Horticultural health-treatment programmes must be able to demonstrate a timely return on investment if they are ever to break the cycle of one-off pilot grants and getting bottom-of-the-barrel funding, the RHS Health & Horticulture Conference heard earlier this month.
Doctors, public health experts, academics, planners and politicians mingled with those in the horticulture trades for the day-long conference at RHS Hampton Court Palace Flower Show on 4 July. Easing the pressure on the NHS through horticulture was the key theme at the event, with much of the day's discussion focusing on how to convince those holding the purse strings to invest long-term in horticulture for health.
The group completed the day by creating a "Horticulture Charter" (see www.rhs.org.uk), plotting the way ahead for the use of horticulture and nature in health promotion.
The conference was one of the 12 "asks" originally promoted in the Ornamental Horticulture Round Table's five-year action plan, published at last year's RHS Chelsea Flower Show. The aim is to see gardening offered as a prescription, addressing both physical and mental health challenges.
But, as RHS director-general Sue Biggs said, those in the room were all "believers" in the power of horticulture to improve health. Getting through to Government will always be more difficult.
The event was hosted by former NHS chief executive Lord Nigel Crisp and launched by the RHS's Dr Alistair Griffiths, who also chaired the round table forum. Among the 15 speakers were Dr Justin Varney of Public Health England, Green Gym inventor Dr William Bird, garden designer Chris Beardshaw and Town & Country Planning Association head of green infrastructure Julia Thrift.
Varney is national lead for adult health and well-being at Public Health England and helps clinical commissioning groups work out how best to spend their money. He said while 10-20 per cent of health problems can be resolved by medicine, another 40 per cent can be changed by lifestyle factors such as exercise, food and stopping smoking. The remaining problems are based on factors such as a patient's job, house and community.
Horticulture can have a big impact on both the lifestyle and community factors - a message some doctors are beginning to understand, though their perception is often limited to gardening therapy, said Varney. "With health and horticulture, people think it's all about gardening. Gardening's great, and it has a very important role to play, but the horticulture sector is a broad, diverse sector, ranging from community agriculture to gardening or forestry, so there's a range of interventions.
"There are therapeutic garden schemes, health walks, landscapes, garden schemes. The challenge for horticulture, as much as physical activity and the arts, is how to talk to commissioners and open up to support interventions."
Navigating the funding system takes time, patience and an understanding of each commissioner's different priorities, he added. Commissioners are faced with acute funding pressures from A&E through to GPs, particularly from recurrent or prolonged treatment costs. They want to know the timescale of the return on their investment, he explained.
"Horticulture, like arts and culture, is challenged on the evidence base - how to show that what we do makes a difference ... If you can't show the timescale, you may get one year's nugget of grant funding, but at the end of the year if you can't show evidence of the effect, that will be non-recurrent funding." Historically, commissioning has been very small-scale and primarily non-recurrent pilots and grants from spare funds, but these have all been cut by austerity.
However, Varney said the evidence base is strengthening. "Moving to sustainable provision requires cultural shifts for both commissioners and providers. They need to recognise that horticulture is a wide spectrum encompassing big business. But providers need to deliver outcomes in real time that are measurable."
Netherlands-based environmental psychologist Professor Agnes van den Berg agreed that the evidence base has expanded exponentially and said what is needed now are systematic reviews and meta-analyses of randomised control trials. A systematic review by The King's Fund, released in May, was a review of reviews, which shows the extraordinary amount of research already done.
However, van den Burg said there are two key questions that require more scientific research. Firstly, it is still unclear why green space improves behaviour, psychology and physiology. Secondly, how to ensure people receive the positive benefits of horticulture and greenery, including whether green space can be designed for optimum health.
The forum will now meet to decide the next steps, with the eventual aim to speak directly to Government about the potential that horticulture holds for health.