, and indeed the setting up of the King's Fund Worl<ing
Party on Hospital Beds. They lay in approaches to the other major
charitable foundation then supporting British hospitals, the Nuffield
Provincial Hospitals Trust. Founded in December 1939, the Trust provided
funds for 'the creation, carrying on or extension ... of hospital and ancillary
medical services' throughout the Provinces.^'' Like the King's Fund, it
received a steady stream of suggestions, applications for funding and
requests for advice from hospital staff. In late 1960 however, the Trust had
received an approach relating to hospital equipment design, including
beds, from a less usual source. The Rector of one of London's foremost
schools of art and design, the Royal College of Art in Kensington, was
concerned to interest them in funding research in this area.^^
The research was to be done in the School of Industrial Design
(Engineering) created at the RCA two years earlier in 1 959, under the
professorship of the Armenian emigre, Misha Black.^^ By the 1960's, Black
was a prominent figure in British cultural life. Since arriving in London in the
1930's his design projects had included the South Bank layout for the
Festival of Britain in 1951 and work for the London Underground's new
Victoria line.^° Well placed to lobby wealthy foundations. Black, together
with the RCA's Rector, Robin Darwin, succeeded in persuading the Nuffield
^^For a history of the Trust, see Gordon McLachlan, A History of the Nuffield Provincial
Hospitals Trust, 1940-1990, London, Nuffield Provincial Hospitals Trust, 1992.
^^Royal College of Art, Studies in the function and design of non-surgical hospital equipment,
Preliminary report, 1 June 1962, Appendix A, p.1.
^^Frayling, The Royal College of Art, pp.1 78-1 79.
^°For a short account of Black's career up to 1965, see 'Designer's honour for Misha Black', SIA
Journal, 152/153, October/November 1965, p.1 2. For his collected writings, see Avril Blake
(ed), The Black Papers on Design, London, Pergamon, 1983.
Provincial Hospitals Trust to fund, initially for one year, a proposed four
year project to investigate the design of 'non-surgical' hospital equipment.^^
It was apparently envisaged that a publication complementing, and
comparable to, the influential 'Studies in the Function and Design of
Hospitals' by the architect Richard Llewelyn-Davies would result.^^ The
NPHT had sponsored this volume, published in conjunction with Bristol
University in 1955. It comprised a comprehensive study of the
requirements for hospital accommodation, the physical environment,
heating, lighting, ventilation, noise control and fire risks, together with
detailed designs for individual departments. The ambitious, four year
scheme which Black now proposed appeared to offer similarly
comprehensive coverage of the fitting out of hospitals once building was
complete. It was to result in:
1 . A report describing how equipment schedules and specifications
are prepared, how the selection of equipment is made, where
equipment deficiencies are, and where future research and
development would best be directed.
2. The classification and preliminary evaluation of types of
equipment as part of the procedure for the selection of
equipment for a new hospital.
3. Some equipment designs offered as better solutions to some of
the more pressing needs.
^^ The stress on 'non-surgical' equipment was intended to reassure medical staff that laymen
were not about to become involved with diagnostic or therapeutic devices. Interview, Bruce
^^Royal College of Art, Studies in the function and design of hospital equipment, Preliminary
report, 1 June 1962, p.2. Richard Llewelyn-Davies' investigation was published as Studies
in the Function and Design of Hospitals, London, NPHT/Oxford University Press, 1955.
Llewelyn-Davies was head of a Division of Architectural Studies at the Trust from 1954-
1960. For an account of hospital building at this period see Jonathan Hughes, 'The
"Matchbox on a Muffin": The Design of Hospitals in the Early NHS', Medical History, 44, no
1, pp.21 -56.
These designs would culminate in recommended ranges of equipment and
furniture, developed in conjunction with selected manufacturers, to be
made available for purchase by hospitals. ^^
To run the project at the RCA, Black intended to appoint a research
fellow, Bruce Archer.^"^ Originally an engineer by training. Archer was
coming to prominence in design circles because of his interest in design
methodology and his early publications on the subject, largely in the
magazine Design.^^ Archer was to become central to the issue of hospital
bed design as carried out in the King's Fund Bed Project and his career
prior to joining the RCA is therefore covered in some detail. It provides
another alternative starting point for an account of the King's Fund Bed. For
although Anthony Barber's remarks in 1 964 or the criticisms of the Public
Accounts Committee in 1963 have often been used to open narratives of
the project, (including Archer's own), he was already heavily involved with
hospital equipment prior to these dates. It was a field particularly suited to
his interests and aspirations.
^^Royal College of Art, Studies in the function and design of non-surgical hospital equipment,
Preliminary report, 1 June, 1962, p. 2. The Hospital Equipment Group was the forerunner of
the Industrial Design (Engineering) Research Unit at the RCA, which became the
Department of Design Research in 1967. For an historical account, see Jean Maclntyre,
'The Department of Design Research at the RCA - Its Origins and its Legacy, 1956-1988,
unpublished MA dissertation, Victoria and Albert Museum and Royal College of Art, 1995.
^"^For a biographical note up to 1971, see L.Bruce Archer, Technological innovation, a
methodology, London, Science Policy Foundation, 1971, (no pagination).
