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Enhancing the Healing Environment

The Enhancing the Healing Environment (EHE) programme has encouraged and enabled nurse-led teams to work in partnership with patients to improve the environment in which they deliver care. The EHE programme has now been completed and the work on dementia friendly-design is being taken forward by the Association for Dementia Studies, University of Worcester.

Putting patients at the heart of design, the programme challenged current thinking and attitudes to the delivery of care, as well as highlighting the important role that the physical environment can play in supporting innovation in service delivery and in improving the patient experience.

EHE projects

We worked with more than 250 health and social care organisations including acute, mental health and community NHS trusts, care homes, hospices and HM prisons to support their healing environment projects.

EHE and dementia

Assessment tools

To support clinical staff and their estates colleagues, we produced a range of resources to enable hospitals and care homes to become more dementia friendly.

Download the EHE dementia tools and design principles

Programme of work

The Department of Health commissioned The King's Fund to develop a number of specific programmes to enhance the environment of care as part of its work to improve the patient experience.

EHE programmes

Launched by HRH The Prince of Wales in 2000, the EHE programme initially focused on improving the acute hospital environment in London. The programme's success led to its extension to mental health trusts and a number of primary care trusts in the capital. The latest phases include work to improve environments for care at the end of life and the environment of care for people with dementia. We also worked with colleagues in HM Prison Service to improve the environment and delivery of health care to prisoners. Read more about completed EHE projects.

Environments of care at the end of life

To support the implementation of the national end-of-life care strategy, the Department of Health provided £1 million to fund new projects in 20 NHS organisations in England, with the aim of physically improving the environment for those who are dying and for their relatives.

Fifteen acute trusts, two mental health trusts, two primary care trusts and one HM prison undertook projects to improve the environment of care at end of life. Projects ranged from palliative care rooms with dedicated accommodation for relatives to the creation of bereavement centres and the redesign of mortuary viewing areas. The programme was evaluated by the University of Nottingham.

The EHE programme continued to support work in hospitals and hospices to improve the environment of care for those receiving palliative care, their relatives and the bereaved. See our work on environments for care at the end of life.

Environments of care for people with dementia

In 2009 a new Department of Health-funded programme was launched to improve the care environment for people with dementia and to support the implementation of the first national dementia care strategy. Ten projects in mental health and learning disabilities settings were launched in April 2009, chosen to reflect the different stages of the care pathway from diagnosis to end-of-life care and to act as exemplars of how practical improvements in the hospital environment can enhance the experience of service users and carers. In 2010 a further 12 projects in acute and mental health hospitals began.

EHE projects in dementia care are already showing how relatively small changes to the environment can reduce anxiety, accidents and incidents of challenging behaviour. The King's Fund and the trusts worked to bring together good practice examples for environments of care for people with dementia.

Following the completion of the EHE programme, the work on dementia-friendly design is being taken forward by the Association of Dementia Studies (ADS), University of Worcester.

EHE in prisons

From 2007, The King's Fund, with the support of Offender Health, worked with teams from HM Prisons to improve the health care environment for people in prison. Projects ranged from improvements to clinic waiting areas and outpatient services to the creation of facilities for those requiring enhanced nursing and end-of-life care. 35 prisons in England and Wales participated in the programme.

Programme success

Forty-eight London NHS trusts took part in the first phase of EHE, and the programme was the single largest investment (more than £2.25 million) that The King's Fund has made in London's hospitals. More than 250 teams from acute, mental health and community hospitals, hospices and HM Prisons participated in the programme.

The programme received widespread recognition as a national exemplar both in terms of the individual projects and as a catalyst for the NHS to consider the impact of the environment on recovery and the way care is delivered.


The impact of the Enhancing the Healing Environment (EHE) programme extends beyond the improvement of physical environments, bringing benefits such as the personal development of team members, innovative new approaches to patient involvement and the fostering of closer links with local communities.

Longer term benefits that have already emerged from the programme include; patients, staff and the public having an increased sense of ownership of the hospital environment, and the potential for well-designed environments to reduce aggressive behaviour from patients. The programme has built strong evidence of the therapeutic impact of good design, and has helped to encourage more widespread use of the arts within hospital settings.

EHE articles and press releases