NZ hospitals in context

As work on Dunedin’s new hospital is delayed amid disagreements and cost overruns, a new book looks at almost 200 years of hospital architecture in New Zealand. Health Design in New Zealand, Te Whaihanga o ngā Whare Hauora o Aotearoa traces the evolution of healthcare design, from small, primitive hospitals that served the early colony to the high-tech facilities of today. Kim Dungey asks author and architect Chris Thom how the book came about and what he thinks of the proposed new Dunedin hospital. 

Why did you write this book?

Having worked on health facilities around the country, I realised that relatively few of them were recorded in architectural histories. Similarly, the names and backgrounds of many of their designers were unfamiliar. I was also interested in how the development of these facilities fitted into the wider social, economic and political context of the time. I began collecting fragments of information and making connections between these, thinking that I would eventually put this information on public record. It was suggested to me that there was enough to form the basis of a book, and thanks to the efforts and encouragement of my colleagues at Chow:Hill, Anner Chong and Darryl Carey, Massey University Press took on the challenge and several sponsors agreed to support it.

Hospitals are some of the largest public buildings in New Zealand yet often their designers are not well known. Why is this?

I was particularly interested in how many designers based in provincial towns, who may have worked only in that area, were referred to as "architect to the [local hospital] board". They often developed deep institutional knowledge and goodwill, and were trusted to create relatively large, complex facilities. More recently, some practices have developed a specialty in health design and often work in co-operation with other New Zealand and international practices, so that a building’s authorship can become unclear.

Sometimes the designers are well known, but for other building types. For example, Frederick Thatcher, who designed the first public hospitals in Auckland and New Plymouth, is renowned for his timber Gothic Revival churches such as Old St Paul’s in Wellington.

Mason & Wales is a highly regarded Dunedin-based firm, and the country’s oldest surviving architectural practice. William Mason designed the 1865 [South Seas] Exhibition building on the site of the current Dunedin Hospital, and the following year it was converted into patient accommodation, replacing the original hospital opened in the Octagon in 1851, on the site now occupied by the Municipal Building and town hall. The conversion was designed by provincial engineer John Turnbull Thompson, who had designed Tan Tock Seng Hospital in Singapore and set out the original plan for Invercargill.

Mason & Wales were later engaged to carry out further modifications and the firm, led by four generations of the Wales family, went on to design most of the buildings at the hospital for the next century. These included the nurses’ home of 1917, extended in 1926 and 1941, now re-purposed as Cumberland College; Queen Mary Maternity Hospital in 1937, extended in 1953 and 1961, which now houses the Otago University surveying school and Hayward College; and the 1935 administration building, which now accommodates psychiatric services. Their last significant building at the hospital is the 1993 oncology building, the bulk of which is reduced by its stepped profile, use of bands of different materials and colours, and domestic-style tiled roof. Mason & Wales also designed the 1898 Frankton Hospital in Queenstown, the 1908 Pelichet Bay Fever Hospital, the new Cromwell Hospital in 1937 and probably Clyde’s Dunstan Hospital in 1900. They also did many of the buildings at Oamaru Hospital from the 1960s on.

Which international hospital designs were adopted in New Zealand?

New Zealand architects followed international trends closely and were early adopters. With a small, widely dispersed population, however, many of our hospitals have been relatively limited in their scale. They have also tended to evolve incrementally as money became available and hence are often an amalgam of several different approaches and styles.

The move of Wellington Hospital from Thorndon to Newtown in 1881 allowed C. J. Toxward to design a new building with an efficient layout of four identical pavilion wards. Alfred Atkins, with his original partner Frederick de Jersey Clere and later Roger Bacon, designed pavilion-style hospitals in several towns from Hamilton to Greymouth.

As medical technology developed, resulting in a greater variety of departments with their own specific space requirement, a more complex "bar" style concept developed but in New Zealand, hospitals evolved into this in a relatively ad hoc manner.

There were disagreements in the earlier 20th century as to whether hospitals should be larger facilities in major centres, or smaller facilities dispersed into rural areas — a debate that has resonances today. Small cottage hospitals opened across Canterbury in the 1920s, many of which were designed by Collins & Harman, which was continued by four generations of the Collins family for more than a century.

Two typologies became popular overseas in the later 20th century. Where land was available, "mat" layouts of informally placed low-rise buildings, separated by landscaped courtyards and often punctuated by one high-rise ward or office block, were popular. The new Gisborne Hospital, opened in 1985, is arguably New Zealand’s best example of this type.

"Block" type designs — high-rise with deep floor plates — were necessary on tighter urban sites. These result in large areas of space with no natural light or outlook, which are heavily reliant on air conditioning and artificial lighting. Stephenson & Turner’s main block at Auckland Hospital is a good example of this typology.

Do you have a favourite hospital building in the Otago-Southland region?

That is a very hard one to answer. The cover of the book is an early image of the Dee St Hospital in Invercargill, which Heritage New Zealand notes is "the only surviving collection of 19th century hospital buildings in the country". As well as the 1866 Porter’s Lodge, 1876 central block and 1879 south wing (the latter two designed by Frederick William Burwell), there is the adjacent 1907 Nurses’ Home in Leven St, designed by Cuthbert John Brodrick.

I also admired Henry McDowell Smith’s Maniototo Hospital in Ranfurly, demolished in 2021, which Heritage New Zealand regarded as "a notable example of a rural 20th century hospital built in a modern style".

When Oamaru Hospital was moved to a more central site in 2000, the new building incorporated the 1875 Grammar School building, designed by Thomas Forrester — an excellent example of adaptive reuse by architect John McKenzie. The early work of his practice, Forrester & Lemon, in the town centre is well-known, but they are also thought to have designed the 1907 building at Oamaru’s "hospital on the hill", and Forrester, his son John Meggett Forrester, the latter’s business partner Ivan Steenson  and his son Harry Steenson were responsible for most of the work on the site for the next half-century.