A series by Archer entitled 'Design and Stress Analysis' appeared in Design as follows:
'Intuition versus mathematics', 90, June 1956, pp.1 2-1 9; 'Design Research', 91, July 1956,
pp.31 -34; 'Analytical Methods for product designing', 93, pp.29-33, September 1956;
'Photo-elasticity for the product designer', 96, December 1956, pp.42-46.
Archer had been invalided out of wartime service in the Scots Guards.
Aptitude tests applied by a resettlement board of the Ministry of Labour
directed him into training as a mechanical engineer, and in engineering
design. From 1945 he worked in production machine design, first in the
cigarette industry, then with electronic products. An opening to teach
production design on the new industrial design course at London's Central
School of Art and Design led to increasing part time work there, which
Archer supplemented by setting up his own consultancy in 1953. One early
client was the eminent British designer Michael Farr, who employed him to
manage projects. At the time, Farr was editor of the magazine Design, and
Archer became a regular contributor.
As a mechanical engineer. Archer had no 'aesthetic' training. He
was however of a mathematical and theoretical bent and had become
increasingly interested in the process of design. Some of his earliest
published papers, which appeared in Design in 1956 - 7, began to explore
the relationship between aesthetics and function, and the role of
mathematics and science in the design process.^'' His account of the
prevailing attitude in mechanical engineering to 'user' factors, such as
comfort or safety, and the whole area of what later became known as
product design, is that they were regarded as 'rather fey'. He judged that
the milieu of an art school would allow him to capitalize on the general
loosening of interdisciplinary boundaries which characterised the
^^This section relies on interviews, Bruce Arclier, 14.5.98, 10.5.99, 9.5.00.
^^op. cit. note 25.
immediate post-war years. It might be possible to involve graduates from
disciplines such as psychology on his projects in a way which would not
have been open to him in a department of engineering. For it seemed
increasingly clear to him that the art of design was, if not actually a science,
certainly amenable to scientific enquiry. He lamented the absence of
'examples of form which is genuinely the product of reliable calculation
based on scientific principles'.^^
Increasingly frustrated at 'not being heard' by the design
establishment. Archer began to move in what he saw as the less
reactionary circles of contemporary art, in particular those centred on
London's Institute of Contemporary Art (ICA). The ICA had been a focus
for the so-called Independent Group, an association of artists, architects
and theoreticians who began to meet there during the 1950's.^^ The Group
actively promoted a more interdisciplinary approach to art and design,
being particularly concerned with (largely American) popular culture, and
with science and technology. Leading members included Rayner Banham,
Lawrence Alloway and Richard Hamilton, the originator of 'pop art'. Archer
was introduced by Hamilton to the Argentine painter and intellectual,
Tomas Maldonado, at that time co-Rector of the experimental German
design school, the Hochschule fur Gestaltung at Ulm.^° Maldonado had
^^Archer, 'Intuition versus matliematics', p. 12.
^^Anne Massey, 'Tlie Independent Group as Design Tlieorists', in N. Hamilton (ed), From
Spitfire to Microctiip: Studies in the History of Design from 1945, London, Design Council,
^°The most extensive account of the school at Dim is in Herbert Lindinger (ed), Ulm Design: Tlie
Morality of Objects, Berlin, Ernst and Sohn, 1990. Robin Kinross, 'Hochschule fur
Gestaltung, Ulm: recent literature', in Journal of Design History, 1, 3-4, 1988, pp.251 -256 is
a review article which considers this and five other publications on the Hochschule. See
also Heiner Jacob, 'HfG Ulm: A Personal View of an Experiment in Democracy and Design
Education', Journal of Design History, 1, 3-4, 1988, pp.221 -234.
been impressed by Archer's interest in design as process, writing
appreciatively about his series of articles in Design .^^ Anxious to heal
widening internal disagreements at Dim as to the 'true nature of design',
Maldonado invited Archer there for a year as a guest instructor in 1960.
The 'extraordinarily small, almost monastic college', known as the
Hochschule fur Gestaltung (HfG) at Dim, in Swabia, has been widely
identified as the successor to the Bauhaus. Like the Bauhaus, it came to
have 'almost legendary status' for some designers, though its existence
was short-lived and its precise legacy much debated. ^^ Founded in memory
of two students executed for political activities by the Nazis in 1944, the
HfG was a privately supported postgraduate school of design run on lines
unprecedented in the German education system. With forty to fifty percent
foreign students and a huge preponderance of guest instructors over
faculty staff, it was intended to be an international centre for teaching,
development and research into the design of industrial products. Explicitly
anti-fascistic, the school was to participate in the making of a new culture,
from spoon to city. A large donation from the US government enabled the
HfG to open formally in 1953.
However, this short-lived experiment (it lasted only fifteen years)
was beset for much of its existence by disputes between different factions
among the staff, ostensibly about the true nature of design and how it
should be taught. Later, the growing student unrest of the late 1960's
^^ Maldonado wrote to Design magazine in April 1958: 'In my opinion it is necessary to free
design criticism from the numerous misconceptions of art criticism terminology and to turn
design criticism into a new scientific design analysis. I appreciate especially in the
magazine the contributions of Bruce Archer and Christopher Jones.' Quoted in Maclntyre,
The Department of Design Research, p. 15.
