Biodiversity Duty report - NHS Ayrshire and Arran - 2014-2017

A duty to further the conservation of biodiversity was placed on public sector bodies in Scotland in 2004. The Wildlife and Natural Environment (Scotland) Act 2011 requires public bodies to provide a publicly available report, every three years, on the actions they have taken to meet this biodiversity duty. This report describes the action that NHS Ayrshire & Arran has taken in the period 2014 to 2017 to meet this duty. 

1. Introduction

Biodiversity Duty

1.1 A duty to further the conservation of biodiversity was placed on public sector bodies in Scotland in 2004. The Wildlife and Natural Environment (Scotland) Act 2011 requires public bodies to provide a publicly available report, every three years, on the actions they have taken to meet this biodiversity duty. This report describes the action that NHS Ayrshire & Arran has taken in the period 2014 to 2017 to meet this duty.

Statement of Organisational Commitment

1.2 There is growing evidence demonstrating the positive relationship between quality, accessible greenspace and mental and physical health and wellbeing; although the mechanisms by which these benefits occur are not yet fully understood^[1]. 

1.3 NHS Ayrshire & Arran takes a proactive role in meeting its responsibility towards furthering the conservation of biodiversity when undertaking its duties. In particular, it acknowledges and actively promotes the role of the natural environment as a resource which can support and sustain good health.

2.   Governance – Leadership and Management of Biodiversity 

Chief Executive

2.1 Accountability for the Board’s biodiversity duty ultimately lies with the Chief Executive.    

Sustainable Development Champion

2.2 The Director of Corporate Support Services has been nominated by the Board as the sustainable development champion encompassing the duty to promote biodiversity. The senior level appointment serves to re-emphasise the Board’s commitment to promoting biodiversity. Furthermore the position brings an element of organisational endorsement and authority on matters relating to biodiversity.  

Director of Corporate Support Services

2.3 The day to day planning and delivery of the Board’s biodiversity duty is delegated to the Director of Corporate Support Services.

Estates, Environment and Sustainability Group

2.4 The Estates, Environment and Sustainability Group is charged with developing an effective strategy for the management and development of all health care property, accommodation and land owned or leased by NHS Ayrshire & Arran to provide health and social care services. The Group’s remit and terms of reference were revised in August 2013 and it now co-ordinates all health and environment and sustainability activity across the organisation. The governance structure is set out below:

2.5 An important aspect of the strategy is to steer and co-ordinate environmental improvements within the estate which have benefits in terms of the health and well being of patients, staff and the wider community and which contribute to delivering the NHS corporate responsibilities on its sustainability agenda, the quality strategy and biodiversity duty. 

2.6 This include maximising the contribution of NHS Ayrshire & Arran to sustainable development by overseeing the local implementation of CEL 2 (2012) – The Sustainable Development Policy for NHS Scotland (2012) and CEL 14 (2010) – The Corporate Good Citizenship Assessment Model. 

2.7 The adoption of the NHS Corporate Greencode Auditing toolkit to facilitate the implementation, maintenance and a programme of continual improvement in the Board’s Environmental Management System provides the opportunity to undertake annual review which is inclusive of the biodiversity process.

Sustainability Management Group

2.8 The Sustainability Management Group was established to implement a number of these priorities and leads the development and implementation of the NHS Board’s Sustainable Development Action Plan, within which, biodiversity reporting is one of a number of strategic priorities. Progress is reported to the Estates Environment and Sustainability Group; Corporate Management Team and ultimately the Action Plan is presented to the NHS Board prior to submission to the Scottish Government.

Greening the NHS Estate Steering Group

2.9  The Greening the NHS Estate Steering Group was established to develop, implement and monitor the Greening the NHS Estate project which aims to maximise the quality of, access to and use of NHS outdoor estate as a health promoting resource for patients, visitors, staff and surrounding community. Progress is reported directly to the Estates Environment and Sustainability Group and has also been reported to the Corporate Management Team. Nationally, progress is reported via the Green Exercise Partnership to the Natural Health Service Steering Group. 

