Green Social Prescribing for sustainable healthcare

Good relationships with others, ourselves and the natural environment as well as a sense of purpose are fundamental elements of good health.

The pandemic has led to many discovering the health and wellbeing benefits of being in nature, noticing, connecting with, and stewarding/caring for, the natural world and there is a strong evidence base to support this lived experience of millions of people.

How can we capture the power of the natural world to support the physical, mental, emotional, social and spiritual health of each person and the population as a whole, helping us all to keep well, stay well and prevent illness? And how can we steward and care for the ecosystems that we rely on so that they are sustained as they sustain us?

The concept of ‘green social prescribing’ has been offered as a solution and a national policy published in the last 12 months has set the agenda in this area.

On the 22nd June, we held the second of our Connecting Q Locally virtual event series where we discussed translating green social prescribing from policy to practice.

We heard from:

  • Nicola Gitsham, Head of Social Prescribing and Community Approaches, NHS England and Improvement on ‘What is Green Soical Prescribing? Why does it matter & how does it fit with social prescribing?’:
  • Jacob Krzanowski, Specialist Registrar in General Adult Psychiatry at the South London and Maudsley (SLaM) NHS Foundation Trust, and Jenny King, Wild at Heart Project Officer, Sheffield and Rotherham Wildlife Trust who shared their experiences of green social prescribing for mental health & long term conditions: 
  • Sam Alford, Senior Manager, Green Social Prescribing programme, NHS England and Improvement who spoke about how green prescribing is being scaled up in the UK and why this is important to do now: 
  • Jane Soothill, Communities and Prevention Officer, Surrey County Council who shared the strategy in the Surrey Heartlands area for systems change to facilitate nature connection, green space use and green prescribing.

Resources for learning and discussion

  1. Watch the recording of the whole event [54.35 mins] here
  2. Try this exercise with your team, organisation or at a regional meeting :
    • select some video clips from the event on different topics and watch these together.  You can find the clips below in the 'video clip library' or on this playlist on Youtube.  Each clip is accompanied by the key learning points. 
    • After watching the clips use these prompts for discussion:
      • What might the benefits be of making green social prescribing available in your area and integrating it into your clinical pathways?
      • What 1 action will you take to help make this happen?
    • Depending on the size of the group you could have a whole group discussion or small group discussions in break-out rooms (for online groups).  
    • You may like to try using virtual whiteboard like Jamboard, Miro, Mural or Padlet that allows the whole group to collaborate wherever they are and also creates a colourful record of your discussion that can be saved and used later on to further your ideas. Here is a  master copy of the jamboard. Please make a copy to use in your own session by clicking on the 3 dots in the top right of the jamboard page.
  3. From the 24th August - 2nd September a series of conversation starters and video clips from the event will be posted each day in the Sustainable Healthcare Special Interest Group on the Q Community platform that brings together healthcare professionals with an interest in quality improvement.  Please do come and join in and contribute to the conversation!  Apply to join the Q community if you aren't already a member, and for existing members do visit the Sustainable Healthcare Special Interest Group; we'd be delighted to welcome you!

Q community button

Video clip library

These clips are also available as a playlist on YouTube.

Overview of series

Dr Olivia Bush sets the scene of how green social prescribing fits with the principles of sustainable clinical practice & introduces this series of virtual events on sustainable healthcare in practice. 

What is green social prescribing?

Hear from Nicola Gitsham, Head of Social Prescribing and Community Approaches, NHS England and Improvement. Key points include:

  • Social prescribing is a way for health professionals, including link workers based at GP surgeries, to connect people to community activities for practical, social and emotional support.
  • Green social prescribing specifically supports people to connect with nature-based activities.
  • All social prescribing is a way for the health service to implement a wholistic approach to health & care and address the social and ecological determinants of health.
  • Social prescribing starts with what matters to the person and is part of ‘personalised care’.
  • Personalised care is one of the five themes of practical changes that all health & care systems have to implement by 2023/24 as part of the NHS Long Term Plan.  One of the targets is for GP surgeries to employ link workers.

 

‘Wild at Heart’; an example of a community green social prescribing project

Hear from Jenny King, Wild at Heart Project Officer, Sheffield and Rotherham Wildlife Trust. Key points include:

  • ‘Wild at Heart’ is a social group for adults, where members can choose from a broad range of seasonal nature-based activities cooking, gardening and nature walks.
  • The group provides the opportunity for staff to get to know participants in a relaxed atmosphere and to encourage participants to explore what they enjoy and what they need for a full and satisfying life.  The starting point is pleasure rather than problems.
  • The approach helps participants to gain confidence in their skills and abilities as well as the opportunity to meet and form friendships with other group members.  Many go on to use their new skills at home and build a healthier lifestyle for themselves as part of the wider community.

