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Space to heal: Unlocking the landscape of healthcare sites
Cherry trees line the newly planted blossom walk in the Secret Garden, Glenfield Hospital, Leicester. © Dora Damian
The NHS Forest is an alliance of healthcare sites run by the Centre for Sustainable Healthcare, and it helps stakeholders to leverage the NHS estate as a part of local green infrastructure networks.
The NHS Forest inspires and supports healthcare sites to transform their green spaces for health, wellbeing and biodiversity. The project helps sites to plan, plant and manage trees, woodlands and green spaces to create habitats for wildlife and sustainable social spaces for people. This helps to ensure the NHS Green Estate is visible valued, and part of local green infrastructure.
The NHS Forest has been providing trees for planting on or near NHS land across the UK since 2009. Currently, through Defra’s Nature for Climate funding and the Trees Call for Action Fund, we are able to supply over 150,000 fully funded trees to NHS England sites. As the NHS estate varies considerably, we offer our trees in a mixture of ways, from curated bundles that support particular needs to large-scale woodland projects.
Our tree bundles range from 10 trees to 240 trees and are chosen to suit a variety of green spaces. For example, there is a blossom bundle made up of a mix of crab apple, hawthorn, hazel, rowan and wild cherry, i.e. species characterised by their blossoms, berries and autumnal leaves. Secondly, sites that wish to create larger woodlands can curate their tree order and have access to a wider range of tree sizes. Lastly, we are supplying a limited number of fruit trees as part of our orchard creation campaign for the 2024/25 planting season, which has diversified our campaign and been very popular so far. During our first season with the Nature for Climate funding, more than 27,000 trees were planted across over 180 trusts in the 2023/24 planting season, a 165% increase in tree planting compared to the previous season.
Activation and engagement
In order for sites to receive trees, we require a small amount of evidence. This includes before and after photographs of the tree planting area, GPS coordinates and maps. We also ask sites to agree to a tree planting agreement that sets out requirements regarding care of the trees over the years. These documents essentially provide our grant providers with all the information they need when carrying out tree checks later.
Given our high intake of applications, the amount of support we can offer individuals can be limited. However, we have weekly drop-in sessions for applicants to ask questions about the process or their order. We also run occasional webinar sessions, recently including how to design and maintain an NHS orchard.
Having worked with the NHS since 2009, the Centre for Sustainable Healthcare has a large reach through sustainable health networks, the NHS Forest Network, training courses, newsletters and the NHS Forest conference. Our outreach methods to promote our tree offer have two key strands, both internal and external to the NHS. Internally, we are part of the NHS Biodiversity working group and other actors in Greener NHS, through which we promote the NHS Forest. We also have connections at the Integrated Care Board and at NHS Trust level, including sustainability, estates and communications teams.
Aside from these groups, we also directly contact sites, for example those that have a low Tree Equity Score. This score indicates a poor urban tree distribution and a low score on variables relating to climate, health and socioeconomic variables. The Tree Equity Score around a healthcare site can indicate risk to environmental hazards that could be reduced with additional canopy cover. Our second method of engagement with sites is through collaboration with key environmental agencies and partners. One example is local authorities with Woodland Creation Accelerator Funding, who have been great advocates of our work and who practically support tree planting that occurs within their area.
There are considerable pressures on the NHS Estate, be that through pressure to develop land for a new ward or to create car parks to accommodate ever burgeoning parking requirements. Space for woodland creation is limited, and to confirm these suspicions it was noted that almost half of our applicants were planting in pockets of land adjacent to roads, paths, car parks or buildings. An innovative example of planting taking advantage of these small spaces has been delivered by Energy & Sustainability Manager for Yorkshire Ambulance Service, Alexis Percival. Alexis has coordinated the planting of 5,000 trees across more than 30 sites over several years. Although ambulance sites can be small, innocuous sites, collectively they can become an impressive patchwork of planting.
Alexis coordinates planting across this broad area through working with staff and corporate partners, and community involvement features highly, with tree planters’ feedback strongly encouraged. The involvement of local communities in the planting activities was a significant positive aspect of tree planting last season, fostering a sense of collective achievement and environmental stewardship. One participant highlighted the educational aspect of tree planting, and a school was involved in the process, providing students with hands-on learning experiences about the environment and sustainability.
Healthcare sites can be utilised to provide wider outcomes for the environment and society, and more green spaces could be activated if NHS England set targets for tree planting and green space improvements.
Another finding from feedback was that the highest motivator for planting was to provide habitat for wildlife and biodiversity. A key example of nature-conscious planting was at Langdon Hospital in Devon. What was originally a woodworking class in a studio soon became mixed with conservation work when occupational therapist, Alex Watkins, decided to teach patients about the lifecycle of the material they were working with. They started restoring a Devon hedge and then continued to expand their hedge planting across the site. They’ve also now recovered a completely overgrown veteran orchard, established a walking trail around the site and installed wildlife cameras, which brings the outside in. Using tree planting and conservation work as part of patient care pathways is a creative way of blending environmental conservation with patient wellbeing.
Case studies such as Yorkshire Ambulance Service and Langdon Hospital are essential for us to communicate the variety of greenspaces that can benefit from our trees and how planting trees can be the first step in wider green space improvements. A couple of participants last season claimed that planting trees has led to patients and staff paying more attention to plants in the hospital area. As a result, elsewhere in the hospital new plant pots were installed and planted, making a visible green change.
These two case studies also indicate the way patients, staff and volunteers can support planting and green space improvements. To complement this, the NHS Forest has developed a match-making service that allows sites to register their green space events and local volunteers to be notified when these events occur in their area. Nevertheless, we recognise the perennial problem faced by sites, of estate management costs, and have provided this feedback and learning to our funder. We continue to seek further funding that would support these maintenance costs as we consider the future direction of NHS Forest.
How could more sites be activated in the future?
Healthcare sites can be utilised to provide wider outcomes for the environment and society, and more green spaces could be activated if NHS England set targets for tree planting and green space improvements. To support them in this goal, future tree planting campaigns must build in the provision of maintenance support with financial support and training on sustainable management methods also considered.
Secondly, the Lord Darzi report1 understood the clear need for preventative action in healthcare. Green spaces have an enormous capacity for this, and the NHS Forest’s Ranger program me exemplifies the potential for NHS sites to link staff and patients to their green space. Rangers enable nature-based interventions and help significantly with awareness building around the benefits of access to green space. They are an enabler of green space use and build confidence in its use, holistically overseeing green space improvements (including tree planting), understanding the site’s potential, and integrating the maintenance of green space into their sessions.
Lastly, we need to see the healthcare site as a part of the wider landscape and in turn the environment as part of public health. Climate breakdown is going to affect whole communities and their environments, so we need to consider public health at a landscape level. We need to view the entire landscape as one that can improve personal and community wellbeing, while also addressing other ecosystem services.
Harriet White is the Woodland Creation and Tree Planting project manager at the NHS Forest.
