The healing power of landscape: Nature, community and resilience in healthcare environments

Curved Terraces Elevating landscapes with

Project: Triptych Place, London Architect: ME Landscape Studio, London Product: Solid Curved Terraces

Solid Serif Loungers in Cloudy Grey

Solid Edge Green Benches

The healing power of landscape

As we step into the pages of this special issue, we are reminded of the profound connection between health and the environments we create.

Landscape design for healthcare facilities represents one of the most vital and timely challenges of our era, offering opportunities not only to support patient healing but also to enrich local communities and nurture the environment.

Healthcare landscapes today extend beyond the conventional. They are active agents of change – places where therapeutic gardens, sensory spaces, and community hubs meet the pressing needs of physical and mental health. As the articles and case studies in this issue reveal, these landscapes are vital in fostering recovery, encouraging resilience, and providing moments of calm amidst life’s most challenging times.

Take, for instance, the transformation at Springfield Village in Wandsworth, where a bold reimagining of NHS mental health facilities has turned a once-closed campus into a vibrant social landscape, including courtyards, sensory gardens, and a 32-acre public park. Here, collaboration among patients, carers, and the wider community has broken down barriers, reducing stigma and inspiring pride in shared spaces. As NHS Programme Director Ian Garlington notes, this project exemplifies how healthcare design can extend its impact far beyond hospital walls.

Elsewhere, the landscapes at Great Ormond Street Hospital illustrate the potential of child-friendly, biophilic environments that blend urban gardens with innovative designs to improve air quality, reduce stress, and provide opportunities for play. Such projects highlight the broader environmental benefits of healthcare landscapes, from enhancing biodiversity to building climate resilience.

Landscape design is not merely an aesthetic addition but a vital component of holistic healthcare. Through collaboration and innovation, it is possible to create spaces that address complex healthcare needs while delivering broader social and environmental value. The insights and case studies presented in this issue underscore the pivotal role of landscape professionals in shaping the future of healthcare environments.

Jane Findlay FLI PPLI Guest Editor

PUBLISHER

Darkhorse Design Ltd

T (0)20 7323 1931 darkhorsedesign.co.uk tim@darkhorsedesign.co.uk

EDITORIAL ADVISORY PANEL

Saira Ali, Team Leader, Landscape, Design and Conservation, City of Bradford Metropolitan District Council

Stella Bland, Head of Communications, LDA Design

Marc Tomes CMLI, Director, Allen Scott Landscape Architecture

Sandeep Menon, Landscape Architect and University Tutor, Manchester Metropolitan University

Peter Sheard CMLI, Landscape Architect

Jaideep Warya CMLI, Landscape Architect, Allies and Morrison

Jane Findlay PPLI, Director FIRA Landscape Architects

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ISSN: 1742–2914

I take cuttings and sow seeds with patients, planting little grains of hope and looking forward, towards a brighter future.

Ashley Edwards

Head Gardener, Horatio’s Garden

Find out more on page 39

Why engagement is essential for designs that heal, inspire and sustain Fostering collaboration in

Two projects putting landscape at the heart of paediatric care

How a change in perspective could redefine our approach to health-care Health creation through landscape

A new approach to hospital design to improve health and wellbeing at a neighbourhood scale

Eight

Make

LI

Therapeutic landscapes

A brief history of hospital gardens

1. Paimio sanatorium, demonstrating the close relationship of the pine forest with the building.

© Clare Hickman

On a bright, sun-filled day this summer I travelled to visit a lauded example of a historic medical institution in south Finland. A place in which the landscape was integral to both the architectural design and the therapeutic aims of the medical staff. Approached via paths woven through the surrounding pine forest, I initially glimpsed Paimio Sanatorium through the surrounding trees –its white walls bright against the dark foliage. Opened in 1933 to treat patients with tuberculosis, it was designed by the famous architecture and design duo, Alvar and Aino Aalto. For them, the location here in the pine forest was as functionally important as it was aesthetically pleasing.

The pine trees were understood at the time to have disinfecting and antiseptic properties that could affect the human body through emanations

carried in the air. The design of the building and the open-air treatment approach (by which windows and doors were kept as open as possible) meant that the forest could be seen, smelt and breathed in by patients. The forest was such an integral part of the therapeutic design, it is now one of the key elements cited in the current application for Paimio to become a UNESCO World Heritage Site.

For all its modernism, Paimio’s history can be understood by viewing it within a much longer history of humans utilising plants and landscapes for health benefits. Evidence of the use of plants in healing practices can be found as far back as the Palaeolithic Age. Many centuries later, gardens were important features of medieval hospital sites across Europe, where they provided sensory places for restoration as well as the material for herbal remedies. They were also seen as spaces that could engender a spiritual sense of wellbeing and it was believed that nature, or God through nature, had provided a remedy for every ailment. In these early hospitals, God was considered to be the ‘supreme physician’.

This dual meaning provided the basis for the emergence of botanic gardens in the sixteenth century,

where attempts were made to reconstruct the garden of Eden by bringing plants together from around the known world. These were also central spaces for medical education as they formed collections of plant material essential for research and the treatment of disease. It is worth noting that this is a very Western Europeanoriented perspective and that there are also complex histories of colonialism and exploitation in relation to plant collecting and botanic gardens, as well as equally important histories of the therapeutic use and relationship to plants by indigenous people.

To return to Britain, we can trace the belief in nature and gardens as therapeutic through the design and use of asylums for the treatment of what we would now class as psychiatric disorders and related conditions. One key example of this is the York Retreat, opened in 1796, which was originally established by the Tuke family, who were Quaker tea merchants, to treat other Quakers who were suffering.

According to Samuel Tuke, at the Retreat there was an understanding of the role of both design and scale. In 1813, he wrote, “I cannot, however, forbear observing, that the courts appear to be too small, and to admit of too little variety, to invite the patient

Clare Hickman

2. The Retreat, an institution near York, for insane persons of the Society of Friends by Samuel Tuke, 1813.

Wellcome Collection

to take exercise. The boundary of his excursion is always before his eye, which must have a gloomy effect on the already depressed mind.” His argument was that this could be compensated by use of wider gardens as well as “excursions into the city or the surrounding country, and into the fields of the Institution” by those who were able.1 By 1847, the Commissioners in Lunacy who regulated such institutions stated in their rules for new asylums that “The airing courts, pleasure grounds, gardens and fields annexed to an asylum, should be of such an extent as to afford the patients ample means of exercise and recreation, as well as the healthful employment out of doors:

and should, as far as possible, be in the ratio of at least one acre to ten patients.”2

These ideas were not confined to such specialist institutions. In the 1860s, doctors John Syer Bristowe and Timothy Holmes were tasked with travelling around Britain to visit hospitals to investigate their design and how they were managed. Of the 67 hospitals they visited in England, 46 were described as having some kind of external grounds. Florence Nightingale shared similar ideas and regarded that light, as well as colour, had therapeutic benefits. In her Notes on Hospitals published in 1859 she wrote: “Among kindred effects of light I may mention, from experience, as quite perceptible

in promoting recovery, the being able to see out of a window; instead of looking against a dead wall; the bright colours of flowers; the being able to read in bed by the light of a window close to the bed-head. It is generally said that the effect is upon the mind. Perhaps so; but it is no less so upon the body on that account.”3

Her preferred hospital design, as stated in her book, was based around small, gardened courtyards, known as the ‘Pavilion design’. In 1854, an anonymous writer thought to be the doctor John Roberton described the Bordeaux Hospital, France, an early adopter of this plan, and how its “tiers of building are separated from each other by a flower garden, and in these

1 Samuel Tuke (1813). Description of The Retreat: An Institution Near York for Insane. Persons of the Society of Friends. Reprinted (London: Dawsons of Pall Mall, 1964), p. 95.

2 Further Report of the Commissioners in Lunacy to the Lord Chancellor (London: Shaw and Sons, 1847). Appendix E, p. 323.

3 Florence Nightingale, Notes on Hospitals, Third Edition: Enlarged and For the Most Part Re-written (London: Longman, Green, Longman, Roberts and Green, 1863), p. 19.

tiers are the sick-wards, each ward isolated from the rest […] and in every ward when you look out of a window it is into a garden”.4

embodied and sensory underpinning to the understanding of why the landscape was so essential for patients. Whether via a view through a window, the sound of birdsong through an open door, the feeling of a breeze on their face when being wheeled outside, or a walk through a garden, these institutions were designed in the belief that the external environment could play a crucial role in respite and recovery. Although it is worth reflecting that despite these intentions, oral history interviews suggest that patients did not always find this approach beneficial. In fact, their overall experience of such places could be of suffering, confinement, sometimes violence or even a pervasive sense of death, the latter of which was certainly true of the sanatorium. The aesthetic and sensory beauty of a garden is important, but a romanticised sense of these institutions should be avoided. Our medical and scientific understanding has changed significantly over time but key features such as free access to natural light and air remain important. Or at least they did until a shift in priorities in the mid-twentieth century. New medical interventions, including the use of antibiotics and developing technology, that saw the body as individual organs and cells, led to new ways of seeing the body, which was often divorced from its connection to the

wider environment. Pressure on land also became more acute as hospital buildings expanded to house the new technology, and the democratisation of car ownership led to the need for vast car parks, often built over designed landscapes.

Recent years have seen a renewed interest in access to nature and the role that well designed, maintained, accessible, and cared for outdoor spaces can play. They offer places of respite for staff and visitors, as well as patients, from the noisy, sensorially overloaded hospital interior environment. Sometimes the response to this has become a technological solution, such as a piped recording of birdsong, but I am hopeful that the future will see real attempts to find ways to allow people to access spaces where they can have meaningful sensory encounters with other living beings. At a time when we are facing a biodiversity and climate crisis, there should be a renewed consideration of therapeutic spaces as places that provide care and respite for plants and animals, as well as humans.

Clare Hickman is Reader in Environmental and Medical History at Newcastle University. She is the author of Therapeutic Landscapes (Manchester University Press, 2013) and The Doctor’s Garden (Yale University Press, 2021)

© Wellcome Collection

4 Editorial, The Builder

20 September 1856, p. 509

5 Editorial, The Builder

11 September 1858, p. 610.

In an anonymous editorial published in the same series in The Builder that year, one writer stated that “the square within the hospital, and the spaces between the pavilions, should be laid out as garden grounds with welldrained and rolled walks, and shaded seats for convalescents”,5 which outlines how these spaces were to be used as part of the patients’ recovery programme as well as something to be seen from the windows on the wards – albeit probably not from a horizontal position in bed.

In these examples there was an

3. St Marylebone Infirmary, Exmoor Street, London: the exterior. Coloured wood engraving by H.J. Crane after F. Watkins, 1881.

© Wellcome Collection

4. Crimean War: Florence Nightingale at Scutari Hospital. Coloured lithograph by E. Walker, 1856, after W. Simpson.

Healthcare design outlook

Healthcare buildings have historically been places of retreat, where concentrated resources of skilled professionals and medical equipment meet in one specialised facility, away from the front line of daily life.

1 https://www.england. nhs.uk/estates/healthbuilding-notes/

2 https://www.england. nhs.uk/estates/healthtechnical-memoranda/

3 https://www. nzcbuildings.co.uk/ pilotversion

The relationship between architecture and landscape in healthcare design is long and enduring, with ever greater opportunities for an integrated approach.

Bob Wills

Buildings battle to defy gravity and landscapes flow with gravity. If the enormous effort of raising a building is to be made, then it must at least be beautiful, and enable designers to acknowledge the former space and place that the new building now occupies – that expanse between earth and sky. It will also need to address any disturbed residual landscape that remains after such an intervention, providing a new context for future designers that is both healing and regenerative.

Healthcare buildings have historically been places of retreat, where concentrated resources of skilled professionals and medical equipment meet in one specialised facility, away from the front line of daily life. The caravanserai in the desert or the asylum on the edge of town are enduring examples of buildings offering excellent therapeutic recovery pathways using managed landscapes. More recently, healthcare buildings are frequently built in crowded city centres, embedded in these densely populated areas to provide dedicated space for emergency care. Their integration with the surrounding landscape is equally necessary for wellbeing, healing and recovery.

When an earthquake and fire destroyed much of San Fransisco in 1906, 40,000 people were sheltered and treated in a tent city set up in Golden Gate Park. The Park was an extensive managed landscape akin to Central Park in New York – providing

a breathing space within the densely populated city sprawl. This temporary canvas city was remarkable in terms of the successful healing outcomes it produced, as measured at the time. Whether this was a result of the beautiful parkland setting or the military efficiency of a team of public health professionals is unclear. Regardless, the abundant beneficial effects of such an open, natural space within the heart of the city provides an illuminating, if unexpected, example of quality landscape in healthcare design. Daylight and fresh air ventilation are the major pre-occupations of designers for healthcare. This is where the interrelationship of building and landscape has mainly been manifested through the inclusion of framed views and openable windows. The ‘Nightingale’ ward and the courtyard plan of the Nucleus template hospital, or the airing courts for patients in secure environments, are classic examples that recognise these fundamentals for health. Today, NHS Health Building Notes1 and Health Technical Memoranda2 offer guidance on standards to enable designers to engineer each type of healthcare environment in a more prescriptive way. BREEAM has also set much higher standards for the integration of landscape for health and wellbeing, and the Net Zero Carbon Building Standard3 has recently been mandated by the NHS for procurement of public buildings for healthcare. The climate emergency has also brought a much greater appreciation of the value of regenerative design.

Healthcare is often divided into sectors of primary, secondary and tertiary. Primary care GP practices, pharmacies and dental clinics tend to be of a domestic scale and distributed widely in residential and small town high streets. These facilities are modest and accessible and their

1. Cavell Community Health and Wellbeing Hub.

relationship to the landscape tends to be similarly modest, perhaps with a front garden or some potted indoor planting.

There is a current trend by Integrated Care Boards to federate these services into health and wellbeing hubs that pull in certain secondary (community) minor surgery treatments and, in some cases, diagnostic imaging and therapy services. The aim is to keep people well, in their homes, and out of acute medicalised care situations for as long as possible. Such buildings become de facto neighbourhood community centres, presenting an opportunity for bolder integration of landscape and healthcare architecture. These facilities are welcoming and within walking distance for patients, perhaps with a café and gym, and social spaces that spill out to a garden for social prescribing activities. They might also be Passivhaus design accredited and flexibly occupied during their long lifespan. Key to their success is their appeal as both a destination and a place to work, with excellent air quality and visual delight provided by the landscape context, both external and internal.

