A new RVH for a new century: maintaining clinical excellence. Annual oration: Royal Victoria Hospital, Belfast, October 2003.

This oration, and the record of it for publication, mainly focuses on the new Royal Victoria Hospital building opened officially on 2 September 2003, but it is interesting to compare and contrast the needs of the Royal Victoria Hospital at the ends of the 19th and 20th centuries. At both times there was increasing dissatisfaction with the hospital's accommodation while the demands on the hospital were increasing rapidly. For example, it was felt that more complicated surgery was much safer in a central facility. In 1900 this was the contrast between home and hospital surgery while towards 2000 the need for intensive facilities for complex major operations was apparent. In both eras the case for a new build was compelling but finances were a major issue. The process for the move to the RVH site and the process for the new build in 2004 had similarities. Firstly, the site of the rebuild had to be established (Figs. 1 and 2). Secondly, it was necessary to change the management of nursing. Thirdly, it was vital to involve medical staff. On both occasions members of the RVH medical staff were closely involved in decisions on the type of hospital and the facilities needed. Even 100 years later one has to