Hospitals need to learn from hospices and cancer care centres about more uplifting design, writes Frank McDonald, Environment Editor

Edwin Heathcote, architecture correspondent of the Financial Times, had a bad time being treated for cancer in a relatively new hospital "doped out on morphine [ and] contained between a pair of kitsch plastic curtains, one printed with flowers, the other with some kind of early 1980s kitchen wallpaper design".

Writing recently in the British Medical Journal, he had no complaints about the "superb treatment and sympathetic care" he received - just about the "almost unspeakably dim architectural conditions", as a result of which "the stunning view over London's rooftops remained stubbornly invisible". While architecture "does not and cannot heal cancer", he pointed to research linking "views of trees, greenery, the sky and natural light with quicker healing", as well as a long history of hospital buildings "appealing to the soul", such as the Invalides in Paris or Wren's Royal Hospital in Chelsea.

It was the "grinding spiritual and aesthetic poverty" of most hospital buildings that inspired the late Maggie Keswick Jencks to establish a movement which has produced an amazing collection of cancer care centres in Britain characterised by "the redemptive power of space, light and sculptural form".

Maggie's Highlands Centre in Inverness, by Glasgow architects Page & Park, was named last November as Scotland's "Building of the Year".

Others have been designed by such well-known architects as Frank Gehry, Piers Gough, Zaha Hadid, Kisho Kurokawa and Richard Rogers - all working free of charge.

This has not gone unnoticed by the Irish Hospice Foundation (IHF). Imbued as much by its own experience, it has initiated a Hospice Friendly Hospitals Programme, in partnership with the Health Services Executive, to implement a change in culture here by "putting hospice principles into hospital practice".

Of almost 30,000 deaths in Ireland every year, two-thirds take place in some form of hospital or institution - two out of every five in acute hospitals.

However, as the IHF says, this particular function of theirs - as places in which increasing numbers of people are going to die - is rarely discussed in public.

Nonetheless, according to social theorist Ken Worpole, the issue of how to make death for hospital patients as dignified as possible "now exercises care professionals in the developed world" - and should also be a priority concern for architects, interior designers, hospital managers and administrators.

In a report for the IHF, Worpole says many of Ireland's older hospitals are "simply not good places from which to leave this world". Who could disagree that "one's last days ought to be spent in conditions of tranquillity and beauty - not facing a windowless wall, with a television blaring in the background"?

One new Irish hospital he visited had a room for the bodies of accident victims awaiting the arrival of grief-stricken families that had "the grim nullity of a police station holding room". This highlighted for him the need to "think long and hard about creating places of final sanctuary and farewell".

His report, Honoured Guests, Honoured Places, argues that good design not only makes hospitals look better, but also enables them to function more effectively. However, "it cannot simply be reduced to issues of beautification, of heritage colour schemes or contemporary furnishing styles and aesthetics".

Worpole cites the TB sanatoriums built in Ireland during the 1950s: "buildings and landscape settings of great clarity and clinical optimism" that provided patients with large amounts of natural light and access to sheltered terraces and gardens - a far cry from the "forbidding barrack blocks seen elsewhere".

In the hospice suite in Stockholm's Ersta Sjukhus Hospital, which he visited, a set of traditional "Nightingale wards" had been converted into a hospice environment, with the nursing staff having the final say regarding the design and furnishing of the new suite of rooms and communal spaces.

"What was achieved was an exquisite atmosphere and sense of hospitality like the very best country hotel," Worpole writes. "In this sense, the hospice offered something more than a home, domestic in feel perhaps, but with a more powerful sense of honour, dignity and occasion."

Ideally, he says, patients, families and nursing staff need to be consulted in realising this larger vision, "raising expectations beyond curtains or blinds, to real design issues of circulation, privacy, access to natural light and uplifting views, communal meeting places and other substantive design matters".

At the Royal Hospital in Donnybrook, Worpole was greatly impressed with the work carried out to personalise bed areas, even though more space for each patient meant a small loss of bed numbers. "This surely is a price worth paying to achieve an increased sense of personal autonomy and homeliness."

Within hospitals, as one contributor at a seminar said, "to have rooms for the dying included at the design stage is not in itself enough - you must embed the behaviour that will support the use of the room for its intended purpose very early on when the building is occupied. This is our greatest challenge."

But finding time for dying patients and their families is a real issue in hospitals where the main emphasis nowadays is on turning over beds.

"Aren't they dead yet?" is often the query that's been "heard in mock-ironic tones from a bed manager desperate to find beds for new patients", as Worpole notes.

An architect with experience of hospital design is quoted as saying that briefs are "very mean" when it comes to areas that don't have defined clinical uses, such as waiting rooms. They are also very defined wall-to-floor and wall-to-window ratios, none of which contribute to good architectural quality.

"Good design needs space and daylight first and good materials second. If you haven't got the first, the second cannot really solve the problems caused," he comments. And there's the rub - if a design brief is mean and inflexible, there isn't much that even a talented architect can do with it.

However, architects may also be at fault, according to one senior hospital administrator in Norway, who told Warpole that most of them "are secular and they simply don't understand how deeply religious hospital buildings can be" - not necessarily in terms of overtly religious places and spaces.

The author interpreted this comment in his report as "a claim for a strong sense of ritual, of processional, of sanctuary and quietude in buildings and rooms that the newly born, the sick, the mentally distressed and the dying, inhabit in ways which we may never fully understand - until it happens to us."

His report advocates single rooms to provide more privacy for dying patients and their loved ones, arranged in clusters around a palliative care nursing station (as in St Olav's Hospital in Trondheim, Norway), with guest rooms where close family or friends can stay overnight if need be.

www.hospicefriendlyhospitals.net