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Hospital beds by design: a socio-historical
account of the 'King's Fund Bed*, 1960-1975.
Ghislaine Mary Lawrence
PhD., University of London, 2001
The copyright of this thesis rests with the author and no quotation
from it or information derived from it may be published without the
prior written consent of the author.
Hospital beds by design: a socio-historical account of the
'King's Fund Bed',1 960-1 975.
This thesis is an account of the origins and early years of the artefacts
known in British hospitals as 'King's Fund Beds'. Launched in the late
1960's, the beds were the result of an elaborate, four-year project run by
the King's Fund, a charitable foundation supporting London's hospitals. In
1967 the Fund published a specification for a bedstead 'suitable for
widespread use in general hospitals'.
The design work involved was done at London's Royal College of
Art. It was led by a proponent of 'Design Methods', a movement concerned
with making the process of artefact design more logical and systematic.
The movement drew heavily on techniques devised in operational research
and subsequently applied to decision making and management in many
walks of life. Because practitioners were unusually reflexive, concerned
about methods and careful to preserve records of their work however
ephemeral, the project offers the opportunity of exploring, in some detail,
the processes resulting in the built form of a mass produced artefact for
use in a medical context.
Taking the 'King's Fund Bed' as the explanandum, an attempt is
made to show how built forms of the bed came to embody not only the
theoretical preconceptions and methodological preoccupations of the
designers, which were to a large extent rooted in an empiricist,
behaviourist account of 'bed use', but also their own aspirations and the
conflicting interests of different professional groups, government
departments and manufacturers. The eventual commercial success of the
'King's Fund Bed' is explored in the light of expansionist and centralising
policies pursued in the British National Health Service at a time when
traditional modes of organisation and social relations still largely prevailed
As a whole, the thesis is an attempt to provide a more broadly
based model for case studies of artefacts.
Chapter One: The King's Fund Bed Project 32
Chapter Two: How to make a bed 66
Chapter Three: Specifications and simulations 91
Chapter Four: 'Real beds': making and selling 124
Chapter Five: 'Real beds': buying and using 148
Chapter Six: The success of the King's Fund Bed 169
List of interviewees 235
My first debt of gratitude is to The Science Museum, for giving me the
opportunity to undertake this study. Secondly, I am grateful to my adviser,
William Bynum, for unstinting support and invaluable advice. Special
thanks are owed to those whom I interviewed about the King' Fund Bed
Project. They gave most generously of their time, even if bemused as to
why, nearly forty years on, someone should be so interested in so many
long-gone details. Bruce Archer and Kenneth Agnew in particular spent
many hours discussing the project.
The staff of the various archives and libraries I have used have
been unfailingly helpful, especially those of the Science Museum Library,
and of the Archive of Art and Design at the Victoria and Albert Museum.
Lastly, I thank all my colleagues and friends, at the Science Museum and
elsewhere, with whom I discussed my research. Their support, both
intellectual and practical, was central to the enterprise.
This page reserved for illustrations.
Hospital beds by design: a socio-historical account of the
'King's Fund Bed', 1960-1975. 1
Detailed case studies of the design of mass-produced medical artefacts
are rare. When it comes to writing about objects, medical historians have
shown greater concern with typology, invention, innovation and the
diffusion and uptake of technologies than with the detailed design of mass-
produced artefacts in common use, which may be contingent on factors
well beyond the immediate 'medical' context. 2 Latterly, certainly, the design
Strictly speaking, there was no such thing as a 'King's Fund Bed'. The King's Fund published
a specification. Manufacturers whose beds met it were allowed to use the term added to
their company name, as in, for example, 'Nesbit-Evans King's Fund Bed'. In time the term
'King's Fund Bed' came into common parlance in hospitals to mean any bed which met
the specification and I shall use it throughout in this sense unless qualification is required.
Typology has long been a central concern of those writing about instruments in medicine.
See for example V. Moller-Christensen, The History of the Forceps, London, Oxford
University Press, 1938. More recent studies have explored the relation of theory and
practice to the invention and use of particular diagnostic or therapeutic technologies.
