hold a real fear for some persons and early return to familiar surroundings is greatly appreciated (Dean & Wilkinson 1969).

The Use of Hospital Beds

Once the effect of operating the new ideas for the treatment of patients in an integrated service upon people directly involved has been considered, it is essential to go on to probe the ways in which planning schemes need to be revised to make the best use of hospital beds. Good medical management under a divisional scheme will achieve efficient use of beds and enable the hospital to deal with many more patients per bed per year (Ministry of Health 1966; Ministry of Health 1967). The rise in the number of patients dealt with at West Suffolk Hospital each quarter from March 1967 to December 1968 is shown in Figure 2.

The concept of planned early discharge from hospital in situations where the patient's home is satisfactory and his clinical condition suitable is intimately bound up with the efficient use of hospital beds (Morris et al 1968). The general practitioner, relieved of some of his responsibilities as a result of the sharing of his work-load with non-medical associates, can help here if he participates in schemes for the early discharge of his patients. A well-organized and well-trained Home Help Service can also be an invaluable aid (Parker 1968). Geriatric Service

Good physical and social rehabilitation of geriatric patients will allow more of them to return to the community. In the areas to be served by these new experimental hospitals, geriatric services are being built up and day hospitals are being erected and brought into use. Each of the new hospitals will have 50 beds set aside for the assessment of acute geriatric admissions. Newly built or up-graded hospitals within the catchment area will provide long-stay beds for geriatric patients to a total of 1.4 per thousand of the population or 10 per thousand of elderly people (ie over 65). Experience has shown that such arrangements must be backed up by voluntary and official welfare services, places in welfare homes, the provision of special housing for the elderly ('warden flats'), and of other flats and bungalows. The problems associated with the care of the elderly are nation-wide. In a study of other areas, it has been estimated that accommodation in purpose-built homes for the elderly is meeting only one-quarter of the total need. Here is the hard core of an important influence on the use of hospital beds. Hospitals rightly remain reluctant to discharge patients to sub-standard living conditions (Government Social Survey 1968).

Other Services

In making plans for these new hospitals it has been assumed that the hospital confinement rate will continue to rise and that the average length of stay of each patient in hospital will fall. The number of beds set aside for maternity patients has been slightly reduced, but the ratio of delivery rooms to beds has been increased.

There will be 50 beds for the treatment of psychiatric patients in addition to accommodation in a day-hospital for 80 patients. It is assumed that hospital and local authority mental health services will work closely together within the district which they serve.

Outpatient, X-ray, pathology and physical medicine departments, as well as operating theatres are to be built to the normal scale of provision for coping with the population of the area.

Architectural Considerations

The project's keynote of economy and efficiency was applied at all levels in the hospital proper; traditional allocations, demarcation lines and degrees of responsibility were all questioned in the light of the need for growth and flexibility in the hospital.

Certain operational policies for the whole hospital were laid down at a fairly early stage and the implications considered as the scheme was developed. Progressive patient care allied with non-allocation of beds to individual doctors or specialties and a housekeeper service were proposed for the in-patient wards. The architectural solution is, of course, a logical reflection of the operational policies of the hospital and yet is strongly influenced by the previous development work of the Department at Walton Hospital, Liverpool, Kingston Hospital, Surrey, and the New Greenwich District Hospital.

When the new hospitals at Bury St Edmunds and Frimley were conceived, many of the problems previously present were absent, particularly problems of phased redevelopment on a restricted urban site. At the same time the architectural team did not wish to lose sight of the advance which had been made in the studies of supply and distribution problems in hospitals (Davies and Holroyd 1969), and the Department was also anxious that the principles employed should be capable, if successful, of a fairly simple adaptation on a far wider scale. For this reason, the architect's 'design idea' was for a two-storey building with courtyards to avoid the use of artificial ventilation, except in areas, such as operating theatres, where it is needed for medical reasons.

The needs of flexibility in the size of wards led to a continuous 'ward band' on three sides of the building, each ward able to accommodate the seasonal adjustment in numbers of beds required for each ward by extension into the adjoining ward unit and giving easy access to the therapeutic and diagnostic departments in the 'core' of the hospital.

Ward treatment rooms were not sited within the wards and were made a part of the central treatment suite which also included theatres and delivery rooms sharing service facilities. At the lower level the outpatient department, antenatal clinic, fracture and accident departments were planned on a closely interrelated basis, merging also with the day hospitals and rehabilitation units (See colour plates). Details of Construction

A few constructional details may be of interest. Studies on external walling showed that for two-storey building load-bearing gas concrete provided the structural stability together with a very high degree of thermal insulation and this material is being used extensively both internally and externally. The basic construction consists of an internal 'H' frame two-storey columns, down the centre of most of the blocks, with precast concrete ribbed floor spanning to ring beams on the perimeter, resting on the load-bearing gas concrete, An extensive system of roof lights provides natural ventilation to internal sanitary accommodation on the upper floors. Thus it is hoped to produce these hospitals of comparatively straight forward construction, not built in phases, but built complete and built quickly.

Conclusions

The pace of the programme has demanded urgent answers to many questions. This has been taxing to the project team and to those providing the whole range of medical and welfare services within both the West