Chloe Shang

Design Philosophy

This project brings together my experience as an NHS patient, conversations with NHS medical and strategic staff, and mentorship with practicing healthcare architects. I am also learning from the rich architectural history of health that runs deep through every culture, with the healing spaces of ancient civilisations mediating the temple and the doctor’s house, and ancestral practices persevering in communities around the world. Through harmonising this research, I arrived at the following design philosophy:

Firstly, I believe in the agency of the patient in overcoming illness. My proposal advocates means of healing beyond conventional medicine; in the words of Maggie Jencks, to help patients find ways of helping themselves. I use hydrology and the tidal cycles on site to craft multi-sensory experiences, and approach the site as a garden and a cornucopia of food and medicine, asking how processes and rituals of healing the body can be synthesised with those of healing land.

Secondly, I embody the architect’s duty of care to the climate, user and construction worker by decarbonising and de-toxifying the construction of healthcare buildings, employing and reusing land and materials for their longevity and negative embodied carbon, and making the most of opportunities for renewable energy.

Finally, the NHS now exists in an ever-deepening state of crisis, but it also stands at the pinnacle of evolution beyond the mega-hospital. 5% of users need the NHS more than the other 95% combined, and a large part of our struggles for GP appointments, hospital beds and emergency services are due to a lack of care in the community for those who need it most.

Therefore, this project proposes assisted living housing alongside physical and psychological treatment spaces for patients with longer-term health conditions as well as day visitors. It eases pressure from the broader NHS, unites the security of the hospital with the autonomy of home, and affords the long-term patient freedom from fear, as help is always just a moment away.

As I began my search for a site, I questioned what we might learn from all these histories and rituals of health, and where we might find our contemporary parallel?

Scars in the Landscape

‘exhausted’

‘depleted’

‘scars in the landscape’

The vocabulary surrounding a quarry at the end of its life borrows from that of illness and injury. There are over 2000 quarries in the UK, but once a site is depleted, natural processes of rewilding may take several hundred years. Until then, they are usually abandoned and become a detriment to their communities.

Largely overlooked is the fact that quarries can make for beautiful landscapes, and inherently sheltered, temperate settings. The Latomie dei Cappuccini, for example, is ‘now covered with a very fertile soil, and since sheltered from the wind, it’s full of all sorts of saplings and fruit trees, never saddened by the storm.’

With this potential in mind, I chose as a case study the site of Penlee Quarry on the southern coast of Cornwall. It is 7 minutes from the nearest major hospital. The climate here is mellowed by the Gulf Stream, which makes it warmer in winter, and cooler in summer, than any other place in mainland England.

Quarrying on site stopped 30 years ago and it has stood empty since. Several proposals to develop it into a marina have failed to be realised, largely due to concerns that a marina would deepen the ‘us’ and ‘them’ divide. The site now costs £200,000 a year to maintain.

The Site as Garden

My proposal aims to heal this ‘scar in the landscape’ into a nurturing space for health, and somewhere that brings value rather than detriment to the community.

At the scale of the site, building is intertwined within three types of garden, each in their own way a cornucopia of healing: kitchen gardens adjacent to the patients’ housing and school of food encourage patient and public to cultivate, cook and eat together. Physic gardens give agency to explore alternative and integrative medicines, and sensory gardens use aromatherapy and the choreography of water as psychological grounding mechanisms.

During the day, for the first time in its history, Penlee Quarry becomes open to the public, hosting a programme of food, medicine, gardening and exercise workshops, and offering access to the landscapes, water therapy and integrative medicine facilities, a library, school of food, restaurant, and amphitheater. 

Cornwall is one of the most deprived regions in Northern Europe and this project engages the community in maintaining health, healing land, and creating local jobs and economic regeneration. The two fields immediately beyond the site are available for development into affordable housing for those working on site.

Healing with Water

Notions of water deities, rituals and ‘healing water’ are ubiquitous in ancient mythology, religious history and traditional medicine, and in our built environment they have manifested as holy wells, spa towns, Turkish baths and sweat houses, sea bathing and the modern spa. Building on this tradition, this project interacts with seawater and hydrology to heal and rejuvenate the patient, and create renewable energy for the site.

