land

Review

DesigningHealingEnvironments:ALiteratureReviewonthe BenefitsofHealingGardensforChildreninHealthcare FacilitiesandtheUrgentNeedforPolicyImplementation

ShereenKhatoon-JaanDin ,AlessioRusso* andJamieLiversedge

SchoolofArts,FrancisCloseHallCampus,UniversityofGloucestershire,CheltenhamGL504AZ,UK * Correspondence:arusso@glos.ac.uk

Abstract: Despitethewell-knownbenefitsofhealinggardensforchildreninhealthcarefacilities, policiesandguidelinesfortheirimplementationarelacking,leadingtotheirundervaluationby policymakers.Thisliteraturereviewinvestigatestheadvantagesofhealinggardensforchildren’s healthandwellbeing,withafocusonpublic-fundedhealthcarefacilities.Thereviewexploresthe definitionofahealinggarden,theories,thevalueofplay,theimpactonchildren’sdevelopment, andtheenvironmentalbenefitsofhealinggardens.Additionally,thereviewpresentssuccessful examplesofhealinggardensinpractice,whileacknowledgingpotentialargumentsagainstthem andassociatedrisks.Duringtheliteraturereview,researchgapswereidentified,andareasforfuture researchwerealsoexamined.Finally,thisreviewcallsforevidence-basedguidelinesforpolicymakers anddesignerstoincorporatehealinggardensintohealthcarefacilities,providingacomprehensive argumentfortheiradoptionandregularaccessforchildren.

Keywords: healingspace;biophilia;policy;landscapedesign;playvalue;theories;salutogenic design;evidence-baseddesign

Citation: Din,S.K.-J.;Russo,A.; Liversedge,J.DesigningHealing Environments:ALiteratureReview ontheBenefitsofHealingGardens forChildreninHealthcareFacilities andtheUrgentNeedforPolicy Implementation. Land 2023, 12,971. https://doi.org/10.3390/ land12050971

AcademicEditor:Thomas Panagopoulos

Received:14March2023

Revised:13April2023

Accepted:21April2023

Published:27April2023

1.Introduction

Copyright: ©2023bytheauthors. LicenseeMDPI,Basel,Switzerland. Thisarticleisanopenaccessarticle distributedunderthetermsand conditionsoftheCreativeCommons

Attribution(CCBY)license(https:// creativecommons.org/licenses/by/

HealinggardenscanbetracedbacktotheGreeksattheendofthesixthcenturyB.C. whentheyused“healingcentres”intemples[1,2]withthespecificusageofnaturalspring water.ThistrendwasfollowedbymonasteriesinEgyptbeforespreadingtoWesternEurope inthe5thcenturyA.D.[3].IntheMiddleAges,cloisterswereusedasprimarysettings forpatientstobetreatedbymonkswithinmonasteries[4].Theycontainedherbaceous plantingwhichwasthoughttobemedicinal.Therewasanemphasisonprovisionsoffresh air,accessingareasofsunlight,anddailywalksaroundthegardens.Throughplagues, migration,andharvestfailure,monasterieswereforcedtocaptheirmedicalresources[5]. Asmonasticismdeclinedinthe16thcentury,theirmethodologiesinusinghealinggardens becameadistantmemory[6].Inthemid-eighteenthcentury,industrialisation,migration, andoverpopulationaccountedforcountlessdeathsduetolackofhygieneandincreasing levelsofpollution[7].Thistriggeredamovementofbuildinghospitalswithintownsrather thaninthecountrysidewhich,atthetime,wereseenasmoresalutary[8].Inthemidnineteenthcentury,theconceptofpaviliondesignhospitalsinEnglandbecamepopular throughJohnRobertonandGeorgeGodwin[9].Themodifiedstyleallowedgardenviews frompatientrooms,increasedsegregationtopreventdiseasespreading,andenhanced ventilation[9].

ThiswassupportedbyFlorenceNightingale:“quiteperceptibleinpromotingrecovery, thebeingabletoseeoutofawindow”[10].Shefurtherdemonstratedthisthroughher findingsofalowermortalityrateinpavilion-stylehospitalsthanothers[9].Sanitisation, naturalsunlight,andcleanairbecameanormalityforpatientstoexpectfromhospitals[8].

Beforepavilion-stylehospitals,“openspacesattachedtohospitalsbecameaccidentsof

Environmental legislation

The brief was to create a planning and development brief as representatives of the local council, for developers whilst adhering to the NPPF, JCS and local planning authorities.

Development requirements

The developer is encouraged to apply “Good design” (Cheltenham Borough Council, 2020,5.1) which is an aspect that will be highly valued when considering the planning application. “Good design with well-considered buildings and spaces is key to making places that are successful” (Cheltenham Borough Council, 2020, page 20, 5.1).

Housing character and layout

37. There is a requirement of 90 new dwellings, of which 20 are for student accommodation, as stated in the vision. Policy HD1 sets out a “site specific requirement of approximately 70 dwellings” (Cheltenham Borough Council, 2020, Policy HD1: Christ College Site B). The additional 20 dwellings required in this development brief is a social strategy that comes under “exceptional circumstances” (Ministry, 2021, page 17, 5.61) in the National Planning Policy Framework where specifying the quantity of homes needed; “unless exceptional circumstances justify an alternative approach which also reflects current and future demographic trends” (Ministry, 2021, page 17, 5.61). In which, the social strategy is to increase the amount of dwellings for the purpose of student accommodation that will discourage an ageing population (refer to figure 41) and assist in Cheltenham, Gloucester and Tewkesbury’s remaining student housing requirement of 179 student beds as shown in figure 42.

the developer should propose to supply a housing mix adequate to fit the 90 dwellings and ensure “that the needs of groups with specific housing requirements are addressed” (Ministry, 2021, 5.60 NPPF) by addressing affordable housing. These dwellings should strive to reach “the character and quality of the local environment” (Tewkesbury Borough Council et al, 2017, SD10.6, JCS).

