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The Green Exercise Partnership (GEP) is a joint venture between Forestry Commission Scotland, NHS Health Scotland, NHS National Services Scotland and Scottish Natural Heritage. It was established in 2007 to improve links between the environment and health sectors in Scotland. It was developed in response to increasing evidence that public health can be improved through the use of the outdoors for physical activity and contact with nature. Demonstration projects have been set up at a number of hospital sites and have included improvements to existing NHS estate woodlands and greenspace including active greenspace management, new and improved footpaths, seating and interpretation. A small number of greenspace for health project officer posts have been created to work with staff and patients in the hospital greenspaces. The GEP requested research to establish the views and perceptions of corporate decision makers, estates managers, and clinicians at a number of hospital sites where an NHS greenspace demonstration project has been developed. The focus of the research is on the impacts and opportunities of greening the NHS estate.

Research objectives

  1. What impacts has the greening the NHS Estate project had so far from the perspectives of clinicians, estate managers, and corporate decision makers in hospitals and Health Boards in Scotland?
  2. What has been the progress towards mainstreaming the concept of greening the NHS Estate and what are the key factors that enable mainstreaming where it is occurring?
  3. What opportunities have the greening the NHS Estate project provided?
  4. Have any barriers been encountered in the demonstration projects and if so have they, or how could they, be overcome?

Findings and Recommendations

The results highlight very positive views of NHS greenspace from the majority of interviewees. This is perhaps unsurprising given that all have been involved in a NHS greenspace demonstration project. Interviewees stated that NHS greenspace can contribute across a range of policies such as health, biodiversity, energy, although many felt the focus should be on health. The key priorities that NHS greenspace can potentially contribute to were identified as physical activity, mental well-being, reduction in length of hospital stay, and contribution to creating less obesogenic environments. Beneficiaries of NHS greenspace were identified as patients, staff, visitors and local communities; however patients and staff were viewed as the priority. There was a strong realisation of the difficulties of monitoring and evaluating these types of complex interventions with a suggestion that a mixed methods approach might be most suitable as there would be difficulties quantifying and monetising many of the benefits gained by the beneficiaries.

The results illustrate that there is potential for greenspace design to be stipulated as an essential requirement for retrofitting existing healthcare facilities, and in the creation of any new hospital facilities.

A strategic approach should be undertaken as there are clearly priority hospital sites near large centres of population with a good greenspace resource to work with for the GEP to focus on.

The GEP work should demonstrate where NHS greenspace has been carried out and how, provide details, proactively advocate the approach, and provide guidance and support for sites that might want to take this up. There are opportunities to publicise what has already been done through existing health networks and strategic meetings. This is already taking place and is on-going.

Latest updates

Further interviews are planned at more hospitals in Scotland and a new briefing note will be developed synthesising the results from the research.

Reports on hospital greenspace demonstration projects are available:

Report to the Green Exercise Partnership on University Hospital Ayr and Ailsa Hospital greenspace demonstration project (2018)

Report to the Green Exercise Partnership on the Royal Edinburgh Hospital greenspace demonstration project (2018)

Our Involvement

The work is being carried out by the Social and Economic Research Group in collaboration with the Green Exercise Partnership and is one element of the work being undertaken by the partnership.

NHS Greenspace
(includes short films and talking heads of the demonstration projects)

Funding & partners
  • The Green Exercise Partnership
Forestry Staff Liz OBrien RzWQYOa.2e16d0ba.fill 600x600 2
Liz O'Brien

Principal Social Scientist