This article is part of the following series: The Hospital Multiple
Earlier this year, the world became familiar with the facade of Britain’s St Thomas’ Hospital when, in late March, it became the backdrop for breaking news. After UK Prime Minister Boris Johnson was admitted to the hospital with COVID-19, the BBC began broadcasting live bulletins from the hospital’s North Wing, where Johnson was convalescing in intensive care. For a while, Johnson relinquished political power under the care of medical staff at ‘Tommies’, as the London hospital is popularly known.
Following this interlude as a patient ‘treated the same as any other’, Tommies – which is also a slang term for low-ranking British soldiers – provided the platform on which Johnson affirmed himself as a strong man able to successfully ‘fight’ off an ‘invisible enemy’. Wartime allusions have subsequently been deployed to represent not only Johnson’s recovery but that of the nation as a whole. The government and press have drawn on iconography from the Second World War in what one commentator describes as a new contagion: the ‘spread of COVID nationalism’ (Davies 2020).
Yet alongside such appropriations, Tommies has also acted as a site for counter narratives to emerge. These reject characterisations of the virus as a ‘foreign body’ (Napier, 2020). Many of the staff at Tommies arrived as migrants to study and work at the hospital. Through public demonstration, they have challenged the idea of ‘laudable sacrifice’ whereby they can reasonably be expected to lay down their lives for their country as a British soldier might (Stein 2020).
A unique disposition
This photo-essay examines Tommies’ material presences and absences across time, exploring how these inform current political mobilisations and affects. While some images are drawn from official archives, others were taken as personal documentations. Tommies holds, I argue, a unique disposition towards the British state. That is to say, it plays an highly ambivalent role in sustaining certain (Imperialist) expressions of British identity.
Below, I aim to show how Tommies gives rise to various ‘hauntings’ (Derrida 1985, Fisher 2009). Mark Fisher (2009) understands Derrida’s term, as a ‘pun on the philosophical concept of ontology, the philosophical study of what can be said to exist’ (43). He described the sense in which contemporary culture is haunted by the ‘lost futures’ of modernity, cancelled by postmodernity and neoliberalism. Rather than representing an attempt to ‘revive the supernatural’, Fisher proposes that ‘hauntology’ can help describe ‘that which acts without (physically) existing’ and which prompts ‘reverberative events in the psyche’. The term usefully ‘brings into play the question of time’, and more particularly, ‘broken time’.
Completed in 1976, the North Wing of Tommies is a Modernist extension that reflects the post-war desire for a society based on egalitarian principles. It was part of a national reconstructive project to create civil infrastructure ‘fit for heroes’ (as the spirit of post-war renewal is often evoked). These aspirations run counter to the principles and policies of the UK’s current populist leader. Consecutive Conservative governments have attempted to sanction and normalise growing social and economic inequality – including those so starkly revealed and reinforced by the pandemic. As such, the North Wing of Tommies stands as exemplar of a particular ‘lost future’. The hospital is a Modernist project that only part- erases the Victorian hospital amongst whose ornate form it so robustly announces itself as mis-fit and ‘relic of the future’ (Fisher 2013: 55).
In making the case for Tommies to be seen as an unstable site for British identity to attach its affects, I draw on writings which discuss the material fabric of ‘new’ Berlin – a city which, like London today, played a key role in allowing the German people to come to terms with the iconic representations of their own Nationalist past. Forms of Nationalism and Modernity are similarly being ‘staged and re-staged, represented and contested’ at the present time in London (Till, 2005: 5). Tommies has become an energised locale for concepts of health, belonging and entitlement to lock and engage. The ‘shock’ crisis, brought about by the pandemic, presents opportunity for the weakening, as well as the consolidation of different interpretations of identity through the ‘soft power’ of culture.
Staging and placement
Part of Tommies distinction can be explained by its location. The central London site in which it is positioned lies at the heart of political power. Located at one end of Westminster Bridge, it squarely faces The Houses of Parliament on the other.