38. The developer is encouraged to refer to the most recent housing needs assessment for Cheltenham included in a consultancy report from Gloucestershire (2020). “Overall, the evidence from HESA data, college literature and Council Tax data suggests that there is a need for accommodation for around:

» 6,600 students in Cheltenham and Gloucester, which, assuming an occupancy rate of 3.6 students per dwelling, this would equate to around 1,830 dwellings compared to 1,108 all-student dwellings identifiable as existing in Cheltenham and Gloucester;” (Opinion Research Services, 2020, 9.23) which supports this sites vision to increase student housing.

39. Additionally, the need for student accommodation derives from Cheltenham’s local plan “needs for specific, high-quality student accommodation and well-designed elderly care provision are key to the future of Cheltenham.” (Cheltenham Borough Council, 2020, page 60, 12.1)

40. The figure of 40% as an affordable housing mix originates from the Joint Core Strategy “minimum of 40% will be sought within the Cheltenham Borough” (Tewkesbury Borough Council et al, 2017, Policy SD12: affordable housing 1.ii) which will also help to encourage a younger demographic to remain or move into Cheltenham.

41. The character and density of the proposed dwellings is expected to meet Policy D1: Design in Cheltenham’s local plan,“development will only be permitted where it: b) complements and respects neighbouring development and the character of the locality and / of landscape.” (Cheltenham Borough Council, 2020, Policy D1: Design). If the developer has any recommendations on how to increase the housing density, they are invited to provide this within the proposal. It is further encouraged that the developer also look at the National Model Design Code 2021 (Ministry of Housing, 2021).

• There is no requirement to have chimneys but the developer is welcome to have dummy chimneys

• The housing style and finish must visually relate to the existing dwellings whether that be through the structure, masonry or colour

• Development should enhance the sense of locality

• Affordable homes should visually match non-affordable homes

42. The 1950s-1960s character of dwellings can be seen in figures 15-17 whereby terraced, detached and semi-detached homes are used. Open balconies are encouraged as they provide opportunities for residents to access open air and plant greenery which would support sustainable development goal “3 health and well-being” (United Nations, 2015). However, If the developer has any recommendations on how to further incorporate this principle, they are invited to include this within the proposal.

Shereen. Din S4002756 AD5603 general, 15: 174a. which infers the protection and enhancement of biodiversity on sites, would apply to the potential wildlife corridor running parallel to the railway track. And is expected that the developer would “contribute positively to biodiversity” (Tewkesbury Borough Council et al, 2017, Policy SD9.2.iii, JCS) as access to open green spaces would “enable and support healthy lifestyles” (Ministry, 2021, 8.92.c, NPPF) for the local community. the developer “should aim to achieve healthy, inclusive and safe places which: a) promote social interaction, including opportunities for meetings between people who might not otherwise come into contact with each other” (Ministry, 2021, 8.92.a, NPPF) and where relevant for the planning application such as public consultation, communicate with local residents (as there is no current local community group). the developer must assess the flood risk of “an area from flooding from all sources, now and in the future, taking account of the impacts of climate change” (Government, 2021, Flood risk and Coastal Change, NPPG) this is significant to achieve sustainability goal number 13; ‘climate action’ (United Nations, 2015). The implementation of sustainable urban drainage from Policy 1NF2 (Tewkesbury Borough Council et al, 2017, JCS) will “ensure that flood risk is not increased on-site or elsewhere” (Tewkesbury Borough Council et al, 2017, Policy INF2.2.iv, JCS), which will also benefit the climate, local area and site.

To summarize, “transport issues should be considered from the earliest stages of plan-making and development proposals” (Ministry, 2021, 9.104 NPPF) and “opportunities to promote walking, cycling and public transport use are identified and pursued” (Ministry, 2021, 9.104.c, NPPF). Alongside this it is expected “e that credible travel choices are provided by sustainable modes” (Tewkesbury Borough Council et al, 2017, Policy INF1.1.ii, JCS) which would include improving the existing transport infrastructure. This underpins the 13th UN sustainable development goal; climate action which is approached through “moving to a low carbon economy” (Ministry, 2021, 2.8.c, NPPF) via more sustainable modes of transport being promoted.

On the whole, the developer should strive towards a sustainable development which means “meeting the needs of the present without compromising the ability of future generations to meet their own needs” (United Nations, 1987) which is also quoted in the National Policy Planning Framework (2021). This should be applied throughout the whole of the development phases whereby “design and construction seeks to use these resources efficiently and decrease waste both during the construction, use” (Tewkesbury Borough Council et al, 2017, 4.3.2, JCS).

2019, Design: process and tools, NPPG). The only good design to be accepted is “High-quality and well-thought-out design, tailored to meet the needs of people and location,” (Tewkesbury Borough Council et al, 2017, 4.4.1, JCS).

Garden design competition- Winning entry