3. Actions – taken to improve biodiversity conservation on the ground

Greening the NHS Ayrshire and Arran Estate

3.1 ‘Greening the NHS Estate’ is a collaborative project between NHS Ayrshire and Arran and the Green Exercise Partnership (GEP), which is primarily a partnership between Forestry Commission (Scotland), Scottish Natural Heritage and NHS Health Scotland.

3.2 In 2011/12 Public Health led a strategic review of the NHS Ayrshire and Arran outdoor estate, with advice and support from the GEP. A total of 86 sites were assessed against criteria including: size; potential for improving health and wellbeing and enhancing biodiversity; how accessible, connected, attractive and appealing they were; and opportunities to involve communities. The Review identified seven sites which offered the greatest development potential to improve access to the outdoors for patient, staff, and the wider community and to create opportunities for improving health and wellbeing. 

3.3 On–the-ground walk-around visits took place at each site involving landscape architects from the GEP, Public Health and colleagues from NHS Estates. Input was also sought from key informants at each site as available. These visits informed the creation of site-specific Landscape Assessment and Development Reports, which were completed in June 2012. The sites were as follows: 

• Ayrshire Central Hospital;
• Arran War Memorial Hospital;
• University Hospital Crosshouse;
• University Hospital Ayr (UHA) and Ailsa;
• Biggart Hospital;
• Girvan Community Hospital; and
• Arrol Park Resource Centre.

3.4 The reports provide a concise analysis of the external spaces at each site and propose a range of actions over a 1-5 year time period which could be implemented to maximise environmental improvements and use of greenspace with a view to improving the health and well being of staff, patients and the wider community.

 ​​​3.5 An overview of the findings was reported to NHS Directors and through the Estates Environment and Sustainability Group. In addition, clinical staff, managers and patients have been consulted on key aspects of the review and implementation process. 

 ​​3.6 UHA/Ailsa was prioritised as a GEP national demonstration site to showcase the health and wellbeing benefits that can be gained from positive investment in and management of the NHS estate. Funding was secured from Scottish Government, GEP (Forestry Commission Scotland), NHS Endowments and Sustrans Scotland to develop a landscape masterplan and carry out improvement works.

 ​​​​​​3.7 The project has brought neglected woodland back into sustainable management and given the extensive area of woodland, meadow and grassland (approximately 28 hectares) a clear purpose as a health improvement asset for patients, staff, visitors and the local community. Approximately 3.6 km of new paths network has been created in the hospital grounds including: 1km of a new Sustrans cycle route which will ultimately connect to the A77; and a network of woodland walks. These are supported by new signage and interpretation. Significant woodland management works were undertaken and approximately 2,500 new trees have been planted and 26 new seats and perches have been installed, all in native green oak. A new teaching circle has also been created in one of the meadow areas. 

3.8 The new network of paths and greenspace developments were officially opened by the Chairman of the NHS Board on 5 October 2015. Staff report that they are using the grounds for walking and relaxation and they are reporting mental health benefits from taking time away from busy wards to ‘de-stress and unwind’. Some staff also report using the paths for ‘walk and talk’ meetings with colleagues. Patients have commented that they find the paths and the spaces ‘peaceful and therapeutic’. In addition to benefits to public health, infrastructure improvements are supporting the NHS Board to meet its corporate objectives relating to climate change, biodiversity, sustainability and good corporate citizenship. 

3.9 Work is now required to promote engagement with, and use of, the outdoor space. Funding was secured in 2016 for a Greenspace for Health Senior Project Officer who will liaise with patients, clinicians, staff and wider community groups to support and enable green exercise, recovery programmes and outdoor learning on site. The Conservation Volunteers (TCV) has been commissioned to deliver this project. To date a new Green Gym is operational on site and a calendar of citizen science, art and conservation events is in place focused on raising awareness of the biodiversity on site. 

