Designed for healing.

Of all the branches of architecture, hospital design presents the greatest of challenges. It addresses the human dimension from birth to death; the architect must create a building primarily for people, but one in which form follows medical function in a variety of very particular ways. A key task is to ensure that efficiency of service is enhanced by the building envelope and the technology that fits within it. That technology changes more frequently, and across a greater range of areas, than it does in many other business environments; the task of designing for anticipated change, but without knowing quite what that change might be, is particularly difficult. Equally difficult is the creation of architecture that will provide the sort of civilised workplace which helps to attract and (just as important) retain good medical staff. But the challenge facing the architect does not end with the provision of a building that is fit for purpose merely from the point of view of the health service provider. If only it were that simple.

The next group of people for whom the design is important are those who visit. Although unlikely to be in the state of distress of many of the patients, they nevertheless are confronted by what at best will be unfamiliar surroundings, and at worst complex and confusing signage and routeing regimes, culminating in cramped and inconvenient spaces in which most of their interaction with a patient will take place. Of course the most important people of all are patients themselves, but patient-based design appears still to be a novelty in a branch of architecture which has become so specialised that general architectural values are frequently underestimated or ignored. Too often, proposals reflect this year's clinical fashions, and the apparently unavoidable consequences of narrow attitudes to budget, materials and layout. Outcomes are downplayed in favour of outputs.

As the buildings in this issue show, the timeless attributes of civilised healthcare environments can be achieved through good architecture, but not if it is ruthlessly constrained or directed by financial regimes based on a misunderstanding of the human and economic costs of poor design. What patients want and need are well-tempered environments where they can suffer and recover in peace and quiet, where sleep is regarded as important rather than an interference with breakfast delivery regimes, and where facilities are designed to ensure privacy and hygiene on the one hand, and decent and accessible facilities for visitors on the other. The case for proper lifetime cost analysis, discussed elsewhere in this issue, is particularly pertinent in the case of healthcare buildings, since the effectiveness of their performance over time will not simply justify the capital investment made to create them, but will contribute sooner or later to the well-being (and sometimes a decent environment in which to die) of us all.