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Most of the discussion around the expansion of intermediate care has focused on appropriate means of rehabilitation, but the environment in which it is provided is also very important, writes Anna Coote.

If the current expansion of intermediate care is intended to speed the process of getting patients out of hospital and back into their own homes, it also signals an acknowledgement that hospitals are not the best places for people to convalesce and prepare to live independently again.

A modern hospital is where we go for treatment, tests or intensive care. A garage, laboratory or repair shop. It is high-tech and expensive; it is not a warehouse for indefinite storage - a function (cynics might say) left to nursing and residential homes.

An intermediate care centre is neither garage nor warehouse. Indeed, the idea doesn't lend itself to industrial metaphors. You have to think of a spa or health farm, or perhaps a school or college. It is where we go to build up our strength and learn or re-learn the skills we shall need for later on.

Most of the discussion around the policy and practice of intermediate care has focused on process rather than environment. What are the appropriate means of rehabilitation - the procedures, activities, standards and safeguards likely to yield the best results? All this is essential. But environment matters too, because the quality of the place in which intermediate care is provided will either help or hinder recovery and restoration.

There is a useful piece of research that demonstrates that patients who look out on trees recover faster than those who look out on a brick wall. This is hardly a counter-intuitive finding. But how much attention is paid to the therapeutic effects of buildings? And how far is this kind of insight brought to bear upon the design of health and social care premises?

The government has embarked on the biggest building and refurbishment programme in the entire history of the welfare state. Many billions will be spent over the next decade on hospitals, primary health care centres, and a range of facilities for specialist health and social care services - including "community hospitals" and other centres for intermediate care.

Many hospitals built in the 1960s and 1970s were acts of cruelty - to the eyes of the public and to the staff and patients who served time in them. If they had a symbolic purpose, it was to celebrate the mastery of science and subjugation of the patient. Mercifully, there are signs that some lessons have been learned since then. But it is doubtful whether all new building projects will now be given the rounded consideration they deserve.

What should be taken into account when plans are drawn up to build or refurbish? That depends upon whose interests are central. Buildings that serve the interests of local "civic pride" or senior consultants may give us a landmark to die for and a shelf full of awards, but there is no guarantee that they will help staff to give their best, or patients to get better. If the interests of patients are central, we should get different results - especially if planners take account of future as well as current needs.

Patients primarily need to be safe from harm, of course. Beyond that, they need congenial surroundings that encourage them to rest and recuperate, to feel good about themselves and - when they are ready - to look outwards and feel optimistic about the future. They also need staff who are healthy, committed, valued and able to work to high standards. All this has implication for the layout and decor of the interior, for natural and artificial light and heat, for ventilation and views, for the use of colour and space, for the relationships between beds, windows, doors, corridors, bathrooms and communal areas.

And it's not just the interior that matters. Location is important - is the building accessible to patients, visitors and staff? Are there good public transport links, or does everyone have to travel by car - increasing health risks associated with air pollution and traffic accidents? Is the building designed to make maximum use of natural light and ventilation, and to harness renewable sources of energy, so as to minimise the use of fossil fuels and keep down the volume of carbon dioxide emitted from the building? Are there trees and lawns and plants, or just a big car park? Are the building materials renewable?

Buildings that damage the environment, that have high running costs, that have a negative effect on human relations and morale are unsustainable and self-defeating in the longer term. But thoughtful planning and design could have the opposite effect and ensure they make a positive contribution to patient recovery.

Anna Coote is director of public health, The King's Fund.