Examples include Joel Howell, Technology in the hospital: transforming patient care in the
early twentieth century, Baltimore, Johns Hopkins University Press, 1995, and J. P. Baker,
The machine in the nursery: incubator technology and the origins of newborn intensive
care, Baltimore, Johns Hopkins University Press, 1996. Both the above genres are
concerned with changes in instrumental design only in so far as they overtly relate to
changing medical theory and practice (whatever the dynamic of this relationship is held to
be). For this purpose, prototypes and 'firsts' are of more concern than 'late' production
models. Design choices embodied in such production models which do not relate directly
to medical 'function' are excluded from consideration. For example, many of the
technologies in the case studies by Howell and Baker are now mass-produced with sheet
metal housing (as of course are many pieces of non-medical equipment), but neither of
the authors discusses this.
of large technological systems in the medical field has been related to the
industrial context. 3 But case studies of single artefact design present rather
different challenges. Although the explanatory factors invoked may, some
would say must, be similar, it appears harder to expose, say, the workings
of power and interest in the articulation of a braking system, or the
adjustments of a bedstead, than in the location of electricity stations on a
grid or the voltages adopted for common usage: harder perhaps, but not
Why study artefacts at all? For at least three decades, historians of
medicine and science have occasionally lamented the failure of their
colleagues to 'use artefacts'. Although often described as invaluable
resources, in practice artefacts have been the Cinderella source in
historical studies of literate societies. Not surprisingly, much of the
complaint about this state of affairs has come from those who maintain, or
are maintained by, collections of historical artefacts. 4 Despite the obviously
situated nature of these claims for the special relevance of artefacts, it
seems reasonable to explore how current historical work might usefully
focus on them. How might they be incorporated into the array of analytical
modes, tools and sources utilised by historians of various persuasions?
Part of the problem indeed seems to lie in the undue promotion of
See for example S. Blume, Insight and Industry: On the Dynamics of Technological Change
in Medicine, Cambridge, Mass., The MIT Press, 1992, a study of the growth of the
medical imaging industry around the new technologies of CT scanning, ultrasound and
magnetic resonance imaging.
For a recent example see James Edmonson, American Surgical Instruments, San Francisco,
Norman Publishing, 1997. Edmonson is curator of the Dittrick Museum of Medical History,
artefacts as historical sources, as explanans rather than explananda.
Compared to written sources, artefacts are deeply ambiguous. 5 This is not
to ignore the huge expansion in textual analysis, the 'linguistic turn' in
cultural studies generally that has both problematised and enriched studies
of the written word. But for many historical purposes written accounts,
treated with due circumspection, are directly useful without extended
analysis. This is rarely the case with artefacts. The ambiguity, connotation
and signifying that occurs 'above and beyond' what it is the author of a text
intended to say is mirrored in full measure by what goes on 'above and
beyond' what an object is expressly designed and used for, and the
artefact has no direct notational purpose.
Until recently, an extremely limited definition of function has been
employed in much writing on the history of technology. As Buchiarelli
points out, a chair is 'more than the physics of the device'. 6 A broader
perspective on function has contributed in large measure to some of the
more recent work in science and technology studies which problematises
the distinction between artefacts and human actors, or elides it altogether. 7
The history of technology is an obvious resource for the study of artefacts
but has been curiously neglected by many of those writing about medical
G.M. Lawrence, 'The ambiguous artefact: surgical instruments and the surgical past', in
Christopher Lawrence (ed), Medical Theory, Surgical Practice, London,
Louis L. Buchiarelli, Designing engineers, Cambridge, Mass., MIT Press, 1994, p. 6 (1996
See for example Madeleine Akrich, 'The De-Scription of Technical Objects' in W.E.Bijker and
John Law (eds), Shaping Technology/Building Society: Studies in Sociotechnical Change,
Cambridge, Mass., MIT Press, 1992, pp.205-224.
and scientific objects. Perhaps one reason lies in the fact that in this
discourse the emphasis is now very much on the technological object as
explanandum, rather than explanans. (It is indeed hard to see how
artefacts might ever have been adequate sources for a history of
themselves, unless an avowedly technological determinist position is
adopted.) A concern with the highly situated and contingent nature of
technological change, and the detail of 'thick description' needed to explore
these issues, has turned historians of technology to case studies rather
than surveys and overviews. 8 This thesis is a case study, inevitably with
somewhat arbitrary boundaries. The lines between object and 'non object',
artefact and 'context', immediate and wider contingent circumstances could
have been drawn differently. The limits of a case study are not easy to
To an extent, mine have been determined by sources. The paucity
of detailed single artefact studies is in part attributable to the lack of
adequate source material. Notoriously, some stages in the design of
certain artefacts are rarely articulated, let alone recorded. This is a
commonplace among historians dealing with production processes akin to
'craft', but probably holds good for many areas of design and technology. 9
See Wiebe Bijker, Thomas P. Hughes and Trevor Pinch (eds), The Social Construction of
Technological Systems, Cambridge, Mass., The MIT Press, 1987, p. 5 for a discussion of
a new emphasis in areas of technology studies with theoretical aims on 'thick description',
that is on 'a wealth of information about the technical, social, political and economic
aspects of the case under study'.
