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Although environmental evidence-based design is still some way behind evidence-based medicine, it is not idle to speculate that there will come a time when we have enough evidence to include the quality of the environment as a method of therapy.

It is important for the whole of the NHS to accept the value of the design of the environment as essential in the development of medical buildings.Any such step change needs support at a number of levels: political, financial (Treasury), administrative and professional.For the first three we have achieved qualified support, but we are still dogged by ignorance and a fixation with lowest price. These can change. The fourth is the most difficult since it covers not only the medical but also the design professions.

The medical profession has so many preoccupations, difficulties and subgroups it is a difficult group to lobby. However, there is a general agreement that health environments are generally poor and could be improved. The National Plan has pumped untold sums into the infrastructure of the Health Service. What has not yet been widely accepted is that these improvements can have genuine therapeutic benefits for patients, save money by reducing length of stay and help to alleviate the depressing effects of cross-infection, which costs at least £1 billion per annum.

There are other spin-off benefits relating to staff morale, recruitment, health and long-term employment. In financial terms this is probably the most compelling factor since 70-80 per cent of hospital costs relate to staff.

Equally, the design of a health building can have a substantial effect on visitors and on the community.

Hospitals are key public buildings, and as such contribute to community morale. The report,2020 Vision: Our Future Healthcare Environments, supported by the RIBA Futures Group and the Nuffield Trust, foresees multifunctional buildings with social, health and other services under one roof. As hospitals are increasingly seen as people-centred therapeutic organisations, there is real potential to design buildings that can actually play a role in the healing process.

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