Most urban hospitals have never had much landscape to speak of, but several specialist hospital types were sited in rural areas, with extensive, purpose-built designed landscapes. Some, which originally stood just beyond the edges of towns, have been engulfed by suburban development, but have until recently resisted large-scale development, and come to be regarded as essential green lungs within the urban environment.

Many rural hospital sites survived remarkably well until the end of the twentieth century, and even where new hospital facilities had been inserted the original design was usually not irreparably damaged, and retained its integrity.

Many historic hospital sites are of significant local historic interest, and eleven have so far been recognised as being of national historic interest in England and have been added to the Register of parks and gardens of special historic interest in England. There are further sites which should be added but the Designed Landscapes Team at English Heritage has not yet assessed all of them. The trend for designed hospital landscapes extended beyond England and there are significant hospital sites throughout the UK, several of which have been included in the Scottish Inventory and Welsh Register.

The most significant hospital landscape type was that of the lunatic asylum, which could occupy several hundred acres of land, and formed a novel variety of the English landscape park, developed from the end of the eighteenth century. The Retreat in York, built in the 1790s, was the earliest example where the landscape around a lunatic asylum was laid out and used for therapeutic purposes (and still is). The Retreat, together with Brislington House, Bristol, significantly influenced British and foreign asylums, particularly the county asylums in England, which were constructed mainly during the nineteenth and early twentieth centuries.

By the mid-nineteenth century many pauper patients with mental illness and disability were admitted to purpose-built asylum sites set away from busy urban areas, with landscapes designed to help cure their condition. Whether the asylums did help effect cures or not is another matter. Nevertheless there was a very strong movement towards the therapeutic use of the landscape.

Almost every county had its own public asylum, and those with a large urban population nearby were blessed with several; over 120 were built eventually. Occasionally large private asylums were also built, along similar lines but more lavishly, including the Royal Holloway Sanatorium (Surrey) and Coton Hill (Stafford). Usually in the 19th century asylums were built on virgin agricultural sites, but some reused earlier landscape parks, including Bexley (Kent) and Claybury (Essex).

By the mid-nineteenth century the landscape elements of the standard asylum were formulated. Whether for paupers, for the 'middling classes', or for the rich, the formula was largely based on the landscape park, but adapted to fit therapeutic needs. Sometimes even a major landscape designer was employed so that the patients had the best restorative environment possible. The typical 19th-century asylum landscape had the whole range of ornamented drives, lodges, avenues, parkland, home farm, kitchen gardens and glasshouses, pleasure grounds, estate walls or fences, and often its own cemetery and cricket ground. In fact it contained most of the usual paraphernalia of the traditional rural estate. The male patients who were capable were persuaded to work on the farm and in the parkland, and the pleasure grounds and parkland were used for supervised recreational activities such as games, picnics and walks.

The main difference between the landscape park and the asylum estate was the presence next to the asylum building of enclosed exercise yards, or airing courts, which replaced the typical Victorian formal terrace which surrounded so many country houses. Male and female patients were, as always, segregated, and for each sex there were several airing courts allocated to different medical classes of patients. The airing courts were laid out ornamentally, usually to enhance a pleasant, elevated view out which was perceived to calm and cheer the patients, and contained benches and shelters, and perhaps privies. From 1950s the airing courts were often opened up by the removal of boundaries, in order to provide a less confined atmosphere for patients.

A development of the 1920s and 1930s was the socalled mental deficiency colony, often using dispersed villa buildings scattered through and respecting an older landscape park. The earliest of these was at Prudhoe, Northumberland, begun c1914, another being at Meanwood Park, Leeds. Others appeared throughout the country, based on an idea developed from the 1890s for self-contained communities for epileptic workers. The idea was to provide a pleasant and therapeutic environment in which to live and work, although in the reasoning behind the segregation of residents away from their homes there were also unpleasant eugenic undertones.

Other hospital types which had significant landscapes were the large military hospitals, the isolation hospitals of the late nineteenth and early twentieth centuries, and the tuberculosis sanatoria of the same period. Many isolation hospitals were sited well away from the urban population where contagious diseases spread like wildfire. Most were modest, but one of the greatest of these landscapes, built in the early 1900s, was Joyce Green, Dartford in Kent, which was recently demolished. Its extensive grounds leading down to the Thames were carefully laid out by the landscape firm Messrs HE Milner and embellished with a wide range of plants by its Kewtrained head gardener. Sanatoria sometimes had extensive grounds including pleasant 'measured walks' to ensure that patients obtained just the right amount of therapeutic exercise and fresh air, and gardens in which they undertook gentle husbandry activities.

Workhouses, which enjoyed a building boom from the 1830s, were often sited at the edge of towns. Their landscapes were similar to but seemingly more compact than those of the asylums, with exercise yards, farm and kitchen garden areas. Many workhouse landscapes were lost when they became NHS hospitals after 1948, so in few cases can the sense of their original layout be made out. Thurgarton, Southwell, is a particularly complete example, recently acquired by the National Trust.

The National Health Service's recent estate rationalisation and care in the community policies mean that many historic hospital landscapes, in particular those of former asylums, are under threat from development, or have been destroyed. The NHS itself estimated in 1995 that over 120 large historic hospital sites were likely to become surplus nationally by 2005.

However, the NHS has issued advice to its trusts that during the planning process 'the wider context must be considered as part of any programme of management and special regard should be given to the desirability of preserving gardens of special historic interest, in particular those which appear on the English Heritage register of parks and gardens of special interest in England.' (Historic buildings and the health service, HMSO, 1995). This is useful, but unfortunately such consideration is not often in favour of the landscape.

Hospitals are regarded as brownfield sites in the planning system, and so the open areas of the landscape, at least, may be identified as a prime location for new development, even if the main buildings are listed and the trees have tree preservation orders. Some sites have been designated as conservation areas, which of course helps their survival dramatically, but these are few and far between. The main need now is for the recognition of the remaining hospital landscapes as locally, and sometimes nationally, important assets for the community. Conservation plans for these extensive and complex sites can be invaluable in helping to identify the particular historic importance of the landscape. They can also help in identifying which historically sensitive areas should be retained, and in which less sensitive areas new development may be sited without major detriment to the historic design. In this way we may achieve the healthy re-use of some hospital landscapes.