Secondary care is in flux too, with district general hospitals being repurposed as treatment centres, perhaps losing their Accident and Emergency capability if another

centre is within striking distance and providing elective and ambulatory care for minor injuries instead. They may also provide less critical care in favour of more rehabilitative or ‘step-down’ care. Longer stays and an increased risk of dementia as people live longer points to the need for less clinical and more therapeutic environments, with attractive views out and accessible outdoor space. Here there is an opportunity to recover lost courtyards and interstitial spaces to reinstate the garden lungs that were conceived in the older Nightingale or Nucleus models but were often infilled to provide clinical space.

Tertiary care requires specialist, highly bespoke facilities. Such buildings have tended to be deep plan and multistorey, within or near city centres, and well serviced by transport and energy infrastructure. Seen as acutely clinical and highly medicalised, their functional requirements have tended to override more therapeutic considerations. However, there is now a greater recognition that the feel of a place has significant value in terms of staff recruitment and private customer satisfaction. This has led to more emphasis being placed on designing excellent staff facilities with attractive outdoor breakout spaces and open views to nature where circadian rhythms can be reinforced.

Landscape opportunities are even

Whether these gravitydefying healthcare buildings are densely urban, suburban, coastal or rural, their occupants will always benefit from a thoughtful and sustainable reintegration into the landscape or cityscape which they have disturbed.

greater for the design of mental health facilities. These range across primary, secondary and tertiary care, from small Child and Adolescents Mental Health Service (CAMHS) day centres to secure forensic psychiatric hospitals. When invited to participate in codesign sessions, patient advocates and service users often reflect on the value of accessible nature, both physically and visually, when they are unwell and at their most vulnerable.

Accessible gardens also relieve boredom for long-stay service users and allow opportunities for quiet reflection for staff and patients alike. Much has been written on the ways in which gardens nourish the mind and entertain all the senses, helping to reduce anxiety, improve sleep patterns and speed up recovery.

Whether these healthcare buildings are densely urban, suburban, coastal or rural, their occupants will always benefit from a thoughtful and sustainable reintegration into the landscape or cityscape which they have disturbed.

Bob Wills is a Director at Medical Architecture’s London studio. He has 30 years’ experience of healthcare design and has played a key role in the delivery of various large-scale mental health and acute health projects.

2. Army Hospital, Golden Gate Park, 1906. © Historical Society

Fostering collaboration in healthcare landscape design

Jane Findlay FLI PPLI

Healthcare landscapes are far more than passive backdrops - they are active participants in the healing process. As we consider the integration of architecture and landscape in healthcare environments, one principle becomes increasingly evident: meaningful engagement and collaboration among stakeholders are essential to achieving designs that heal, inspire, and sustain.

The process of designing for healthcare is inherently complex, shaped by diverse voices - from architects and landscape architects to healthcare professionals, patients, and community members. Each perspective brings unique insights into what constitutes a therapeutic environment. Effective stakeholder engagement ensures that these insights inform a cohesive design narrative, where landscapes complement architectural intent and respond dynamically to the needs of their users.

Co-creation

Collaboration, however, is not simply about consultation - it is about co-creation. Involving patients and service users in design sessions, as highlighted in the mental health sector, demonstrates the transformative power of participatory design. These voices often emphasise the value of accessible green spaces, underscoring their role in fostering resilience, reducing anxiety, and supporting recovery. Such spaces are not just desirable but essential, particularly in long-term

care settings, where gardens provide opportunities for movement, sensory engagement, and quiet reflection.

Equally, the interdisciplinary partnership between healthcare providers and design teams is crucial. By aligning operational priorities with regenerative design principles, we can create spaces that are as functional as they are restorative. Whether through integrating gardens into high-density urban hospitals or reclaiming interstitial spaces in district facilities, collaboration ensures landscapes are not an afterthought but a central component of the healthcare experience.

Integrating landscape

The case studies over the following pages bring these principles to life, showcasing projects where collaboration has unlocked innovative solutions. From reimagined hospital courtyards to community health hubs designed for inclusivity and social prescribing, these examples highlight the profound impact of integrated landscapes on health outcomes. They serve as a testament to the power of stakeholderdriven design, demonstrating how thoughtful engagement can turn ambitious concepts into spaces that truly transform lives.

As healthcare systems adapt to evolving demands, the role of landscape architects in advocating for integrated, stakeholder-driven solutions cannot be overstated. By championing collaboration, we not only enrich our designs but also affirm the profound connection between people, place, and healing.

Jane Findlay FLI is a Director at Fira and Past President of the Landscape Institute

1. The woodland garden at the Sir Robert Ogden Macmillan Centre in Northallerton.

© Fira

1.

Typology: General hospital | Location: Wandsworth, London

Springfield Hospital

A new ‘village’ at the heart of this hospital is breaking down health stigmas and connecting it with the community.

South West London and St George’s NHS Trust

South West London and St George’s has been at the forefront of mental health transformation for the best part of a decade. As a leading NHS Mental Health Trust, it serves 1.2 million people across the London boroughs of Kingston, Merton, Richmond, Sutton and Wandsworth.

Since it was established in 1994, several of its key services have been delivered in outdated Victorian buildings. In recent years this has changed as works have moved forward to develop a bold landscape that breathes new life into parts of its ageing estate.

The Trust’s Better Environments Programme is working to deliver state-of-the art facilities, both to improve patient care and, at the same time, to open up NHS sites to the community to break down mental health stigma.

Through the sale of surplus land not required for mental health care, and with some additional funding, the Trust is part way through a £250 million investment to develop new mental health facilities at Springfield Hospital in Wandsworth and Tolworth Hospital in Kingston.

The programme began at Springfield, where the Trust has worked together with patients, carers, staff, and the wider community to reimagine a new social landscape across its 92-acre estate. This has seen the site transform into a new ‘Springfield Village’ with a public square, shops, cafés, a gym, hundreds of new homes, new hospital buildings, and a new 32-acre park. The park includes a pavilion café, an amphitheatre, youth shelter, play areas, sensory gardens, and a trim trail to support the health and wellbeing of all who use it.

As part of the changes, the Trust has also launched a programme of mental health first aid training for the community to help raise mental health awareness and boost mental health literacy.

At the heart of Springfield Village are the cutting-edge Trinity and Shaftesbury buildings. Together, they represent a £150 million investment to create better facilities for patients. The buildings have been designed to provide high-quality inpatient services that deliver mental health care in a bright, modern setting.

Construction began in January 2020 and continued throughout the pandemic. Trinity, which opened in December 2022, is home to over 30 teams and provides care to patients in two acute wards, two specialist

wards (including national deaf services), and a range of outpatient services. The Shaftesbury Building followed in October 2023 and supports several specialist and forensic wards.

Co-designed with patients, carers and service users, architect and landscape architect C.F. Møller used guiding principles of space, light and nature in the development of the buildings. Both include spacious

It’s really useful to have that place where it’s almost integrated in the community because of the stigma that family or visitors have towards visiting you.

1. Springfield Hospital Village.

There is no comparison between where Jupiter Ward was previously and its new home in Trinity. It has been a marvellous surprise to see this beautiful, airy and light building compared to where we were.

Study

ensuite bedrooms, colourful artworks and garden courtyards, providing places for rest and reflection.

As part of the innovative design, Springfield’s new facilities feature 20 world-class artworks created in partnership with arts and mental health charity, Hospital Rooms, one of the largest art projects of its kind undertaken in the NHS.

Taking place over three years, Hospital Rooms led 120 art workshops with patients, carers and staff, that inspired incredible conversations, collaborations and artwork proposals. From this, artists co-designed 20 pieces of vibrant and uplifting artwork that have helped to shape new creative spaces for mental health care in South West London.

Springfield Village is a unique landscape, offering something special to NHS staff, residents and patients alike. It gives concrete expression to the important changes in attitudes to mental ill health that have taken place over the past decade and shows how much can be achieved when patients, carers, staff and local people come together to shape their communities.

Ian Garlington is Better Communities Programme Director at South West London and St George’s NHS Trust

NHS staff member

2. Springfield Park.

SWLSTG

3. Springfield Hospital Village.

SWLSTG 4. Springfield Hospital Village.

SWLSTG

Typology: Paediatric care | Location: Westminster, London

Healthy Hospital Street

Reclaiming road space for a child-friendly hospital arrival at Great Ormond Street Hospital.

Design

Great Ormond Street Hospital (GOSH) is known for being a leader in the field of medicine, but were you aware that it is also a pioneering thinker when it comes to landscape?

Up to 750 seriously ill children and carers arrive at the hospital every day and yet, like the streets outside most London hospitals, Great Ormond Street itself is dominated by traffic. The hospital’s ambition is to make Great Ormond Street work better for patients, visitors, staff, and the local community so GOSH has been working with LDA Design on a concept which reclaims road space, replacing it with a series of beautiful garden rooms. Changes have been made carefully to balance placemaking with the complex demands of hospital logistics.

The aim is to create a welcoming and loved place at the heart of the community, providing a healthy biophilic environment which is a pleasure for the senses. There will be places to relax and communal dining. Climate resilience is enhanced, including through the

incorporation of rain gardens, and the street design is rooted in a low-carbon approach that considers the whole life of all elements. In particular, proposals target improvements in air quality, reducing the pollutants nitrogen dioxide (NO 2) and fine particulate matter (PM2.5), which cause respiratory illness and damage lung function in children. By creating London’s first ‘Healthy Hospital Street’, the hope is that other hospitals across the city will follow suit.

This child-friendly landscape, incorporating surrounding streets, includes ‘play on the way’ features that extend along the entire street. A series of street events have brought the hospital and local community together ensuring local primary school children and patients were involved in the co-design process. The proposals provide a glimpse of the potential that the public realm has to offer and reflects growing national recognition of the need to invest in health-enhancing environments.

Scott Carroll CMLI is a Director at LDA Design

You cannot overestimate the importance of doorstep play and what this can mean for children’s hospital experience – as well as providing respite for carers and staff.

1. An impression of the proposed Healthy Hospital Street. © LDA Design

Magali Thomson, Project Lead for Placemaking at GOSH

LDA

We want to ensure children can play and have usual experiences of childhood, including being outside and in nature. Having this highly accessible roof garden will open this up to children who, due to their treatment, health condition, mobility or other reasons, may find it hard to go outside.

Typology: Paediatric care | Location: Westminster, London

Children’s Cancer Centre

A

‘modern twist’ on healing gardens focused on play, learning and rest for Great Ormond Street Hospital.

Sallyanne Pitt,  Head of Play Services at GOSH

Great Ormond Street Hospital (GOSH) has been a beacon of paediatric care since it was founded by Dr Charles West in 1852. Over 150 years, it has continually set the standard in medical care for children, and in 2018, BDP was commissioned to design GOSH’s new Children’s Cancer Centre. From the outset, the design included a strong emphasis on outdoor spaces to reconnect patients and their families with nature.

Our landscape design for the hospital embraces the concepts of ‘House’ and ‘Garden’. It offers a blend of sensory experiences with spaces for children and young people of all ages, focusing on play, relaxation, and healing. This approach evolved from early consultations with the GOSH Young Person’s Forum, where young patients explained that they miss interacting with nature when they are in hospital and expressed a desire for a nurturing, homely environment connected to the outdoors.

At the heart of the design are ‘garden bays’, a modern twist on healing gardens. These outdoor areas create a sanctuary for patients, families, and staff. One of the highlights is the rooftop garden on level

ten, which is divided into three unique sections: The Glades, The Enchanted Forest, and The Secret Garden. Each serves a distinct purpose: active spaces encourage outdoor play and physiotherapy, which aid in recovery; educational zones promote social interaction and learning; and quiet areas provide peaceful spots for contemplation and rest, offering a welcome escape from the clinical environment.

The planting strategy across all the gardens centres around sensory plants that change with the seasons. Brightly coloured flowers such as asters, crocosmia, and echinacea stimulate the visual senses, while ornamental grasses create a gentle soundscape as they sway in the wind. Additionally, the planting design incorporates fragrant varieties, including lavenders and mock orange at waist height, along with climbing roses and honeysuckles on pergolas, creating a rich olfactory experience. All plants will be non-toxic, thorn-free, and compliant with infection control guidelines.

The approach reintroduces a much-needed connection with nature, creating a peaceful and restorative environment that complements GOSH’s commitment to world-class paediatric care.

Gabriela Henriksson Bayliss CMLI is a Landscape Architect and Associate Director at BDP

1. Great Ormond Street view. © Secchi Smith

Typology: Rehabilitation | Location: Loughborough

Defence Medical Rehabilitation Centre

A specialist facility for the rehabilitation of injured armed forces personnel continues to set the standard for landscape-led healthcare design with a new national facility for civilians.

Philanthropic efforts and location

The Defence Medical Rehabilitation Centre (DMRC) is a cutting-edge facility in the UK providing rehabilitation for injured armed forces personnel. Its development was driven by the vision of the late Major General Gerald Grosvenor, the 6th Duke of Westminster, who saw the need for a world-class rehabilitation centre and led the fundraising efforts. His aim was to improve the services offered at Headley Court, the UK’s previous military rehabilitation centre, by building to the highest standards and integrating advanced medical technology with a therapeutic, healing environment.

The DMRC project was built on the Stanford Hall Estate in Leicestershire, selected for its central location, accessibility, and proximity to major hospitals. The estate’s 360 acres provided peaceful surroundings that would align with modern rehabilitation approaches that emphasise the role of nature in healing. Fira’s role has been continuous for the last 15 years, from site selection, master planning and detailed design for both the armed forces and civilian-focused phases of the project.

The dual purpose: military and civilian components

The DMRC, which opened in 2018, replaced the centre at Headley Court and serves as the primary rehabilitation centre for the armed forces. It provides advanced services for serious injuries, including trauma, amputations, and neurological care. Rehabilitation is not

1. The Defence Medical Rehabilitation Centre. © Fira

Fira

Case Study

limited to physical recovery; the centre offers psychological support to help service members reintegrate into society, whether they return to service or transition to civilian life.

In addition to military-focused services, the National Rehabilitation Centre (NRC), which serves civilians, is under construction. The NRC will build on the expertise established at the DMRC, through the same state-of-the-art techniques, to treat civilians recovering from trauma, serious illness, and neurological conditions.

Design and landscape

The DMRC’s design emphasises a holistic approach to recovery. The architecture and landscape were thoughtfully planned to enhance healing by incorporating green spaces, walking trails, and access to nature. These elements play a crucial role in the recovery process, particularly for mental health and wellbeing, aligning with the growing recognition of the therapeutic benefits of nature in landscape design.

Collaboration with clinicians and patients during the planning and design phases ensured that the environment supported both physical and psychological recovery. The centre’s focus on mental health is essential, considering the psychological impact of traumatic injuries and the importance of holistic care in rehabilitation.

