As we once were Hospital Beds and the King’s Fund Project
Dr. James Andrews, consultant geriatrician at the West Middlesex Hospital, stated in 1971, that those few consultants who took an interest in hospital beds, would find them classified as hospital furniture and not as medical/surgical equipment.
The standardisation of hospital beds was a long-standing aim of health administrators. Way back in 1939, many hospital beds would not fit into the ambulances earmarked for transporting patients across country when the Emergency Medical Service came into being on 3rd September 1939. However, little action seems to have resulted. Hospitals continued to order a few beds to be built according to their local needs and designs. Although in the late 1950s, the NHS Hospital Services Division was considering bed designs, it was not until the early 1960s, that Enoch Powell, the Minister of Health, was prompted into action by an acute shortage of nurses. He wanted a hospital bed, which would reduce the physical labour when nursing a bed-ridden patient. His successor, Anthony Barber, was horrified to find that manufacturers currently offered more than three hundred different patterns of hospital bed. The House of Commons Public Accounts Committee increased pressure for action by emphasising the financial advantage of standardisation.
So what happened?
In 1961, Professor Misha Black, head of industrial design at the Royal College of Art, had asked Bruce Archer to lead a research project in the function and design of non-surgical hospital equipment including hospital beds. Archer created a small team to join him, which included Gillian Patterson, Kenneth Agnew and Doreen Norton . Doreen’s knowledge of nursing the elderly and ward practice proved decisive at an early stage because she represented ‘user needs’, which were central to Bruce Archer's design. In April 1962, Black and Archer had met the Ministry’s Chief Architect to arrange a pilot study at the West Middlesex Hospital. Later that year Archer presented the results of their work to the Nuffield Foundation, which had funded the research. The organisation had expected concrete suggestions or designs but instead received a highly abstract, theoretical 43-page report. The Foundation hated it, refused any more funding and told Archer to go away and never darken their doors again!
At this point in the story, just like the US cavalry riding to the rescue in Hollywood western film, the King’s Fund saved the situation. The Fund was in a dilemma at that time. Before the NHS, it had been primarily involved in supporting London’s prestigious voluntary hospitals but now it needed another role in the new NHS. It had decided that it should be involved in hospital catering, equipment, and the training of hospital administrators, while continuing to organise the Emergency Bed Service. It had the idea of setting up a Hospital Centre to provide information about hospital planning, organisation and equipment. Thus, when Misha Black approached for help, the bed project fitted neatly into the Fund’s concept for its future. Acceptance was assured when it was asked by the Ministry of Health to act on its behalf in the standardisation of medical beds.
Once again, Archer was leader. Extensive consultations followed with emphasis on reducing the physical effort of the nursing workload, which was now a political priority. It was emphasised that a bedstead was a place for diagnosis, therapeutic treatment and rehabilitation, but also it must capable of being moved around the ward or hospital premises. Large numbers of hospital staffs were questioned with the expectation that the answers would improve the design specification. Extensive field trials followed, particularly at Chase Farm Hospital in North London, where 20 prototype beds were installed for three months on a female surgical ward. Trained observers recorded all bed-related activities from 6am to 10 pm. The whole project cost £35,000, (equivalent to over £½ million in today’s money). The King’s Fund accepted the design specification, which became a British Standard. The new model provided advances over current models with height adjustment through a greater range, fast bed elevation using foot controls, good stability, electrostatic safety and improved cleaning features. The mattress platform could be raised, lowered, or tilted, as required. The hinged foot piece could slide out to form a shelf, level with the top of the mattress, to take the bedclothes when the bed was remade. Cot sides could be attached and sockets were provided for drip-poles, monkey poles and other attachments.
The newly designed bed became widely adopted, replacing hundreds of other bed designs. However, it was not without criticism. Andrews, in particular, remarked that the flat-rigid design of the bed suited certain types of patient such as orthopaedic and coronary care patients but not necessarily geriatric patients. They had not been included in the trial ward although, as was remarked, many patients on the surgical ward were elderly. He found, in his study of high/low beds, that bed height was rarely changed for bed making unless a senior member of the staff directed otherwise. He extoled the value of the four-sectioned bed, which could be manipulated into 15 positions. Overall, he thought the King’s Fund bed was not entirely relevant for geriatric wards and gave it only faint praise.
Changes in clinical and therapeutic procedures brought about changes to the original King’s Fund design. Different types of beds were developed for medical/surgical wards, maternity units, critical care wards and prevention of pressure sores. The new designs reconsidered height adjustment for the entire bed, the head and feet. Cot sides, which still attracted critical attention with strong emphasis on very cautious use, were re-examined as were the electronic buttons used to operate the bed and other nearby electronic devices. Sadly, perhaps, reviews of these newly designed beds make little mention of the pioneering work of Archer and his colleagues, who started the ball rolling.