New report highlights positive impact of landscaping and access to nature on the patient experience
The positive impact of landscaping and access to nature on patients and staff is explored in new guidance for NHS trusts across the UK. BBH spoke to the main author of the document, Aileen Shackell, and found out why more needs to be done to champion and enhance outdoor spaces
“In recent years the focus has been on the sterility of the internal therapeutic environment and on medication, and much less emphasis on the outdoor environment,” says Aileen Shackell, director of Aileen Shackell Landscape Design.
In 2011, she was asked by the Forestry Commission and the Centre for Sustainable Healthcare to write a report on the NHS Forest project, which was set up to improve access to green space for NHS patients and staff through the provision of trees in the grounds of healthcare facilities.
However, she decided to stretch the brief and explore the wider benefits of creating therapeutic outdoor spaces.
More recently the emphasis has been on the internal clinical environment and we are only now coming full circle and considering the outdoor spaces too
The resulting publication, Greenspace Design For Health and Well-Being, is aimed at an NHS audience, but has a much wider relevance to anywhere that has health and wellbeing as an objective, including nursing and care homes.
Shackell said: “If you go back to Victorian times, mental health asylums were quite often built alongside farms and they concentrated on horticultural therapy. A friend of mine who was a mental health nurse and who was still working in the 1970s remembers taking patients into the meadows as part of their recovery.
“But more recently the emphasis has been on the internal clinical environment and we are only now coming full circle and considering the outdoor spaces too.”
The 80-page report explores how nature can assist in recovery and general wellbeing through reduced blood pressure, muscle tension and pulse rate, alleviation of depression and a reduction in aggressive behaviour, as well as enhancing staff performance and retention.
It states: “There is a growing body of evidence, much of it rooted in scientific research, that being in a natural setting, or even just viewing the outdoors from inside, is highly beneficial for health and wellbeing.”
But despite this evidence, the UK healthcare sector has been slow to catch on.
We need to start looking at it in terms of getting the best value for money out of our ground maintenance budgets by using outdoor areas to improve the patient experience and contribute to better health outcomes too
Shackell told bbh : “Where we are with healthcare is a bit like the school grounds movement 10 years ago when we thought it was OK for children to run around on tarmac. Only relatively recently schools have bought into the idea that well-designed and well-thought-out outdoor spaces make pupils more relaxed and less stressed and on the whole schools have run with this. We need to see the same thing now in the health sector.”
But this will depend on a change in culture and greater consideration of the impact of interventions.
Shackell said: “In most trusts there is no single person to lead this work who has an understanding of both the requirements of ground maintenance and the clinical evidence of the therapeutic benefits of being outside, so there is no advocate to push this forward, even on new sites where there has been major investment in the outdoor spaces.
“Because no one is speaking up, it quite often falls to ground maintenance teams or estates and facilities managers to maintain these spaces. They spend a lot of money cutting the grass so it looks nice on the photographs on the website, but no human ever steps foot on it. This can be because it is not a welcoming place to be or because access is restricted. In one fairly-new PFI-funded hospital we looked at, there were 18 courtyard areas and 17 of them were kept locked because often it is not convenient to have people going outside. This is a disgrace.
“We need to start looking at it in terms of getting the best value for money out of our ground maintenance budgets by using outdoor areas to improve the patient experience and contribute to better health outcomes too, and this report offers advice on the best ways to do this.”
Greenspace Design For Health and Well-Being. Click here to access