Rehabilitation facilities

The client user group meetings revealed a spectrum of clinical requirements for external spaces, resulting in the creation of a variety of passive and active rehabilitation areas, all tailored to address each department’s nuanced brief.

A series of private courtyards were designed as extensions of internal clinical spaces to support specific aspects of rehabilitation, such as balance and proprioception. Within these spaces, elements such as steps, ramps, low walls, and textural variations within paving are all utilised for physical rehabilitation and the development of ‘back to life’ skills.

Horticultural therapy facilities and informal, private counselling spaces were also created to provide safe spaces for patients to come to terms with their injuries in a calming and stress-free atmosphere. The wider parkland site provides further opportunities for more active patients to participate in sports-based rehabilitation.

Future prospects and collaboration

The DMRC and NRC will share resources, infrastructure, and staff to provide efficient, world-leading care for both military personnel and civilians. The DMRC’s development marks a significant advancement in the UK’s rehabilitation services for military personnel and the planned NRC will extend these services to civilians, creating an integrated healthcare facility that serves the nation. By uniting military and civilian rehabilitation under one roof, the DMRC will set a new standard for care in both the military and national healthcare landscapes.

Jane Findlay FLI PPLI and Victoria Phillips CMLI are Directors and Andy Webster CMLI is an Associate at Fira

2. The Defence Medical Rehabilitation Centre.

© Fira

3. The Defence Medical Rehabilitation Centre.

© Fira

2.

Typology: Mental health | Location: Liverpool

Alder Hey in the Park

A new landscape ties together a healthcare campus for children’s mental health

The new Community Cluster at Alder Hey children’s hospital in Liverpool is an integration of the new Catkin Centre and Sunflower House buildings with the associated landscape, The project required close collaboration between architects Cullinan Studio and landscape architects Turkington Martin.

The challenge was to meet the aspirations of the Alder Hey Trust to create a world-class open space for health and wellbeing, which befits the name of the hospital, Alder Hey in the Park. Shaped by extensive local consultation, the project provides an inclusive landscape amenity for hospital staff and visitors as well as the wider community of East Liverpool.

The Catkin Centre looks out onto neighbouring Springfield Park and provides a new home for outpatient services including autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), development paediatrics, Child and Adolescent Mental Health Services (CAMHS), eating disorders, and crisis care. It offers engagement space, quiet rooms, consulting rooms, family therapy rooms, an art and music therapy room, offices, and meeting space. Next door, Sunflower House is a home-from-home for young people with complex and enduring mental health conditions, comprising a 12-bed inpatient facility for children aged 5–13 with the most challenging mental health conditions.

The approach to the landscape design is predicated on the widely recognised benefits to mental health and physical wellbeing that visual and physical contact with nature can bring. Opportunities for contact with planting are maximised so that visitors are able to both see and become immersed within a lush green environment. The concept of an intensely planted landscape has informed the approach to the design of all the external spaces.

We recognised that, for many people, their arrival at the car park would be their first Alder Hey experience, and so it needed to be light, welcoming and uplifting. A planted pedestrian route rises along the change in level from the car park to the entrance and is embraced by a combination of perennials, shrubs, trees and wildflowers. The central garden is framed by a cloister, ensuring everyone can visually connect with nature as they pass between waiting areas and patient rooms. Planting is raised to seat height and windows often push out into the courtyard to maximise the visual connection between interior and garden. Within the garden there are both quiet, contemplative areas and more open spaces in which to meet and socialise, with views out over the park. Furniture is a combination of moveable pieces to allow

1. Alder Hey long cross section.

© Cullinan Studio

2. Alder Hey exterior. © Paul Raftery

2.

Cullinan Studio, Turkington Martin

The approach to the landscape design is predicated on the widely recognised benefits to mental health and physical wellbeing that visual and physical contact with nature can bring.

flexibility and choice, together with fixed seating integrated with planted edges. Flowers and foliage colours are intentionally concentrated in different parts of the garden to evoke different moods, from the calming effects of blues, whites and purples, to potentially more stimulating reds, oranges and yellows.

The garden at Sunflower House creates a calm retreat for residents, conceived as a sensory garden and social space, and animated by the

presence of water. A variety of seating spaces are carved into raised planting areas, offering opportunities for small groups to gather or for individuals to find time to reflect alone. The planting has a strong sensory appeal that combines the graceful movement and sounds of ornamental grasses with the evocative scent of herbs, such as mint, thyme and rosemary. Textured leaves and strong colour further enhance the experience. Elsewhere within this planted structure are areas where patients and families can become involved in growing plants themselves, together with more open spaces for play. The gardens are now maintained by the Green Volunteers, a group set up by the Trust to look after their new healthcare landscape.

Mike Martin CMLI is a landscape architect and Director at Turkington Martin

Roddy Langmuir is an architect and Practice Leader at Cullinan Studio

3. Site plan.

© Turkington Martin

4. Alder Hey courtyard.

© Paul Raftery

Typology: Palliative care | Location: Maidenhead

Thames Hospice

Nature and seasonality shape the design philosophy of this wetland hospice landscape

1. Aerial view of Thames Hospice and Bray Lake.

© Ståle_Eriksen

Churchman Thornhill Finch, KKE Architects

The garden emphasises the health-giving properties of the natural world through a realisation that we are part of nature

2. View of rerouted stream passing through the hospice to Bray Lake. Bridges connect patients, staff and visitors with the fluvial landscape and seasonal change.

© Ståle_Eriksen

3. Inpatients’ rooms with individual garden terrace overlooking communal lawns, meadows and lake.

© Ståle_Eriksen

Thames Hospice adjoins a variety of rural landscape typologies including flood plain, former gravel extraction pits, residential woodland, fields and a highway. Each of these edges has been embraced and drawn into the hospice, helping to ‘dissolve’ the sense of boundary, enclosure and territory.

In developing the masterplan with the client, KKE Architects and our engineers, Price & Myers, we shaped the site’s topography, watercourse and layout to translate the flood risk into a design strategy that embraced the fluvial environment: a complex task that demanded close working with our client team to ensure the full understanding and potential of this approach.

Churchman Thornhill Finch promoted this vision, which was supported by technical engineers, planners at Royal Borough of Windsor and Maidenhead as Lead Local Flood Authority, and the Environment Agency, to secure approval and realise the full potential of the site. Stormwater management and flood compensation were provided through the site levels and parking strategy, with a stream rerouted to pass through the hospice, and water shed from the site attenuated within the parking area before being discharged to the lake.

The sense of peace and freedom offered by this unique wetland landscape is, we hope, of profound value to patients. Equally important is what it offers to staff, carers, and visitors, helping them cope with the day-to-day rigours of caring in an environment of bereavement and healing. Bridges within the grounds provide a direct visual and physical connection to this waterscape, prompt allegorical reflection, and serve to subtly separate care functions within the facility.

For us, a hospice garden should balance the tradition of the garden as a place of retreat and meditation with its references to the transience of life (through the expression of seasonality). The garden emphasises the health-giving properties of the natural world through a realisation that we are part of nature and are surrendering to the natural world, giving a sense of solace to patients.

Thames Hospice blends built form and landscape, creating a serene and supportive environment for patients and their families. The design team approached the project with sensitivity to the site’s natural features, particularly the interaction with the adjacent lake and a culvert running through the property. The landscape plays a key role, with the hospice nestled into its surroundings, allowing nature to form a peaceful backdrop to the spaces within.

The brief was to create spaces that enhance the experience of all stakeholders, while ensuring the organisation of these spaces reflected the latest research in healthcare and hospice environments. This process involved numerous consultation

Wildflower meadows have been sown extensively across the site to gently transition into the water’s edge of Bray Lake. An open hedge and woodland edge transitions to existing woodland and residential properties along London Road. Deciduous broad-leaf planting to the south has been reinforced and extended into the site with scattered groups of new woodland plantings that enhance habitat value and create a healthier, more complex edge. Swales, streams and pools criss-cross the landscape and have enabled a host of marginal planting zones to be created.

Rich planting palettes, including nectar-rich species, and restored native habitats at the lake’s edge become more ornamental and floral toward the heart of the hospice. In this way, nature is drawn close and offers an ever-changing seasonal landscape.

sessions with clinical teams, facilities staff and patients to understand the building’s flow, maximise its potential, and emphasise the importance of community and social support that it provides to the wider community.

The building’s mass has been broken down into smaller, domestic-scale structures, connected by courtyards and garden spaces. This creates a homely atmosphere, offering patients privacy and comfort, while avoiding the institutional feel of a larger facility. The human-scale design promotes a sense of calm and dignity for those receiving care.

Kyle Fowler is an Architect at KKE Architects

Andrew Thornhill CMLI is a Director at Churchman Thornhill Finch

West Dereham Garden, Queen Elizabeth Hospital

A set of design principles for dementia-friendly spaces guide this new hospital garden

In architecture, landscape design plays a vital role, particularly in healthcare settings such as dementia care facilities. At PRP Architects our aspiration is always to create safe, accessible spaces for vulnerable adults and older individuals with cognitive and sensory impairments. Through landscape, we strive to infuse joy into everyone’s lives, particularly those facing difficulties or nearing life’s end. Our collaborations extend to charities, local authorities, the NHS, housing associations, and private developers.

The West Dereham Garden is a testament to one particular collaboration with the King’s Lynn NHS Foundation Trust. The client envisioned creating a tranquil, dementia-friendly garden space for patients, carers, and staff of the West Dereham Ward at the Queen Elizabeth Hospital in King’s Lynn, Norfolk. To avoid a clinical

ambience, the ward features a memory wall and local photographs, which will be further accentuated by the garden, designed as a natural extension of the ward.

Alongside the Housing Learning and Improvement Network, PRP Architects contributed to a set of design principles that direct the creation of dementia-friendly outdoor spaces, ensuring they meet the needs of both residents and their carers.

Within these, ‘Access’, ‘Movement’ and ‘Orientation’ are crucial elements in the design of dementia-friendly gardens. Paths are typically level, clear, and easy to navigate to all mobility needs, with features such as trees or other landmarks providing navigational cues. Continuous walking routes, without dead ends, encourage patients to explore freely while reducing the risk of disorientation.

1. A sketch of the dementia-friendly garden at the Queen Elizabeth Hospital in King’s Lynn. © PRP

PRP Architects, King’s Lynn NHS Foundation Trust 1.

Typology: Dementia care | Location: King’s Lynn

The principle of ‘Memory and Mental Mapping’ is supported by the inclusion of familiar elements that help stimulate memories. Sensory features such as fragrant plants and visually striking flowers play a significant role in activating cognitive function. Raised planting beds allow residents to engage in gardening, offering a sense of routine and purpose, which can be particularly beneficial in recalling memories and providing structure to daily activities.

‘Sensory Stimulation’ is integral to dementia-friendly gardens, with carefully selected plants and textures offering multi-sensory experiences. Strongly scented herbs and vibrant, textured plants stimulate the senses, helping residents stay connected to their surroundings.

Finally, ‘Shelter and Shade’ ensures year-round access to the garden, with pergolas, trees, and shaded seating areas providing

comfort and protection from the elements. This ensures the garden can be enjoyed in different weather conditions, further enhancing its value as a therapeutic space.

By adhering to our four core design principles and involving the hospital community in its creation and upkeep, the garden will promote independence and freedom for the patients. The activities facilitated in the garden will instil a sense of normality and structure into daily routines, contributing significantly to a comprehensive treatment plan in conjunction with medical assistance.

2. Many people with dementia will have experience of gardens and gardening – access to external space can trigger positive memories and provide a sense of achievement.

© PRP

3. The garden attached to the Dementia Ward in King’s Lynn, being enjoyed by carers and patients as well as medical professionals.

© PRP

I am not a natural gardener; I don’t have green fingers, but I know the value of co-production – to work with those who will be benefiting from the garden in order to create a space that will be calming and offer patients and carers what they would like to see. I was surprised that people with dementia wanted so much activity within their surroundings

It is essential to include the opinions of end users, and make sure patients and carers have as much opportunity as possible to design the garden.

Emma Harrison is Patient Experience and Public Involvement Lead at the Queen Elizabeth Hospital, King’s Lynn

Angeli Ganoo-Fletcher CMLI is Landscape Director at PRP Architects

Typology: Cancer care | Location: Leeds

Maggie’s Centres

Maggie’s Centres are places where people with cancer, and their friends and families, can find free practical and emotional support. Here, Maggie’s Leeds shows the essential role of landscape.

Heatherwick Studio, Balston Agius, Maggie’s Leeds

1. The Maggie’s Centre in context.

© Hufton + Crow

Heatherwick Studio was commissioned to design a new centre at St James’s University Hospital in Leeds and enlisted landscape design practice Balston Agius to work with them to deliver the project.

The site chosen was the last patch of greenery at the hospital – a grassy hill, bounded by roads and surrounded by large buildings. The six-metre difference in level across the site offered the opportunity to follow its natural contours, so that visitors could enjoy views of the Yorkshire Dales and a connection to the world beyond the hospital. It was this connection to the natural landscape beyond, as well as the tenacity of a Viburnum opulus (guelder rose) that informed the decision for the landscape to be predominantly British native woodland.

The centre is built from warm, natural materials and at all times those using the centre, whether patients or staff, are surrounded by the landscape, which acts as buffer to the harsher built environment of the hospital. The relationship between the centre’s architecture and the visitor’s experience extends beyond the uplifting effect of its surrounding landscape. The front door, for example, is a psychological threshold – the point at which someone might start to accept a cancer diagnosis. Not everyone will be ready to open the door straight away, so there is a bench to sit outside, or a private path to wander quietly through the planting.

The planting scheme works on several levels: in terms of biodiversity and green corridors, but also the progression that a

woodland landscape offers a visitor. Those receiving treatment experience a dynamic and changing landscape through the seasons, over the course of their treatment. The seasons can give hope to those who set themselves milestones – determined to see the bluebells or spring blossom the following year. It was important too that the landscape could partly look after itself; the focus for the Maggie’s team should be on the patients, not on the horticulture.

Michael Balston is a Consultant and Marie-Louise Agius is a Senior Director at Balston Agius.

The relationship between the centre’s architecture and the visitor’s experience extends beyond the uplifting effect of its surrounding landscape.

2. Approaching Maggie’s Leeds. © Hufton + Crow

Design illustration.

Balston Agius

1. Restorative landscaping.

© Tobermore

2. Therapeutic spaces.

© Tobermore

Typology: General hospital | Location: Welwyn Garden City

QEII Hospital

A restorative outdoor space, with a thoughtfully designed hardscape courtyard at its heart

Tobermore

The modern era has seen an increased interest in health and wellbeing, across industry, government, and the public. These issues affect us all, both in terms of how they impact people’s lives, and what our collective industries can do to mitigate them. Hard landscaping plays an important, but often forgotten, role in the spaces and places of healthcare provision.

