Experts from the health and green-space sectors have welcomed the publication this month of a practical guide to designing therapeutic spaces around hospitals and healthcare sites. Greenspace Design for Health and Well-being, written by landscape architect Aileen Shackell, highlights the role of well-designed outdoor space in the recovery from and even prevention of many illness and surgical procedures.
Commissioned by the Centre for Sustainable Healthcare and published by the Forestry Commission, the initial idea was to create a practical tool for those involved with the NHS Forest scheme to help them improve the outdoor spaces in which they were planting trees to create therapeutic environments. But it has developed into something far more significant.
All agree that the guide provides nothing new in terms of evidence about the curative benefits of the outdoor environment. But it does, for the first time, make a specific case for protecting and improving hospital open spaces.
Equally as important, say green-space practitioners, the fact that it is rubber-stamped by the Forestry Commission and NHS signifies a vital shift in mindset that they insist must be harnessed to secure support. And not just for the outdoor spaces on hospital sites, many of which are under threat of being sold off to raise funds, but also for green space in general.
This "step-change", experts say, is further evidenced by the trend for primary care trusts' (PCTs) investment in outdoor health initiatives such as green gyms and health walks in their local parks.
So how effective can the message from such a publication be in further influencing the decisionmakers? The experts have their say.
Aileen Shackell, Author of Greenspace Design for Health and Well-being and director of landscape design consultancy Aileen Shackell Associates
"I am hoping that this will be influential in protecting open space around hospitals and health establishments but it has a wider relevance as well. Selling off land for housing development is obviously very attractive to some of our hard-pressed PCTs that are up to their eyes in private finance initiative debt.
"The book is trying to make it clear why it is important for people who are in recovery to have access to the outdoors and the natural environment. If we have more understanding about those benefits, we are more likely to think about protecting our open spaces rather than just building on them. Having NHS and Forestry Commission backing helps massively with credibility because they are acknowledged as experts in their fields.
"The message of the book is to think about design and the space's ultimate use and maintenance needs. It is obvious that there are many practical reasons why outdoor spaces often aren't used and without addressing that you won't get anywhere. Often it's not to do with design but practical reasons like littering and lack of maintenance.
"They need to be designed with adequate resources for maintenance from the outset. There is no point designing something too elaborate but equally a very low-maintenance design can often mean a very bland space that may not have the desired therapeutic benefits."
Sid Sullivan, Parks consultant
"This publication shows that hospitals are recognising that healing goes on as much outside as it does within the walls and that is an interesting mindset change. It raises the quality of our evidence and the support for the sector, and we must use it to protect our green-space budgets.
"Government listens to the NHS and the medical profession, and what we have in effect is the NHS saying that the money being spent on parks is a major contributor to public health and well-being. We must now get those advocates on our side to help raise the issue to Government of how much is being stripped from our budgets.
"The arguments are clear - NHS space is no different to all our other green space but we have far more of it to offer at a local level. The NHS is trying to reduce spending on drugs and what this tells us is that the green environment may enable them to do that because it contributes to health and well-being.
"Therefore, we should get some of our funding from the Department of Health. That is surely the argument we need to engage with now. It is obvious from this kind of publication that a cut in parks funding is a cut in public health provision."
Dr William Bird, Founder, Intelligent Health
"We already know about the benefits of nature and how it helps healing but what is new here is that it's applied particularly to hospitals and suchlike with practical guidance.
"There is a lot of enthusiasm but it is going to be hard to sell this concept without some proof of cost benefit. Wherever you spend money in the NHS, you have to have a benefit that can be costed. With money so tight it might have been nicer to see that given a little more importance.
"For anyone who has a healthcare institution or anywhere people are more vulnerable, this is a very useful document to help them understand what the benefits can be. This concept is something that is applicable not just to the health sector but to schools, housing estates and sheltered accommodation. Is this strong enough ammunition to make a change? I think that is unlikely in a difficult economic climate, but it is a step in the right direction."
Paul Bramhill, Chief executive, GreenSpace
"We welcome the document. It highlights that using outdoor spaces was common practice in the earlier part of the last century and has become forgotten in the drive for clinical excellence and the advancement of technical capacity.
"We've been wanting the health sector to better recognise the role of the green environment as a means of improving the health of the nation both in terms of preventing illness and poor health and in reducing the impact of illness and improving recovery rates. This guide may do much to encourage the health system to make better use of its grounds and the opportunities it presents. Let's hope that this becomes a steppingstone to the greater engagement of the health sector in the debate around access to quality green environment and the impact on quality of life and well-being."
Russell McDonnell, Director, Mac Greenspace Solutions
"The guide sums up what most parks managers should already know - that association with good-quality green space is good for people. It's not new but it is valuable in reiterating best-practice messages.
"Savvy parks managers are already working hard to secure every ounce of additional investment they can, many in partnership to improve parks using health initiative funding. Parks have been used as healthy living centres for decades, but in many cases the standard of maintenance and the opportunity to engage with local people is being lost.
"Parks and local green space as an industry has no Government champion - it has no national body that can use its weight to influence at the highest levels. Groups such as the Environment Agency, Natural England and the Forestry Commission may dabble and dip into green-space policy when it suits, but only for their own agendas.
"The industry, now more than ever, having faced over a decade of growth through the work by CABE and the Heritage Lottery Fund, needs a Government agency to champion its cause. Otherwise all the investment and regeneration of parks that we have seen will be lost through budget cuts."
Mary Bagley, Parks and countryside service manager, Wirral Parks & Countryside
"This is all based on very sound research and core principles. If it is actually used by hospital and NHS trusts, it will be a good thing. What I will be interested in is whether GP commissioning will further this idea and prescribe green space for healing.
"There is already a lot of healthcare investment going on around the country in outdoor initiatives. We are having a lot of outdoor equipment put into our open spaces that we could never have had without PCT funding - it is a great partnership. We in green space are great value for money for people's health and well-being but it is as much about preventive healthcare - think about how much that could save the NHS.
"This is the perfect time to be forming partnerships with the local health service, as public health goes to local authorities. It will make it easy for the NHS and public health practitioners to invest and make the difference."