Girvan Community Garden 

3.10 In partnership with the NHS, Girvan Community Garden and Volunteers have set up Green Gym sessions. The scheme aims to encourage volunteers outdoors into the fresh air and exercising through gardening. The initiative supports NHS Ayrshire and Arran’s commitment to health and well being through physical activity and contact with nature.

Girvan Community Hospital Wind Turbine 

3.11 Whilst creating sustainable ‘green’ energy, the erection of a wind turbine on the new Girvan Community Hospital site initially caused problems for local birds. This difficulty was overcome by the use of ‘white’ lighting which attracts both birds and bats away from the turbine blades.

East Ayrshire Community Hospital- Dementia Friendly Garden

3.12 In collaboration with BAM, site owners, NHS Ayrshire & Arran- through its Staff Lottery Fund- allocated funding for a dementia friendly garden for the benefit of patients, visitors and staff. The local community around the Cumnock area was supportive in shaping of the project. Its direct involvement in the garden’s formation and longer term maintenance requirements should ensure that the garden remains a valued and well used asset for years to come.  The Forget-me not garden continues to improve each year and has brought lots of enjoyment for patients, relatives and staff. 

Arrol Park Therapeutic Sensory Garden 

3.13 Funding was also allocated in 2011 from the Staff Lottery Fund to provide a therapeutic sensory garden within Arrol Park Resource Centre, Ayr. The garden is tailor-made to fulfil the needs of the continuing care patients and community clients served by the unit. It continues to improve each year and has brought lots of enjoyment for patients, relatives and staff. 

Other Garden Projects and Green Spaces

3.14 A significant number of picnic benches and outdoor seating has been provided over the period 2014-17. The furniture compliments the existing garden and other green spaces throughout hospital and related sites. The materials used are long lasting and weather resistant being made from environmentally friendly materials yet retains a natural timber effect in keeping with their surroundings. Increasing requests to the Staff Lottery Office for similar items have been made reflecting their popularity. By helping to maximise the use of the outdoor spaces for both patients and staff, it has served as a small, but practical means of actively promoting the important link between quality greenspace and general physical/mental well being. Projects financed by the Staff Lottery fund include:

• Patio Area, Procurement/Estates, Ayrshire Central Hospital;
• Ballot Road Clinic, Irvine;
• Eglinton House Courtyard, Ailsa Hospital;
• CT/MRI Dept, Ayr Hospital;
• Shared Garden, Clonbeith/Dunure Ward, Ailsa Hospital;
• Former Bowling Green, Ailsa Hospital.

4. Mainstreaming

NHS Greenspace: Strategic Review

4.1 In addition to securing strategic accountability and governance for biodiversity management and greenspace development in NHS Ayrshire and Arran (see section 2), the strategic review of the NHS Ayrshire and Arran outdoor estate and associated Landscape Assessment and Development Reports, have informed the NHS Boards approach to greenspace development and enhancement across the estate over the coming years. 

Ayrshire Central Hospital and Woodland View 

4.2 The GEP demonstration site has acted as a catalyst for greenspace projects at other sites prioritised in the strategic review. As well as retrofitting existing sites NHS Ayrshire and Arran is committed to ensuring that biodiversity and greenspace development are key considerations in the planning of new build projects. The construction of the new Woodland View Community Hospital within the grounds of the existing Ayrshire Central Hospital, Irvine provided the opportunity to consider how best to maximise the use of greenspace for health, wellbeing and recovery from the outset of the planning process. 

4.3 Funding was secured from NHS Endowments to employ landscape consultants to develop a woodland management plan and access proposals for an inaccessible and underutilised area of woodland on site covering approximately 6.45 ha. A funding bid for Woodland In and Around Towns (WIAT) funding has recently been approved and work can now commence to: gently thin the woodland; create a woodland walk and open glade which can be enjoyed by staff, patients and the wider community; and enrich the planting species within the woodland.

