The Hospital Environment Matters. Revisiting some earlier ideas

By Sheila Altes

We are revisiting some of the work we did when the proposals to close the Crown Street Site were first raised. The article was written some years ago. These ideas are still relevant.


Liverpool Women’s Hospital is a specialist hospital dedicated to the care of women, babies and their families in a safe friendly environment. It opened in 1995 and is located on Crown Street, Toxteth in a modern landmark building (NHS Choices).

In 2013 a new development of the reception area incorporated a comfortable seating area, cafe, shop and a play area for children. It opens up onto a landscaped courtyard with seating, a herb garden was planted for use by the hospital chefs and a memorial garden was opened to offer bereaved families a private space within the hospital grounds.

Another garden “The Garden of Hope and Serenity” was opened in 2016.

“This garden is a lovely area where our women, families and staff can relax in the sunshine and escape life on the wards”

(Kathryn Thomas, Chief Executive at LWH).

The idea for this garden came from nurses at the gynaecology unit who recognised that women and families visiting the Emergency department would benefit from a space away from but near to the department to have an area of calm to process their thoughts and feelings.

There is a wealth of literature that confirms the importance of trees and gardens for patient recovery and should not be ignored. A much-cited study, published in 1984, by environmental psychologist Roger Ulrich was the first to use the standards of, modern medical research to demonstrate that gazing at a garden can sometimes speed healing from surgery, infections and other ailments.

Although it is clear that this will not cure disease, it has been proven that just five or six minutes spent looking at views dominated by trees, flowers or water can begin to reduce levels of anger, anxiety, stress and pain. This can allow other treatments to help healing and induce relaxation that can be measured in physiological changes in blood pressure, muscle tension or heart and brain activity.

Studies have shown that loud sounds, disruptive sleep and other chronic stressors can have serious physical consequences and hamper recovery (Ulrich,1994).

Henry Marsh, the celebrated neurosurgeon and writer has stated:

“……… these big hospital are horrible places really, the very last thing you get in an English hospital is peace, rest or quiet which are the very things you need the most”. He goes on to say that the garden he created at St. George’s Hospital,” ….. is probably the thing I am proudest of.” (The Observer).

Not all gardens are equally effective. A study found that tree lined vistas of fountains or other water features, along with the greenery of mature trees and flowering plants appealed the most. The more greenery versus hard surfaces the better (Cooper Marcus and Barnes 1994).

The plan for the new Royal hospital includes a landscaped garden. According to Brian Zeallear from NBBJ:

“Through creating smaller buildings around the periphery and having public roads and pedestrian corridors through the site, we can stitch back the existing city. The centre will feel like a public square.  The hospital is in a dense urban area but once the landscaping is done….it should make you feel you are in nature through the manicured grass, trees and water features”.

However sitting in a public square surrounded by public roads is hardly the restorative qualities of greenery, flowers and other nature content envisaged by Ulrich.

Liverpool Women’s Hospital is at present situated in a quiet, landscaped and safe environment. Although it is in a fairly central location it is protected from the sounds and pollution of traffic.

There is now substantial evidence on the adverse effects of air pollution on different pregnancy outcomes and infant health. The evidence for the impact of air pollution on infant mortality, primarily due to respiratory deaths in the post natal period seems to be solid (WHO 2005). There is now new evidence that shows air pollution particles from traffic affects the health of unborn babies ( Miyashita & Liu 2018).

Less consistent though still suggestive of a causal link to air pollution are lower birth weight, a higher incidence of preterm births and intrauterine growth retardation. Moreover, the evidence shows clearer relationships between particulate matter and traffic-related air pollution than other pollutants.

The intrauterine, perinatal and early childhood periods, during which the lungs are developing and maturing are very vulnerable times. These are times when the lungs are more susceptible to injury by air pollutants. Exposure during these periods reduces the maximal lung functional capacity achieved in adult life and can lead to increasing susceptibility, in adulthood, to infections and the effects of pollutants such as tobacco smoke and occupational exposures (Vierira 2015). Also there is sufficient evidence of a causal relationship between exposure to lead to neurobehavioural deficits in children in terms of cognitive impairment (WHO2005).

While it is impossible to avoid all air pollutants, advice from many sources include, remaining indoors when air pollution is high and even when air pollution is low it is best to avoid polluted roads (Greenpeace 20017). Campaigns to avoid exposure to air pollutants include moving school entrances from busy roads and the use of pram covers to protect babies from being exposed to harmful particles.

In the face of all the evidence of the harmful effects of air traffic pollutants on neonates, it is inconceivable that the environmental effects of building a hospital for women and babies in the middle of one of the most traffic-dense areas of the city have not been considered.

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