From reservoirs at the top of the quarry, freshwater runs in streams and waterfalls designed to amplify sound, provide evaporative cooling, and draw attention to sensory experience to rejuvenate, immerse and escape from internal stress.

The built fabric of the project centers on a chapel in the middle of the lake, housing a reflective skyspace inspired by James Turrell, and pellucid prayer rooms emotionally immersed in water and landscape.

The thalassotherapy buildings are carved into the quarryscape by the seafront. They comprise two pools which reach into the sea and retain water from high tide as well as internal tempered hot and cold environments and turkish-style baths.

Above: Collage combining The Baths of Cracalla, Rome; Turkish Baths at Jermyn St; a Turkish bath by T. Allom, the Healing Baths of Wiesbaden; the Baths of Diocletian.

Renewable Power

A tidal bridge crosses the lake, and the movement of seawater through the bridge generates 1.4 gWh of renewable energy per year, which can be shared to the adjacent towns of Newlyn and Penzance. The planting of water reeds and sedges creates habitats for aquatic wildlife, and alone removes 17,000 tonnes of CO2 per year.

Living in the Walled Kitchen Garden

Back in Ancient Greece, the priest-physicians of the Asclepieion valued, above all, sleep as their method of cure. Patients spent nights in ‘temple sleep’ during which they would hope to receive healing dreams: visions of cures from the gods.

In today’s hospital ward, we are woken by flurries of nurses and doctors with beeping machines. Human communication is less discreet than the Gods’, and the thin polyester curtains do nothing to muffle even the most private or heartbreaking of conversations.

At the scale of the neighbourhood, my project mediates the need for privacy and dignity with a desire for gathering. Patients’ rooms are embedded within walled kitchen gardens, where the collective rituals of cultivating, harvesting, cooking and eating encourage patients to keep active in the pursuit of healing body and land. Each neighbourhood comprises 30 rooms, two nurse’s rooms, and growing spaces, kitchens, lounges and utilities. 

The stone core to each room forms its structure and utility spaces, and patients can leave their screen walls entirely open, allowing all living spaces an immediate dual-aspect connection with the neighbourhood beyond.

The Architect's Duty of Care

Decades of austerity and stagnation have diluted healthcare into an architectural purgatory and a pervasive environmental poison. Even ‘clean’ materials like CLT release formaldehyde from the adhesives within, which can cause respiratory conditions and leukaemia.

The ugly truth is: for every fatal accident in the construction industry, 100 workers die from a work-related cancer, so why are vinyl, epoxy, resin and latex ubiquitous in our hospitals?

As a profession, we have a responsibility to build upon past, present and emerging knowledge to realise that there is a world of materials beneath our feet which have been used for construction since Neolithic times. They contain no toxins or dangerous chemicals and require no harmful manufacturing processes. The main barrier to their adoption in healthcare is perceived cost: today, stone has been relegated to a high-end decorative material, leading to high waste and inflated costs. However, where large-scale stone is used as a structural material, not to mention extracted directly from the building site, it is cheaper than conventional hospital building. Conversely, emerging products like Dowel-Laminated Timber (DLT) replace glue with timber dowels, achieving a completely additive-free material; its cost will decline the more we use it.

Planning permission was granted to extract a further 28Mt of stone from Penlee Quarry, but this was never realized. So, using the stone existing on site including leftover tailings, the buildings of this project will be constructed using a palette of loadbearing stone blocks, stone bricks, dowel-laminated timber, and timber frame.

For the most part, architects are oblivious to the stagnation of ambition and design standards in healthcare, resulting in the unconsidered and overpriced reuse of the same ideas, materials and construction methods. Moreover, we are reluctant to engage with healthcare because we are avoidant of the complexity of its regulations, and put off by the clouding lens of pity or fear through which we view illness. 

I hope that this project will urge those who see it – whether patient, policy-maker or architect – to become a little more excited about the architecture of healing, and a little less afraid of it.