GREEN WAYS to HEALTH Case Study – Royal Edinburgh Hospital
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GREEN WAYS TO HEALTH Case Study – Royal Edinburgh Hospital nature.scot GREEN WAYS TO HEALTH ROYAL EDINBURGH HOSPITAL CASE STUDY ‘It’s good for patients to have The GREEN EXERCISE PARTNERSHIP is something on the ward that’s a joint venture between Forestry Commission different from their daily routine’ Scotland, Scottish Natural Heritage, NHS National Services Scotland and Health Chirlene Hall, Staff Nurse Scotland (the health improvement board of the National Health Service in Scotland). The Partnership aims to build links between the health and environment sectors, following growing evidence that public health can be improved by getting people engaged with the natural environment. Through its Greening the NHS Estate programme, the Partnership aims to establish at least one project in each of the eleven mainland Area Health Boards to show the health benefits that flow from positive investment in and management of the NHS estate – the greenspace around hospitals and healthcare centres. Public events give the garden a place in the local community. ROYAL EDINBURGH HOSPITAL The Royal Edinburgh Hospital is the main mental health hospital for the Lothian area. It occupies a large site in Morningside, in the south of the city, and includes units specialising in dementia care, learning disability, and addiction. There are over 500 in-patient beds. The original hospital opened in 1813, funded largely through donations that followed the death of the poet Robert Fergusson. A contemporary of Robbie Burns, Fergusson died at the age of 24 after a period of severe mental ill-health, during which he was confined in the city’s asylum. Fergusson’s doctor was so concerned at his poor treatment that he set up a fundraising campaign to build a new hospital that would treat mental illness with greater dignity and sensitivity. Since then, the hospital has been altered and extended many times. A major re-development programme costing over £300 million is currently underway, and two major new units opened in 2017: a purpose-built national brain injury unit, named after Robert Fergusson, and the Royal Edinburgh Building, which houses dementia care wards as well as acute mental health services. GREEN WAYS TO HEALTH ROYAL EDINBURGH HOSPITAL CASE STUDY ‘It’s a very calming space’ A GARDEN WITH SPACE FOR ALL The garden looks well-established, but has only been on its Jonathan Bell, Recreation Assistant present site since 2014, when the entire operation was moved from a part of the hospital’s grounds that was to be cleared for redevelopment. Day-to-day work in the garden is managed by a Garden Coordinator, who works with a core team of around 30 keen volunteers. There is plenty of scope for them to pursue their own passions: a highly-organised system of compost bins is master-minded by someone with a special interest in natural fertilisers. Some of the garden’s features are the result of collaboration with other organisations. The raised beds were built as part of the ‘team challenge’ programme run by The Conservation Volunteers (TCV), in which staff from the Royal Bank of Scotland contribute to their local community through practical projects. The design of the garden has evolved through consultation with patients and hospital groups in the Greenspace Artspace The compost system is very well-organised. Public Social Partnership, a group focused on maximising the therapeutic benefit of public space for green and environmental A VISION FOR GREENSPACE activity. The vision was for the garden to be accessible as well as Funding from the Green Exercise Partnership (GEP) has beautiful, to have shelter, and to have multiple uses. The garden supported work managed by the Cyrenians, a charity whose is divided into different sections that allow flexible use, and mission is to support ‘people excluded from family, home, work or community’. Originally focussed on working with homeless ‘People who take part in activities like people, the Cyrenians now address four broad themes: Family and People, Home and Housing, Work and Skills, and Community these are more likely to get out of and Food, which includes their work at the Royal Edinburgh. hospital sooner’ Chirlene Hall, Staff Nurse The charity was first invited to be involved with the hospital in 2009, when the then Chair of NHS Lothian saw the potential of developing greenspace and environmentally-based activities. The Cyrenians’ work is managed by a Service Manager who also looks after a similar scheme at Midlothian Community Hospital near Dalkeith. Through the Our Natural Health Service action programme, the REH Community Garden is one of the ‘NHS Greenspace for Health’ pilot schemes, which are demonstrating ways to encourage use of the NHS outdoor estate by patients, staff, visitors and the local community. At the heart of the organisation’s work is the Community Garden, a large space that includes flower beds, lawns and attractive