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The Hollywood film Patch Adams has highlighted the use of art and culture - and laughter - in hospitals. A Manchester conference took a serious look at the issue.

Did you hear the one about the doctor who went to visit a patient who was terminally ill with cancer? He dressed up in flowing white robes, donned a pair of angel wings and, while strumming a harp, began talking about pearly gates and the life hereafter to the dying man.

This is no joke. Patch Adams, immortalised in a recent Hollywood film, is no ordinary doctor. He believes that clowning around is one of the best therapeutic weapons in a clinician's armour.

Dr Adams thinks arts aid the healing process. And more than 400 like- minded practitioners, managers, researchers and policy makers, from 26 countries, met in Manchester last week to hear his mantra.

'If people feel happy, they will get well quicker and there is little point making someone better if they feel miserable,' he said.

'I learned in medical school that if someone had cancer and I cut it out successfully that was a good outcome, when in fact I had given them 10 more lousy years. I realised we had to offer them their life back through arts and culture.'

So, 31 years ago, he set up his own hospital. All the staff live there, making it a communal venture. They have never asked for payment and the treatment mixes traditional and complementary medicine with music, dance, painting and anything else that makes patients happier.

'Art wasn't something we wanted to add to medicine; it was our life and we put medicine into it,' he said.

His philosophy embraces not only patients, their friends and relatives, but also doctors and nurses.

He even had a message for harassed hospital managers who might feel least able to inject a bit of fun into their working lives - particularly if they wish to remain employed.

'If you become the person people take their breaks with, you will never be fired,' he said. 'If you take incremental steps of outrageous behaviour you will endear yourself so much you can move onto more outrageous behaviour.

'Walk backwards for a day, and if you have any trouble say you heard me say it, so a doctor recommended it to you.'

Many people are naturally sceptical. Dr Adams' lifestyle and methods are at the more outrageous end of the arts-in-health philosophy. Nevertheless, the movement has some influential friends.

Former chief medical officer Sir Kenneth Calman told delegates of his ambition to turn the Department of Health into the Department of Health and Happiness.

Sir Kenneth addressed the sceptics directly. 'It all seems like a very good idea but some people have to ask, 'Does it really change things?' The answer is, it does and that's why we should invest in it.

'The Department of Health has sufficient evidence to invest properly in arts in health and now one of my key crusades will be how we can invest more in arts in health.'

But he acknowledged the need for more co-ordinated evaluation of the evidence. 'At the end of the day, the people who give out the money need to know there is some value in it,' he added.

Evidence that it can work was provided by Roger Ulrich of Texas A&M University.

In a study of patients who had undergone major heart surgery, he found that those exposed to pictures of trees and lakes came off powerful pain- killers earlier than those who were not shown the pictures, and they spent less time in hospital.

'At a cost of $30 to $40 each it is irrational not to have these pictures of nature in intensive care units,' he said.

Many UK hospitals and other NHS bodies have adopted arts and culture.

North West regional office has used art to promote public health in Liverpool.

In 1997, an artists' competition was held to mark the 150th anniversary of the appointment of the city's pioneering medical officer of health, William Henry Duncan.

'Having these art works heightened the public's understanding of what public health is all about,' according to Maggi Morris, who co-ordinated the project.

The French government is already convinced of the efficacy of arts and culture in hospitals.

Patrice Marie, from the French ministry of culture, told the conference that it fully backed attempts by health and cultural organisations to come together to 'improve the quality of people's lives'.

Next month the culture and health ministers will sign a national convention giving culture an official role in hospitals for the first time.

Under a twinning scheme, painters, actors, musicians and clowns will make agreements with their local hospitals to provide their services and will be paid professional rates.

Not surprisingly, finance was a problem.

'Where there is a lack of nursing staff, how do you convince a hospital to put money into culture?' Mr Marie asked.

The average annual cost of an agreement is about FF90,000 (£9,000). A hospital would normally put up around£1,000 and the culture ministry about£3,000. The French government sought private partners to fund the balance.

'We now have 11 major companies such as Glaxo Wellcome, Lego, McDonald's and Air France, signed up to a three-year agreement which will generate around FF1m in the first year,' he said.

UK delegates were clearly impressed by the French initiative. John Wyn Owen of the Nuffield Trust said the conference should send a message to the UK government urging it to examine the French model.

'We should be saying to the government: 'Get a copy of the convention, it is something you might explore and sign,'' he told delegates.

There is some political interest in the scheme - the conference received messages of support from health minister Baroness Hayman and culture secretary Chris Smith.

But with the government concentrating on waiting lists and introducing the New NHS, few delegates believed there will be a national strategy for cultural hospitals in the near future.