While hard landscaping is often the last thing people think about during the construction process, it is the first thing people see. We all make subconscious judgements based on these first impressions, instantly deciding whether a hard landscaped area is welcoming or off-putting. This ambiance is critically important in healthcare settings where patients require as calming a setting as possible.

One such project Tobermore was proud to be involved in was the construction of the QEII Hospital in Welwyn Garden City in Hertfordshire, a stunning medical facility with tasteful hard landscaping and complementary greenery. Presented with various paving options by Tobermore, the contemporary aggregate finish of Sienna block paving and Mayfair slabs was the perfect look for a modern, restorative outdoor space.

Explaining the importance of hard landscaping design in creating welcoming spaces, Glen Macfarlane of Macfarlane + Associates commented: “The courtyard is the heart of the scheme, creating a space for users to escape to away from the building. The hard landscape creates a dynamic environment, enhancing positive views. The soft landscape elements provide softening and greening to the building facades, improving key views in and out of the hospital, aiding in creating a therapeutic space for users.”

This dynamic synergy is reflected in the collaborative approach required for designing and realising healthcare spaces, with Tobermore working in close tandem with the architect, Penoyre & Prasad, landscape architect, Macfarlane + Associates, and main contractor, Balfour Beatty.

A landscape-led approach to designing healthcare facilities is becoming of the utmost importance, especially at hospitals like the QEII that feature physiotherapy and rehabilitation units as well as children’s outpatient services. Hard landscaping is taking centre stage at the heart of our nation’s health.

Typology: Primary care | Location: Stirling

Stirling Health and Care Village

A series of therapeutic gardens and public realm hold together a pioneering community health facility in Scotland

rankinfraser landscape architecture, NHS Forth Valley

Stirling Health and Care Village is located on the former Stirling Community Hospital site in Stirling, Scotland.

rankinfraser landscape architecture worked on the landscape masterplan and detailed design, which focused on knitting two new purpose-built facilities into the fabric of the existing hospital site. The new buildings, the GP &

Minor Injuries Centre and The Bellfield Centre (with 100 elderly care bedrooms), bring together a wide range of health and social services.

jmarchitects completed the site masterplan in 2013 and designed the two buildings. The client team comprised Stirling Council, NHS Forth Valley and the Scottish Ambulance Service. The project was delivered

1. Aerial image of the site.

by Robertson through hub East Central Scotland and was completed in 2018.

The GP & Minor Injuries Centre is located on the north side of the original hospital site, the part of the site closest to the centre of Stirling. It created accommodation for existing health services, including minor injuries, X-ray facilities and GP out-of-hours services. Several GP practices and the Scottish Ambulance Service also relocated to the new centre.

The public realm at the entrance to the building forms a gateway from the town into the hospital and connects the new building to the existing hospital. Grass landforms with tree planting clearly direct pedestrians to the main building entrance, and there is a second entrance from the main car park on the other side of the building.

Retained mature trees provide height in the entrance area, which helps embed the building into the hospital context, while new tree planting coordinates with the existing tree species and helps to create spatial structure and seasonal interest. Planting around the building provides separation and privacy between paths and building windows, including consultation rooms. At the centre of the building are two courtyard gardens planted with birch trees, and the main waiting areas look out onto these garden spaces.

The Bellfield Centre provides short-term inpatient care and assessment or rehabilitation for people who require additional support following an operation or illness, including stroke. The integration of health, social and residential care delivered the first service model of its kind in the UK.

The Bellfield Centre is situated to the south of the hospital site, and the building is stepped to respond to the topography, with a series of courtyard gardens and balconies that maximise the southerly aspect. The courtyard gardens are important therapeutic spaces that can be viewed and accessed from internal social spaces and bedrooms.

The outdoor spaces provide seating, raised beds for growing and a specialist area for mobility rehabilitation. Dementia-friendly design was a key requirement for the client throughout the building and landscape in terms of wayfinding, materiality and sensory experience.

The therapeutic experience of The Bellfield Centre is enhanced through the integration of a detailed arts strategy, led by Artlink Central. Artworks are present throughout the building and have a specific focus on dementia-friendly design as they provide opportunities for reminiscence. In the courtyard gardens, lanterns illuminate when darkness falls.

A Green Activity Trail has subsequently been completed, close to The Bellfield Centre and designed by erz landscape architects. This trail runs around the hospital site to connect to the GP & Minor Injuries Centre and consists of a series of engaging activities with therapeutic benefit to those receiving care, staff and visitors of all ages.

Kirsty Knott CMLI is an Associate Landscape Architect at rankinfraser landscape architecture

The project managed to take advantage of sunlight and landscape to create a general feeling of wellbeing throughout the site. Adjacencies offer clients ease of access to social areas and outdoor spaces, encouraging independence. Clear spatial layouts throughout assist in orientation.

NHS Forth Valley

Typology: Mixed-use | Location: Bangkok

Jin Wellbeing County

A mixed-use development in Thailand, including residential, commercial and healthcare facilities, with a design based on principles of sustainability, wellbeing and community.

Located in the Chao Phraya Flood Plain in the suburbs of Bangkok, Jin Wellbeing County is designed with consideration to the surrounding landscape and local climatic conditions, including a polder system, which helps retain water to manage flash floods during the rainy season and utilise it for irrigation purposes across the site. The landscape includes a variety of plants that have been arranged to imitate a forest, while the site’s water management system ensures there is an adequate supply of water during dry season. A creek runs through the site acting as the main drainage and treatment system, while a biopond is used for water retention, enabling irrigation throughout the year. This resilient ecosystem is home to a big variety of urban wildlife, including birds, aquatic animals, insects and squirrels, maintaining biodiversity on the site and surrounding areas.

Circulation routes around the site are fitted with ramps, handrails and seating areas, allowing residents to move around safely and enjoy the surrounding landscape. Rough surface materials are used to reduce the risk of slipping, along with adequate lighting for night-time usage, while the paths are optimised to accommodate ambulance and emergency services vehicles.

The landscape has been designed to enhance the feeling of community through the provision of group activity facilities, as well as chance encounters along the site paths. A selection of seating areas and outdoor tables around the site offer a sense of retreat, while an edible garden allows residents to grow their own fruit and vegetables and creates opportunities for communal gatherings and workshops.

Prapan Napawongdee is a Landscape Architect and Co-Founder of Shma Company Limited

Shma Company Limited, Openbox Architects

1. Water management scheme.

© Shma

2. Jin Wellbeing County.

© Panoramic Studio

Jin Wellbeing County has been designed as an urban park where the buildings occupy only 50% of the site. The outcome is a senior living facility that provides clean air and great outdoor spaces for the residents to explore, contributing positively to their physical and mental wellbeing.

The project reflects Eastern values and traditions of multigenerational living, aiming to cater for the needs and interests of people of all ages. The architecture is based on flexibility, allowing the layout of the residencies to be transformed in order to accommodate residents from different age groups, including wheelchair users, as well as the provision of living quarters for full-time caregivers. At the same time, our aim has been to provide a living environment that doesn’t resemble medical facilities. As such, the installation of rails, bars and walking support equipment only happens when necessary, enhancing the feeling of domesticity for abled-bodied residents, while the design integrates accessible routes throughout.

The development is designed like a campus, including facilities that allow residents to learn new skills, engage in a variety of activities and meet new people.

The masterplanning of Jin Wellbeing County is based on four living unit models: Household, Small House, Open House and Neighbourhood. This resembles the different social environments in which one might find oneself, from a family to a village, a district, and eventually a town, aiming to create a feeling of belonging and community among residents.

The project has been designed according to strict guidelines for tropical weather. All buildings are long and slim, stretched along an east–west axis that enables cross-ventilation and allows natural light in to the buildings. Vertical fins in timber print patterns help to cut excessive sunlight during late morning and early afternoon, while giving a touch of warmth to the overall presence.

Nui Ratiwat Suwannatrai is an Architect and Founder of Openbox Architects

3–4. Jin Wellbeing County.

Typology: Orthopaedic care | Location: Stanmore

Horatio’s Garden, Royal National Orthopaedic Hospital

Considered design and horticultural therapy sessions offering spinal injury patients an oasis of hope

Tom Stuart-Smith Studio, Horatio’s Garden

1. Landscape design.

© Tom Stuart-Smith Studio

2. Horatio’s Garden curved pathways.

© Tom Stuart-Smith Studio 3. The design enables close engagement with the planting for users. © Tom Stuart-Smith Studio

Horatio’s Garden is a wonderful charity that creates gardens to support those recovering from life-altering spinal injuries. During the design process we were aware the garden would be experienced from a unique perspective, with most patients either in hospital beds or wheelchairs. The garden, therefore, needed to deliver direct restorative and rehabilitative benefits to those who had recently faced traumatic injuries, with often lifechanging results and a wide range of mobility needs

The garden now provides an escape from the clinical and overwhelming hospital environment. It is accessible and visible directly from the wards, and is therefore an integral part of each

Patients often come to us from the major central London hospitals, where the views out are rarely green and rooms are many floors up in a multistorey building. For many patients, this also means that their introduction to the garden will be their first time using a wheelchair. This can be a daunting prospect, but the flat surfaces and gently curving paths encourage people to explore, knowing they can do so safely. Patients often practice their wheelchair skills with NHS staff in the gardens, providing a nonclinical environment to work in.

People are pleasantly surprised to find that they have a lush oasis to explore, right on their doorstep, and we’ve had patients comment that it almost feels like a resort. Direct access from the ward rooms means people are often out enjoying the sun or taking a breath of air between their occupational therapy and physio sessions. It’s also a place for quiet reflection or socialising, and the two sides of the garden allow for this. For visitors, it means a pleasant setting to meet their loved one, and they appreciate the privacy that the pods and garden room allow.

For me, the real joy is seeing people immersed in nature, and I am in the privileged position of being able to show people the everyday wonder of plants. The beautiful and intelligent planting by Tom Stuart-Smith Studio allows me to do this with ease, picking

patient’s day-to-day life. Patient experience was carefully considered and prioritised at every stage of the design process, and the experience-led approach followed consultation with many groups in the Horatio’s Garden community, including gardeners, NHS physiotherapists and, critically, patients.

The masterplan includes two distinct garden areas that serve very different purposes. The first, designed around socialising with family and other patients, is centred around a garden building designed by Stephen Marshall that houses workshops and activities for patients and visitors. The second space, the contemplative garden, includes garden ‘pods’ and a series of calming water features that offer patients privacy and respite from the ward. Thus, the garden allows for both vital support and personal contact, as well as moments of calmness and solitude that are so needed during recovery.

The language of the garden is of curved, organic paths through planting, allowing varied and inviting journeys through both gardens. Semi-circular ‘nooks’ are arranged throughout so that, once inside, patients are encircled by planting and not directly facing the hospital buildings, providing privacy and a sense of escape. Islands of planting, breaking up the paths, allow patients and visitors to feel fully immersed in the natural elements of the garden.

out plants with scent, interesting texture, colour, or even sound. In my horticultural therapy sessions, I take cuttings and sow seeds with patients, planting little grains of hope and looking forward, towards a brighter future.

Ashley Edwards is Head Gardener at Horatio’s Garden

Max Harriman is a Landscape Architect at Tom Stuart-Smith Studio.

Space to heal: Unlocking the landscape of healthcare sites

The NHS Forest is an alliance of healthcare sites run by the Centre for Sustainable Healthcare, and it helps stakeholders to leverage the NHS estate as a part of local green infrastructure networks.

Harriet White

The NHS Forest inspires and supports healthcare sites to transform their green spaces for health, wellbeing and biodiversity. The project helps sites to plan, plant and manage trees, woodlands and green spaces to create habitats for wildlife and sustainable social spaces for people. This helps to ensure the NHS Green Estate is visible valued, and part of local green infrastructure.

The NHS Forest has been providing trees for planting on or near NHS land across the UK since 2009. Currently, through Defra’s Nature for Climate funding and the Trees Call for Action Fund, we are able to supply over 150,000 fully funded trees to

NHS England sites. As the NHS estate varies considerably, we offer our trees in a mixture of ways, from curated bundles that support particular needs to large-scale woodland projects.

Our tree bundles range from 10 trees to 240 trees and are chosen to suit a variety of green spaces. For example, there is a blossom bundle made up of a mix of crab apple, hawthorn, hazel, rowan and wild cherry, i.e. species characterised by their blossoms, berries and autumnal leaves. Secondly, sites that wish to create larger woodlands can curate their tree order and have access to a wider range of tree sizes. Lastly, we are supplying a limited number of fruit trees as part of our orchard creation campaign for the 2024/25 planting season, which has diversified our campaign and been very popular so far. During our first season with the Nature for Climate funding, more than 27,000 trees were planted across over 180 trusts in the 2023/24 planting season, a 165% increase in tree planting compared to the previous season.

1. Cherry trees line the newly planted blossom walk in the Secret Garden, Glenfield Hospital, Leicester.

Activation and engagement

In order for sites to receive trees, we require a small amount of evidence. This includes before and after photographs of the tree planting area, GPS coordinates and maps. We also ask sites to agree to a tree planting agreement that sets out requirements regarding care of the trees over the years. These documents essentially provide our grant providers with all the information they need when carrying out tree checks later.

Given our high intake of applications, the amount of support we can offer individuals can be limited. However, we have weekly drop-in sessions for applicants to ask questions about the process or their order. We also run occasional webinar sessions, recently including how to design and maintain an NHS orchard.

Having worked with the NHS since 2009, the Centre for Sustainable Healthcare has a large reach through sustainable health networks, the NHS

Forest Network, training courses, newsletters and the NHS Forest conference. Our outreach methods to promote our tree offer have two key strands, both internal and external to the NHS. Internally, we are part of the NHS Biodiversity working group and other actors in Greener NHS, through which we promote the NHS Forest. We also have connections at the Integrated Care Board and at NHS Trust level, including sustainability, estates and communications teams.

Aside from these groups, we also directly contact sites, for example those that have a low Tree Equity Score. This score indicates a poor urban tree distribution and a low score on variables relating to climate, health and socioeconomic variables. The Tree Equity Score around a healthcare site can indicate risk to environmental hazards that could be reduced with additional canopy cover. Our second method of engagement with sites is through collaboration with key environmental agencies and partners. One example is local authorities with Woodland Creation Accelerator Funding, who have been great advocates of our work and who practically support tree planting that occurs within their area.