G. Sturt, The Wheelwright's Shop, Cambridge University Press, 1934, is the classic account
cited by historians of technology and design as a rare attempt by a craftsman to document
a craft practice before it ceased to exist. On the difficulties of studying craft practices in
the history of technology, see A. Pacey, 'The History of Technology', in P. Corsi and
P.Weindling (eds), Information Sources in the History of Science and Medicine, London,
Butterworths, 1983, pp.44-60:50.
For industrially produced artefacts, where records must have existed, they
are seldom preserved. Engineering drawings, company meeting minutes,
sales records and customer complaints do not often survive in quantity for
individual products, certainly in the medical field. 10 For the 1960's artefact
that is the subject of this thesis, however, extensive archival material does
exist. The 'King's Fund Bed' was the result of a project to devise a
specification for a bedstead 'suitable for widespread use in general
hospitals' which was meticulously documented at the time. 11 Indeed
analysis of, and reflexivity about, the design process were as important to
some of those involved as the resulting specification. For the project was
as much about design as it was about beds. The King's Fund Bed was
both test case and advocate for a new method of designing artefacts that
was to replace unexamined intuition with overt, systematic and logical
procedure, in fields ranging from product engineering and industrial design
to architecture and town planning.
Like many 1960's initiatives, systematic design methods were
rejected and repudiated by many almost as quickly as they had been
embraced. 12 By the late 1970's what had become known as the Design
In the medical equipment field, the mergers and take overs which have changed the
situation from that obtaining in the post-war years, where numerous medium to small
concerns existed, to the present one where a few large multinational companies
dominate, have resulted in successive losses of such archives as had been maintained.
Design of Hospital Bedsteads, King Edward's Hospital Fund for London, 1967, p. 12.
Bernard Levin characterises the decade as one when it was 'never easier to gain a
reputation as a seer, never was a following so rapidly and readily acquired . . . however
temporary their adherence might prove.' Bernard Levin, The pendulum years: Britain and
the sixties, London, Jonathan Cape Ltd., 1970. p. 9. For other accounts of the post- war
decades in Britain, see Kenneth Morgan, The People's Peace: British History, 1945-1989,
Oxford, Oxford University Press, 1990, and Alan Sked and Chris Cook, Post-war Britain :a
political history, Harmondsworth, Penguin Books, 1979 (2nd edn.1984).
Methods movement was, according to some commentators, in 'terminal
decline', and 'in the intellectual climate of post-modernism became so
passe as to be almost written out of history.' 13 The King's Fund Bed,
however, went on, and on. British manufacturers still sell it today. The
assumption that the success of the bed, in terms of its widespread
adoption, was related straightforwardly to the method of its design is one
which will be examined closely in this thesis. For the Ministry of Health
(from 1968 the Department of Health and Social Security), the ultimate
general acceptance of King's Fund Beds in hospitals represented success
in a rather separate endeavour. The introduction of a standard design for a
high profile artefact in the National Health Service, at a time when
consultants and hospital administrators alike were still wary of increasing
centralisation, was no small matter, and had considerable economic
As indicated above, the archival sources for the King's Fund Bed project
are relatively rich. King Edward's Hospital Fund for London was
established in 1897 to provide financial support for London's voluntary
hospitals. 14 Its archives are deposited in the London Metropolitan Archives.
Andrew King, review of C.T. Mitchell, 'Redefining Designing', Van Nostrand Reinhold, 1993,
Journal of Design History, 7, no 1, 1994, pp.61 -63:63.
For a history of the Fund see Frank Prochaska, Philanthropy and the Hospitals of London:
The King's Fund, 1897-1990, Oxford, Clarendon Press, 1992. It was known until 1902 as
'The Prince of Wales Hospital Fund for London to Commemorate the 60th year of the
They include the Minutes of the Working Party on Hospital Bedsteads
together with the considerable amount of correspondence, memoranda,
meeting notes and ephemera generated by the project. I have made
extensive use of these, together with Minutes of the Fund's Management,
Hospital Services and Hospital Centre Committees where appropriate.
The paperwork of the Department of Design Research (and its
various precursors) at London's Royal College of Art, where the King's
Fund Bed specification was drawn up, and all the design work for
prototypes carried out, was hastily deposited in the Victoria and Albert
Museum's Archive of Art and Design in the late 1980's. This followed the
closure of the Department in the reorganizations of the College's new
Rector, Jocelyn Stevens, appointed in 1984. 15 The material includes the
project files, together with those of related projects from which design
solutions were 'borrowed', and administrative and policy files of the
Department. Since the staff were instructed never to throw away so much
as a scribbled note or sketch, this archive is very extensive indeed and was
fully maintained as a resource during the life of the Department. 16 The
hasty manner in which it had to be deposited, however, has sometimes
made subsequent access problematic in the absence of a complete
Ministry of Health and DHSS archives relating to the project are
Queen's Reign'. In the mid-1960s the charity became known officially as 'The King's
C. Frayling, The Royal College of Art: 150 Years of Art and Design, London, Barrie and
Jenkins Ltd, 1987, p.198.
