Alder Hey children's hospital, Liverpool

Alder Hey children's hospital in Liverpool, founded in 1848, predates Great Ormond Street and is one of the busiest children's hospitals in Europe Photograph: Christopher Thomond

Nurses, doctors and NHS staff at work at Alder Hey. A regional specialist centre, the hospital attracts patients from as far afield as Shropshire, Cumbria and north Wales Photograph: Christopher Thomond

Although Alder Hey's standing was temporarily damaged by the organ retention scandal in the 1990s, it is the ageing buildings that are now threatening its world-class reputation Photograph: Christopher Thomond

Patient Hozaifh Patel in his cubicle. In the wards – designed to standards pioneered by Florence Nightingale in the 19th century – there is little natural light, and few places for sick children to play Photograph: Christopher Thomond

Another view of Hozaifh Patel in his ward cubicle Photograph: Christopher Thomond

The timing of Alder Hey's application for its urgent new building is sensitive, as it was made a week after the Royal Liverpool hospital requested a £450m loan for a similar newbuild project Photograph: Christopher Thomond

A mother and daughter at Alder Hey. The hospital used to have restricted visiting hours, but following overwhelming evidence that children get better quicker if their parents are with them, the restrictions were abolished Photograph: Christopher Thomond

A nurse with a patient Photograph: Christopher Thomond

A nurse using a cramped service lift Photograph: Christopher Thomond

According to David Houghton, a senior staff member at the hospital: 'Alder Hey is not safe by design anymore. It gets really hectic – distressed parents, food trolleys, medical deliveries. It's like a busy street market' Photograph: Christopher Thomond

A poster encouraging hand washing to discourage infections Photograph: Christopher Thomond

Intense activity at the nurses station as consultants carry out their duties on ward E3 Photograph: Christopher Thomond

Alder Hey currently treats 2,000 patients a year. The hospital's management says that if patient growth continues at the rate seen in the last few years, the numbers of children coming to Alder Hey will increase to almost 375,000 by 2015 – a figure with which the hospital 'just could not cope' Photograph: Christopher Thomond