There are considerable pressures on the NHS Estate, be that through pressure to develop land for a new ward or to create car parks to

accommodate ever burgeoning parking requirements. Space for woodland creation is limited, and to confirm these suspicions it was noted that almost half of our applicants were planting in pockets of land adjacent to roads, paths, car parks or buildings. An innovative example of planting taking advantage of these small spaces has been delivered by Energy & Sustainability Manager for Yorkshire Ambulance Service, Alexis Percival. Alexis has coordinated the planting of 5,000 trees across more than 30 sites over several years. Although ambulance sites can be small, innocuous sites, collectively they can become an impressive patchwork of planting.

Alexis coordinates planting across this broad area through working with staff and corporate partners, and community involvement features highly, with tree planters’ feedback strongly encouraged. The involvement of local communities in the planting activities was a significant positive aspect of tree planting last season, fostering a sense of collective achievement and environmental stewardship. One participant highlighted the educational aspect of tree planting, and a school was involved in the process, providing students with hands-on learning experiences about the environment and sustainability.

Healthcare sites can be utilised to provide wider outcomes for the environment and society, and more green spaces could be activated if NHS England set targets for tree planting and green space improvements.

2. Tree

© Alexis Percival

3. Langdon Hospital orchard.

© Centre for Sustainable Healthcare

4–5. Mulching newly planted saplings at Southmead Hospital.

© Vicki Brown

Another finding from feedback was that the highest motivator for planting was to provide habitat for wildlife and biodiversity. A key example of nature-conscious planting was at Langdon Hospital in Devon. What was originally a woodworking class in a studio soon became mixed with conservation work when occupational therapist, Alex Watkins, decided to teach patients about the lifecycle of the material they were working with. They started restoring a Devon hedge and then continued to expand their hedge planting across the site. They’ve also now recovered a completely overgrown veteran orchard, established a walking trail around the site and installed wildlife cameras, which brings the outside in. Using tree planting and conservation work as part of patient care pathways is a creative way of blending environmental conservation with patient wellbeing.

Case studies such as Yorkshire Ambulance Service and Langdon Hospital are essential for us to communicate the variety of greenspaces that can benefit from our trees and how planting trees can be the first step in wider green space improvements. A couple of participants last season claimed that planting trees has led to patients and staff paying more attention to plants in the hospital area. As a result, elsewhere in the hospital new plant pots were installed and planted, making a visible green change.

How could more sites be activated in the future?

1 https://www.gov. uk/government/ publications/ independentinvestigation-of-thenhs-in-england

These two case studies also indicate the way patients, staff and volunteers can support planting and green space improvements. To complement this, the NHS Forest has developed a match-making service that allows sites to register their green space events and local volunteers to be notified when these events occur in their area. Nevertheless, we recognise the perennial problem faced by sites, of estate management costs, and have provided this feedback and learning to our funder. We continue to seek further funding that would support these maintenance costs as we consider the future direction of NHS Forest.

Healthcare sites can be utilised to provide wider outcomes for the environment and society, and more green spaces could be activated if NHS England set targets for tree planting and green space improvements. To support them in this goal, future tree planting campaigns must build in the provision of maintenance support with financial support and training on sustainable management methods also considered.

Secondly, the Lord Darzi report1 understood the clear need for preventative action in healthcare. Green spaces have an enormous capacity for this, and the NHS Forest’s Ranger program me exemplifies the potential for NHS sites to link staff and patients to their green space. Rangers enable nature-based interventions and help significantly with awareness building around the benefits of access to green space. They are an enabler of

green space use and build confidence in its use, holistically overseeing green space improvements (including tree planting), understanding the site’s potential, and integrating the maintenance of green space into their sessions.

Lastly, we need to see the healthcare site as a part of the wider landscape and in turn the environment as part of public health. Climate breakdown is going to affect whole communities and their environments, so we need to consider public health at a landscape level. We need to view the entire landscape as one that can improve personal and community wellbeing, while also addressing other ecosystem services.

Harriet White is the Woodland Creation and Tree Planting project manager at the NHS Forest.

planting event with Yorkshire Ambulance Service.

Health creation through landscape

LI Policy & Communications Committee member, Luke Engleback, argues for a change in perspective away from health care, towards health creation.

Systems thinking

Human health and wellbeing are affected directly and indirectly by the environment at every scale. This article sets out the context of why healthcare should be considered differently, and why funding to invest in health creation by design is important.

Conventional funding of health, housing and the environment is considered in silos, but a holistic approach is needed to repair the complex adaptive socio-ecologicaltechnical system of which humans are a part. Human health and wellbeing are affected from planetary to microbial scales, with system scientist Donella Meadows explaining, “Systems surprise us because our minds like to think about single causes neatly producing single effects. We like to think about one or at most a few things at a time.” However, “Systems happen all at once. They are connected not just in one direction, but in many directions simultaneously.”1

Luke Engleback

CMLI FRSA

1 Thinking in Systems – a primer, Meadows, D., 2008, Chelsea Green

2 Structure, function & diversity of the healthy human microbiome, The Human Microbiome Consortium, 2012, Nature 14,6.

1–2. Making much more of SuDS in Germany for play in Freiburg (1), and as a cooling feature Winnenden (2). Paving and decoupled roof drainage is conveyed in channels, reducing excavations. The water storage feature is re-circulated to maintain water quality.

© Studio Engleback

3 Green spaces and respiratory, cardiometabolic, and neurodevelopmental outcomes, Fernandes et al, 2024, Environment International

4 Long-term biodiversity intervention shapes health-associated commensal microbiota among urban day-care children, Roslund et al, 2021, Environment International

5 Healthy Planet

Healthy People, UN Environment Programme.

6 https://www.statista. com/statistics/236541/ per-capita-healthexpenditure-by-country/

The human microbiome is a biodiverse dynamic system comprising over 1,000 species of microorganisms that outnumber human cells by 10:1 and without which we cannot operate. We acquire our microbiomes mostly in childhood through what we eat, touch, breathe and experience, but these non-genetic influences on health, termed the exposome, continue through life. Urban human microbiomes are invariably less diverse than those living in rural areas, which is an issue, as low biodiversity in the gut is linked to health issues including obesity and inflammatory bowel disorder.2 Studies show that children

raised in green environments have better health3 and pre-school children playing in leaf litter and soil have a more diverse microbiome, with a lower level of pathogens than children playing in sterile spaces.4

In the United Nations’ sixth Global Environment Outlook report, Healthy Planet, Healthy People,5 evidence shows that a healthier planet contributes directly to healthier people, whereas environmental degradation increases the burden of disease and exposure to pollutants, and reduces ecosystem contributions from nature. Landscape-led planning and design can make a significant contribution

through measures that address the climate, biodiversity and pollution emergencies alongside health.

Healthcare investment

Spending on conventional healthcare is no guarantee of more successful health outcomes. For example, the USA has the greatest per capita spending on health but ranks 35th in the global league table of healthiness, behind Cuba.6 The UK ranks 19 th and it seems that quality of life (wellbeing) and nutrition play a major role in the best-performing countries. Green spaces are also vital: the Natural Capital Accounts for London showed

that public green spaces had saved the NHS almost £1 billion in averted admissions,7 while also addressing a range of other issues including carbon sequestration and storage, and thermal and flood regulation.

Taking another perspective, the global healthcare sector accounts for over 10% of global economic output,8 but it is also responsible for around 4.4% of global carbon emissions9 – a larger share than global aviation or shipping.10 Healthcare has become increasingly medicalised with 100,000 tonnes of pharmaceuticals consumed globally every year, raising serious concerns about pharmaceutical pollution in the environment.11

Health and wellbeing are related concepts, but not synonymous. Two

measures in particular build on the view of better health contributing to economic progress and happiness: Disability Adjusted Life Years (DALYs) and Quality Adjusted Life Years (QALYs). The World Health Organization (WHO) uses DALYs to illustrate years of life lost to ill health, disability or death, instead of simply counting disease and death. In the UK, the National Institute of Health and Care Excellence (NIHCE) uses QALYs to assess the cost-effectiveness of drugs and interventions, but this assessment is viewed only through a single-disease lens.

In the same vein, Sally Davies, a former Chief Medical Officer for England, advocates for ‘total health’, comprising the wider health

environment and expanded healthcare systems.12 Nigel Crisp, former CEO of NHS England, is also an advocate for health creation which considers the causes of health, rather than the causes of disease and ill health. He has set out his view in Health is made at home: Hospitals are for repairs (2020).13

Evolving health concerns

Global humanity changed rapidly from being 92% agrarian in 1800 to 56% urban today,14 although in Europe this percentage is much higher, with the population ageing and living longer with multiple morbidities. By 2039 people in the UK over 65 will outnumber those under 16 by 6.3 million,15 which will bring new

3. Apartment entrance off a home-zone road in the Vaubin District of Freiburg. Nature on the doorstep, vegetated bin and bike stores, surface water channel in the road.

© Studio Engleback

7 https://www.london. gov.uk/programmesand-strategies/ environment-andclimate-change/ parks-green-spacesand-biodiversity/ green-infrastructure/ natural-capital-accountlondon

8 https://www.who. int/publications/i/ item/9789240017788

9 International comparison of healthcare carbon footprints, Pichler, P. et al, 2019, Environmental Research Letters

10 https://noharm.org

11 https://eeb.org/ the-problem-ofpharmaceuticalpollution/

12 Whose health is it anyway? Davies, S.C., Perason-Stuttard, J., 2021, Oxford University Press

13 Health is made at home: hospitals are for repairs, Crisp, N., 2020.

14 World Population Prospectus, UN Dept. of Economic & Social Affairs, 2024

15 The United Kingdom’s Aging Population, Irving, E., ThoughtCo, 2020

3.

16 https://www.who. int/health-topics/ noncommunicablediseases#tab=tab_1

17 https://www. reuters.com/article/ business/healthcarepharmaceuticals/ chronic-diseaseto-cost-47-trillionby-2030-wefidUSL5E7KI0V3/

18 https://www.who. int/initiatives/globalnoncommunicablediseasescompact-2020-2030

19 https://www. theguardian.com/ environment/2024/ apr/09/human-rightsviolated-inactionclimate-echr-ruleslandmark-case

20 Loneliness as a health issue, The Lancet editorial, vol 402, 2023

21 https://www.gov. uk/research-fordevelopment-outputs/ fair-society-healthylives-the-marmotreview-strategicreview-of-healthinequalities-in-englandpost-2010 https:// www.health.org.uk/ publications/reports/ the-marmot-review-10years-on

22 https://www.who. int/about/governance/ constitution

23 https://www.unep. org/resources/makingpeace-nature

24 Shaping Neighbourhoods, Barton Grant and Guise, 2021, Routledge

25 https:// expanseproject.eu/

healthcare challenges.

Non-communicable diseases (NCDs) are responsible for 73.2% of all deaths each year16 and cause long-term ill health, which the UN estimates will cost the global economy $47 trillion by 2030.17 However, NCDs currently receive only 1–2% of global financing for health.18

Meanwhile, climate change continues to adversely affect vulnerable groups. Older people, especially older women, are more vulnerable to heatwaves, which are more acute in urban areas. In April 2024 over 2,000 Swiss women successfully sued their own government at the European Court of Human Rights over climate change inaction that threatens their future health.19 Loneliness is also recognised

as a major public health problem that can be amplified or diminished by quality of place. Social isolation is associated with increased risk of cardiovascular disease, hypertension, diabetes, infectious diseases, impaired cognitive function, depression and anxiety.20

Finally, increasing health inequality and deprivation are underlying drivers of poor health. Michael Marmot’s reviews of health and inequality in England (2010 and 2020)21 showed a gap of 19.9 years in life lived in good health for a woman from the 10% most deprived areas compared with a woman from the least deprived. The equity challenge extends further to awareness and action for disabled and neurodiverse people as well as gender and racial equality.

Health creation by design

The WHO constitution defines health as “A state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity”. 22

At the macro scale, action to reverse global environmental decline reduces threats to human health and wellbeing. Environmental changes cause direct, ecosystem-mediated, and displaced effects on health (Fig 1). Climate change brings a variety of risks to communities, healthcare systems and population health as a consequence of heat-waves, flooding, drought and cold (Fig 2). These environmental emergencies need to be tackled together and the United Nations Environment Programme (UNEP) report, Making Peace with Nature (2021),23 outlines how through the framework of the 17 UN Sustainable Development Goals (SDGs). SDG3 is directly concerned with good health and wellbeing. A more tangible impact on individual health is made at neighbourhood, street or site scales. Barton, Grant and Guise have brought together evidence and examples of working with natural systems in their book, Shaping Neighbourhoods (2021).24 The urban exposome drives around 70% of the non-communicable disease burden (including obesity, asthma, depression and diabetes), but as most urban environments can be modified, this provides a great opportunity for disease prevention and health creation.

The EXPANSE project25 is researching those aspects of the urban environment that contribute most to heart disease, urban-environment health connections, and interventions that most effectively promote health. Some conditions have several drivers: obesity, for example, is not only linked to exercise and diet but also to the density, connectivity and greenspace in a neighbourhood that shape an individual’s lifestyle.

With this in mind, Sustrans’ Healthy Street Design Check tool 26 is worth noting to encourage walking, wheeling and cycling by addressing the whole street environment through ten indicators that measure

Fig 1.

Fig 2.

the experience. A key focus is to reduce traffic volumes and speed, and improve safety and air quality. Small interventions such as rain gardens, shelter, shade, better lighting, and improved road crossings are recommended.

Design takeaways

In summary, the multiple drivers for good health in the urban environment27 include: –

Density and proximity: Essential amenities located within 15 minutes of home. –

Mobility and transport: Good connectivity by foot, bicycle and public transport.

– Mixed use: A ‘complete neighbourhood’ mixing of public services, green spaces, access to

good food, and commerce.

– Landscape and environment: Diverse, linked green and blue spaces encouraging conviviality, recreation and regular contact with nature.

– Housing and energy: Quality homes that minimise energy and water bills through design.

– Increasing accessibility and reducing loneliness by design.

An excellent example of this approach is the Healthy City Generator,28 a new design tool developed by Healthy Cities in Barcelona with EIT Urban Mobility and the University of Lisbon. Connections between health outcomes and urban design inputs are made to calculate the effects of interventions using 20 urban determinants of health and 30

health indicators. The health impacts of interventions such as green streets are illustrated in terms of life expectancy improvement per person, deaths avoided per year and DALYs avoided per 100,000 residents. The economic impacts are shown as estimated overall health cost savings per year, per person, and the return on investment in an intervention over time. This allows design measures to be tailored to a particular area, and for iterations and benefits to be tested at the design stage.