Interview, Kenneth Agnew, 22.6.00
relatively sparse. Files from the Supplies Division of the Ministry, which
dealt directly with the project, and whose Controller sat on the King's Fund
Working Party on Hospital Bedsteads, were among the last to become
available at the Public Record Office for the period in question. 17 When
they could be consulted, in the Spring of 2000, it was disappointing that
none of the files directly relating to this relatively high profile project
appeared to have been preserved. Not unexpectedly, the overall quantity
of material selected for preservation from the Supplies Division, together
with other less 'glamorous' areas such as engineering, was far less than
that retained from general policy files. While this is understandable, it
underlines some of the difficulties faced by historians of technology,
particularly in the field of mass-produced and relatively mundane items. It
might be noted in passing that the amount of taxpayer's money spent
annually by NHS supplies officers in the early 1960's was 'more than what
is spent on the whole of the universities of Great Britain, including buildings
and staff, more than is spent on law and order, the police, courts, and
Ministry of Health files relating to wider issues, such as equipment
standardisation and contracting arrangements in the NHS, do survive
however, and proved particularly useful in tracing the history of changing
policy on supply from the outset of the Service. 19 This area is largely
17 File Series MH136.
Sir Bruce Fraser, Permanent Secretary, MOH, to a meeting of the Supplies Officers
Association in 1963. British Hospital and Social Service Journal, June 7, 1963, p. 676.
19 MH1 36/11, MH136/13, MH136/17.
neglected in secondary sources. 20 Other archives holding small amounts of
material relevant to the project or its protagonists include those of the
Royal College of Art itself, the Royal College of Nursing Archives at
Edinburgh, the archives of Chase Farm Hospital on the outskirts of North
London where prototype bedsteads were trialled, and the BBC Archives at
Beyond these archival sources this thesis also relies on interviews
conducted with some twelve individuals who participated in the King's Fund
Bed project, whose working lives were affected by it or who were employed
in the Ministry of Health or the bed making industry at the time. A list of
these interviewees, together with brief biographical details, is provided as
an appendix. Although this is not an oral history project per se (in that the
interviews are merely one among several evidential sources) I have
referred to recent works on the genre with a view to acquiring, I hope, the
necessary circumspection when dealing with this kind of evidence. Oral
History, an Interdisciplinary Anthology, edited by David Dunaway and Willa
Baum, includes the useful essay, Theory, method and oral history by Peter
Friedlander. 21 There is a clear spectrum of practice between the more
sociologically orientated historical methods which seek out the participant
account precisely because it is a situated one, and may analyse not only
Webster's official history of the health services alludes to the four reports on the
organisation of the hospital supplies service since 1 948 in a single footnote. They were
the Messer Report of 1958, the Hunt Report of 1966, the Collier Report of 1976, and the
Salmon Report of 1978. Charles Webster, The Health Services Since the War, London,
HMSO, 1996, Vol II, p.936.
Peter Friedlander, 'Theory, Method and Oral History', in David K. Dunaway and Willa K.
Baum (eds), Oral History: An Interdisciplinary Anthology, Walnut Creek, Altamira Press,
content but the interview situation itself, and more traditional studies which
anticipate that oral history will be straightforwardly revealing of 'what really
In terms of secondary literature I have had to consult material from
widely differing disciplines and disciplinary histories. A full account of the
King's Fund Bed project involves the history of the National Health Service,
hospital building, administration and supply, nursing, design and
manufacturing in Britain, the history of the human sciences and of the so-
called 'cyborg' sciences 22 .
For the political and economic dimensions of the hospital service in
the post-war decades, Webster's official history of the health services in
Britain is invaluable, together with his shorter history of the NHS, and the
volumes by Geoffrey Rivett and Gordon Macpherson provide additional
'insider' perspectives. 23 A rich source for the relatively understudied area of
hospital administration has been the professional journals, in particular the
British Hospital and Social Service Journal 24 This, a principal journal for
hospital managers (and, until the mid 1970's, social workers) contains a
wealth of material in the form of editorials, articles (authored by supplies
officers and engineers as well as administrators) and advertisements,
The term 'cyborg sciences' is used by Andy Pickering, see below.
