Greening hospital courtyards can be transformational: in healthcare sites, enclosed outdoor spaces tend to be close to wards and clinics and ideally placed for both patients and staff to reach. For a patient waiting for treatment or convalescing, or a clinician taking a break, a vibrant courtyard garden can be a very welcome find. Yet turning a concrete space between buildings into an attractive and well-used garden area is challenging. There may be no soil there, making it necessary to carry it in through pristine clinical areas; a stark expanse of wall can be hard to cover; and it may feel too overlooked for comfort.

NHS Forest sites with courtyard gardens

Broomfield Hospital in Chelmsford, Essex, is especially well endowed, with 13 courtyard gardens within its precincts. Among these are two spacious, well-tended areas with plentiful planting and seating, adjacent to the main atrium; two securely enclosed sensory gardens, only accessible from care of the elderly wards; and a large garden serving the respiratory ward which has recently been refurbished. The renovation focused on plants that would bring colour and buoyancy, including tall perennials (Verbena bonariensis) which are frequently covered in butterflies.

Broomfield Hospital ward courtyard garden
Broomfield Hospital ward courtyard garden. Photo: Carey Newson / Centre for Sustainable Healthcare 2021. Attribution 4.0 International (CC BY 4.0).
Broomfield Hospital ward courtyard garden
Broomfield Hospital ward courtyard garden. Photo: Carey Newson / Centre for Sustainable Healthcare 2021. Attribution 4.0 International (CC BY 4.0).

Our research highlights the role of hospital courtyard gardens in both patient and staff wellbeing. A ward sister interviewed for our Space to Breathe project said, “A lot of doctors feel that this is a nice area to give news, because it’s completely away from the ward, nobody can hear you … it’s quite peaceful, and you haven’t got interruptions.” She felt access to a garden was especially valuable for patients in palliative care: “Sometimes it’s just nice to feel the air on their face, you know, and this is something really, really easy that we can do for them.”

How to create a courtyard garden

The amenity offered by a green courtyard will depend on its position within the hospital, so start by exploring who will be able to easily reach the space, and how they are likely to make use of it. Is this a waiting area for patients; a place they can meet with relatives; an outdoor extension of a cafeteria; a space for rehabilitation; or perhaps a mix of these? Will it be used by patients, visitors, staff, or all three? Work closely with potential users to understand their aspirations for the space, and what they need and want from it.  

Access is always a critical issue. Too often, green courtyards remain locked as if they are there to be looked at but not fully enjoyed. Consider at an early stage how these arrangements will work: not only how you will ensure that there is an unlocked door, but how the space will welcome potential users and reassure them that they have permission to use it. Signage and comfortable seating will help convey this. Tables with movable chairs rather than fixed seating make it simpler to make space for a wheelchair. This may be an easier choice in a courtyard where oversight from the building makes the unwanted removal of garden furniture less likely. Similarly, courtyard gardens have good scope for sculptures or other art installations that can help to give the space its own identity.

Access difficulties can make maintenance complicated, from removing pruned vegetation, to ensuring adequate watering. Drought resistant plants, such as

lavender, shrubby wallflower and sedums, can help. Courtyards can be shaded spaces, especially if small, so this is a further constraint for the design of planting schemes.

Privacy is often a critical consideration. For example, it’s important to anticipate how treatment rooms will be affected by the garden’s use and how far those sitting out feel they are in a ‘goldfish bowl’. This can particularly affect staff hoping to enjoy a break out of the view of patients. The use of screening from tall plants or garden structures and the positioning of seating can help to break up space so that users feel less exposed and find it easier to have quiet conversations. But this may be problematic in some situations – for example, if staff wish to closely monitor vulnerable patients while they are outdoors. As always, this points to the importance of detailed consultation at an early stage in planning.

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