This is a zone of rivalrous power where different but related national institutions mediate the relationship of the citizen towards the British state. Other emblematic buildings and ‘flagship’ national institutions surround Tommies. These date mostly from the Victorian period and include neighbouring Lambeth Palace (home to the Archbishop and Church of England) as well as the former County Hall (once seat of the London Mayor and the Greater London Council). Diagonal to Tommies is the newest addition in this cluster, Portcullis House, a post-modern office space for Members of Parliament.
Certain British cultural affects have been used to explain how these buildings relate. Using tropes of politeness, for example, one critic speculates that Portcullis House lacks ‘civic grace’ and takes-up a position of ‘pugnacious opposition’ next to Pugin’s ‘well-mannered’ masterpiece (Glancey, 1999). London’s former Mayor, ‘Red Ken’ Livingstone, used this vantage point on the opposite site of the Thames (the same side as Tommies) to post high unemployment numbers on the roof of County Hall in the 1980s. Livingstone drew the ire of then-Prime Minister, Margaret Thatcher, who abolished the Greater London Council (GLC) in 1985 and this visual reproach of her Monetarist economic policy along with it (the council building remains standing to this day, but has been repurposed as luxury hotel). Such evacuations prove that robust outward appearances can belie institutional vulnerabilities: ‘Architecture is intimately exposed to ongoing interpretive changes to content’ (Pogoda & Traxler, 2018: 158). The seat of Local Government power in London was effectively removed from the picture in this single act.
Beyond its status as a London hospital, Tommies has long acted as placeholder for narratives of national recovery. The North Wing intentionally sought to embody the values of the National Health Service (NHS). As the architects stated: ‘The new building will sustain and strengthen Tommies’ place as a National hospital’ (GSTH 1976). The NHS was conceived as the keystone of the welfare state, a health service in which ‘the rich and the poor are treated alike,’ a system whereby ‘poverty is not a disability and wealth is not advantaged’ (Bevan 1953). The socialist principles upon which it was founded are implicit in Tommies’ organisation of clinical space. They linger in the design of wards here, even as the foundational principles of the NHS have been eroded by what one author describes as stealthy ‘dismantlements’ in more recent decades (El-Gingihy 2015).
Histories of conflict & care
Along with location, rich histories of conflict and war emerge through Tommies’ accumulation of architectural forms. Florence Nightingale’s designs for its ‘pavilions’ – high-ceilinged wards with airy balconies – were based on understandings of communicable disease drawn from the Crimean war. Only when medical knowledge advanced could wards be built one atop of each another, facilitating towers of unrestricted height. The North Wing emerged out of disagreement over how to best deal with damaged inflicted by German bombers during The Blitz. (Photographs taken at this time reveal the gap in the hospital fabric through which Parliament peeps as a near-miss.) Long struggles over the future development of the hospital were navigated through designs drawn up in the 1950s and 60s by a succession of architects (Hughes 2000).
The 13-story tower was intended to be the first of many other (unbuilt) high rise multiples, a proposal which would have seen a ‘dream hospital’ rise-up along the Thames. One 1958 press report extolled plans for a new ‘block so modern it will be a patients’ and doctors’ paradise… it will have panoramic views over London… an ultra-modern hospital which will tower over Westminster’.
When it opened in 1976, the North Wing was heralded by Hospital managers as marking ‘a giant step forward in the standard of hospital provision’. A celebratory pamphlet stated that: ‘In fact, many hotels would envy the superb views over London that the wards command for patients’ (GSTH 1976: 31). The sense of equal entitlement was an implicit component of the architectural elevation, one realised in a decade when social and health inequalities reached historic lows. In this sense, the North Wing can be seen as an exemplar of ‘the virtue of infrastructure as social good’ (Pinto 2018), in that it allowed citizens to take up a ‘rightful place’ in the NHS – as patients and workers – regardless of their ability to pay, their class or ethnic background.
As well as an occasion for celebration, however, the opening of the North Wing in 1976 was shaded by disappointment. A reluctant ‘accommodation’ of Victorian infrastructure was forced by the economic recession of the 1970s when budgets were cut. This was a painful scaling back acknowledged by managers as ‘an agonising re-appraisal’. Cut backs in this recessionary period in the 1970s prefigured decades of austerity that would follow, when the abandonment of socialist principles were more explicitly advanced through periods of boom and bust.