^^This account relies on the sources in note 30.
further de-stabilised the Hochschule. Its funding, often precarious, received
a fatal blow when the regional Baden Wurttemberg parliament withdrew
financial support, the culmination of an ever worsening relationship
between the conservative local community and the fiercely intellectual and
reformist 'Ulmers'. 'In the rosy haze of the Adenauer years . . . and the
kidney shaped coffee table, the inhabitants of Dim considered the products
of what they called the 'hochschule fur ungestaltung' to be a standing
provocation - or at least a farrago of incomprehensible aberrations.'^^ The
HfG was disbanded in 1968, the staff voting against a merger with Stuttgart
University Architecture Department which offered state funding but loss of
When Archer arrived in 1960 the HfG was still vibrant, although
factional disagreement among the staff was intense. He identified two main
factions: the 'mathematician/scientists' and the 'designers'. Since each
apparently considered that he had been brought in to support the other
side, he was able to do little to diminish their differences of opinion. But the
year of intense discussion with the mathematician/scientists, and
observation of the designers at work in their ateliers at Dim, gave him much
food for thought. Reyner Banham, musing much later on what it was that
took a 'devoted band of Britons', including himself. Archer and Richard
Hamilton to Dim in the late 1950's and early 1960's, concluded that it was:
... a peculiar combination of interests that were mostly transient on the
British side but more permanent at the Hochschule, more concerned
with its basic orientations and its long-term patterns of intellectual
growth. Both sides sought a way out of the local impasses into
which design theory had fallen, but whereas the British impasse was
one of almost total vacuity, the exhaustion of the 'gentlemen's
^^Lindinger (ed), Ulm Design, p.1 18.
Jacob, HfG Ulm: A Personal View, p.234.
agreements' of the 1930's and the lack of anything but the arts and
crafts to fall back upon, the German situation seemed to us, as
revealed by Tomas Maldonado, to be one of excessive rigidity, a
cast iron system of categorical imperatives. But this was impressive
to us visitors because of its relentless logic and intellectual clarity. I
used to wonder why anybody bothered to speak to me at Dim; I felt
so stupid in my lack of dialectical method, and my head ached from
having to find intellectual justifications for observations like 'Yes, I
would like another bread roll'. Yet it was profoundly exciting to be in
a milieu where issues about design could be discussed so
intensively, especially if one had just come from London where there
was at the time no intellectual discussion of design at ali.^^
For Archer, who had also been frustrated by the profoundly
unintellectual state of the London design world, and whose aspirations
towards a more 'scientific' approach to design had much in common with
the theoretical position adopted by Maldonado at that time (this later
changed). Dim was an ideal environment in which to refine his ideas on
design. Increasingly, he was preoccupied with the possibility of devising a
new, systematic method of design. This led him into complex areas of
mathematics which he discussed at Dim with a mathematician and
planning theorist, Horst Rittel.^^ Perhaps not surprisingly. Archer found he
inclined more to the 'mathematicians' camp, (which also included
theoreticians and scientists from other disciplines, such as applied
psychology) rather than to that of the 'designers' such as Hans Gugelot and
OtI Aicher. The latter asserted to him that their work was creative and
expressive of fundamental truths, a view they substantiated with reference
Lindinger (ed), Dim Design, pp.57-8 .
Rittel was subsequently at the Institute of Urban and Regional Development, University of
California, Berkeley. His faculty seminars there were published as The Universe of Design,
Berkeley, University of California, 1964. Archer discussed with Rittel the problem of
modelling decisions which involved qualitative variables. Rittel advised him that a solution
would be found in pure, rather than applied, mathematics, 'since non-quantitative
relationships were at the heart of pure maths'. Interview, Bruce Archer, 10.5.99.
to Platonic philosophy and Gestalt theory. Their characteristic 'Dim' style,
often described as 'pure' or 'clean', became closely associated with Braun
and several other companies who commissioned the School's designers
around 1960. Particular features were the use of Platonic solids, the
elimination of colour except for 'functional' purposes, and the adoption of
the new sans-serif typefaces then being devised in Switzerland.
Observation of the designers at work in their studios, however, led Archer
to the view that they were in fact formulaic, rather than creative, using 'rules
of thumb which gave a family likeness to different products.'^'' These Dim
designers had little sympathy for Archer's growing concern with elucidating
what they saw as the essentially creative process of design. Others at Dim
were not so dismissive, however, and Archer's work there was influential. It
formed the basis of the design method taught at the Hochschule after he
left, and a student project there constituted the earliest trial of his new
Archer left Dim at the end of the academic year in 1 961 . Other
commentators bear out his account of intense factional disputes. The
period 1960-62 was identified as witnessing the height of a controversy
over theoretical versus practical courses at Dim, and 'the exact role that
analytical methods should play in the design process'. ^^ By the time the
As an example he cited the detailing of the rectangular Platonic solids favoured by the Ulm
designers. They showed him that if both horizontal and vertical edges were given the same
radius, where they met at the corners formed a hemisphere, looking 'as though a ball
bearing was trapped beneath the casing'. They therefore routinely used a different radius
on the vertical edges. Interview, Bruce Archer, 10.5.99.