4.4 The development of gardens and greenspaces around the new hospital building has also been a priority and an arts strategy for the site has been themed around connecting the outdoor and the indoor spaces.

4.5 Further joint working with, and grant funding from, Sustrans Scotland has also led to the upgrade of a footpath, linking Woodland View to the neighbouring community of Castlepark and National Cycle Network route 7, to dual use pedestrian/ cycle path status. Work is also progressing with North Ayrshire Council to create an active travel hub on site. This will complement the existing paths infrastructure being implemented within the hospital grounds as part of the new build developments. 

University Hospital Crosshouse 

4.6 The other large hospital site which was prioritised in the strategic review is University Hospital Crosshouse. This is a more challenging site as it has very little existing greenspace, however a landscape architect has been employed to develop proposals in partnership with the Healthy Hospital Group on site which will focus initially on introducing some new decorative planting and specimen trees at the entrance and approach to the hospital. This will help screen the prevailing winds and car parking and reduce the impact of the hard surfaces, which currently dominate the site.

Links with other polices, strategies and initiatives

4.7 Greenspace development is a key priority in both the Ayrshire Healthy Weight Strategy 2014-2017 and the Physical Activity Workplan 2015-2017.

4.8 Protecting and enhancing biodiversity and greenspace development are also key elements within the NHS Ayrshire & Arran Property and Asset Management Strategy (PAMS).

4.9 The role of biodiversity in contributing to NHS Ayrshire & Arran’s Climate Change Adaptability Policy Framework Plan is also recognised.

 5. Partnership 

Our Natural Health Service Steering Group

5.1 NHS Ayrshire and Arran’s Director of Public Health has been representing the territorial Boards in Scotland on the Our Natural Health Service Steering Group since its inception.  This partnership is chaired by Scottish Natural Heritage and brings together partners from across the health and environment sectors in Scotland. It is focused around three key priorities of: NHS Greenspace; local Green Health Partnerships; and green infrastructure for wellbeing.

Community Planning Partnerships and Local Outcome Improvement Plans (LOIPs)

5.2  The Board supports and promotes Community Planning Partnership priorities in the three local authority areas in Ayrshire and is playing an active role in the developing LOIPs.

Ayrshire Local Biodiversity Action Plan 

5.3 NHS Ayrshire and Arran has not been actively involved in the development of the Ayrshire Local Biodiversity Action Plan. However, through close engagement with associated groups such as the Ayrshire Green Network the ‘Greening the NHS Estates’ project has benefited from knowledge and good practice exchange. 

The Ayrshire Green Network

5.4 NHS Ayrshire and Arran is now a member of the Ayrshire Green Network and has presented to the Network on NHS greenspace developments in Ayrshire and Arran.

UHA /AIisa

5.5 NHS Ayrshire and Arran continues to work closely with the GEP to progress biodiversity related projects, notably the UHA/ Ailsa demonstration project detailed in Section 3. In particular, there are close working relationships with Scottish Natural Heritage and Forestry Commission (Scotland) in this project. However, close partnership links have also been made with Sustrans Scotland and South Ayrshire Council.

Ayrshire Central Hospital and Woodland View  

5.6  At the Ayrshire Central site in North Ayrshire there is close partnership working with Forestry Commission Scotland, North Ayrshire Council and Sustrans Scotland and through the new North Ayrshire Active Communities Strategic Partnership which is co chaired by North Ayrshire Council and the Health and Social Care Partnership. 

5.7 Work is underway to explore the possibility of establishing a Green Health Partnership (GHP) in North Ayrshire which will be supported by the Our Natural Health Service partnership. This GHP will bring together health and environment sectors, amongst others, to further develop the green infrastructure in North Ayrshire, including NHS sites, and maximise their contribution to supporting health and wellbeing.  