Nuanced feelings of loss and gain continue to be felt at this out-of-joint site. Of all the figures from the past to retain ‘ghostly’ material presences at Tommies, Florence Nightingale’s is perhaps the most reoccurring. In addition to a life-size statue in Central Hall, there is a bespoke Museum at basement level devoted to celebrating Nightingale’s life and work. Her name is also celebrated in the title of the ‘Nightingale School of Nursing’.
Hauntings can ‘intercede in hospitals’ acting as ‘places of redress for restrictive pasts’ (Pinto, 2018: 626) some have suggested, including those borne directly out of Britain’s post-colonial history. In 2016, the memory of another nurse of the Crimean War found prominent position outside the North Wing. A larger-than-life rendition of the Jamaican-born nurse, Mary Seacole, is depicted in bronze, eyes set on a far future horizon (and Big Ben opposite). This tribute to Seacole was hard fought for, over a ten-year-long campaign, by senior nurses from the Windrush generation keen to see the contributions of all nurses from this Caribbean countries publicly acknowledged. The placement of this artwork angered many of Nightingale supporters who thought their champion more ‘entitled’ to such an honour.
Indeed, as a group of sociologists have recently pointed out, the NHS has always been a ‘an imperially-resourced service,’ with the NHS ‘a site of anti-migrant agitation and an institution heavily reliant on migrant labour,’ (Fitzgerald et al, 2020). Karen Till also writes of feelings of ambivalence prompted by memory and place: ‘Places are never merely backdrops for action’ but places where people ‘can return, make contact with their loss, contain unwanted presences or confront past injustices’ (Till, 2005: 8).
Critical readings of how Seacole’s statue was allowed to take shape here suggest it is best interpreted as another type of forced accommodation (part of the larger future-facing project embodied by the North Wing, though disguised in an arcane art form of the past). As the sole statue of a named Black British citizen in the whole of London, it was only made possible through ‘the loyalty’ that Seacole showed the British military – one historian of Black history asserts (Siblon 2020).
Indeed, at the unveiling of the Seacole statue, a jumble of conflicting loyalties became visible, with many flags planted at this spot to claim it as their own. Till argues that ‘one of the way people make ghosts appear, is by selective remembering particular parts of the past through place… to haunt is to possess some place’ (my italics). Tensions over the meanings ascribed to historic figures such as Seacole are keenly felt at Tommies and pre-date the joyful demonstrations of Black Lives Matter protesters – who toppled Edward Colston’s statue this summer. The protests highlighted the continuity between contemporary injustices and those committed in the (imperial) past. At Tommies, a site full of dislocations but also sly alignments, histories of race, sex and class are being mediated in relation to empire. Tommies evidences how ‘culture wars’ have been waged over many decades and periods, not just those of recent years.
My own history intersected with that of Tommies when I curated a series of artist-led projects across the Nightingale School of Nursing in 2016, part of a wider cultural programme centered on the theme of ‘utopia’. I invited contemporary artists to engage with medical students on this topic. Discussion amongst nursing students at Tommies centred around the ideal of the ‘perfect nurse’ and drew on archival images which threw light on contemporary political struggles.
That year, nurses and junior doctors were engaged in an industrial dispute with the Health Secretary over their pay (relative to working hours). These changes would likely adversely impact care, they argued. One protest saw healthcare workers spill over from Tommies picket line as they linked hands across Westminster Bridge, a chain that extended its reach into the environs of Parliament Square. I witnessed this spontaneous event – undocumented anywhere else to my knowledge – with artist Anthony Schrag, who photographed the connecting human chain. Their steps strike a rhythm amongst the architectural motifs in what appears as an artful performance of collective solidarity. Such actions are testimony to the ‘lost futures’ of a more socially egalitarian society that rupture periodically into the present at a site, one which solicits acts of trespass and redress across territories of time and space.
