Healthy hospitals

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.

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

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.

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.

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?

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.

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.

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

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

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.

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