Case Study

NHS Forest – Nature Recovery Rangers programme, UK

Sector: Health
Highlights: Community wellbeing, recreation, ecological uplift, carbon mitigation
Project owner: NHS Forest, Centre for Sustainable Healthcare
Project start: Spring 2021 – ongoing
Location/s: Across the UK
Community impacted: Urban
Hazards mitigated: Heat stress, Flooding
Number of vulnerable people made more resilient: 148,676*
Case study provided by: NHS Forest

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The NHS Forest programme includes over 360 healthcare sites, which have created occupational therapy gardens, staff allotments, productive orchards, meadows, outdoor gyms, rooftop terraces, ponds full of wildlife, bee borders, and more. The programme highlights the opportunities for integrating nature into healthcare facilities, thereby improving community wellbeing while enhancing the climate resilience of health infrastructure.

About the Project

In Spring 2021, as part of the NHS Forest programme, three NHS sites hired Nature Recovery Rangers to take part in a pilot project to improve green spaces and to help integrate nature into patient care, staff wellbeing and community engagement, and to encourage staff and patients to use them. Following the success of the pilot, the programme was expanded at its original locations and extended to two more sites.

The rangers are employed and managed by the Centre for Sustainable Healthcare (CSH), providing a connection to national networks, resources and opportunities to share ideas and experiences. Their work is overseen on a day-to-day basis by NHS managers at their health sites, ensuring that the rangers’ work is closely tailored to local needs, including reaching new sections of their communities and developing the ecological and health value of their sites. The rangers have a remit to run nature engagement activities and act as advocates for biodiversity; leading on growing food, wildlife-friendly gardening, nature walks, tree planting and more.

The NHS Forest programme

The NHS Forest programme combines resilience and sustainability to improve the wellbeing of staff and patients and to advance the climate resilience of healthcare infrastructure. Tree planting and protection of existing woodlands is a particular priority, with some larger healthcare sites benefitting from woodlands within their grounds, and many other hospitals prescribing the use of neighbouring patches of woodland to their patients, using these spaces for staff breaks and community events to improve the health and wellbeing of the community through physical activity, socialising, and engaging with nature. The NHS Forest is currently leading a Defra funded project to plant 150,000 trees on NHS sites over the next two years as well as offering ecological advice.
The programme also encompasses a network of more than 370 healthcare sites that allows the sharing of best practice around a range of elements, including tree planting, food gardens, courtyard and therapeutic gardens, meadows, orchards, walking trails, rooftop gardens, blue spaces, and the use of rangers.

Some hospitals in the NHS Forest network have also included courtyard gardens to increase green space within the site. Broomfield Hospital, for example, features 13 courtyard gardens within its precinct. This includes two spacious areas with plentiful planting and seating, two enclosed sensory gardens that can only be accessed from wards for the elderly, and a large garden serving the respiratory ward which has recently been refurbished.

The network also includes places where therapeutic gardens have been developed to be used in mental health care, as seen at Guild Park NHS site. This space has a polytunnel, raised plant beds, a chicken coop, aquaponic growing systems and a covered training area. Some service users are employed through the scheme on fixed-term contracts and have gone on to gain horticultural qualifications, facilitating their community involvement after being discharged.

Achieved Outcomes

Social

The green spaces, tended to by the Nature Recovery Rangers, contribute to the care of patients, both preventing health issues, supporting recovery, and creating a healthier environment. For example, Mount Vernon Cancer Centre’s Fern Garden is designed to allow chemotherapy patients to have access to a green space where they can sit with family and loved ones and view the garden through large windows when indoors. This space also has a bespoke wooden shelter which was specifically designed to allow patients the option of receiving treatment in the shelter, contributing to a more restful and restorative experience. Similarly, Liverpool’s Broadgreen Hospital has an accessible sensory garden to support physical therapy and at Homerton Hospital, the ranger worked with the Diabetes Unit to introduce an allotment space for use in patient care, post-care support and the encouragement of healthy behaviours.

The inclusion of nature in NHS sites also provides an accessible and relaxing space for staff to take breaks, and encourages staff involvement in supporting ecosystems, for example through planting wildflowers, herbs, vegetables, and trees. These changes improve the work environment of healthcare facilities and encourage staff to spend time in the fresh air and sunlight, with benefits for health and stress reduction. Staff who spend time in green spaces have been shown to have better wellbeing than those who do not.

The wider community outside the hospital may also engage with these green spaces. For example, Nature Recovery Rangers in Liverpool are supporting local school children to learn about wildlife habitats in the gardens of Broadgreen Hospital.

Throughout the first year of the rangers being employed, the NHS Forest programme team evaluated the response to the rangers’ activities and the benefits they bring. The overwhelming response from participants and staff members was that the rangers’ activities were beneficial for their wellbeing, inspired them to take action to protect the environment, increased their understanding of the natural environment and made the area a better place to live, work and visit.

Environmental

The programme also enhances the resilience of natural ecosystems by developing and protecting green spaces and vegetation, thus reducing urban heat, purifying the air, and reducing flood risk. For example, the Liverpool-based ranger worked closely with the hospital’s groundskeepers, encouraging them to adopt the ‘No Mow May’ campaign which allowed areas of grass to grow undisturbed throughout May. This resulted in the creation of extensive wildflower meadow areas, with the appearance of bee, march and pyramidal orchids. The latter orchid was the first record of the species in the city of Liverpool, illustrating how these small changes can contribute significantly to the biodiversity of the sites.

Other hospitals have included blue spaces in their design, which have been shown to have similar benefits to mental health and wellbeing as green spaces. Southmead Hospital, for example, includes a sustainable drainage system, which incorporates 4,900m² of attenuation ponds as permanent wetland features. They are fed by runoff water from the car parks which passes through swales to clean it before it flows into the reed-filled ponds. This sustainable design makes the site more resilient to flooding.

Economic

The increased use of nature across NHS sites also has economic benefits for the NHS and the wider community. The use of orchards and fruit, vegetable, and herb gardens allows the NHS to reduce costs associated with food production. Moreover, a 2021 study by the UK government found that the mental health benefits associated with access to woodlands alleviated mental illness and thus reduced costs to the NHS and employers, with potential for annual savings of £185 million; the NHS’ inclusion of woodlands on their sites may thus contribute to reduced costs and protection for the mental health of the UK. Additionally, CSH recently commissioned the NHS Trees and Woodland Valuation Pilot Study from Forest Research. This study found that trees and woodlands have a high monetary value to NHS sites that often isn’t accounted for.

How has carbon mitigation been integrated?

The use of green spaces inherently includes carbon mitigation, as vegetation, trees and high-quality soil have carbon-sequestrating effects. The NHS aims to be the world’s first net zero national health service, eliminating its direct carbon footprint by 2040. The NHS Forest supports these efforts in multiple ways, beyond capturing carbon. Green spaces on healthcare sites speed up post-surgery recovery, reduce the need for painkillers and benefit the wellbeing of hospital staff. Green gyms and woodland walkways can promote sustainable forms of exercise, and composting facilities can reduce the amount of waste sent to landfill. Fresh fruit and veg supplied by hospital allotments and orchards can reduce food miles, encourage healthy eating and result in a lower-carbon diet.


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