There is not enough attention to detail, not enough care, not enough commitment

Sir Stuart Lipton

Some of the hospitals, he says, face basic problems like leaking sewage, unusable rooms and no air conditioning.

And not enough importance is being given to the impact of building design on patient care.

Whether patients recover or die makes no difference to the Private Finance Initiative (PFI) contract to design and build.

However, research shows that hospital design can have a significant effect on patient health - both by making their surrounds more pleasant, and by boosting staff morale.

Substantial programme

Sir Stuart, who is head of the government's Commission for Architecture and the Built Environment, told the BBC: "Sixty to seventy new hospitals over the next few years is probably the most substantial building programme that the NHS has seen for decades, we are talking of billions of pounds.

"They can get it right and the hospitals will be uplifting, efficient, or they can become blots on the landscape - the tower blocks of the 60s."

"There is not enough attention to detail, not enough care, not enough commitment.

"The present round of PFI is effectively sub-contracted obligations. It is not that the buildings are being built inefficiently, but the contractor has got nothing to do with the medical process - they are two separate functions, which effectively should be one."

Air conditioning

Henry Marsh is a senior consultant neurosurgeon at the specialist Atkinson Morleys Hospital in south London.

I don't know what experience Prince Charles has of working in hospital kitchens

David Hinchliffe

Within two years his department will have moved from its own Victorian building surrounded by woods and gardens to a wing of the brand new St George's Hospital, a PFI.

Mr Marsh said: "My main worry at the moment is that there is no air conditioning, and I don't know if it will be possible to open the windows because they will probably find all sorts of health and safety rules about patients not jumping out of windows.

"So if we are unlucky the windows will not be openable, and we won't have air conditioning."

Cumberland Infirmary was the first PFI hospital opened by the Prime Minister in spring last year.

It has since become notorious for design flaws, including a glass atrium which heats up in summer because there is no air conditioning.

David Hinchliffe is concerned about design flaws

Mr Marsh said: "We have been told 'you will be comfortable, you will be comfortable'. I daresay that's what they told them in Carlisle as well at the Cumberland hospital, and they will be baking to death."

Mr Marsh is also concerned that his new office is 10-15 minutes walk away from the children's ward. At present he is just around the corner.

"Quite a lot of children I treat have brain tumours and not surprisingly the parents are mad with anxiety.

"Here I can nip up and see people anytime. Just one or two minutes reassurance and chat makes an enormous difference to how a hospital stay feels."

Design flaws

David Hinchliffe, chairman of the House of Commons Health Select Committee, is also concerned about the design of PFI hospitals.

His committee has uncovered a number of problems:

• confusing layouts
• corridors being too narrow to be able to turn a hospital trolley round
• difficulties for nursing staff actually seeing patients because of the layout of the wards

If you compare PFI with traditionally managed hospitals, you are getting a far greater quality of product

Keith Clark

"If he hasn't then I think we would be better talking to people who have had that experience who can offer relevant comment as to how future layouts and design can enhance the work that they have to do within the hospital sector."

Keith Clark, chief executive, Skanska UK, a company which is involved in building PFI hospitals, said that while contractors had no experience of medical issues, people within their consortia did.

"If you compare PFI with traditionally managed hospitals, you are getting a far greater quality of product."

A Department of Health spokesman said the PFI was providing the NHS and patients with the biggest hospital building programme in its history.

"PFI has nothing to do with the design of the hospital, it is merely a way of securing funding for a new hospital.

"The important difference is that when the PFI option is used any mistakes which are made - such as the atrium issue in Carlisle - can be rectified at no additional expense to the taxpayer - which is what is happening at Carlisle."