Webster, op. cit note 21 , also Charles Webster, The National Health Service: apolitical
history, Oxford, Oxford University Press, 1998, Geoffrey Rivett, From Cradle to Grave:
Fifty Years of the NHS, London, King's Fund, 1998, Gordon Macpherson (ed), Our NHS:
A celebration of fifty years, London, BMJ Books, 1998.
The British Hospital and Social Service Journal continued as the British Hospital Journal and
Social Service Review from February 1965, then as the Health and Social Service Journal
from 1972. After 1976 it was known as the Health Service Journal.
providing insight into the concerns of this key group of hospital staff. For
nursing, secondary sources are less sparse. The work of Christopher
Maggs has included reflection on the historiography, as well as the history,
of nursing. 25 There remains however a dearth of material covering ward
practice in recent decades. Here nursing textbooks and the procedural
manuals of individual hospitals are a double-edged resource; not to be
relied on as accounts of actual practice, they yet represent the official line
to which designers were required to tailor their products.
Design history has established itself relatively recently as a reflexive
discipline, as evidenced by primers with titles such as Design History and
the History of Design, described on its publication in 1989 as 'the first
explicitly theoretical examination of the subject'. 26 Nevertheless, for the
British context, useful bibliographies such as A. J. Coulson's A
Bibliography of Design in Britain, 1851-1970, were published prior to this,
as was a fairly small amount of insightful work on the history of industrial
design and the industrial designer, such as Penny Sparke's Consultant
Design: the History and Practice of the Designer in Industry 27 The low
status of industrial designers in Britain until the 1960's, the involvement of
See Christopher Maggs (ed) Nursing History.The State of the Art, London, Croom Helm,
1 987, and Christopher Maggs, Sources for the History of Nursing in Great Britain,
London, King's Fund Publishing, 1984.
John A. Walker, Design History and the History of Design, London, Pluto Press, 1 989.
A. J. Coulson, A Bibliography of Design in Britain, 1851-1970, London, Design Council, 1979.
Penny Sparke, Consultant Design: The History and Practice of the Designer in Industry,
London, Pembridge Press, 1983. See also Jonathan Woodham, The Industrial Designer
and the Public, London, Pembroke Press, 1983, and the useful bibliographic essay, 'Notes
on the Historiography of Design' in Carlo Pirovano (ed), A History of Industrial Design vol
3, 1 91 9-1 990, Milan, Electa, pp.404-41 3.
industrial design with the market place, and the general poverty of theory in
British design have been prominent themes.
There is a vast literature on the history of the human sciences. As
an overview, I have found Roger Smith's Fontana History of the Human
Sciences particularly helpful, together with reflections on the writing of this
volume and the origins of the term 'human sciences'. 28 It was from the
variously differentiated disciplines of psychology, applied psychology,
social psychology and sociology that theory and methods were borrowed
by those who, in the post-war years, sought to apply the approach of the
natural sciences to ever-widening areas of practical human activity. On
methodology per se in the social sciences, and, importantly, its relation to
practice, nothing comparable to Jennifer Piatt's history of sociological
research methods in America exists for the British situation, but given the
US domination of the field in the post-war years this volume still proved an
insightful guide. 29
Histories of operational research (or, in the United States,
operations research) consist in large measure of internalist participant
accounts which celebrate war-time achievements and/or promote peace-
time applications. 30 Rather few critical or analytical studies of the
Roger Smith, A history of the human sciences, London, Fontana, 1997. See also his article
'History and the history of the human sciences: what voice?', History of the Human
Sciences, 10, No 3, 1997, pp.23-39 and John Christie, 'The human sciences: origins and
histories', History of the Human Sciences, 6, No 1, pp.1 -12.
Jennifer Piatt, A history of sociological research methods in America, 1920-1960,
Cambridge University Press, 1996.
For a typical account see the opening chapter, 'The evolution of an attitude' in Patrick Rivett,
Concepts of Operational Research, London, C.A. Watts and Co Ltd., 1968, pp.1 -13.