This was the design of a wristwatch by Reinhart Butter. Archer subsequently defended
criticism of the design on the grounds that it had been developed 'on the basis of
legibility experiments conducted under the supervision of an applied experimental
psychologist'. Bruce Archer, letter, The Architect's Journal, September 21, 1966, p. 728.
Lindinger (ed), Ulm Design, p. 143.
controversy abated somewhat, Archer was back in Britain and already
working on hospital equipment. This was perhaps fortunate. The direction
in which resolution occurred would not necessarily have been congenial to
him. Maldonado's early views on the role of rationalism and science in
design lost ground and the syllabus at Dim was revised by the sculptor
turned graphic designer, OtI Aicher. Topics such as 'operational research'
were 'discreetly dropped', although the role of science in design continued
to be hotly debated.^"
Analytical or systematic design methods such as Archer was
devising were initially received rather less critically in Britain and North
America than in Continental Europe. And as another Ulm Faculty member,
Gui Bonsieppe, later remarked:
Anyone who works out rational criteria of decision making, and
who prides himself on optimizing design solutions, is by that very
fact presenting himself as a solid, serviceable sort of person, just
what an industrial system requires. "^^
The comment, while certainly not directed at Archer personally, was
apposite. After completing his year at Ulm, Archer needed a job, preferably
in a field where he could perfect and try out his method. Before he left Ulm,
Archer accepted Misha Black's offer of a research fellowship at the RCA to
run the hospital equipment project. The socially relevant nature of the
project suited the RCA, anxious at that time to rebut charges of ivory tower
elitism. "^^ It suited Misha Black, who was engaged in dragging his new
Department into a closer involvement with industry."^^ And it very much
Lindinger (ed), Ulm Design, p. 145.
Lindinger (ed), Ulm Design, p.1 12.
Frayling, The Royal College of Art, pp.1 78-9.
suited Archer, for whom hospital equipment design appeared to have 'a
near perfect combination of quantifiable and non-quantifiable variables. '"^"^
Studies in the function and design of non-surgical hospital
Archer began work on the hospital equipment project in September 1961,
bringing with him Reinhart Butter, one of his students from Dim, as an
assistant. So convinced was he that 'as soon as you have put something
away in a filing cabinet you have embarked on a particular way of working',
he resolved that he and Butter should have only a temporary office with
temporary furniture, away from the future project team and indeed outside
the College altogether, until they had drawn up the methods they would
adopt. "^^ The RCA, through an arrangement with the Science Museum,
found them an office tucked away behind the Aeronautics Gallery of the
latter institution. The products of their discussions were recorded, partly in
English and partly in German, in a series of lengthy working documents.'^''
In general these were couched in abstract terms and exhibited a
preoccupation with methodology, with rigorous, often self-referential,
Interview, Bruce Archer, 14.5.98.
This was the official title of the hospital equipment project.
Interview, Bruce Archer, 6.8.98.
This was because each used his first language in discussions, on the basis that it was harder
to express complex ideas in a second language than it was to understand them. Curious
observers of their intense lunchtime conversations in the Victoria and Albert Museum
cafeteria often concluded that both were speaking Dutch. The documents are in
AAD/1 989/9, Job 1, Working Documents 5-14.
definition and with stepwise progression that was to characterise most of
Archer's published worl<. For example, 'Task four' in the initial breakdown
of work outlined by Archer and Butter was 'to prepare a system for locating
and identifying all relevant information'. It had seven parts: part three was
'to set out a procedure for preparing an authoritative list of sources of
information', part four was 'to prepare the authoritative list of sources of
information', part five was 'to set out a procedure for preparing an
authoritative list of existing information and current investigations' and part
six was 'to prepare an authoritative list of existing information and current
Their concern with 'thorough and conscientious organisational
preparation' was manifest, as was their insistence that the wide ranging
investigation should only proceed 'stufenweis" (in steps). While Working
Document Two was an 'Overall programme of work for the investigation'.
Working Document Three was a 'Report on Task 1'. Working Document
Four was a 'Report on Task 2, parts one and two', and Working Document
Five was a 'Report on Task 2, part three'. This last contained a typical
example of the way in which the style aspired to the abstract and
mathematical even when considering the most mundane and practical
affairs. The following analysis was provided as a justification for the list of
office equipment required:
1 . For the purpose of this report the key to the basic organisation for
the investigation is figure 4 and para 3.31 in Working
2. The establishment of staff for the first year's work is laid down in
Working Document 3 para 3.13 as follows:
Task 1 for the investigation liad been described as 'tlie codification of terms of reference for
tlie investigation', Task 2 was 'tlie creation of a basic organisation for tlie investigation'.
AAD/1 989/9, Job 1, Working Document 2, Appendix B.
one full-time research leader
one full-time assistant
one part-time secretary.
3. An examination of possible systems and equipment offered by
various potential suppliers is described in Working Document
1 , para 3. 24.