summer houses as well as vegetable plots and raised beds. Cabins in one corner of the garden house a meeting space, office and tool storage. An open-sided food preparation area boasts a home-made wood-fired pizza oven. Making pizza in the wood-fired oven is a popular activity. ‘You don’t even feel like you’re in the SHELTER IN BAD WEATHER Elsewhere in the hospital grounds, the Cyrenians share three hospital’ large glasshouses with Artlink, an organisation that works Frances Aitken, Senior Charge Nurse to widen participation in the arts and to promote creative therapeutic work. The glasshouses provide useful indoor spaces for bad weather, and seeds grown here are planted out in the garden. Some plug plants are provided to the hospital’s Estates team to use in their maintenance of the wider grounds. The hospital’s ambitious redevelopment programme has recognised the benefits of giving patients and staff contact with greenspace. The design of the new Royal Edinburgh Building includes garden courtyards, accessible directly from the wards. Next to one of the entrances to the hospital estate, old apple trees mark the site of the oldest surviving urban orchard in Scotland. Saved from being cleared during the hospital’s redevelopment, it is now an attractive space with seats set amongst wildflowers, which the Cyrenians and other hospital groups use throughout the year. CONTRACTS FOR CARE Raised beds in the new hospital courtyards have In addition to running the community garden, the Cyrenians built-in tool storage. employ nine sessional staff to run activities with patients through contracts with the hospital’s services for older people, provide quiet areas as well as places areas specifically for learning disability and rehabilitation. Other programmes with groupwork, which meet the needs of all its users. mental health rehabilitation, Child and Adolescent Mental Health Services and the Forensic Unit are funded through Depending on their care needs and assessment, patients might grants. Many activities take place in the courtyard gardens visit in their own time or together with clinical staff as part of a designed as part of the wards, but they can also involve structured programme. Activities include making bird feeders ‘taking the garden into the ward’ through activities like and bug hotels from found materials, learning how to use tools, making potpourri, bird feeders, and herbal tea. and preparing food from the garden’s produce as well as actual gardening tasks. The varied spaces make a good base for Ideally, greenspace activities and spending time outdoors mindfulness work, encouraging patients to be grounded in would be part of everyday care, not just something that takes their physical surroundings. place in formal sessions. To help work towards this, the Cyrenians are actively promoting the garden’s’ use through Public events help to spread awareness of the garden to the training workshops and discussions with clinical staff. community beyond the hospital. In 2018, it hosted a lively Big Lunch event, part of an initiative set up by the Eden Project to THE BENEFITS encourage communities to get together. The effects of contact with greenspace and plants, whether through visits to the garden or taking part in ward-based The garden’s staff and volunteer team are focussed on activities, confirm the findings of many other projects. improving patient outcomes but are also committed to Patients are calmer and happier, and their activities can lead encouraging the wider community to be involved: the to remarkable breakthroughs. People suffering from severe Cyrenians recognise the value of social, outdoor experiences dementia can be stimulated by the sight of flowers or the in maintaining good mental and physical health for everyone. smell of herbs to recall places, people and experiences, Many volunteers have had experiences in the hospital as and will break months of silence to talk about them. patients or outpatients, through visiting family members or as staff. Events help the gardens reach out to the wider Some patients might normally only be able to focus on an community to attract new volunteers, keep community interest activity for ten or fifteen minutes. But participants in in the project alive, and support the year-round fundraising work of the coordinator and volunteers. GREEN WAYS TO HEALTH ROYAL EDINBURGH HOSPITAL CASE STUDY ‘The Community Gardens at the REH are now an essential part of our work across all of the services helping support patients through their recovery. Patients and staff return from the gardens with a smile and feeling calm. For some patients the work in ‘I have spent an inordinate amount of time building relationships with the ward or in the garden is a hospital staff’ first step towards recovery’. Hugo Whitaker, former Cyrenians Service Manager Tim Montgomery, hospital manager, Royal Edinburgh Hospital therapeutic activities run by the sessional staff can spend an hour-and-a-half focussed on tasks like making herbal sachets.