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Can we afford to have our hospital buildings in a poor state of health?

Perhaps Lucy Carmichael did not choose her words as wisely as she might have done, when she wrote: 'Efficient healthcare delivery is the most pressing concern for NHS trusts and their preferred bidders. The creation of a healing environment and good urban design almost inevitably take second place.' One's first reaction is 'well, of course'. Imagine the uproar if the opposite applied, with doctors explaining that they weren't doing much to heal patients, but still their hospitals were really, really nice places in which to be sick - and die.

But this is an unreal dichotomy, and Carmichael, writing in CABE's Design Reviewed 2, is saying something important. You can't set one thing against another in this crude fashion - otherwise we would perpetually be asking: 'put aside money for the arts or offer disability benefit?', 'tackle Third World debt or mend the roads?', and 'stop drunken driving or put money into education?', and rapidly all sorts of issues that people rightly care about would disappear from our agenda.

Good hospital design is a concern for us all. Recently, on our pages, architect Chris Dyson picked St Mary's Hospital, Paddington, as the worst building he had ever seen, prompting a response from one of the original architects. He said that the hospital worked well, was delivered on time and on budget, and was designed from the inside out - so what if it didn't look pretty?

He had a point, of course, but then another of CABE's criticisms of contemporary hospital design is that it is too short-sighted about long-term functioning. Yet again, though, we must avoid a false dichotomy - this time between function and appearance. The smaller health buildings featured on our buildings pages this week (pages 24-37) show that good design is certainly achievable at a relatively small scale. And, of course, it must be on the scale of large hospitals as well. Playing a major role in our cities, they must be good neighbours and must not depress the people who walk past them, work in them or stay in them. Other countries have some great hospitals, as we have done in the past. The question is not whether we can afford good design for our hospitals, but whether we can afford not to have it.

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