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Bristol Royal Hospital for Children

Location: Bristol Royal Hospital for Children, Bristol, UK

Artists: Ray Smith, Eva Elsner, Annie Lovejoy


The new Bristol Royal Hospital for Children, opened in 2001 and dedicated to the care of children and their families across the south west of England, marks a milestone in the field of arts in healthcare. The creation of a purpose-built new children’s hospital created a rare opportunity in the UK to involve artists at the concept design stage of a major healthcare building. The new hospital is the product of an extensive programme of work, incorporating research concerning innovative ways of funding the project – £11million had to be raised through a public fundraising programme- and extensive investigation – both local and international – into what a world class children’s hospital might be in the 21st century. The extent of consultation with staff, patients, parents etc. was on an unprecedented scale with far reaching preliminary patient surveys and over forty user groups contributing to the design process.

Three artists, Ray Smith as lead artist, Eva Elsnerand Annie Lovejoy, and architects Whicheloe Macfarlane MDP, contributed to the consultation process and fed into the creation of the arts strategy and final commissions programme. This case study therefore focuses on the early stages of the project and the development of the strategy for the commissions programme. This strategy led to the commissioning of artworks by over twenty artists for the new building, many of which are site specific or integrated within the fabric of the interior. The use of vibrant colour and the powerful presence of the contributions of visual artists are integral to the distinct identity of the new hospital.

Background to the Project

Development of the capital project by United Bristol Healthcare Trust (UBHT) began in earnest in 1992, and the doors were opened to patients in April 2001. Public Art South West and Bristol City Council’s Arts Development Unit were involved in early discussions with UBHT, advised on sources of funding and advocated the benefits of involving artists at the concept design stage of this major capital project.

From 1993/94 the Trust’s Project Team and the hospital’s fundraising arm, The Wallace & Gromit Grand Appeal, began a programme of visits to other children’s hospitals in Europe and the USA to explore different models and approaches. As well as amassing an overview of best practice internationally, the visits generated inspiration and ideas around architecture, design and the possibility of the inclusion of art. A close relationship developed between Bristol and the Hasbro Children’s Hospital, Rhode Island, USA. Hasbro had recently gone through the process of building a new hospital, shared a family-centred ethos, and had incorporated art and colour within its new hospital which made it of particular interest to the Bristol team.

The Bristol Children’s Hospital was committed to a philosophy of looking after the whole family as well as the child. From the early 1980s a family-focused approach had been adopted which involved bringing families into the hospital environment to make children’s transition from home to hospital more comfortable. The hospital’s ethos and the results of initial research convinced the Trust that the new building should be based on three important principles:

  • The child’s eye view of the physical surroundings and how the child feels.
  • The need for a relaxed, interesting and secure environment to reduce fear and tension for the child and the family as a whole.
  • Recognition of the vital role that the family plays in the treatment and recovery of the child, so aiming to meet the needs of the whole family.

Believing that the arts could play a critical role in achieving these goals both through input to the building design and as a unique means of involving and consulting users, in winter 1996-97 the Trust appointed arts consultant Lesley Greene from a shortlist advised by Public Art SouthWest, to develop an arts strategy for the new hospital.

Key Principles of the Strategy Development

An initial assessment period by the arts consultant identified some key issues to be addressed by the feasibility/strategy development stage:

  • Children’s hospital staff had little previous experience of working with artists although the old building had one much loved mural in the entrance. There was an urgent need to explore how artists might work with staff and patients and to test what the challenges might be for staff, children and artists.
  • The overall project was driven by a fundamental commitment to consultation. At every stage architects and design team members were urged by the Project Team to talk to people and to find out the child’s and family’s perspective on any issue.
  • Project architects Whicheloe Macfarlane MDP had been appointed in autumn 1995 and designs for the hospital’s exterior were already completed. Lesley recognised that if artwork was to be in any way integrated within the design and fabric of the building, a lead artist or artists should be recruited immediately to work with the design team on plans for the interior.

Significantly Lesley felt it was critical for artists to contribute actively to the strategic development stage, consulting and involving users, and creating pilots and precedents for practice. As a result a number of artists were commissioned to undertake research residencies integrating creative activities within the feasibility stage.

Interior Design Collaboration

In the spring of 1997 Ray Smith was selected as lead artist to undertake a pilot ‘design only’ project working with the architect David Radford and interior designer Lee Cheong, on the integration of art and colour within key public interiors. During the first fifteen days Ray also worked with children at the hospital looking at ways of integrating their ideas into the preliminary designs.