4. The list of requirements is therefore obtained by equating the
factors described in paras 2.1 , 2.2 and 2,3 above.
The resultant list of requirements was tabulated against 'particulars of the
equipment ultimately supplied'. Despite the elaborate statement of the
method used to arrive at the list, a somewhat Spartan picture of the office
equipment emerges. It comprised 'a typist's table, rack (stationary, light
oak), broom, stamp (rubber), pad (ink), cups (white, four), together with
eight books. In addition to Webster's Dictionary, Roget's Tliesaurus and
the London A-Z, these were the Hospitais Year Book, a copy of the
l-iospital Plan for England and Wales and the Fifth Report of the Nuffield
Provincial Hospitals Trust, together with two nursing texts, A General
Textbook of Nursing by Pearce and Practical Notes on Nursing Procedures
Archer's contact with the hospital milieu was not limited however to
the perusal of these volumes. It was during the preliminary year of this
project that he first came into contact with senior administrators on the
Regional Hospital Boards, and with senior civil servants at the Ministry of
Health, including the Undersecretary for Hospital Services, Raymond
Gedling, and W. E. Tatton-Brown, who held the newly created position of
AAD/1 989/9, Job 1 , Working Document 5. Evelyn Pearce, A General Textbook of Nursing,
London, Faber and Faber Ltd., 1959., J.D. Britten, Practical Notes on Nursing Procedures,
London, E. and S. Livingstone Ltd., 1960.
chief architect at the IVIinistry.^" Apart from these meetings, Archer, with
Butter and later a project team, spent the year's work almost exclusively
concerned with information, its sourcing, organisation and processing. The
management systems devised might well have been applied to any sphere
of design, or indeed any field involving research and information
It was not until these systems were drawn up that other members of
the team were appointed. Gillian Patterson, originally employed as Archer's
secretary, was an arts graduate who rapidly became a key member of the
'core' research team. She was mathematically adept and took on special
responsibility for information handling. Subsequently she ran entire projects
when they inclined more to this field than to actual design and engineering,
and became a Research Fellow in the Unit. Apart from a period spent
obtaining an MA in the Department of Fine Arts at the RCA, Patterson
worked for the Unit until she retired in 1988.
Kenneth Agnew, newly graduated from the Department of
Engineering Design at the RCA but originally trained as an architect, was
also to become a central figure in the Unit, leading many subsequent
projects in both the medical and non-medical fields. He left the RCA in
1978, having been deputy head of the Department of Design Research, to
become Professor of Design, University of Ulster.
A nurse, Doreen Norton, was the fourth member of the core team.
Norton was unusual among her contemporaries in that she had a sustained
Creation of a Chief Arcliitect's post at tlie Ministry of Healtli liad been anotlier attempt at cost
reduction. See Webster, The Health Services since the War, p. 39.
It was in fact described as tlie 'Design of a researcli management system' in a list of jobs
undertaken by the Department of Design Research compiled much later by Archer. Bruce
Archer, 'List of Active Jobs', personal communication, 1998.
interest in nursing research and had published in the field. She was a co-
author with the geriatrician, A. N. Exton-Smith, of An Investigation of
Geriatric Nursing Problems in Hospital.^^ It was probably the Royal College
of Nursing that recommended her for the project.^^ Apart from nursing
officers from the Ministry of Health who were involved on a very intermittent
basis, and the 'nurse juries' arranged at the beginning of the project (see
Chapter Three), Norton was the principal source of information on nursing
and ward practice generally. She left to take up a research position with the
National Corporation for the Care of Old People in 1963, but had
considerable input into the King's Fund Bed Project at decisive early
stages. She was the spokesperson on 'user needs', and the concept of
'user needs' was central to Archer's method of design.
The result of the team's first year's work, however, from September
1 961 to September 1 962, was not, it seems, what the sponsors expected.
Instead of concrete suggestions or designs for hospital equipment, the
NPHT were presented with a highly abstract and theoretical 43 page report
entitled 'Studies in the function and design of non-surgical hospital
equipment'. In the words of the Report, as the end product of the year's
work, it consisted virtually entirely of information garnered from outside
sources, the investigation having been organised 'as an information
seeking and evaluating body'. In the design method which Archer was
devising, a precise formulation of the design problem was essential, and
this was what, in his view, the Report represented. A subsequent three
Doreen Norton, Rhoda McLaren and A.N. Exton-Smith, An Investigation of Geriatric Nursing
Problems in Hospital, Edinburgh, Churchill Livingstone, 1962 (1975 reprint).
Interview, Doreen Norton, 22.4.99. An account of Norton's work appeared in the Daily
Telegraph, 'The shy reformer working to brighten our hospitals', February 22, 1 968.
year programme for solving the problem of designing and specifying 'non-
surgical' hospital equipment was proposed. It involved the formation of
three groups: a pilot study sub-unit would
become responsible for specifying and selecting fixed and movable
equipment of the class defined, for a projected hospital
development. This group will strive to satisfy all the commissioning
authority's needs and in doing so will it will indicate to the workers in
the other subunits what the problems are in the implementation of a
specific project and where the gaps in knowledge lie.