phenomenon exist. An important exception lies in recent work by economic
historians who have highlighted the close links between notions of
optimisation in operational research and maximisation of value or utility in
economic theory. Many of these authors attended a conference at
Erasmus University, Rotterdam, in 1999 entitled Economists at War. The
(intended) emphasis was on the Cold War, but the collected papers (as yet
unpublished) comprise a sophisticated antidote to the 'Boy's Own' history
provided by participants in operational research. In particular, Philip
Mirowski's paper provides an exploration of how operational research has
been constituted in the U.S. and Britain, as well as being a valuable
bibliographical resource for its history. 31
Further insights into operational research come from historians of
science who have studied that group of disciplines which Andy Pickering
calls the 'cyborg sciences', in contradistinction to the 'traditional' social
sciences. 32 The cyborg sciences 'elided the difference between people and
things'. Pickering's 'incomplete list' of cyborg sciences comprises
operations research, systems dynamics, general systems theory,
cybernetics, cellular automata, self-organisation, game theory, artificial
intelligence, neural networks and information theory. Notwithstanding
Philip Mirowski, RAND/OR: How Operations Research put the Rigor in the Mortis,
unpublished typescript, 1999. See also 'Cyborg Agonistes: Economics meets O.R. in mid-
century', Social Studies of Science, 129, 5, October 1999, pp.685-718.
Andy Pickering, Units of analysis: Notes on World War II as a discontinuity in the social and
cyborg sciences, unpublished typescript, 1999. See also Andy Pickering, 'Cyborg History
and the World War II Regime', Perspectives on Science, 3, 1995, pp.1 -48, and Andy
Pickering/History of Economics and the History of Agency', in J.Henderson (ed), The
State of the History of Economics, Proceedings of the History of Economics Society,
London, Routledge, 1997, pp.6-18.
debates about what it actually was, operational research is often included
under this umbrella, either as a discipline in its own right or as some sort of
general precursor of more extensive attempts to apply the sciences of
information and control to society. Both Pickering and Donna Haraway
have looked specifically at sciences in the post-war era to which the
relationships and analogies between machines, humans or societies were
central. Pickering has examined the disciplinary history of the cyborg
sciences, or perhaps more accurately the lack of it, as they faced 'the old
problem of social reproduction: where was the next generation of cyborg
scientists to come from?' 33 This has connections with a large body of work
on artificial intelligence into which I have not ventured. Haraway has
focused on biology, and the transformation of central areas of that
discipline 'from a discourse on physiology ... to a discourse on cybernetic
technological systems', with the post-war creation of sociobiology as 'an
engineering-humanist discourse theorizing about society as a design
problem in information exchange and control'. 34 Apart from these broadly
based analyses, which are of relevance to understanding why the
designers of a hospital bed in Britain in the 1960's should have had
recourse to methods borrowed from operational research, there is also
recent historical work on cybernetics, that quintessential 'cyborg' science. 35
Pickering, Units of analysis, 1999, p. 6.
Donna Haraway, 'The high cost of information in post-World War II evolutionary biology:
ergonomics, semiotics, and the sociobiology of communications systems.', The
Philosophical Forum, XIII, Nos 2-3, 1981-2, pp.244-278: 245, 247.
Steve Heims, Constructing a social science for Postwar America: The Cybernetics Group,
1946-1953., Cambridge, Mass., The MIT Press, 1993.
Post-war 'management science' however, perhaps the most direct
descendant of operational research, still lacks a full historical account. This
is in contrast to the number of studies which address pre-war Taylorism
and time and motion studies. A few works, such as that by Urwick and
Brech, are relevant but again the emphasis is on the U.S. 36 Critiques from
the left are to be found in Doray, and in the Radical Science Journal, and
concentrate largely on the effects on workers. 37
In addition to this introduction, the thesis comprises six chapters. In
Chapter One I describe the circumstances leading to the setting up of a
working party on the design of hospital bedsteads by the King's Fund in
1963 and introduce the concerns of the main protagonists from the Fund,
the Royal College of Art and the Ministry of Health. Chapter Two outlines
the design methods which the leader of the RCA team espoused, their
relation to changing trends in design methodology generally and their links
with widespread attempts to apply the methods of the natural sciences to
areas of practical human activity previously considered beyond their remit.
Lyndall Urwick and E.F.L. Brech, The Making of Scientific Management, 2, London, Pittman,
1953. On the difference between the British and the U.S. situation, and the relation of
Taylorism to the post-war scientific management movement, see Kevin Whitston, 'The
Reception of Scientific Management by British Engineers,1890-1914', Business History
Review, 71, Summer 1997, pp. 207-229. Whitston goes well beyond the time period given
in his title.
Bernard Doray, From Taylorism to Fordism: A rational madness, Free Association Books,
London, 1988 and Scientism and the Left Radical Science, 13, 1984.
Chapter Three deals with the main events of the project as it was
implemented at the RCA and The King's Fund from June 1963 until
February 1967, when the final specification was published by the Fund. It
covers the drafting of specifications, the construction of models and
prototypes and the production of twenty hospital beds to the RCA's design
for trialling in a district general hospital. Chapters Four and Five deal with
'real beds', that is beds produced to the King's Fund specification on a
commercial basis after it was finally published in 1967. Chapter Four deals
with industry and commerce, Chapter Five with purchasing and use. In the
concluding chapter I address the issue of the success of the King's Fund
Bed as a means of unpicking some of the implications that the
circumstances and methods surrounding its design had for its specification
and early built forms. Clearly the notion of success begs the question of 'for
whom', and requires further definition.