His initial fifteen-day contract resulted in a written report, proposals for the colour scheme and designs for a number of agreed spaces. The design proposals were evaluated and whole heartedly approved by the Project Team and formed part of the bid to the Lottery for support of the design development of the commissions programme. At the outset any additional design fees and commission would have been dependent upon a successful funding application tothe Lottery, however in order to meet interior design deadlines in July 1997, the Trust identified additional funds to extend Ray’s design contract. The pilot project subsequently evolved into the major commission and collaboration of the commissions programme.

Working in close partnership with Lee Cheong, colour proposals were developed for the public areas on the six public levels of the building. Initial consultations with staff had generated the suggestion of a rainbow theme. Responding to this, Ray proposed the notion of a movement through adjacent harmonies of the colours pectrum as one travels up through the floors, creating distinct identities for each level, signalled by concentrations of vibrant colour at key orientation points - the stairwell and lift lobbies - allowing the visitor an almost instinctive sense of place or direction. In developing an overall plan for colour, lighting, materials, textures etc., Lee and Ray worked to establish the essential visual identity of the hospital seeking to enhance orientation and above all to give the whole environment a fresh and uplifting feel – creating a good place to be.

By involving Ray as lead artist during the feasibility stage, the potential for the design team to collaborate with an artist on the design of integrated elements of the interior was tested and proved. His inclusion on the team at this early stage allowed an integrated overall design concept which included the use of vibrant colour throughout the main public areas; unique designs for doors,floors, ceilings, furnishings, crash barriers, nurses’ stations and major input to key locations such as the main reception and Outpatients Waiting Area. The colour scheme and integrated artworks also provided a framework for the siting of further artists ’ commissions.

More detail on the design outcomes of the feasibility stage and the development and implementation of the designs are in Role of the Lead Artist.

Artist in Residence

Artist Eva Elsner was recruited through a national advertisement to explore children’s perceptions ofthe hospital environment. Her starting point was a belief that a child’s sense of identity is inextricably linked with the home and community and that being placed in an unfamiliar healthcare environment can be asource of anxiety and alienation.

Her three month residency in the old hospital in autumn 1997 resulted in the creation of a fascinating exhibition of ‘Boxed Worlds’ which presented children’s constructed boxed collections of found and made elements reflecting their views of the hospital as compared with their homes. The finished exhibition was full of clues as to how the children felt. For the artist, these were further illuminated by conversations with the children in the process of making the work.

Some important findings were included in Eva’s report of the residency, some of which became an integral part of the commissioning strategy. For example, she identified the way in which children mentally section off the medical treatment areas from bed and play areas and stressed the need for the hospital to have as many non-medical spaces and distractions as possible. The children’s delight in some of the more interactive processes explored in the residency suggested to Eva that some of the commissioned artworks should ‘exploit the children’s excitement for discovery’. This recommendation is reflected in the range of final commissions that include many works which engage the viewer through interactivity or sheer inventiveness. Eva also noted that children enjoyed the scale of the boxes; the experience of peeking into the seminiature alternative spaces captured their imaginations. This finding was also recognised by lead artist Ray Smith who designed a series of unexpected and miniature exhibition spaces within the main staircase of the new hospital.

As the first of an anticipated series of artists’ residencies, Eva’s experience also drew attention to a range ofissues that would be relevant to future projects. Eva remarked upon the importance of the Play Specialists who work on each ward in acting as a vital link between artist, staff and patients. The Play Specialists were a great source of support and indeed with many subsequent projects have played a critical role. The need for an arts studio was identified – for storage of materials, a dedicated space for arts activity as distinct from the school or play areas, and a place for reflection and planning for the artist. As a result a creative arts studio was designed as an integral part of the new hospital.

Architects in Hotwells Primary School, Bristol

In the summer of 1997 the architects designing the new children’s hospital, Whicheloe Macfarlane MDP, worked with Year 6 pupils in Hotwells Primary Schoolto consult with them about what they would like to see inthe hospital environment. Seven different groups of children responded to the invitation to develop design ideas for the Outpatients Waiting Area that had been identified as a key area for an arts input.

The planning-for-real project resulted in many imaginative ideas from the children about possible themes and design details. The outcomes confirmed recommendations already made including child height reception desks, child level windows, colourful floor designs and opportunities for film and video screenings. Imaginative proposals such as a ‘whale cinema’ helped to inform how spaces might be developed in the hospital. Although the ‘whale’ was not realised, this did contribute to ensuring that the Outpatients Area was designed as a flexible space that could, out of hours, be used for non-medical activities such as films, video and performance.

