Pilgrim's Progress: The Landscape of the NHS Hospital, 1948-70

This article argues the politics of land-use was fundamental to the challenges of realizing Britain's welfare state. It makes this case through a focus on efforts to plan and design new hospitals in the National Health Service (NHS) between 1948 and 1970. It pays particular attention to the Pilgrim Hospital in Boston, Lincolnshire which serves as an exemplar of a sort of politics that has been largely overlooked due to an overemphasis on central government. At the Pilgrim, a private landowner claimed inadequate consultation had produced a hospital proposal that was counter to local opinion, resulting in their farmstead being preserved within the grounds of a modern tower-on-podium facility. Working back from this aesthetic compromise, the significance of the landscaped hospital is introduced and situated within patterns of NHS land transactions and conflicts over site acquisition. This analysis re-orientates historical research to better reflect the decentralized nature of post-war planning in Britain. It does so by demonstrating how the welfare state internalized the criticisms of wider publics and powerful existing cultural and economic frameworks. These necessary processes formed the real groundwork for state modernization.