One of the key changes needed in the NHS is to relieve the chronic overloading of this healthcare system of last resort. Planning, design and retrofitting healthier cities up-streams health care into health creation: an essential investment in future health outcomes. In mending the broken NHS, it is important for the government to think in systems rather than silos and take a broader view to reducing the burden on the health service. The 1.5 million new homes it has committed to must demonstrate and deliver this.

Luke Engleback CMLI FRSA sits on the Landscape Institute Policy & Communications Committee and various design review panels. Studio Engleback is a founding signatory of UK Landscape Architects Declare.

4–5. The standard approach to balancing ponds in Cambridge (4) and Bourne (5), is unattractive. Conventional higher carbon underground drainage creates these lower invert levels and deeper basins.

© Studio Engleback

The health impacts of interventions such as green streets are illustrated in terms of life expectancy improvement per person, deaths avoided per year and DALYs avoided per 100,000 residents.

26 https://www. sustrans.org.uk/ our-blog/news/newhealthy-streets-designcheck-launches/

27 https://healthy-cities. com/

28 https://healthy-cities. com

www.factoryfurniture.co.uk

Reimagining the hospital

Building health and wellbeing in society requires building hospitals that are more than the sum of their parts, and that contribute to local neighbourhoods.

Prachi Rampuria, Soham De

The NHS is facing unprecedented challenges. A waiting list of five million must be addressed by increasingly exhausted front-line workers, against the backdrop of more than ten years of budgetary attrition and a large-scale reorganisation of the 2012 Health and Social Care Act.

To make matters worse, these challenges must be addressed in the context of widening threats to public health including climate change, poor-

quality homes1 and social isolation. Compounding this situation, many NHS providers are doing their best to deliver an ever greater complexity and volume of care from a healthcare estate that in large parts is well past its best, no longer fit for purpose, and with a huge maintenance backlog.2 Overall, the NHS estate faces a unique confluence of interrelated pressures. This is clearly a time that demands new thinking about hospital planning and design. Ultimately, however, the outcomes of treatment must depend on the patient population’s underlying levels of health and wellbeing. For maximum cost-effectiveness, therefore, we need new design ideas that increase hospitals’ capacity to treat illness in ways that also help to build a wider wellness.

However, even when they form well-distributed systems at regional scale, most hospitals have negative impacts on wellness at neighbourhood scale. We find the current approach to integration of hospital infrastructure within neighbourhoods to be problematic and hence this article focuses on it.

Rethinking the neighbourhood scale

Typically, even the best-distributed hospitals are only loosely integrated with other neighbourhood activities, which nudges people away from the physical exercise of active travel. To build wellness, however, we need neighbourhood design that counters the obesity epidemic by fostering more active lifestyles.

Large, impermeable hospital footprints deter pedestrians and cyclists by forcing them to make detours: blocks larger than 200 square metres have this car-dependent impact.3 To avoid this, we must seek opportunities to break the hospital block size down to walkable dimensions. In the case of alterations to existing facilities, the starting point is to seek opportunities to create new streets through the site when renewing outdated building stock. This generates our first design principle: Walkable blocks.

1 BBC News. 2021. 11 charts on the problems facing the NHS. [online] Available at: <https:// www.bbc.co.uk/news/ health-50290033> [Accessed 10 June 2021].

2 Publications. parliament.uk. 2021. House of Lords, The Long-term Sustainability of the NHS and Adult Social Care – Select Committee on the Long-term Sustainability of the NHS. [online] Available at: <https:// publications. parliament.uk/pa/ ld201617/ldselect/ ldnhssus/151/15106. htm> [Accessed 10 June 2021].

3 Sevtsuk, A. et al (2016), Pedestrian accessibility in grid layouts: the role of plot, bock and street dimensions, Urban Morphology 20(2): 89–106.

1. Typical organisation of hospital estate sites with large impermeable footprints that discourage walking and cycling at the neighbourhood scale.

© EcoResponsive Environments

2. Principle 1 – Walkable blocks.

© EcoResponsive Environments

Walkability, however, requires more than walkable-sized blocks. In these times of perceived strangerdanger, we need reassurance to feel safe on the street. ‘Eyes on the street’4 from adjoining buildings bring a sense of security,5 but there is a problem: most of the activities inside hospitals are too private to offer casual surveillance. By their nature, to maintain patient dignity, hospitals are essentially introverted buildings. To improve oversight, hospitals need to be ‘sleeved’ behind other activities such as housing and other complementary wellness-building amenities at ground-level, such as shops, cafés, gyms, or studios for yoga or art therapy. These are valuable both for the hospital itself and for the wellness of the wider community, and can transform the introverted hospital silo into an outward-facing wellness hub.

These more street-related activities offer a double advantage: unlike the introverted hospital edge, they create economic as well as social value from their street-edge location. There is a great deal of evidence showing that long thin, strips of land alongside streets are highly efficient in property development terms,6 so two birds can be killed with one stone here. As well as providing space for activities that benefit wellness-building, this offers opportunities for creative thinking about value capture to increase the financial viability of the emerging hub as a whole. Taken together, this generates our second design principle: Sleeving and locating activities for ‘street life’.

It has been well known that hospital patients recover faster with views of nature than with views of brick walls, and we now know that green settings also reduce the levels of pain relief required. Green experience helps maintain and develop wellness too: evolving in natural environments, it is unsurprising that humans have developed a fundamental affinity with other natural systems that we call biophilia.8 Because they help reduce stress,9 green surroundings make for more harmonious, trusting relationships with others,10 enabling us to develop cultural capital in the

4 Jacobs, J. (1961) The death and life of great American cities. New York: Random House.

5 Gehl, J. (2010), Cities for people, Washington: Island Press, Chapter 2: Senses and Scale.

6 March, L and Steadman, P. (2020, 1971) Geometry of Environment, and Berghauser-Pont, M. and Haupt, P. (2007) The relation between urban form and density, Urban Morphology, 11(1), 62–65.

7 Ulrich R.S. (1984) ‘View Through a Window may Influence Recovery from Surgery’, Science Issue 4647, 420–421.

8 Wilson, E.O. (1985), Biophilia, Cambridge, Mass: Harvard University Press.

9 Gidlow, C.J. et al (2016), ‘Natural Environments and Chronic Stress Measured by Hair Cortisol’, Landscape and Urban Planning 148, 61–67.

10 Sullivan, W.C. et al (2004), ‘The fruit of urban nature: Vital neighbourhood space’ Environment and Behaviour, 36(5): 678–700.

3. Principle

2

– Sleeving and locating activities for ‘eyes on the street’.

© EcoResponsive Environments

4. Principle 3 –Maximise green exposure.

© EcoResponsive Environments

process. Wherever possible, therefore, our neighbourhood wellness hub should take advantage of opportunities to incorporate natural elements and create green corridors connected with the wider context.

To maximise the connectivity of the system as a whole,11 and encourage the multisensory experience of birds, butterflies and pollinators, we can design these green corridors to pierce the hospital sleeve, flowing through into the internal spaces of the hospital itself. Where green corridors penetrate the sleeve, we can create small street-related pocket parks for children’s play and informal gatherings. Within the hospital itself, green spaces allow internal spaces such as wards to experience natural settings while maintaining their own privacy.12 These green spaces also provide opportunities for local volunteers to engage in therapeutic gardening activities, in the process providing fresh produce for the hospital kitchen. These considerations generate our third design principle: Maximise green exposure.

Hospitals have complex internal circulation requirements. Some work there every day; others are unfamiliar with the place; many are very stressed. Legibility and psychological atmosphere are key

11 Forman, R.T.T. (1995), Land Mosaics: the ecology of landscapes and regions, Cambridge: Cambridge University Press. 12 Assets.publishing. service.gov.uk. 2021. [online] Available at: <https://assets. publishing.service. gov.uk/government/ uploads/system/ uploads/attachment_ data/file/957205/ National_Model_ Design_Code.pdf> [Accessed 18 June 2021]

13 Yang H. (2021) Emotional Journey | Service Design Tools. [online] Available at: <https:// servicedesigntools. org/tools/emotionaljourney> [Accessed 15 June 2021].

It has been well known that hospital patients recover faster with views of nature than with views of brick walls and we now know that green settings also reduce the levels of pain relief required.

design considerations,13 and landscape can have a significant role to play.

The overall aim of the system is to provide privacy and dignity for patients, together with easy horizontal and vertical access between departments, separately for staff and visitors. To make this work, we should organise distinct systems of horizontal and vertical access integrated with views and access to well-designed landscape areas that both enhance legibility of internal layouts and are stress-relieving.

The main staff system, frequently used to move between departments, gives rise to many unplanned encounters between staff members. Research suggests that these offer opportunities for impromptu discussions that are important for the effectiveness of the overall system.14 15 We should therefore design nature-rich subspaces to facilitate these.

The main public system is used by people who are often highly stressed and anxious. As well as being directly legible, landscaped spaces offer a sequence of sensory experiences designed to create a low-stress balance between boredom and overstimulation. These considerations generate our fourth design principle: Legible landscape-integrated internal streets.

Finally, to benefit patient experiences, clinical outcomes and staff wellbeing, hospitals must be able to adapt to changing health and care demands and technical services over time. As the move towards greater regional distribution of services gathers pace, the balance of space requirements between hospital facilities and related housing and other services is likely to change.

Our typology allows NHS real estate to stay connected with these opportunities as they evolve. At the block scale, green courtyards could become new green streets, allowing hospital elements to accommodate more outward-looking activities such as housing, teaching or research facilities. This generates our fifth principle: Realising opportunities through time.

5. Principle 4 –

Legible landscapeintegrated internal streets.

© EcoResponsive Environments

6. Principle 5

– Realising opportunities through time.

© EcoResponsive Environments

Before After

Conclusion

Ultimately, a hospital’s performance is built on the underlying health of the population it serves. How we integrate healthcare infrastructure at the neighbourhood scale is critical to this. At the scale of a hub or campus, our principles reimagine hospitals as the seeds of neighbourhoods that foster wellness by supporting active lifestyles. Creating links between the hospital and the neighbourhood’s wider activities also offers opportunities to enhance the value of the NHS real estate, potentially increasing the funding available for the hospital facilities themselves.

14 Hertzberger, H. (2015), Architecture and Structuralism: The Ordering of Space, Rotterdam: NAI, p. 80.

15 Carthey, J., 2008.

Reinterpreting the Hospital Corridor: “Wasted Space” or Essential for Quality Multidisciplinary Clinical Care?. HERD: Health Environments Research & Design Journal, 2(1), 17.29. 6.

Taken together, these principles should not be seen as a rigid recipe. If used creatively, the same underlying principles will generate unique, situation-specific outcomes. There is, however, a common factor: these principles help the designer break free from the concept of the hospital as an isolated element. The whole, in healthcare terms, becomes more than the sum of its parts.

Prachi Rampuria and Soham De are Co-founding Directors of urban design and architectural practice, EcoResponsive Environments, and authors of EcoResponsive Environments (Routledge, 2024).

Ultimately, a hospital’s performance is built on the underlying health of the population it serves. How we integrate healthcare infrastructure at the neighbourhood scale is critical to this.

Green infrastructure and the NHS estate

Natural England North East and Yorkshire looks at how to activate the NHS estate for positive health outcomes for people and nature.

Esther Smith

Recent years have seen a growing recognition of the profound impact that natural environments can have on health and wellbeing.

Natural England’s vision for healthcare facilities, as with all urban landscapes, includes working with nature to make places with which people connect and resonate. This includes beautiful spaces for recreation and reflection that also foster biodiversity, mitigate air and noise pollution, sequester carbon and alleviate urban heat island effects and flooding risks.

The NHS estate, with its vast network of facilities and land at the heart of communities, presents an unprecedented opportunity to adopt an approach that considers how nature and people can thrive together.

“Working in a more integrated way benefits people, place and the environment. Bringing these aspects together in hospital and community settings helps to connect us all back to nature,” says Cara Courage, Natural England’s Principal Manager for Sustainable Development in Northumbria. “Nature’s role in healing is well known, so there is no better place to bring it all together than in hospital estates.”

NHS initiatives such as Greener NHS1 and joint enterprises like Green Social Prescribing2 are building the case for health and nature, and along with the Biodiversity Net Gain (BNG)3 legislation introduced by the

government earlier this year, they are helping to improve the natural environment in and around healthcare facilities.

BNG provides a real opportunity for embedding environmental outcomes for healthcare facilities as the developer and as the landowner. Firstly, healthcare facilities looking to meet the 10% BNG can create rich and biodiverse areas for patients and staff to enjoy. In this scenario it is important the BNG is considered early in the project, starting with an ecological survey of the existing biodiversity value and utilising the biodiversity metric to design a scheme that benefits both people and nature.

There are perhaps even more significant opportunities for the NHS as a landowner, through ‘habitat banking’,4 which involves enhancing or creating habitats that can be sold to developers looking to meet their BNG. Discussions

1 https://www.england. nhs.uk/greenernhs/

2 https://www. england.nhs.uk/ personalisedcare/ social-prescribing/ green-socialprescribing/

3 https://www.gov. uk/government/ collections/biodiversitynet-gain

4 https://www. futureparks.org.uk/ habitat-banking

are underway with various NHS trusts in Yorkshire as to how they might use their land (such as the edges of helipad fields) to improve the habitats and sell units.

For healthcare estates considering what BNG could mean for them, the best place to start is to understand the value of biodiversity units that exist, speak with local planning authorities about the potential local demand for different units, and start exploring the possibilities.

Action on the ground

5 https:// naturalengland.blog. gov.uk/2024/05/24/ our-natural-healthservice/

6 https://nhsforest.org/ blog/biodiversity-forhealthcare-sites/

7 https://www. yourvoice.westyorksca.gov.uk/wynature

In Bradford, the local NHS Trust is pioneering a ‘green therapy’ initiative5 that harnesses the natural environment to improve health outcomes within psychiatric care. This understanding informs practical site management plans, supported by patient and staff activities including crafting bird boxes, installing accessible planters for staff

and patient gardening, and participation in the NHS Forest tree planting scheme.6 These initiatives provide spaces for green therapy and contribute to environmental outcomes as well as boosting nature.

In Yorkshire, the NHS Yorkshire Ambulance Service’s Fairfield Green Space project is transforming a major site near York into a thriving hub for people and nature.

The project draws on funding from NHS Charities Together and supports species such as tansy beetles and water voles. Sheltered, reflective spaces also provide busy NHS Ambulance employees with time out in nature, and natural learning spaces provide innovative outdoor classrooms for the NHS and other organisations that are keen to improve site development for nature and people.

The site supports the creation of green corridors in the area, ultimately

linking to one of Natural England’s National Nature Reserves further south, and it has been featured in Local Nature Recovery Strategy publications.7

Working in a more integrated way benefits people, place, and the environment. Bringing these aspects together in hospital and community settings helps to connect us all back to nature.”

