The following correction was printed in the Guardian's Corrections and clarifications column, Wednesday August 24 2005
In the article below, we incorrectly identified Jon Rouse as the chief executive of Cabe (Commission for Architecture and the Built Environment). Mr Rouse moved from Cabe to become chief executive of the Housing Corporation last year. Richard Simmons succeeded him at Cabe.
'Take two abstract watercolours, a melodious string quartet and an easily accessible view of a garden twice a day, and you should be right as rain in no time." It's not your average prescription for recovery from ill health. Increasingly, however, health workers and patients are realising the importance of non-medical factors in providing the most efficient and effective treatment.
This is particularly true of hospital patients. However routine the procedure, a stay in hospital is a daunting prospect. And traditionally built hospitals are hardly conducive to reducing stress: long, windowless corridors, complicated sign-posting, cavernous, echoing wards and dull, institutional colour schemes combine to oppress the patient and their family. But in the midst of the biggest building programme the health service has seen for years, this is beginning to change. Bodies such as the Commission for Architecture and the Built Environment (Cabe), which champions design as a force for economic and social change, are pressing for hospitals to be designed along more patient- and staff-friendly lines.
"Cabe's research demonstrates how good design can increase staff morale, patient wellbeing and even reduce the use of painkillers," says its chief executive, Jon Rouse. The need for change is backed up by Cabe's recent internet survey, which invited people's experience of hospital environments and recorded responses such as "dehumanising", "Kafkaesque", "grim", "windowless", "designed to confuse" and so, depressingly, on.
So how is the patient going to notice the difference? "A lot of it will be intuitive. A sense that you're in an environment contributing towards healing, rather than just a box," says Cabe research adviser Kate Trant. It's about more than just making hospitals more attractive. "You say 'design' and people think 'looks', but it's about the way the space is organised. Simple things such as the placing of electrical sockets and sufficient storage space, so people aren't falling over things."
Frequently these "simple things" can make a huge difference. A 2004 study in Stockholm discovered that replacing sound-reflecting ceiling tiles with sound-absorbing ones in a coronary critical care unit led to patients sleeping better, suffering less stress and resulted in fewer re-admissions. Similarly, patients with severe depression who stayed in east-facing rooms with high levels of sunlight were found to stay in hospital 3.7 days less than those who didn't.
Innovative hospital designs, funded by the King's Fund Enhancing the Healing Environment programme, include a courtyard at the Royal Brompton in west London that was developed into a haven for patients and visitors, a corridor at Barnet and Chase Farm, north London, that was redesigned to distract patients on their way to theatre, and a stained glass window in the ward for the elderly at St Mary's, Paddington. An evaluation of these and other projects found that the benefits included reduced levels of vandalism and violence, faster patient recuperation, improved staff morale and higher levels of recruitment and retention.
Other projects that have adopted innovative approaches in consultation with staff and parents include the cystic fibrosis unit at the London Chest Hospital, which commissioned artist Esther Hardie to create a unique environment featuring mosaic artwork made by the patients, and the new oncology wing at St James Hospital Leeds, which will incorporate landscaped terraces and courtyards.
Many of these examples involve an overlap between the fields of healthcare, design and the arts, with the arts becoming an increasingly important part of the healing process. Paintings in Hospitals loans 4,000 pictures to more than 250 hospitals, hospices and other healthcare facilities, including pieces by Elizabeth Blackadder, Peter Blake and Quentin Blake. Last year, it received £100,000 from the Department of Health and NHS Estates to increase its collection, a grant that was seen as part of a new government initiative to strive for better-designed hospitals.
Jo Desmond, senior curator for Paintings in Hospitals, is a passionate advocate: "We started off lending pictures to wards and waiting rooms; now it's much more widespread. In the past there were difficulties in terms of funding; do you spend the money on a scanner or a picture? But there's been a shift - hospitals realise that environment plays a big part."
Many patients also benefit from live music provided by Music in Hospitals. "We stage more than 4,000 concerts a year," says Diana Greenman, the charity's chief executive, "and the wonderful thing is watching the way that music can break down barriers. Patients who have difficulty opening up and talking can be reached through music.
"I was at a concert a while ago. There was a patient there, plainly in some distress and pain, and as the music started she gradually quietened down, and then her fingers started tapping, and by the end of the concert, instead of being slumped in her chair she was sat bolt upright, singing Land of Hope and Glory and waving a Union flag. And we've had people who've suffered strokes and can't speak and they'll be singing along to a well-known song."
The Chelsea and Westminster Hospital, a leading light in the fields of design and the use of art and music, conducted a study of the effects of visual and performing arts on its patients. Amid a swath of evidence for the beneficial effects of the arts in hospitals, it found that: live music performed in the waiting area of the clinic was effective in lowering the blood pressure of patients; duration of labour was 2.1 hours shorter, and requests for epidurals diminished, when women in labour were in the presence of a specially designed screen; patients exposed to visual arts and live music during the pre-operative period required less induction agents before anaesthesia; and patients exposed to visual art and live music during the post-operative period required less analgesia and stayed one day less in hospital.
All of which means that aesthetic and design considerations, visual arts and live music have a quantifiable effect on the medical wellbeing of patients, the morale and retention of staff and therefore the use and levels of hospital funding. As, on a slightly less widespread basis, do visits from clown doctors and carefully selected cats and dogs. And every one of them is a lot more fun than having a drip attached.
· For more information: Paintingsinhospitals.org.uk; Music-in-hospitals.org.uk; Petsastherapy.org.uk