An 'inductive studies' sub-unit would 'provide analyzed catalogue
information for the pilot study group'. The pilot study group would 'raise
questions for a third sub-unit, the 'peripheral studies group', who would
'provide tabulated information for the pilot studies group, and so on'.
Archer, with Misha Black, had already had a meeting at the Ministry of
Health in April 1962, as a result of an approach to the Chief Architect to
request that they suggest a suitable hospital for the pilot study. The new
West Middlesex, a district general hospital being built at Isleworth, just west
of London, was nominated.
The Nuffield Provincial Hospitals Trust, however, declined to
continue with funding. Although Archer considered that the Nuffield
governors, dominated as they were by eminent medical men, had resented
any suggestion that lay professionals might be better at specifying hospital
equipment, it seems likely that the highly abstract and theoretical nature of
the document with which they were presented had come as a surprise.
Large sections of the Report were devoted to laying down precise
definitions, terms of reference and objectives. Llewelyn-Davies' book, by
contrast, was an accessible and practical handbook widely used by
architects involved in hospital building. With only £600 of the grant
remaining. Archer decided to disband the team and use the money to allow
Agnew to develop at least one tangible example of how their methods
could result in useful equipment. The chosen item was a lockable ward
medicine trolley, which was duly produced and trialled.^"^ Although
ultimately quite successful, this was not enough, it seems, to persuade the
NPHT to renew their grant. The projected next phase of what was to have
been a four year project was now in abeyance unless another sponsor
could be found.
In August 1962 Misha Black approached the King's Fund in the
hope that they would take over financing the project.^^ A key player in the
pre-NHS medical metropolis, the Fund had lost its original purpose with the
coming of the Health Service. No longer involved primarily with financially
supporting the running of London's prestigious voluntary hospitals, officials
of the Fund had been re-defining its role since 1948.^^ They turned to such
areas as hospital catering, equipment and, in particular, the training of
hospital administrators and other non-medical staff. They also continued to
run the Emergency Bed Service and the Nursing Recruitment Service on
behalf of the MOH. In some ways the Fund was a more likely sponsor for
the RCA project than the Nuffield Trust. Less dominated by the medical
elite, less involved with sponsoring medical research, and with strong
allegiances to the traditional concerns of lay hospital management for
patient welfare, they had already made it their business to advise on
hospital equipment, and had plans to open a centre where hospital staff
^"^The method of design of the medicine trolley was described in Royal College of Art, Studies in
the function and design of non-surgical hospital equipment, Supplement to preliminary
report, November, 1962.
Misha Black to Hall, 2.8.62, A/KE/PJ/1 7/1 .
'Future of the King's Fund', British HospitalJournal and Social Service Review, August 23,
could familiarise themselves with what was available.^'' And as noted
above, receipt of a number of enquiries regarding hospital beds had
already led the Fund to consider setting up a working party on this subject
before Black approached them about the hospital equipment project. ^^
The King's Fund Working Party on Hospital Beds, which first met in
February 1963, was of a traditional composition for the Fund.^^ In the chair
was the Honourable Mrs R. M. T. Campbell-Preston, chairman of
Westminster Press Provincial Newspapers and a member of the South
West London Group Hospital Management Committee. The members
comprised a matron from a London teaching hospital, a ward sister from a
non-teaching hospital, a consultant in physical medicine, an engineer 'well
known to the Fund' who was chairman of a large engineering firm, together
with the former Secretary of a London Hospital Management Committee
who was now the Regional Staff Officer of the North West Thames
Metropolitan Hospital Region. Slightly less usually, a senior representative
from the Ministry of Health was also included. This arose because the
Working Party was deputed to carry out for the MOH that part of Enoch
Powell's five-fold survey of hospital equipment which related to hospital
Known as the Hospital Centre, this opened in large (20,000 sq ft) central London premises in
1963, during the course of the bed project. It incorporated the Fund's Division of Hospital
Facilities and the Hospital Catering Service and was intended to provide information on all
aspects of hospital planning, organization and equipment. The centre included a lecture
theatre and conference facilities. The entire first floor was made over to 'a changing display
of hospital equipment'. 'The Hospital Centre's Unique Role', British Hospital and Social
Service Journal, April 5, 1963, p. 393.
The Secretary of the Northern Group HMC, in possession of a legacy to re-equip a private
patient's wing, suggested in September 1961 that the Fund provide a grant for the study of
the use of different bed positions. It was known that the Royal Marsden Hospital had just
installed some electrically powered beds at a cost of £200 each. The Fund, although
sympathetic to the idea, refused a grant on the basis that 'the Nuffield Trust was 'initiating
similar work'. A/KE/PJ/1 7/1.
King Edward's Hospital Fund for London, Design of Hospital Bedsteads, p. 4.
bedsteads. The initial attendance of the Undersecretary, Gedling, was
perhaps an indication that, notwithstanding Powell's concern with saving
nursing time, the Ministry had never lost sight of the potential economic
benefits of standardising hospital equipment.