There are two obvious initial contexts in which to situate the project:
hospitals under the National Health Service circa 1960, and British
industrial design at the same period. The rest of this introduction is taken
up with brief outlines of these contexts, which will be enlarged on in the
The hospital context
The early 1960's saw an ongoing review of the first decade of the National
This outline relies largely on the sources in note 24.
Health Service. 39 Several large scale initiatives, in particular the Ten Year
Hospital Plan, created a climate of expansion and increased resources. 40
Only five new hospitals were built between 1945 and 1964; the Hospital
Plan of 1962 specified '90 new and 134 substantially remodelled hospitals
to be started by 1970-71'. Capital expenditure of £200 million for 1961-
65/66, and £300 million for 1966-70/71 was assumed. 41 Hand in hand with
increased financial allocation, however, went increased attention to cost
monitoring and the better use of resources in the light of rising expenditure
on the NHS during the 1950's. But for some key issues, finance was not
the major problem. New hospital building led to scrutiny of ward design and
nursing complements. The perceived shortage of nurses that had beset the
NHS from the beginning persisted during the 1960's. Against this
background, a constant round of committees and review bodies debated
the proper role, remuneration, training, status and organisation of nurses. 42
In organisational terms, the original structure of the NHS was still in
place. Hospitals operated largely independently of local authority health
services and the general practitioners. Their basic administrative structure
remained the Regional Hospital Boards (RHBs) to whom Hospital
The period 1948-64 has been characterised as one of 'resource starvation and policy
neglect', Webster, The National Health Service, p. 30. The Guillebaud Report of 1956
failed to substantiate suspicions of wasteful overspending, suggesting that more, rather
than less, resources were required.
40 A Hospital Plan for England and Wales, (Cmnd 1 604), HMSO, 1 962.
Ibid, p 13.
Webster, The Health Services since the War, pp.1 8-1 9, 170-177, 437-441, Rivett, From
Cradle to Grave, pp.1 02-1 09, 1 86-1 91 .
Management Committees (HMCs), performing the day to day management
of groups of hospitals in a district, were responsible. 43 The teaching
hospitals had retained their own Boards of Governors and a greater
measure of autonomy. But the 1960's saw intense debate as to the proper
form of internal administration for hospitals, in terms of structure, personnel
and methods. The older style, pre-NHS lay management had persisted
through the medium of the Hospital Management Committees but the
influence of these Committees had declined since 1948. They were
increasingly dominated by the Regional Hospital Boards. As development
money flowed, the power of the RHBs grew. 44 And both lay governance,
and the old-style hospital administration, were challenged by protagonists
of a new 'scientific' management, fast gaining ground in commerce and
Within medicine itself, professional interests and allegiances were
changing as hospital practice became fragmented into increasing numbers
of new specialties. These included those building on new technologies,
such as cardiac surgery and radiotherapy, and those which were centred
on newly identified areas of need, such as geriatrics and paediatrics. As
well as the creation of new specialities, the 1950's saw the extension of
specialist care to new geographical locations. At the inception of the NHS,
planners had given prominence to the fact that consultant services were
unavailable in parts of the country distant from the metropolis or a major
Fourteen Regional Hospital Boards were created at the outset of the NHS. Wessex RHB
was created in 1959, and a separate RHB for Wales in 1974. Rivett, From Cradle to
Rivett, From Cradle to Grave, p. 172.
city. There had been roughly 4,500 consultants in 1948; by 1960 there
were around 7000. 45 Many of the new posts were created, not in traditional
areas of medicine and surgery, but in specialties such as anaesthetics,
psychiatry, pathology and, later, geriatrics. Against this trend towards wider
geographical availability of specialist care, increasing levels of
specialisation in high technology areas were soon considered by the
profession to warrant their concentration in 'centres of excellence', or at
least where minimum standards of resourcing could be guaranteed. 46
While the burden, or perhaps opportunity, of policing qualifications and
training needs was shouldered by the professions, these changes in
service provision had considerable implication for planners and
administrators at most levels in the NHS. In particular, the intention to
centre the hospital service on the concept of the District General Hospital,
a 600-800 bed unit providing consultant services in all major specialties,
with psychiatric and geriatric units on site and greatly expanded out-patient
facilities, brought these issues to the fore. 47
Factors such as these shaped both the context for development and
the intended context of use for new artefacts in British hospitals in the
1960's. It is in these contexts that much material for what has been termed
'thick description' for accounts of the King's Fund Bed will be found. But the
hospital context alone is not the only one in which the King's Fund Bed
Rivett, From Cradle to Grave, p. 137.