 

‘The Green Walking Initiative’; an example of nature-based therapy in secondary care

Hear from Jacob Krzanowski, Specialist Registrar in General Adult Psychiatry at the South London and Maudsley (SLaM) NHS Foundation Trust. Key points include: 

  • The Green Walking Initiative piloted the introduction of a weekly walk in a greenspace for psychiatric inpatients accompanied by members of staff, in units nationwide.  A guide to setting up this project in your area and spread and scaling this work can be found in the resouces section below.
  • Why is this initiative important?
    • This is a rare example of a nature-based therapy initiative in secondary care (rather than the community).
    • Addresses inequalities in access to green spaces as patients often don’t have access to green spaces during their hospital stay despite the fact that many hospital sites are adjacent to and on green spaces.
  • The richness of the impact was best captured through accounts of how it felt for staff and patients’ to be off the ward and in nature.  Staff described how patients were ‘transformed’ by the walks and how the effect was ‘unbelievable’.
  • Where the initiative flourished it had a ‘ripple effect’ with other green initiatives being seeded.
  • Embedding even a relatively simple intervention in a care pathway at sites required a huge amount of energy and long-term commitment.  Key elements of success included selecting staff members at sites who would own and champion the project and pilot sites being one of a larger community of sites working on the initiative at the same time.

 

What is the Green Social Prescribing Programme?

Hear from Sam Alford, Senior Manager, Green Social Prescribing programme, NHS England and Improvement who speaks about how green prescribing is being scaled up in the UK and why this is important to do now. Key points include:

  • This 2-year initiative is exploring:
    • how the use and connection to natural environment can be increased through green and blue social prescribing referrals.
    • how green and blue social prescribing can be implemented at scale and embedded.
  • The programme focusses on mental health (although there is evidence for the benefit of green social prescribing in physical health as well).
  • The initiative is being carried out through collaborating with a wide range of partners including local integrated care systems, Public Health England, Sports England, DEFRA, NHS England, Natural England and the Natural Academy of Social Prescribing.
  • 7 Pilot sites have been chosen.  All sites are:
    • focussing on communities that have been especially hard hit by the coronavirus pandemic & areas of high level of health inequalities.
    • using a collaborative approach and co-designing work to make sure that services are delivered in a way that make sense to local people and set up so that prescribers feel confident to refer to the services.
  • The 7 sites are geographically diverse (coastal, rural and urban areas are all represented) and have different models for working with partners.
  • The initiative makes funding available for both project delivery and for exploring sustainable funding for the future that will allow green social prescribing to be embedded.

 

Interview from one of the Green Social Prescribing ‘test and learn’ pilot sites

Hear from Jane Soothill, Communities and Prevention Officer, Surrey County Council who shares the strategy in the Surrey Heartlands area for systems change to facilitate nature connection, green space use and green social prescribing. Key points: 

  • Surry Heartlands have established a broad partnership to develop a vision of how they their health and social care system and clinical pathways to look different after this pilot.  The partnership includes the clinical commissioning group, hospital trusts, primary care, local authority, councils, VCSE sector and green sector
  • Working groups have been established for a variety of workstreams including evaluation & training, community engagement.  Each group is co-chaired by a representative from the health sector and another from the green/leisure sector.
  • To share learning the site has established their own local online network.  They also share learning with other test and learn sites through a dedicated space on the NHS collaboration platform.
  • The site has found that green/blue social prescribing is an area that brings people together and to which large numbers of people are willing to dedicate their time and energy.

 

Q&A

Funding & stakeholder engagement

Key points:

  • Social prescribing requires a varied range activities in a local area.  Delivering this range starts with finding out about the needs of the local population, mapping what is currently available (e.g. using the ‘Commonplace’ platform) and identifying gaps.
  • Where social prescribing works well local areas have a place-based strategy that involves cross-sector partnerships and a model of ‘share investment funding’ i.e. they are attracting different sources of funding rather than relying on statutory funding.

 

Staff training, policies and quality assurance

Key points include:

  • For existing programmes where staff work with vulnerable people the ‘Institute of Outdoor Learning’ have produced a best practice document providing guidance to support staff and organisations to offer responsible care.  This includes practice advice on staff training and policies.
  • As part of the initiative quality standards will be developed so that organisations can go through a quality assurance process.  This will help referers to be able to refer with confidence.

 

Will funding for providers go to large national organisations or local organisations?

Key points: 

  • The initiative is about local engagement and working in local areas and that will be where funding is most likely to be allocated.  Local groups usually have that local sensitivity and local need, are part of that community and know how to imnplement services in those communities.

 

Evaluation; how can the benefits be measured?

Key points: 

  • The measure depends upon the change you want to see (and for whom e.g. patients, staff, community).  There is an existing range of different measures.
  • Evaluation can detract from the patient experience so it is important to identify what is essential to capture and focus on that.
  • One of the objectives for test and learn pilot sites will be to identify what the useful outcomes are and what evaluation methods are best suited to green social prescribing.  For example, Surrey Heartlands are looking at the benefits of storytelling methods.

 

Resources

Networks

Green social prescribing & why it matters

‘Wild at Heart’; an example of a community green social prescribing project

‘The Green Walking Initiative’; an example of nature-based therapy in an inpatient psychiatric hospital setting.

The Green Social Prescribing Programme

Quality assurance

  • ‘Institute of Outdoor Learning’ have produced a best practice document providing guidance to support staff and organisations to offer responsible care. 

Evaluation

Courses

  • Green Space and Health: Research from around the world demonstrates that 'green' prescriptions are increasingly being used by healthcare professionals.  This course explores the evidence, showcases examples of green prevention and therapy and illustrates how you can integrate these into your own practice.

This project is funded through Q, by the Health Foundation and NHS England and NHS Improvement. You can view more topics of the connecting q locally series, here