1. Healthcare Facilities, from Natural England Green Infrastructure Planning and Design Guide 2023. © Natural England

Links between NHS Green Plans, Local Nature Recovery Strategies and local authorities’ urban greening ambitions offer great opportunities here to create networks of multifunctional, wildlife-rich green urban spaces

Meanwhile, the NHS Mid Yorkshire Teaching Trust has undertaken significant development projects to integrate nature into their healthcare settings. The Trust has maximised its green spaces, creating a mosaic of habitats that support rare species such as wych elm, including a palliative care site replete with wildflower matting, living walls, fruit trees, scented plants and a wisteria arch.

The success of these initiatives highlights the need for effective collaboration across disciplines and sectors, and the Tees Valley Nature Partnership’s Health and Wellbeing working group demonstrates the power of a joined-up approach across

2. The Cherry House at Fairfield Green Space for NHS Yorkshire Ambulance.

© Alexis Percival

3. The Cherry House at Fairfield Green Space for NHS Yorkshire Ambulance in use for NHS sustainability skills workshop. © Alexis Percival

4. Feedback from participants from NHS England Education Northeast Workshop.

© Esther Smith

8 https:// designatedsites. naturalengland.org.uk/ GreenInfrastructure/ DesignGuide.aspx

9 https://www.gov.uk/ government/news/ natural-englandunveils-new-greeninfrastructureframework

a broader area. By bringing together partners including local authorities and voluntary organisations, the group has provided significant input into the development of the South Tees Joint Strategic Needs Assessment for the creation of high-quality green and blue spaces.

Natural England is playing a key role in facilitating this cross-sector dialogue and contributed to an NHS England Education Northeast Workshop at a recent conference. Using an interactive approach with a wide range of NHS colleagues, participants explored green infrastructure design features from both natural environment and human health perspectives.

Green infrastructure resources such as the Natural England Green Infrastructure Planning and Design Guide 2023 8 have proven especially useful to support an imaginative approach to site development, providing a model for healthcare sites with a range of possible management interventions and related benefits.

Antony Muller, a Natural England Senior Officer for Strategic Plans for Places, said, “Feedback from the delegates was thoughtful and positive, with key messages emerging around the value of a toolkit to help healthcare facilities to understand costs and identify practical options for the retrofitting of green infrastructure features. Separately, we identified the need to engage with NHS estates colleagues to share the Green Infrastructure Framework9 and influence both the design of new facilities and the maintenance of existing ones.”

Challenges and opportunities

These innovative partnerships are inspiring, yet challenges in securing consistent funding, aligning diverse stakeholder priorities and ensuring long-term site maintenance remain.

As these groundbreaking examples demonstrate, the opportunities outweigh the challenges

Natural England will support these challenges through partnership working in place, using the Green Infrastructure Framework, BNG and links to healthy placemaking and nature recovery. Links between NHS Green Plans, Local Nature Recovery Strategies and local authorities’ urban greening ambitions offer great opportunities here to create networks of multifunctional, wildlife-rich green urban spaces linking to each other and wider, wilder networks for nature which also contribute to the health and responsible enjoyment of our communities.

As these groundbreaking examples demonstrate, the opportunities outweigh the challenges. As more healthcare providers take a considered and collaborative approach to nature and people on their sites, the benefits are clear. From improved patient outcomes and staff wellbeing, to enhanced nature and climate resilience, the results will speak for themselves, and we can expect to see a continued expansion of these initiatives.

Esther Smith is a Senior Adviser at Natural England Health and Environment North East and Yorkshire and works at a regional level to strengthen partnerships between health, nature and environment sectors.

Translating research into practice

1 Boys, J., 2016. ‘Architecture, Place and the “Care‐Full” Design of Everyday Life.’ In Care and Design: Bodies, Buildings, Cities (John Wiley & Sons), 155–177.

2 Cohen, S. & Fenster, T., 2021. ‘Architecture of Care: Social Architecture and Feminist Ethics.’ Journal of Architecture (26): 257–285.

3 Imrie, R. & Kullman, K. 2016. ‘Designing with Care and Caring with Design.’ In Care and Design: Bodies, Buildings, Cities (John Wiley), 1–17.

4 Krasny, E. 2019. ‘Architecture and Care.’ In Critical Care: Architecture and Urbanism for a Broken Planet (MIT Press), 33–41.

How can we secure better healthcare environments for end users by ensuring that the holistic value of landscape is not excluded from final delivery?

Dr Rebecca McLaughlan

In the face of climate change, economic disparity, ageing populations and mounting rates of mental illness, recent scholarship has called for a reappraisal of the connection between design and care; and a subsequent reorientation of education and practice towards an ethic of care.1–4 This scholarship tends to valorise a particular version of practice, one that engages with communities, non-governmental organisations and municipal authorities on projects intended to meet the needs of marginalised groups. Though a compelling theoretical proposition, much of this scholarship remains conveniently at arm’s length from the realities of contemporary practice, including the need for architecture and landscape architecture to remain financially viable professions. What if we broaden the definition of architects that ‘care’ to also include those who are committed to advocating for definitions of value beyond the economic, and that demonstrate both the willingness and the skill to fight for that value to be recognised throughout project procurement?

1. An artist’s impression of Footscray Hospital, currently under construction in Melbourne, Australia. The design takes seriously the wellbeing benefits of views and access to nature by positioning a large public green space within the centre of the site. © Cox Architecture, Billard Leece Partnership, Tract Consultants.

My current research traces the relationship between research-informed design, procurement models and the end user benefits embedded in the subsequent built form.

‘Difficult buildings and occasional battlegrounds’ is an apt descriptor for healthcare projects. I’ve researched the design of these environments for more than a decade, and architects consistently lament the flawed procurement systems that result in compromised design outcomes for end users. Many of these compromises occur in relation to landscape, where budgets are cut despite veritable mountains of evidence confirming the value, not just of landscape views, but of access to quality green space to improve the wellbeing of hospital patients, their families and healthcare teams. While cost is the excuse typically offered up for compromises deemed necessary, my research confirms what most design practitioners already know – compromises also arise from perceptions of risk related to innovation; conflicting stakeholder preferences; the constraints of government supplier agreements; the promise of short-term savings over longer-term economic returns; even cleaning procedures, and the desire to standardise them across a large building. All these factors play a role in obstructing the implementation of design solutions intended to support physical health, psychological wellbeing, learning (including that which is necessary during rehabilitation) and social connection. Yet the savings associated with these compromises are often negligible.5–6

At a broader scale, what this tells us is that the capacity of built (and landscape) environments to extend care goes beyond the question of having reliable evidence. Instead, this is inextricably tied to the agency of the designer within a complex procurement ecosystem that often acts to constrain it.

Lags in the uptake of evidence by designers themselves have been lamented by academic researchers. Among the explanations tendered include the costs of research engagement for design practices and their clients; a lack of expertise relative to sourcing and evaluating research; and the risk of experienced practitioners becoming set in their ways.7–9 Yet little of this research examines the obstacles related to the procurement process itself. This fact is significant. Jos Boys has suggested that to understand the ways that designers ‘care‘, we should not consider built outcomes but ‘how one acts as a designer‘.1 This is inherently difficult, given such acts are often concealed behind the closed doors of confidential meetings, or buried within built outcomes that obscure the arguments fought and lost. Perhaps more important than the question of who these ‘caring’ designers may be is the question of how they manage to successfully navigate complex procurement processes to secure better healthcare environments for end users?

Conversations with a range of healthcare designers, both in Australia and internationally, reveal a shared set of practices. The most common is the justification of landscaped spaces as part of a project’s Environmentally Sustainable Design (ESD) strategy. I can point to examples of significant roof gardens, in paediatric and palliative settings alike, that barely survived the ravages of budget cuts and did so only owing to their necessary contribution to meeting ESD targets.

The presence of a ‘design champion’, someone working within a healthcare organisation but in support of the design team’s vision, is another factor to which architects commonly attribute successful outcomes. As one architect noted in relation to a medical professor

arguing for openable windows in palliative care settings, “You can’t ignore a professor telling you... that a person with slipping consciousness is still going to register [fresh air] as fundamental.”5 What is curious about this is just how easily a designer saying the very same thing can be ignored. The utilisation of academic literature to validate a design response is another, sometimes successful, strategy. Yet the uptake of that evidence by key stakeholders seems, again, more important than the evidence itself. This speaks further to the critical role of a design champion in negotiating better end user outcomes.

While none of this is likely to surprise, more interesting is the role of deeper forms of engagement with end users, such as through co-design practices, that “empower clients to set higher quality briefs that enable design teams to deliver higher quality projects”.10 My current research traces the relationship between researchinformed design, procurement models, and the end user benefits embedded in the subsequent built form. Across the typologies of paediatric, palliative and mental healthcare, we are seeing extensive co-design processes with end users that architects credit with minimising compromise within value management processes. What can be provisionally hypothesised here is that deeper forms of end user engagement may be a powerful lever to support greater architectural agency within the procurement process. These stories of success deserve closer examination to better understand how the profession could be reorientated, not simply to aspire to care, but armed with the skills to successfully put this ethic into practice.

Dr Rebecca McLaughlan is a Senior Lecturer in Professional Practice, Architectural Design and Research at the University of Sydney. Her research examines the impact of healthcare environments on end user wellbeing across paediatric, oncology, palliative and mental health care settings.

5 McLaughlan, R. & Kirby, E. 2021, ‘Palliative Care Environments for Patient, Family and Staff Wellbeing: An Ethnographic Study of Non-standard Design,’ BMJ Supportive & Palliative Care, advance online publication: bmjspcare-2021-003159.

6 McLaughlan, R. & Richards, K. 2023. ‘Evidence and Architectural Competency within the Procurement Ecosystem,’ Ardeth (10): 230–249.

7 Stichler, J.F. (2016). ‘Research, Research-informed Design, Evidence-Based Design: What Is the Difference and Does It Matter?,’ Health Environments Research & Design Journal (10): 7–12.

8 Lawson, B. (2013) ‘Design and the Evidence,’ ProcediaSocial and Behavioral Sciences (105): 30–37.

9 Hamilton, D.K. (2014). ‘Research Informed Design, Best Practice, and Fresh Perspectives: Can We All Get Along?,’ Health Environments Research & Design Journal (7): 94–97.

10 McLaughlan, R., Richards, K, and Smith, C. (In press). ‘Architects as Knowledge Brokers? Understanding the Role of Research Investment in Contemporary Practice and its Relationship to Academic Research.’ Architectural Research Quarterly

Next steps for Landscape and Carbon

Introducing the next phase of the Landscape Institute’s pioneering programme on reducing carbon in landscape projects.

Andrew Rylah

Although the built environment sector contributes almost 25% of our greenhouse gas emissions,1 to date the focus has mainly been on decarbonising buildings. The spaces between buildings remain

a significant blind spot and many barriers exist for landscape practitioners in understanding, calculating and communicating the carbon impact of our schemes.

In March 2024, the Landscape Institute (LI) and British Association of Landscape Industries launched the well-received report ’Landscape and Carbon’. Highlighting the integral role of landscape in reducing embodied and whole-life carbon emissions, the report provided valuable insights

for practitioners.

Building on the eight recommendations the report set out, the LI has now established a Steering Group and three Task & Finish groups (introduced below) to deliver practical outputs that will empower and inspire practitioners to develop their own embodied carbon reduction strategies and methodologies and accelerate our collective progress towards net zero development.

Underpinning each group is our

Project Carbon Assessment, Processes and Tools

This group is working to agree and recommend a freely available, standardised, whole-life carbon assessment process for selfregulated use by practitioners of landscape-related work.

Key themes include:

Practitioner-friendly outputs: Developing resources that add value, allow for incremental accuracy improvements and are adaptable for future review and development.

Suppliers, Data & Materials

This group focuses on encouraging the use of Environmental Product Declarations (EPDs) so they become common practice among UK suppliers and across industry sectors. We want to develop and promote leading practice around EPDs that is aligned to existing industry tools, is accessible to practitioners, informs decision-making, and facilitates commercial and professional benefits. This work involves liaison with third-party accreditors and engagement with organisations that host EPD databanks.

– Tool and standard integration:

Impartially identifying existing tools and standards (e.g. PAS 2080 and BS EN 15978), recognising their strengths, limitations and potential application throughout the RIBA stages and project process.

– Carbon reduction guidance: Producing and sharing guidelines for carbon reduction, setting carbon baselining processes and developing incremental reduction targets towards net zero.

We’re keen to collaborate with other professional bodies and organisations to ensure our outputs are aligned with existing methods and standards. Outputs will consider the diverse types and scales of landscape projects, from urban to rural.

The group will target hardscape sectors, especially those where the impact of EPD guidance and support on carbon emissions may have greatest effect. We also recognise the important challenges around soils and nursery production (in terms of both supply and potential sequestration), where data is among the least advanced. The benefits of producing EPD guidance in this sector would be significant for practitioners because of the current gap in provision.

This work focuses on connecting with industry bodies to encourage

and promote EPD development and to ascertain member engagement. We will also investigate generic EPDs, recognising their particular importance for smaller enterprises where the cost of bespoke EPDs can be prohibitive.

Do you have experience, knowledge or data that will help us to quantify the carbon of softscaping elements in landscape projects?

Please get in touch at policy@landscapeinstitute.org

2. Member schemes such as Cator Park by HTA Design, which reused 30,000m3 of demolition material to shape the landscape, are leading the way on material reuse.

© HTA Design

Inputting metrics into the Pathfinder tool, the team established that it will take 39 years for the project to absorb its embodied carbon, and argue that clients, developers, local authorities and other designers need to be more transparent about carbon. Read more in Landscape Autumn 2023: Pioneering the park of the future.

Education

This initiative will develop educational resources, including a general introduction to EPDs and a glossary of key carbon terms for landscape practitioners. It will include ways to raise awareness and educate clients about the role of landscape in reducing carbon emissions, considering ESG factors and such stakeholders as the public and the finance and insurance sectors. We are also considering the delivery of EPD training at different levels to

focus on producing accessible, freely available, practical resources, or building on existing ones for aligned sectors. Such resources would inform and add value to the landscape sector, raising its profile within the wider built environment. To date, groups have focused on developing topic scopes for the next 12 months, with the possibility of fresh goals and further targets beyond 2025. Our next steps involve granular project planning within each group and detailing the key tasks that will deliver benefits to target audiences.

We’re in the midst of a climate

equip practitioners for work with suppliers and specifiers. The topic will connect with the other groups around such themes as:

– Understanding underpinning legislation, regulation and ethics and identifying gaps around landscape.

