King's Fund policy director Richard Murray and Jane Ellison MP, Parliamentary Under-Secretary of State for Public Health, will launch the report, commissioned by the National Gardens Scheme from the health research and policy think tank.
NGS’s beneficiary charities include Marie Curie, Macmillan, Queen’s Nursing Institute and Hospice UK.
The report, written by David Buck, recommends:
At a strategic level:
The Department of Health, the Department for Environment, Food and Rural Affairs (Defra) and the Department for Communities and Local Government should align their policies that impact on gardening and gardens. They should identify gaps in evidence and make it easier for their delivery chains to support gardening and its positive health impacts.
The NHS five year forward view (NHS England et al 2014) is the future plan for the NHS. The role of gardening in supporting health should be considered as part of three of its key programmes: New Models of Care; Healthy New Towns; and Social Movements for Health.
Other strategic enablers – including the planning system, the Public Services (Social Value) Act 2012 and Public Health England’s role in evidence collation and dissemination – can and should be used to support the role of gardening in improving and maintaining health.
Key influencers in the health, environment and gardening and horticulture sectors need to develop a joint strategy to better influence policy on gardens and health and help ensure their sustainability.
At a local level:
Directors of public health, health and wellbeing boards and local government should use the evidence in this report to support and develop their public health plans and actions.
Clinical commissioning groups (CCGs) should include gardening as one of many opportunities for patients in social prescribing projects, and together with other stakeholders (including the third sector and local councils) explore the case for reciprocal gardening schemes in their localities.
The role of gardens and gardening in supporting health should be considered as part of place-based population health systems, particularly as local approaches to public services devolution and NHS sustainability and transformation plans mature over time.
The Local Government Association should work with partners to ensure the sustainability and therefore continued health benefits of high-quality public gardens through, for example: o innovative funding models o helping to create access to private gardens with others o developing access to allotments o supporting reciprocal gardening schemes.
Consideration should be given to developing excess unused and unloved public sector land for community gardening schemes where appropriate and where there is demand. Implementing and developing the evidence base:
The existing evidence base should be assembled, maintained and disseminated in ways that decision-makers can act on. This should include evidence from the full range of methodologies and not solely from RCTs, with a focus on what works, in what circumstances and for whom. Public Health England and the National Institute for Health and Care Excellence (NICE) will have an important role to play in this, alongside the Local Government Association and NHS England.
Further research on RCTs, complex public health evaluations and economic evaluations is needed to better establish the mechanism through which gardens and gardening impact on health for different populations across the life-course. There should be a focus on equity, which is rarely considered in existing research despite the evidence that some groups have less access to gardens, gardening and green space than others.
To make a business case for gardening from a health perspective, The King’s Fund has reviewed the wider literature. For example:
Increasing access to parks and open spaces could reduce NHS costs of treating obesity by more than £2 billion (Groundwork, no date).
Green walls and trees could remove some air pollution from streets; trees are the better option though the overall effects are low, but factoring in the noise pollution impact reductions could improve the return on investment to health (Kilbane-Dawe 2012). For example, London’s tree-cover (which includes gardens) provides a wide range of benefits linked to health including carbon storage, flood alleviation and amenity value, valued in total at more than £130 billion (Kenton et al 2015).
Access to green space can reduce mental health admissions, resulting in additional savings for the NHS (Wheater et al 2007). The New Economics Foundation estimated the value of the Ecominds programme (a programme supported by Mind to offer outdoor experiences including gardening for those with mental health problems) for five participants to be around £7,000 each through reduced NHS costs, welfare benefit reductions and increased tax contributions (New Economics Foundation 2014).
The national evaluation of the British Trust for Conservation Volunteers (BTCV) Green Gym project (Yerrell 2008) between 2005 and 2009 estimated that for every £1 invested in green gyms, £2.55 would be saved in treating illness related to physical inactivity. Social prescriptions for woodland activities for those with mental health problems in the Scottish Branching Out programme suggest a cost of £8,600 per Gardens and health 41 quality-adjusted life-year (QALY) – highly cost effective by NICE benchmarks (Willis et al 2016).
Community gardening has been shown to lead to possible NHS savings. For example, Garden Partners in Wandsworth (Jackson et al, no date) suggested an estimated potential saving to the NHS in one year of the project to be £113,748 for those who reported an improvement in their health. When widened to include those who reported that their condition was no worse, this gave a potential saving of £500,223.
Greenspace Scotland (2011) has collated a wide range of social return on investment studies, including on community-growing initiatives.
More broadly, gardening is part of social prescribing or community referrals. There are some examples, such as in Rotherham, where social prescribing – which included gardening – has reduced A&E attendance, outpatient appointments and inpatient admissions and led to increases in wellbeing. The Rotherham scheme was estimated to be able to pay for itself over 18–24 months in terms of reduced NHS use.