Arts and Technology Consultancy

Annie Lovejoy an artist with great experience of digital arts was shortlisted and interviewed for the position of lead artist and subsequently commissioned in summer 1997 to research and advise on possible uses of new technology within a healing environment.

The discussion paper which Annie produced was informed by consultation with the Deputy Head Teacher from the school hospital and the Play Team Manager, as well as information from parent/patient surveys.In it she outlined a number of possible educational uses of CD Rom, intranet and internet packages both for children and for parents/families in relation to information about specific conditions, treatments, general information about the hospital etc.

Annie recommended artists’ residencies as a good way of working with new technologies. Those consulted had also stressed the need for personal human interaction alongside technological activities. Annie also commented on the increasing levels of computer literacy in children and adolescents. She advised that artist-led projects might create an alternative experience of new technologies to the ‘shoot ‘emup’ style gaming that dominates many young people’s computer game participation. Particular suggestions included ‘jamming’ or musicmaking on-line, which could involve creating new music through sampling.

As a direct outcome of Annie’s discussion paper and Eva’s residency, and as part of an ongoing programme of introducing staff to the possible roles of artists, two collaborative residencies were set up in the winter of 1997. Michelle Duxbury was the first Digital Artist in Residence and Bertel Martin was the first Poet in Residence. One outcome of the residencies was a unique Nativity Play involving children who were staying in the old hospital over Christmas.

Impact on the Arts Strategy

In addition to the specific outcomes detailed above,the contributions of artists within the feasibility stage also collectively informed the integral structure and principles of the future commissions and long term arts programme including the following recommendations detailed as part of the strategy document written by Lesley Greene.

  • All future artists’ briefs to encompass working with children in some way.
  • The arts strategy and programme should create opportunities for children in hospital to make links with the outside world through active connections with external arts organisations and schools.
  • The establishment of an Arts Advisory Group was recommended to oversee the commissioning process. The group eventually included representatives from: - hospital clinical, management and estates staff; the design team; The Grand Appeal; independent local arts organisations; parents; Public Art South West and Bristol City Council’s Arts Development Unit. The group was chaired by Project Director and Deputy Chief Executiveof the Trust, Graham Nix, whose presence brought essential financial and fundraising direction, and indicated the commitment to the arts programme for the Trust.
  • The need for an ongoing professionally co-ordinated arts programme incorporating music and performance arts, in order to ensure the sustainability of the original commissioning programme and its maintenance.Follow this link for more detail on the current arts programme.

Follow this link for the Introduction to the Commissions Strategy written by Lesley Greene in October1997.


From an early stage Lesley recognised the need for project evaluation and was keen to assess the role that art could play in relieving stress. Consultant Paediatrician at the hospital Professor David Baumwas a keen supporter of the arts programme and he also saw it as imperative that it be evaluated. He recommended the involvement of Maggie Redshaw, an Environmental Psychologist from the Institute of Child Health, University of Bristol and raised support for a study from the Champions of Child Health Fund.For more information see Consultation and Evaluation.


Artists were funded to work on the strategic development stage by a range of means. Annie Lovejoy’s consultation and Ray Smith’s initial pilot project of 15 days were funded from the strategy budget, part of the Trust’s capital budget.Eva Elsner’s residency and Maggie Redshaw’s evaluation study were supported by grants from Champions of Child Health. The Trust also identified some additional funds internally in order to continue Ray’s involvement at a critical stage in the development of the interior designs. All subsequent commission design fees were subject to the successful outcome of the first application to The National Lottery Arts Council of England Capital award. The eventual costs of commissions’ fabrication and installation were supported by a dedicated public fundraising campaign by the hospital’s charitable trust The Wallace & Gromit Grand Appeal. www.grandappeal.org.uk

Team Working and Project Champion

The project is the result of outstanding creative and co-operative team working. Lesley Green directing the arts programme and David Radford as lead architect were key driving forces of the project and The Grand Appeal fundraising team made the whole thing financially viable.

Project Director, Graham Nix worked tirelessly to instil a sense of the special nature of the project to all who contributed to its realisation, whether sponsor, carpenter, electrician or artist, in order to ensure their best efforts, and to build a strong sense of achievement and local ownership in the unique project. He played a critical role both in putting the team together and in directing and supporting it throughout its five-year development. Despite enormous challenges in terms of funding, his and UBHT’s commitment to the central place of the arts programme within the scheme ensured the project’s full realisation. Without such vision and conviction within the senior ranks of the Trust’s management, the arts programme might easily have been lost or watered down.

© Copyright Jane Connarty 2002.