Cardiac surgery, for example, and the treatment of major accidents, were regarded as
requiring special units of this kind.
The District General Hospital, HMSO, 1961.
may be situated. As noted above, the project was as much about design as
it was about beds.
British Industrial Design, circa 1960
For much of the twentieth century, British industry had remained committed
to 'an anonymous staff designer who received little or no public
recognition'. The situation described in 1931, whereby the designer was
understood by the manufacturer to be somebody who was going to earn a
very moderate wage all his life '.. not., as much as a dentist, or a lawyer, or
a doctor ... the journeyman in industry and . . . treated as such' was
largely unchanged in the post-war years, despite the rise of the consultant
designer in the United States. 48 A very small number of industrial design
consultants on the American model existed in London in the 1950's. A very
few large manufacturing companies had employed resident designers
before the war, but this was far from the norm. 49 In any case, after the war
much of British manufacturing was still in the hands of small to medium
sized firms. If a 'designer' was to be found in such concerns, he was likely
to be a single draughtsman preparing drawings for the workshop. This was
Penny Sparke, 'Great Britain: Eclecticism, Empiricism and Anti-Industrial Culture' in Carlo
Pirovano (ed), A History of Industrial Design, vol 3, 1919-1990, Milan, Electa, 1992,
pp.1 82-1 97:1 82.
The moulding division of British Industrial Plastics appointed a staff designer in 1 931 . This
was almost unheard of except in the decorative art industries such as textiles and
wallpaper. John Vale, 'Designing for Moulded Plastics in the Post-War Period', N.
Hamilton (ed), From Spitfire to Microchip: Studies in the History of Design from 1945,
London, Design Council, 1985, pp. 67-71:67.
certainly the prevailing situation in the medical equipment field. 50
The post-war decades saw rising consumption not matched by
growth in manufacturing, together with the loss of traditional colonial
markets. Concern over Britain's failing exports fuelled new initiatives to
promote design, such as the Britain Can Make It exhibition at the Victoria
and Albert Museum in 1946, and the formation of the Council of Industrial
Design in 1944. 51 The precursor of the Council was the Design and
Industries Association, in existence since 1915 in order to 'encourage a
more intelligent demand among the public for what is best and soundest in
design'. The Times approved: 'entirely practical ... not vaguely artistic'. 52
The close connection of industrial design with commerce and utility
perhaps made practitioners particularly susceptible to an overall
conservatism which characterised the mainstream of British design for
much of the twentieth century. Numerous commentators have identified
this tendency, together with the lack of any theoretical underpinning after
the decline of the Arts and Crafts movement of the late nineteenth
century. 53 Such theoretical writing that was produced largely strove to
situate British design in relation to the Modernist movement, and the British
version of Modernism lacked the political radicalism of its European
Interview, Peter Siddall, 19.6.00.
Raymond Plummer, 'Fitness for Purpose: the Story of the DIA.', N. Hamilton (ed), Design
and Industry: The effects of industrial design and technological change on design,
London, Design Council, 1980, pp. 5-11.
Ibid, p. 5.
See for example Sparke, 'Great Britain: Eclecticism, Empiricism and Anti-Industrial Culture'
counterpart. There was no British equivalent to the Bauhaus, or its
successor at Ulm, where the purpose was 'to establish as one entity
professional ability, cultural design and political responsibility'. 54 This
theoretical vacuum was a matter of frustration to some but also of
opportunity. The proper source of design theory was not at all obvious, and
there were some surprising contenders. When increasing numbers of
industrial design courses had been set up by the end of the 1960's,
entrants might find themselves studying
. . . synergetics, general systems theory, theory of games, chemistry and
physics, topology and projective geometry, cybernetics,
communications, meteorology, geology, biology, science of energy,
political geography, ergonomics and production engineering,
(and/or) sociology, anthropology, psychology (perception, human
engineering factors, ergonomics) and, in fact, all the behavioural
sciences . . .
Kenneth Frampton, 'The Ideology of a Curriculum' in Herbert Lindinger, Ulm Design: The
Morality of Objects, Berlin, Ernst and Sohn, 1990, pp.1 30-1 43:1 31.
Misha Black, 'Engineering and Industrial Design', Proceedings of the Institution of Mechanical
Engineers, 186, 74/72, 1972, pp.897-91 2:908, quoting R.Buckminster Fuller and V.