Standardisation of equipment had been discussed at high level at
the MOH since at least 1958. Although the Ministry had accepted the
Messer Committee's conclusions that year that joint (rather than central)
contracting 'provided the only practical method of combining the
advantages of large scale buying with the existing autonomy of hospital
groups', Powell's concern with 'the mechanization of the nurses task' had
again brought the matter to prominence.^" So, too, had unrelated events in
the 1950's concerning other kinds of medical equipment. Between 1947
and 1954 there had been thirty six explosions in operating theatres in the
UK, apparently caused by sparks igniting anaesthetic gases, and
prompting the MOH to convene a working party which produced
recommendations in 1956.^^ But the increasingly rapid and largely
uncontrolled introduction of electromedical equipment into hospitals
continued, and was viewed as a potentially serious risk to patients and
staff. The Ministry had employed a single Electrical Safety Officer since
1950.^^ In theory this individual was responsible for the safety of all
electrical devices (apart from x-ray equipment) in all NHS hospitals; an
®°Report of the Messer Committee on Hospital Supplies, quoted in 'Hospital Supplies and the
Hunt Report', British Hospital and Social Service Review, December 9, 1 966, pp. 2361 -
2367 and 2361.
Report of a Working Party on Anaesthetic Explosions including Safety Code for Equipment
and Installations, HMSO, 1956.
erview, Kenneth Dobbie, 6.6.00, i
Hospital and Social Service Journal, March 3, 1 966.
^^Interview, Kenneth Dobbie, 6.6.00, see also 'Hospital Engineers and Safety Officers', British
impossibly large task that was further compounded by the relative lack of
electrical engineering skills then available on site. In the pre-war years
hospitals had frequently employed marine engineers. Their prospects in
shipping were dwindling and their expertise with steam was relevant to the
major equipment then present in the hospital milieu: that for heating and
autoclaving. By the mid 1960's, the superintending engineer at the MOH
was led to conclude that:
the present image of the hospital engineer is too closely allied to the boiler
house ... in the past the boiler house was very important but you
don't need to look into a crystal ball to see that the steam boiler will
disappear from the hospital just as the steam engine has
disappeared from the railways . . . '^^
He urged hospital engineers to take more interest in electrical, and
particularly electronic, equipment. ^"^ A few of the most prestigious hospitals
employed chartered engineers, but these were largely mechanical.
Electrical engineering skills were not widespread in the Service, and the
issue of electrical safety was unlikely to recede. Standardisation of
equipment offered one way of reducing potential hazard.
There were, therefore, not only financial reasons why equipment
standardisation was of considerable interest to the MOH in the early
1960's. But undoubtedly economics was to be the most enduring concern.
Powell's time at the Ministry came to an end in October 1963.
'The outlook in hospital engineering', British HospitalJournal and Social Service Review,
June 25, 1965, p.1198.
The initial reluctance in several branches of engineering to adopt electronic devices had
considerable implications for medical equipment design in the 1960's. For an example see
G.M.Lawrence, 'Design Solutions for Medical Technology: Charles Drew's Profound
Hypothermia Apparatus for Cardiac Surgery' in R.Bud, B.Finn and H.Trischler (eds).
Manifesting Medicine: Bodies and Mactiines, Amsterdam, Harwood Academic Publishers,
'Mechanization of the nurses task' was not pursued to any extent as a
solution to the nursing shortage. Electrical safety was tackled by the
issuing of technical memoranda by the Ministry of Health. But 'supplies'
(including consumables) continued to account for very substantial
expenditure. In 1963 around twenty percent of hospital expenditure came
under this head.^^ This figure represented an increase of between 25 and
30 per cent on the previous year's. 'I am heartily sick, wrote the Deputy
Secretary,' when visiting hospitals, of being shown new beds, or lockers,
"built specially to our design", no doubt at considerable extra cost.'^^
The Hospital Services Division, instructed to look into the matter of
standardising equipment in 1958, had produced a discussion document for
the Regional Hospital Board Secretaries. Its author, Gedling, took the
opportunity of getting the files out again, 'since the work linked up with the
Minister's discussion on the mechanization of nursing'. As a start, he wrote,
'I should like to see proposals for producing standard specifications for one
or two common items of non-technical equipment, and I think that beds and
bedside lockers are as good examples as any.'^^
Undersecretary Gedling's place on the working party was later
deputed to the less senior but more useful Controller of Supplies at the
MOH, J. F. Hunt, who was to become a significant player in the King's
Fund Bed project. ^^ By 1962, the Public Accounts Committee was
Office of Health Economics, Hospital Costs in Perspective, 1963, p. 5.
^^'Deputy Secretary to Secretary', 1 7.8.62, MH1 36/1 1 .
^'''Deputy Secretary to Secretary', 14.8.62, MH1 36/11.
J.F. Hunt, Assistant Secretary, MOH Supplies Division replaced Gedling on 23.10.63.,
breathing down the necks of the MOH and their Report for the year 1962-3
made plain that they regretted the delay in the preparation of standard
specifications, since they had raised the matter the previous year.^^ They
urged 'their introduction at the earliest possible date'. They were confident
that 'future Committees would follow with interest the progress made in
drawing up the specifications'/" Hunt was deputed to chair a committee of
enquiry into hospital supplies in 1962. In the Hunt Committee's Report,
published in 1966, the organization of supplies on an area rather than a
hospital group basis would be advocated, as would increasing
standardisation, as essential, if sensitive, courses of action. ^^ The King's
Fund Bed was potentially a prominent example of what might be achieved.
