Ed Baker, Director at Broadway Malyan, provides a fascinating case study of how Singapore is using the principle of integration to design healthcare facilities to be purpose built for fighting pandemics.

The global pandemic has put health infrastructure under the spotlight in almost every country in the world. This doesn’t just mean hospitals, but also community-based health which is crucial to caring for our ageing population, opportunities for integrating wellbeing into our parks and green spaces, supporting mental wellbeing and how healthcare and residential spaces might coexist more organically.

The protection of our good health has infiltrated almost every aspect of our lives: from how and where we work to how we travel, how we shop, how our children are educated, and how we see our friends and family.

Arguably, this should always be the case: if you support a healthy society, national healthcare costs drop, the reliance of our older generation on the state is reduced and quality of life is improved.

With current Health and Social Care Secretary Matt Hancock promising £2.8 billion for six new, large hospitals in the UK by 2025, could this be the time for the UK to get healthcare design right?

Taking lessons from across the globe

Our globalised world has brought globalised viruses. This has shown how outdated and unfit for purpose some of the UK’s hospital buildings are – buildings that were not built for an age of pandemics. Inflexible facilities with ageing services have struggled to cope with sudden peaks in infections with the result that other services have suffered.

However, this is not the first pandemic of the 21st century. It was following the country’s experience with SARS in 2003 that the Singapore Health Ministry decided to invest in a major transformation of its healthcare infrastructure to shore up the country against the next – and they believed inevitable – pandemic.

Health City Novena was commissioned by Singapore’s National Healthcare Group and the Singapore Health Ministry. It is an integrated “health city”, a 17-hectare scheme built around the existing Tan Tock Seng Hospital, and located in the Novena district in central Singapore.

It is mixed-use by design, incorporating healthcare, medical education and translational research, commercial, leisure and community uses. It links existing healthcare facilities and the Lee Kong Chian School of Medicine, as well as the National Centre for Infectious Diseases (NCID) which has become the centre of Singapore’s Covid-19 response. Together these facilities create the largest healthcare complex in Singapore, serving the daily needs of patients, visitors, staff, students and residents.

Designed for a pandemic, the site and the buildings within it include some practical design solutions: distinct levels of connectivity allow patient and clinical connections to be isolated from those of the public; whole health centres such as the NCID, which is surrounded by residential areas, can be isolated; methods of deploying hospital resources throughout health complexes without involving external providers, which could possibly be extended to deployment across cities and countries; and increased control of indoor environments to maximise natural ventilation and minimise air conditioning and circulation, depending on the reaction of the virus (controlled humidity in indoor environments has been shown to have a positive impact on infection rates.)

Co-existing with a social and urban fabric

While well-designed buildings can undoubtedly help ease pressure points in the healthcare service and deliver intelligent solutions, they cannot alone address every issue surrounding healthcare today. However, evidence-based research has proven that the quality of the environment does make a significant contribution to improving patient satisfaction and raising staff morale. Our core philosophy when designing and master planning these spaces, therefore, is more to do with the creation of therapeutic settings that promote a feeling of wellbeing, rather than the management of ill-health.

Health City Novena is a sustainable community set within a network of beautiful open spaces, promoting pedestrian movement, and connecting to the Mass Rapid Transit (MRT), Singapore’s railway network, at Novena.

Our intent was to create a lively place that co-exists within the existing social and urban fabric, becoming a sustainable eco-system. It has been designed around a cluster concept of commercial and transport hubs, ambulatory, integrated learning, intermediate care, healthcare and private healthcare with a community park and significant public realm tying the elements together. The masterplan sets aside preconceived notions of hospitals and creates an environment that will facilitate new methods of care for now and the future.

With a focus on the open spaces and landscape, the overall concept is the design of “A Healthcare Community in a Park”. This landscape-led approach reinforces the primary aim for the creation of a unified healthcare community that will inspire wellbeing and recovery through its beautifully designed buildings and open spaces. This approach was strengthened by landscape guidelines that promote horizontal and vertical greenery with public spaces on the ground level and a series of green terraces and green walls throughout all levels of the buildings.

With approximately 30,000 people expected to use the facilities daily when it is complete, the design ensures that all users can access them efficiently and effectively. This is achieved by linking the buildings at three levels: street level, basement and via sky bridges, operating a dedicated shuttle bus service and locating outpatient facilities next to the MRT station.

The future of pandemic design?

Looking at the current Covid pandemic we are convinced that certain elements of our approach have aided the authorities in Singapore to manage their response. It is important to acknowledge that things work very differently in Singapore. The country has a much smaller population with greater trust in the institutions that govern. This enabled the government to effectively employ surveillance, testing and contact tracing early on, as well as using data dashboards to depict infection trends across age, sex and location, and to plot the recovery time of infected individuals.

But there are nonetheless lessons for the Government and NHS Trusts in the UK from projects such as Novena. They cannot afford to spend billions of pounds only to find that by the time these buildings are procured and built, they are already obsolete. Flexibility designed in from the outset, and a holistic approach to health prevention, cure and wellbeing are crucial to the success of medical developments of the future to meet the ongoing challenges of ageing populations as well as future pandemics.

Hospitals are increasingly becoming centres of the community. For many of our projects in Singapore – like Health City Novena – the focus has been on how to better connect the hospitals to the wider context and make them more outward facing. For planning, this includes better integration with public transport, cycling and pedestrian connections (transit-oriented development) and the design of more mixed-use environments including community uses and retail within the wider plans. Many of the traditional hospital estates in the UK are very inward facing and this is something that could change in the next wave of hospital building.

The focus on open-space planning has been one of the primary drivers of Health City Novena. This landscape-led approach helps inspire wellbeing and recovery through its beautifully designed buildings and open spaces but also creates a campus environment that is welcoming and community focused. Singapore – like many countries in the world – has an ageing population. As part of a shift in planning policy, there has been a concerted effort and investment in research around the design of age-friendly communities and neighbourhoods. Many of these principles that drove Health City Novena can be applied at the hospital estate level from the external to internal environments with a focus on elements such as safety, inclusive mobility and therapeutic environments.

The Covid-19 pandemic has made us all appreciate both the positives and shortcomings of our local neighbourhoods and communities, including the quality of our local parks and green spaces and our immediate environments. For planners, this has highlighted the importance of investing in green infrastructure beyond the hospitals, bringing wellbeing into our daily lives, and how to fully integrate healthcare and wellness within our communities and cities.