– Appreciating the lifetime carbon impact of materials, including considerations when selecting lower carbon materials, with a

and ecological emergency, and it’s precisely the time to be engaged in the design and delivery of landscapes to address these crises. We must position ourselves at the top table, catching up with other built environment professions, taking responsibility for our carbon impacts, and leading the conversation around climate resilience and adaptation.

Andrew Rylah is Policy & Public Affairs Manager at the Landscape Institute

focus on whole-life usage and end of life.

– Guidance on carbon measurement tools for design, build and operation.

– The sequestration potential of different landscapes, soils and plants.

– Mitigation, adaptation and regenerative approaches, including recycling and circular economy practices.

We greatly appreciate the contributions of our expert volunteers and are keen to attract a variety of professionals across sectors to advance key topics. If you are interested in finding out more or participating in this vital work, please get in touch at policy@ landscapeinstitute.org, and scan the QR code to read the original report.

3. Mayfield Park, Manchester, by Studio Egret West, has taken a climate-aware approach to delivery.

A landscape-led approach to planning reform

Drawing on the Landscape Institute’s response to the government’s proposed planning reforms, Policy & Communications Committee Chair, Ian Phillips CMLI outlines the key principles for landscape-led planning.

Ian Phillips CMLI

The UK’s evolving planning system holds great potential to lead the way in sustainable development. However, ensuring that growth aligns with environmental priorities will require careful consideration of landscape, green infrastructure, and cross-boundary coordination.

The government’s review of the National Planning Policy Framework (NPPF) and wider planning system, which opened for consultation in September 2024, highlights these tensions. With a target of building 1.5 million new homes, as well as new infrastructure in health, transport and energy, the challenge facing policymakers is to ensure that ambitious proposals for development and growth are aligned with those in climate resilience, nature restoration, and public health.

In its consultation response to ‘Proposed reforms to the National Planning Policy Framework and other

changes to the planning system’,1 the Landscape Institute offered a set of recommendations to the government which would help to ensure that any reforms make the most of this vital opportunity.

Prioritising landscape in planning Integrating landscape into planning enriches the built environment and adds value, providing both functionality and natural assets to complement buildings. A landscapeled approach fosters cohesive and sustainable communities, ensuring that development aligns harmoniously with rural and urban settings, thus improving quality of life.

Emphasising green infrastructure

Green infrastructure (GI) is a multifunctional land-use approach that enhances public health, climate resilience, biodiversity and social equity. Local authorities should adopt a clear GI strategy in their planning policies to provide ecosystem services benefits like flood mitigation, cleaner air and habitat conservation. Prioritising GI contributes to sustainable development that respects and supports the value of natural ecosystems.

Promoting a systems approach to regional planning

A resilient planning system should work regionally, acknowledging natural, rather than political, boundaries. This systems approach encourages cross-boundary collaboration on water management, nature recovery, and green infrastructure. Such regional strategies lead to cohesive landscapes that support Nature Recovery Networks, reduce flooding risks and promote more sustainable land use.

Recognising the potential of greenbelt land

Greenbelt land, historically designated to prevent urban sprawl and coalescence, holds untapped potential for ecosystem services. Strategic planning allocations for development in greenbelt must incorporate making best use of the associated land to enhance the environment, improve water management and support climate resilience and biodiversity. Good landscape planning and design can ensure that these areas are valued as assets that strengthen local ecosystems, while retaining their key planning purpose.

1 https://www. landscapeinstitute. org/consultation/ proposed-reforms-tothe-national-planningpolicy-framework-andother-changes-to-theplanning-system/

1. Cherry Hinton North Design Code, winner of the ‘Excellence in Landscape Planning and Assessment’ award at the LI Awards 2023. The code was co-created by McGregor Coxall and Pollard Thomas Edwards, and emphasises the interconnectedness of movement, social connectivity, public space and nature. © McGregor Coxall

Good landscape planning and design can ensure that these areas are valued as assets that strengthen local ecosystems, while retaining their key planning purpose.

Upholding Environmental Assessments

Strategic Environmental Assessments (SEAs) and Environmental Impact Assessments (EIAs) provide critical insights into potential environmental impacts early in the planning process. These assessments help avoid unforeseen environmental damage, supporting sustainable planning by ensuring all projects are evaluated for their environmental effects from the outset. The Institute’s publication, Guidelines for Landscape and Visual Impact Assessment, 2 is a vital tool in carrying out such assessments.

Ensuring quality and affordability in housing

All housing needs to be sustainable, resilient and hospitable. Local authorities should implement design guides that prioritise quality, climate resilience, affordability and the importance of good landscape provision in place-making. Good design using sustainable building materials, attention to life-cycle costs and durability in construction will improve user experiences while reducing environmental impacts and making homes fit for living.

Leveraging landscape design to combat climate change

Climate resilience can be achieved through thoughtful landscape design. By optimising siting, layout, topography, orientation and microclimate, developers can enhance energy efficiency and environmental adaptability. This approach makes urban spaces more resilient to climate extremes and creates aesthetically pleasing, comfortable areas for residents.

Allocating and expanding space for nature

To combat biodiversity loss, local plans should formally designate sites for nature conservation and recovery

and seek funding contributions from development. Such sites can contribute to Nature Recovery Networks and link green infrastructure across landscapes, creating biodiversity-supporting corridors. Incorporating natural areas into urban planning benefits ecosystems while enhancing residents’ physical and mental well-being.

The Landscape Institute’s recommendations offer a path towards resilient and thoughtful planning that respects the natural environment while addressing housing and development needs. Landscape professionals can spearhead this vision by promoting sustainable, effective and aesthetically pleasing outcomes in both urban and rural development, shaping communities that are ready for the challenges we face.

Ian Phillips CMLI is Chair of the LI Policy & Communications Committee and has over 35 years’ experience in local government, private and NGO sector landscape planning.

To collaborate or contribute to LI policy development, get in touch with LI Policy & Public Affairs Manager, Andrew Rylah, at policy@landscapeinstitute.org

2 https://www.

Putting nature at the heart of health

The value of a landscape-led approach to healthcare facilities, and a look ahead to the LI Elections 2025

Carolin Göhler FLI

The health and wellbeing of people is fundamentally linked to the environmental health of nature and local communities.

By harnessing landscape in the planning, design and management of healthcare facilities, we can start to unlock a more strategic, systemsbased approach to health and provide integrated, joined-up solutions to the challenges we face – not just in public health but by making the most of the landscape in terms of climate, biodiversity and delivering enhanced green growth.

In the budget unveiled by the Chancellor of the Exchequer, Rachel Reeves in the autumn, the government announced the continued delivery of the New Hospital Programme, albeit after a review has been conducted. This is encouraging news, but we argue that any review of the way we plan, design and deliver hospitals must seek to take this holistic, joined-up perspective into account, with early engagement of landscape professionals to enable a landscapeled approach that maximises value for society, nature and the economy. Early master-planning, particularly of larger healthcare facilities, will create peace and beauty as much as functionality

- for patients, visitors, staff and volunteers alike: something so needed in a demanding work environment.

The evidence and case studies in this edition of the journal show the positive outcomes of quality, landscape-rich interventions. As well as providing therapy and care, healthcare facilities and their setting have the potential to help us decarbonise our built environment, boost biodiversity and kickstart urban regeneration.

A landscape-led approach, driven by landscape professionals, is essential for realising this ambition, ensuring multifunctional design and management solutions, and putting nature at the heart of health.

Looking ahead

These ambitions aren’t unique to the landscape sector. Building partnerships with the healthcare sector and across the wider built and natural environment is essential to maximise short and long-term benefits, and the Landscape

Institute welcomes continued engagement and collaboration with industry, government and our members.

As we look ahead to the LI’s next Corporate Strategy, which will lead us up to our centenary, we’re making great strides to ensure the years ahead are full of opportunity and fuelled by a strong, stable and collaborative organisational culture.

Your voice in shaping the future of the profession is essential, and with the LI Elections 2025 coming up next year (see page 70), I urge you all to consider the positive impact that you can make for LI members and the landscape profession. We need your voice and expertise to help lead on a range of issues, from the health of the nation to the health of the planet. There has never been a more important, exciting, moment to get involved.

Carolin Göhler FLI is President of the Landscape Institute

1. An artist’s impression of ‘Challenging public health inequalities across Bradford District’, winner of the ‘Excellence in Public Health and Wellbeing’ and the ‘President’s Award’ at the LI Awards 2023.

© Bradford Metropolitan District Council

Shaping a better future for the profession

My role as a student representative on the LI Advisory Council and why volunteering is so important.

Marko Yau

My connection to landscape started with my passion for plants. I have always been intrigued by nature. My hobby is identifying plants on the street and learning about their characteristics.

Whenever I have time, I like to explore the outdoors.

I arrived in Sheffield in 2019. Having been born and raised in Hong Kong, everything here was new and exciting for me. I made a great choice by enrolling in the University of Sheffield’s Landscape Architecture course, which has been a game-changer for me. I remember visiting the Peak District during the introductory week in my first year – it’s amazing to see such a picturesque landscape just beyond your doorstep.

Throughout my undergraduate experience at Sheffield I specialised in ecology, which gave me a wide range of opportunities to work on projects from bird survey reports to ecological masterplanning. The support from tutors and peers along the way has been invaluable.

I have always been keen on volunteering, frequently helping in

Sheffield’s local gardens, as I believe it’s the best way to interact with plants and get to know the community better. It’s also about gaining a sense of belonging and giving back to the local neighbourhood. Similarly with the Landscape Institute Advisory Council; it enhances my understanding of the LI and allows me to contribute to shaping a better future for the profession.

I started my volunteer role as a student representative for the Yorkshire and Humber branch in 2022. This opened up the valuable opportunity to join the Advisory Council last year. My role as a student representative on the Advisory Council is to represent the student body and attend in-person and online meetings throughout the year. For example,

I attended an in-person meeting in London this summer. The Advisory Council team was divided into small groups, discussing issues and exploring New Ways of Working from a governance perspective. It feels great to give back to the LI with my perspective as a current landscape student, speaking up about our needs, and encouraging other students to get involved in different LI events. Student members are the future of the landscape profession and we make a vital contribution to LI life.

Marko Yau is a fifth-year Landscape Architecture MLA student at the University of Sheffield

Making a difference: Landscape Institute Elections 2025

Rob Hughes

In early 2025, the Landscape Institute will launch the biennial elections of its Advisory Council and Board of Trustees.

There has never been a more important time to get involved and make a difference at the LI and within the wider profession, to benefit people, place and nature. The elections are an opportunity to play a part in shaping the future direction and inspire the next generation.

From climate action to nature recovery, to public health and wellbeing, the diverse skills and expertise of landscape professionals are essential for driving positive change and championing landscape solutions to the biggest challenges facing society today.

Your voice matters. We will be seeking nominations from new and diverse leaders from across our

dynamic profession to share their experience and knowledge to inspire people and progress across the landscape sector and beyond.

Members are at the heart of our decision making and our New Ways of Working, which fosters a culture of collaboration and consultation between all those who shape our organisation and the landscape profession, including members, volunteers, Board, and staff.

Diversity and inclusion at all levels enable better communication and engagement between everyone, and we encourage members from all backgrounds to put themselves forward.

Role

President-Elect

Vice President

Honorary Secretary

Honorary Treasurer

Advisory Council (Chartered representative)

Advisory Council (Associate representative)

Advisory Council (Student representative)

Non-Chartered Trustee

Elections 2025 timeline

– March: Nominations open

– April: Nominations close

– May: Elections open

– June: Elections close

– Thursday 1 July: Start date for all elected candidates.

Roles and legibility

We will be seeking nominations for the roles below. More details of role descriptions and eligibility criteria will be shared early in 2025.

Rob Hughes is CEO, Landscape Institute

Who can apply

– Current Chartered / Fellow members only

– Current Chartered / Fellow members only

– Current Chartered / Fellow members only

– Current Chartered / Fellow members only

– Current Chartered members only

– Current Associate members only

– Current Student members only

– Non-Chartered industry professionals

1. The Landscape Institute College of Fellows gather at a recent event to discuss the future of the LI.

Landscape Institute

LI Campus

LI Campus offers access to all LI recorded events including three years of online events and conferences. campus.landscapeinstitute.org

Healthcare facilities: Health and wellbeing through landscape-led design

Continue your learning with guest editor, Jane Findlay PPLI, and other authors at this two-part masterclass exploring landscape-led approaches to designing, planning and managing healthcare facilities.

Catch up on LI Campus with this masterclass to examine historical and evidence-based methods for delivering healthcare facilities and green spaces, within the UK and internationally, to foster more sustainable communities and deliver positive outcomes for health, wellbeing and biodiversity. Key topics include the history of healing landscapes; collaboration for integrated solutions; improving the patient journey; emerging technologies; funding and skills.

Visit campus.landscapeinstitute.org to catch up on the masterclass, which is open to both LI members and non-members.

Jane Findlay is a landscape architect, Immediate Past President of the Landscape Institute, and the founding director of Fira. Jane is particularly experienced in designing healing landscapes in the healthcare sector, having worked on all scales of healthcare facilities and some of the largest healthcare projects in the UK.

Jeremy Parker is a Director of Fira with over 30 years of landscape design experience. He has developed a particular interest in healthcare environments, especially related to oncology, mental health and end-of-life facilities.

Romy Rawlings is Director at Deep Green and has been a landscape architect for over 30 years. She is the author of Healing Gardens and will share her learnings on the healing powers of plants at physical, visual and molecular levels, along with recent findings in studies such as psychoneuroimmunology.

Liz Rees is Greenspace for Health Programme Director at the Centre for Sustainable Healthcare and is a committed climate campaigner and advocate for systems thinking. Liz is passionate about creating access to green space for marginalised communities, active travel, and sustainable food systems.

Bob Wills co-leads, the Medical Architecture London Studio. He has over 25 years experience in healthcare design in the UK and around the world, and has played a key role in the delivery of various large-scale mental health and acute health projects. His interest lies in the use of research and development methodologies to improve the quality of the built environment.

Luke Engleback CMLI FRSA sits on the Landscape Institute Policy & Communications Committee and various design review panels. Studio Engleback is a founding signatory of UK Landscape Architects Declare.

1. Defence Medical Rehab Centre by Fira.

Commercial Stone & Paving

The Christie Proton Beam Therapy Centre, Manchester

The UK’s first NHS high-energy proton beam therapy centre opened at The Christie Hospital in 2018. Hardscape supplied several Kellen Elementale Zwart straight and radius seating to the scheme along with Light Blue Crystalpave paving.

Landscape Architects : Fira Landscape Architecture.

Client : The Christie NHS Foundation Trust, Central Manchester

and Salford Royal NHS Foundation Trust.