Schrag went on to establish The Secret Society of Imperfect Nurses, a forum which provided a safe, clandestine space for the sharing of vulnerabilities. In doing so, he prefigured post-pandemic protests against compulsory heroism. For Schrag, only by embracing our vulnerabilities as potential sources of strength was it possible to mobilise ‘a resistance movement against perfection’. This call was part of his larger mission to develop ‘a social forum that aimed to explore expectations and limitations of being a professional carer in today’s NHS, as well as a wider reflection about the notion of the perceived utopia of the healthcare system, in general’ (Schrag, 2016:10).
Schrag’s intentions stands in stark contrast to Boris Johnson’s use of his own near-death experience at Tommies to avoid rewarding those who saved his life – through pay raises that would afford them a ‘living wage’. Johnson later reasserted hierarchies of power, asking the public to ‘applaud bankers’ as much ‘as nurses and doctors’, part of his post-pandemic rallying call to ‘build, build, build’. He seeks to re-allocate feelings of attachment through symbolic identification rather than material support. The conditional restrictions that allowed the memory of Seacole to take form outside The North Wing can thus be neatly by-passed in favour of a singular emotive response – as ‘competing symbolic claims hamper straightforward affective attachment’ (Pogoda & Traxler, 2018).
The perfect nurse is presented as one compliant with military codes and unquestioned command structures. In protests which took place on Workers Memorial Day at Tommies in 2020, this social order was directly refuted: ‘Nobody goes to work to die’ one banner ran. Placards appropriated the NHS acronym to read, provocatively: ‘Not Hancock’s Slaves’ and ‘Black Nurses Lives Matter’.
Tommies’ then present a ‘fluid mosaic’ of signs, which gives it an ‘unstable optic identity’ (Till, 2005: 5) reflective of the reckonings with histories of social justice it embodies. NHS workers struggle to retain the vestige rights and freedoms provided by the Welfare state whilst working within stricter restrictions set on British citizenship – through partial entitlements bourne of ‘hostile environments’.
The fate of Tommies might not be so dissimilar to the abolition of the GLC. Indeed, it can be seen as the further continuation of Thatcher’s neoliberal agenda. This time around though, the abolition of the NHS and its iconic emblems will not be openly declared, but hidden under public protests of praise and claps for carers. It will be a ‘restructuring’ from within that allows the NHS acronym to stand as brand misnomer (behind which private firms, such as Serco, can hide their outsourced involvement.)
The German historian Sarah Pogoda worries that haunting is ‘too romantic’ a word to describe the repossessions taking place in the pandemic’s wake which, she claims, more resemble ‘exorcisms’. Perhaps this is an idea worth entertaining in relation to a new cancer hospital built at Guy’s Hospital, Tommies’ partner hospital a little further down the Thames. Top floors are reserved for private patients with NHS patients occupying lower tiers. Here, we can see the ‘envy’ cited in the 1976 pamphlet satisfied 40 years later through this re-purposed funding model. Money from one part of the hospital (the private) is said to pay for the (public), presented not as incursion as much as cause for gratitude.
The two-tier society this model establishes is perhaps what Johnson has in mind with his latest call to ‘build back better’ – a continued project of welfare state deconstruction, disguised as one of national recovery. The discursive spaces opened-up by performative activism at Tommies could provide the tools for ‘vivid public discourse’ on these points, as much as I raise them here for ‘experts’ and academics (Pogoda & Traxler, 2018: 166). It is through the public performances of protestors and artists that publics might escape the status of ‘consumer to become citizens who engage with an ambiguous national history and identity’ (Pogoda & Traxler, 2018:165). Conflicting interpretations of wartime experience take on a fresh impetus as they play across this hospital site in the pandemic’s wake. Tommies sits centre stage of political, economic and cultural struggles to imagine a better future by way of a tragic present and many painful pasts.
Dr Frances Williams completed a doctorate in 2019 at Manchester Metropolitan University where she studied the field of practice known as ‘arts in health’ in relation to devolution and the British State.
I thank Dr Wanda Zyborska, as well as Anthony Schrag and Becky Shaw, for commenting on earlier drafts.
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