"Some old hospitals are too small or their specialities have changed," says Jonathan Street, spokesman for North Thames Region of the NHS. "For modern acute care, you need modern buildings, for example with floors and ceilings that can be moved. Some of today's medical equipment is two storeys high and doesn't fit into Victorian buildings."
Property values, local politics and other factors help determine a hospital's long-term prognosis, which means that some manage to remain close to their healing roots.
Circle 33 Housing Trust and New Islington Housing Association converted the Old Royal Free Estate on Liverpool Road in Islington, providing 178 residential units in variably sized flats and houses, including four homes specifically designed to wheelchair standards. The scheme includes a Psychiatric Rehabilitation Association day centre, and sheltered accommodation.
Circle 33 also redeveloped the Jewish Hospital in Haringey at a time when Tottenham had a large Jewish population and medical science was at a stage such that the facility was known as the Home for Jewish Incurables. The building became obsolete, Tottenham's demographics shifted, and the listed building on two acres is now 79 units of social housing.
In Kensington, the Royal Brompton is currently being redeveloped for luxury housing, and in Hampstead, Inverforth House and Mount Vernon were both recently refurbished. Indeed, before becoming a hospital, Inverforth House had been home to Lords Inverforth and Leverhulme and the banker John Gurney Hoare. In nearby Friern Barnet the erstwhile psychiatric hospital that is now Princess Park Manor is not quite as luxurious but enjoys a sizeable expanse of mature parkland.
Many hospitals were built on spacious grounds in urban as well as rural locations not only because more land was available in Victorian times and earlier this century, but also because space had therapeutic and practical value: "An asylum should be placed on elevated ground and should command cheerful prospects, should be surrounded with land sufficient to afford outdoor employment for males, and exercise for all patients, and to protect them from being overlooked or disturbed by strangers." This was the view of the Commissioners in Lunacy, quoted by an architecture researcher from York University, Robert Mayo, in a report for the Royal Institute of Chartered Surveyors.
These principles are readily evident in Virginia Park, the former Holloway Sanatorium in Virginia Water, Surrey. Here, historical buildings designed by WH Crossland grace 24 acres of walled parkland. (To the general public, Crossland is probably better known for the Royal Holloway University in Egham, which he also designed.)
Derelict for many years, the 100-year-old property was destroyed by vandals for fun, and by thieves for profit. The thieves stripped lead from the gutters, which facilitated further water damage. But with English Heritage oversight and a punctilious restoration project mounted by the developer, Octagon, craftspeople in various disciplines returned the buildings very near to its original condition.
The Grade II listed chapel is now a recreation hall housing a swimming pool beneath a hammerbeam roof. "The entrance hall, now fully restored, is a riot of brilliant colours, patterns and grotesque imaginary creatures, designed in accordance with the `French Method' to distract and enliven the patients," Mayo notes.
Rich in mineral wells, Harrogate is also rich in hospitals and sanatoriums, many of which have had their day. Like the Holloway Sanatorium, the 1824 Royal Bath Hospital was disused and heavily vandalised until the developer, Crosby, rode to the rescue. On six acres, Sovereign Park has 78 units, including 13 apartments in the main hospital building.
Also in Harrogate, Crest Homes has secured the seven-acre Harrogate General Hospital site for 150 units. The Raven Group, a developer specialising in listed buildings, is currently involved in several hospital conversions such as St Mary's Hospital in Hereford, where nearly 100 new units will be built on 46 acres, and St Andrews Hospital in Norwich, where 90 units will appear on 15 acres.
In medieval Chester, Bryant is developing 100 units at the Royal Infirmary. Apartments will be available in the refurbished hospital building, and new-build mews and town houses are also being constructed.
Among the most spectacular developments will be Crest's Claybury Hospital: a full 235 acres of listed buildings, towers and turrets, ancillary buildings, park and woodland near the M11 in the London Borough of Redbridge. The sales office opens next year for a development expected to take seven years.
The term "ancillary buildings" does an injustice to an extraordinary complex of interconnected buildings with interior courtyards and surrounded by ancient woodland. Last century, soldiers dropped like flies in hospitals as well as on battlefields. "Lack of ventilation was identified as the key problem, and as a result hospital and asylum design was improved through the pavilion system of radiating ward buildings built to a high standard," Mayo notes.
"When we built the Chelsea and Westminster, we closed five hospitals," says Mr Street. "In building the new University College Hospital, we are closing UCH, Middlesex, Elizabeth Garrett Anderson, and the Hospital for Tropical Diseases."
A defunct hospital may not die in the sense that, as with the Elizabeth Garrett Anderson, it will be incorporated into the new facility. But others live on only because they have value as homes. Not everyone approves, but many fine buildings, would otherwise turn to dust.
Robert Mayo, `The Adaptive Re-use of Victorian and Edwardian Hospitals and Asylums', RICS, 0171-222 7000. Estate agents: Bryant 01942 728728; Crest North 01423 501661; Crest South 01932 847272; Crosby (01423 524644); Raven 0171 235 0422; Octagon 01372 361777