Greening the NHS Estate in Scotland

Kevin Lafferty, national policy advisor for access, health and recreation at Forestry Commission Scotland (FCS) explains how a unique project to increase NHS Greenspace is helping to improve health and wellbeing outcomes in Scotland…

There is a growing body of evidence establishing the link between green space and positive health and wellbeing. However, it is still an area that requires more research and policy support because it is perceived to be a nice-to-have rather than an essential part of NHS estate management.

Possilpark Health and Care Centre garden

In Scotland, the Greening the NHS Estate programme is aiming to influence the mainstreaming of green exercise into health policy and practice. Through a number of demonstration sites, the programme is improving NHS grounds for health and wellbeing purposes and encouraging more people to make greater use of outdoor spaces and woodlands.

Managed in partnership by NHS Health Scotland, Scottish Natural Heritage and Forestry Commission Scotland under the Green Exercise Partnership (GEP) the programme has explored greening options with estates and public health departments in most of the 14 Area Health Boards in Scotland.

A key target is to develop demonstration projects at all of Scotland’s mainland area health boards. Around £2.5m, including £1m from the Scottish Government, has been invested in the programme over several years.

Demonstration projects

Currently, there are six live demonstration projects at NHS sites across Scotland, which have involved a range of works, involving the retrofit of existing facilities and integration of greenspace design into new builds.

Ayr hospital teaching circle

The development of plans is bespoke to each site, based on consultation with estates and public health departments, as well as wider staff and patients. Many of the projects have included a combination of upgrades to path networks to encourage walking and cycling; improved signage and way-marking and planting of trees, wildflower meadows and vegetable and flower plots.

For example, at NHS Forth Valley Royal Hospital the grounds have been transformed to include way-marked trails, accessible paths, signage, an outdoor teaching circle and a timber pier viewpoint at Larbert Loch.

Ongoing work at Gartnavel Royal and Gartnavel General Hospitals in Glasgow includes restoration of the site’s many original outdoor features, including a summerhouse and walled garden, marking a return to the 19th century idea of linking healthcare to exercise, fresh air and nature.

Most recently, a new path network has been opened at NHS Ayrshire & Arran University Hospital, providing attractive places for exercise, relaxation and recuperation.

Evaluation

Evaluation of individual demonstration sites has revealed that NHS Greenspace is making a positive impact in a number of ways, including:

• Increased connectivity between the built and natural environment
• Increased awareness of and use of green space by staff, patients and visitors
• Use of green space as part of patient therapy activities and recovery programmes
• Increased use of NHS Greenspace by other groups, such as local residents, community groups and
• on-site nurseries
• Improved habitats for wildlife and biodiversity.

There is support for NHS Greenspace, but many recognise there are challenges in using NHS Estate maintenance budgets on green space.

There are some concerns about the public perception of health boards spending NHS resources on preventative and recuperative healthcare: gardens rather than medical equipment or more nurses.

While this concern is understandable, active management is a more sustainable approach than neglect and investing in NHS Greenspace is a cost-effective way of increasing opportunities for preventative, therapeutic and restorative benefits for staff and patients. Other barriers tend to be cultural and attitudinal.

For example, a key pressure at most NHS sites is car parking and transport. Improving access infrastructure for pedestrians and cyclists and reducing the dominance of motorised transport creates better physical environments for people and encourages physical activity. The challenge is to make walking and cycling a priority over driving.

Future plans

Despite a number of challenges, there is real potential for green space to be stipulated as an essential requirement for retrofitting and new build NHS projects.

If we want to have a truly progressive healthcare system that promotes good health and prevention, we have to consider the impact and benefits of promoting a greener NHS.

There are exciting opportunities to use the NHS Estate far more effectively to promote better health outcomes for patients, staff, visitors and the wider community, and Greening the NHS Estate is creating a model for the core integration of green space that can be used across NHS Scotland and beyond.

Read the December issue of ABC+D Magazine