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Architecture (MA)

Chloe Shang

Chloe is an architectural designer and writer graduating from the Royal College of Art in 2023. Prior to joining the RCA, she completed her Part I the University of Cambridge and worked as an Architectural Assistant at Hopkins Architects and Haworth Tompkins, where she contributed to a number of housing, commercial and education projects.

Since joining ADS5 at the RCA, Chloe’s work has explored what future architectures of healing could become. She aims to underline the architect’s duty of care to both the user and the construction worker by challenging the custom that healthcare architecture must be cold and apathetic, and opposing the usual use of carbon-intensive and toxic materials in its construction. Following the framework of ADS5, she adopts minimally-processed stone and timber to offer a new, compassionate architecture of healthcare which is not only carbon negative but also cost-efficient. For her work on this topic, Chloe has been awarded the RIBA London Student Prize, RIBA Wren Insurance Association Scholarship, and Architecture Foundation Writing Prize.

Architecture's Medical History: Line drawing, after Gandy’s 1830 painting depicting the evolution of architectural language

There is little in the physical fabric of hospitals to embody the emotional and deeply human nature of the events they mark: no attempt to celebrate or grieve, to share in joy or pain. This has not always been so. For the Ancient Greeks, as an example, temples dedicated to Asclepius, the God of Healing, were built on hilltops overlooking the sea, far removed from the dirt, heat and noise of the town, and their method of cure was water, diet, music, prayer and sleep. 

In the millennia since, the hospital building has ‘leapt from being a monument to God to a monument to science, leaving the idea of being a monument to humanity behind.’ (Edwin Heathcote, 2021) As reliance on medical technology increased throughout the 20th Century, architecture took on the characteristics and materiality of the machinery it hosted. Esther Sternberg describes that ‘the hospital’s physical space seemed meant to optimise care of the equipment rather than care of the patients.’

My belief is that spaces of healthcare have a singular opportunity to embolden, console and uplift at times when we need it most. As the NHS stands at the pinnacle of evolution beyond the mega-hospital, it is the goal of this project to build upon past and present knowledge to explore and elevate future architectures of healing.

Left: 'Architecture's Medical History'. Line research drawing, referencing Gandy’s 1830 painting of the perceived relationships between architectural languages. This drawing describes the evolution of the hospital building using landmark case studies, from bottom to top: Asclepieion at Epidaurus, 6th Century BC; Hospices des Beaune, 1443; Ospedale degli Innocenti, 1419; St Thomas’ Pavilion, 1859; Paimio Sanatorium, 1932; Guy’s Tower Block, 1974; Guy’s Cancer Centre, 2016.

GIF of historical references in medical architecture
Infographic: how dangerous is a day in hospital?
Infographic showing the popularity and proven efficacies of integrative medicines

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?

Aerial views of a sample of quarries from around the UK

Scars in the Landscape



‘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.

GIF showing the Latomie dei Cappuccini and Ca'n Terra, Menorca
Aerial view of the site and plans of its historical development
GIF showing photos from a site visit

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.

Line drawing of masterplan
Aerial view of proposed masterplan
Collage: the Baths of Cracalla; Turkish Baths at Jermyn St; Healing Baths of Wiesbaden; Baths of Diocletian

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.

The choreography of water through stone
Plastercast model of thalassotherapy building
Overall view of the Thalassotherapy Building
View into plunge pool with copper handrails
View into plunge pool with skylight
A tidal pool reaches out into the sea, retaining water from high tide

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.

Diagrams showing the tidal range on site and the proposal of a tidal bridge
Growing in the Walled Kitchen Garden

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.

Living in the Walled Kitchen Garden
A stone core to each patient room forms its structure and utility spaces.
A stone core to each patient room forms its structure and utility spaces. The blocks, extracted from site, are minimally-processed, making this method of construction cheaper, cleaner and faster than conventional hospital building.
The cores are met with dowel-laminated timber walls and ceilings.
The cores are met with dowel-laminated timber walls and ceilings, creating warmth and softness for the patient and eliminating the presence of toxic adhesives used in other pressed-timber products.
Skylights give patients often restricted to a horizontal position a view of the sky and stars.
Oak setts flooring creates a tactile underfoot experience for the patient whilst reducing the risk of slipping. Skylights give patients often restricted to a horizontal position a view of the sky and stars.
A simply-constructed stone brick screen acts as a shading and privacy device.
A simply-constructed stone brick screen acts as a shading and privacy device and allows dappled light to animate the interior, creating an uplifting quality.

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.

Cost and embodied carbon values of materials

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.

The RIBA and Wren Insurance Association