Furthermore, the project was the only one of its kind thought likely to come
to fruition in time to appease the Public Accounts Committee. The working
groups set up by Barber in response to the Public Accounts Committee's
findings were not expected to report before the end of 1964 at the earliest.
But centralisation remained a sensitive issue in the NHS. In an internal
MOH paper Gedling warned 'We are here contemplating a serious
reduction in the power of HMCs and Boards of Governors and must expect
opposition'. ^^ Promotion of standardisation was considered more likely to
succeed if it came from the 'neutral' voice of the King's Fund, rather than
the Ministry. Some old-style hospital governors disliked central control as
much as their medical colleagues, and the more flamboyant took special
Civil Appropriation Accounts (Classes l-V)1961-2, HMSO.
''°Civil Appropriation Accounts, (Classes l-V) 1962-3, HMSO.
Report of the Committee on Hospital Supplies Organisation, (Hunt Committee), HMSO, 1966.
'The specification and purchase of hospital equipment', 18.4.63, MH1 36/11
delight in flaunting Ministry directives/^ The Ministry had a good
relationship with the Fund, who were, in turn, respected by senior medical
staff and hospital administrators. Perhaps because of lay dominance, the
King's Fund traditionally managed to walk the tightrope between the MOH
and hospital staffs.
The secretary to the Working Party was a relatively new official of
the Fund, Irfon Roberts. Roberts had hoped to go into the Colonial Service
when he was decommissioned after the war ended. Thwarted by ill health
he had opted for hospital, instead of colonial, administration.^'* Taken on to
the King's Fund Bursary scheme, to train in hospital administration, his first
task for the Fund had been to run a two year investigation into the
organization of portering work in hospitals, which he completed in a single
year. During the time that the Working Party on Hospital Beds was in
operation Roberts was made an Assistant Director of the Hospital Centre.
It is clear that he was the engine driving the Working Party and did most of
the work generated by it.
In the event, the Hospital Development Committee of the King's
Fund did agree to sponsor completion of the RCA's hospital equipment
study, from March 1963. From June, it was agreed that the RCA's studies
See for example the anecdote by 'Monitor' in tlie Britisli Hospital Journal and Social Service
Review, May 28, 1965, p. 963. On his first day of a new job, the author had admired the
new staff dining room. ' "Yes", said the House Governor, "it is rather pleasant and, funnily
enough I received a letter from the Ministry today with approval to build it" '.
^"^Interview, Irfon Roberts, 27.7.98. There are strong links between the armed forces and
hospital administration in the NHS at this period, certainly in the former voluntary hospitals
and at the King's Fund. A former Royal Naval Officer, Jack Langworthy, ran the
Emergency Bed Service at the King's Fund from 1 951 , turning down a job in MI5 to do so.
The Secretary of the Fund at the time, Roger Phalps, had commanded a naval
minesweeper and was known to favour an ex-Navy man for the job. In the selection of the
Emergency Bed Service telephone operators, former Wrens (Womens Royal Naval
Service) were given precedence. Taped interview, Jack Langworthy, no date, A/KE/Box
284, tapes 7-8.
would focus on the hospital bed, and that they would report to the Working
Party on Hospital Bedsteads. This connection, fostered by informal
discussions between Archer and Roberts in which the former outlined his
ideas about rational design, and by difficulties and delays in the planned
selection of equipment for the West Middlesex, brought about a conflation
of interests which did much to ensure the existence of the artefact known
as the King's Fund Bed.
In December, the Working Party visited the Royal College of Art.
Misha Black presented a report 'explaining the scope and purpose of the
inquiry into the design of hospital equipment sponsored by the King's Fund
and associated with the West Middlesex Hospital. It was noted that since
June, particular attention had been directed within the enquiry to the
question of hospital bedstead design'. A presentation by Archer followed,
outlining what had been done so far and what was proposed ... the
administration and clerical arrangements could not all be achieved from the
team's own resources. '^^ From this point on, the project was integrated with
the research of the Working Party. In the short term, it was agreed that the
RCA team and the King's Fund Working Party would pursue their own
separate lines of enquiry on bedsteads, pooling all information they
obtained. To some extent this proved to be like trying to pool oil and water.
The King's Fund Working Party was gradually compiling a list of
characteristics which hospital bedsteads should possess. This they did
largely by their traditional method of seeking informally the opinions of
senior hospital staff with whom they had good working relationships. Their
list of characteristics was produced in October 1963.^^ By that time,
''^A/KE/PJ/17/19, KFWPHB Minutes, 4.12.63, Item 11.
'Notes on characteristics of a liospital bedstead suitable for the majority of patients',
however, the impetus for the project lay firmly with the RCA team, who
were following at least the early stages of the complex systematic design
method which Bruce Archer had been devising over the past five years or
23.10.63, revised 1.11.63. AAD/1 989/9.