Community Garden Projects

5.8 The pursuit of numerous garden projects throughout NHS Ayrshire and Arran has resulted in collaboration with volunteer groups in the local communities. The participation and support resulting has enabled the promotion, development and maintenance of the gardens and greenspaces, for example, the Girvan Community Garden Volunteers, continuing local community involvement in the dementia friendly garden, East Ayrshire Community Hospital and the various ‘Green Gym’ projects. 

Breaking Ground Project

5.9 NHS Ayrshire and Arran works in close co-operation with Breaking Ground, which has been operating at Eglinton Country Park, North Ayrshire since 2011.Originally set up as a ‘Green Gym’ in 2009; the group is now self-sustaining with the Council Park Ranger Service taking the lead role. 

5.10 People with a range of health conditions from mild depression through to brain trauma and longer term difficulties are referred by their GP to the Green Gym. The aim of the group is to give people an opportunity to: learn new skills; meet new people; develop a regular routine; and improve their mental and physical wellbeing in an outdoor setting. Participants are encouraged to take part in warm up activities and to prepare their bodies for physical activity, helping to improve circulation and mobility whilst experiencing a diverse range of practical tasks from digging ponds, erecting fences, planting trees and shrubs to general garden tasks. Consequently, the project benefits health and wellbeing and the wider environmental/biodiversity aims.

6. Communication

6.1 The Greening the NHS Estate project is raising awareness of the benefits of greenspace to health. The links between health improvement, sustainability and healthcare services have been described as a, ‘virtuous circle’; as one area positively feeds another. NHS Ayrshire and Arran has achieved this through:  

• Director of Public Health’s Annual Report 2016
• Case study- UHA/ Ailsa
• UHA/ Ailsa Woods and Walks information leaflet
• NHS Ayrshire &Arran website
• Staff bulletins and blogs
• Inputting to newsletters
• Input at conferences
• Outdoor educational activities
• Investment in information, signage and interpretation on key sites (UHA/Ailsa Campus)A programme of consultation, information and engagement with staff, patients, the community and other stakeholders has been evident in respect of the recent UHA/Ailsa developments and more recent proposals at Ayrshire Central Hospital. This has  included consultation on the infrastructure proposals and direct engagement and involvement of clinicians in the development of Green Gym and Branching Out programmes to support health wellbeing and recovery at UHA/ Ailsa.
• Good practice generated through the Greening the NHS Estate project has been shared by the GEP and NHS Ayrshire & Arran at national conferences, which include being shortlisted as finalist at the 2016 NHS Scotland conference for a poster presentation. GEP commissioned a film to showcase the work of the national demonstration sites including UHA/ Ailsa. These include a trailer; short film; and main film as well as four short films focusing on design and planning; patient and user experience; health professionals; and GEP and environment 

 7. Monitoring/Measuring Impact

Greening the NHS Estate: UHA/ Ailsa National Demonstration Project

7.1 An evaluation plan is in place for the Greening the NHS Estate project which has been adapted from the GEP Monitoring and Evaluation Framework. This is overseen by an evaluation sub group of the Greening the NHS Estate Steering Group which is representative of Public Health, The Conservation Volunteers, Forestry Commission Scotland and Scottish Natural Heritage. 

7.2 At the demonstration site at UHA/ Ailsa two staff surveys (2014 and 2016) have been carried out by Scottish Natural Heritage. The purpose of the surveys was to gauge reaction to the greenspace improvements which had been put in place and to help determine if staff attitudes and behaviours regarding use of hospital greenspace have changed since a baseline survey undertaken at an earlier stage of the improvement programme in 2014.

7.3 A number of positive shifts were observed since 2014 in staff attitudes and behaviours regarding awareness and use of hospital greenspace including: greater awareness that the UHA/ Ailsa hospital grounds could be used for the enjoyment and well-being of staff, patients, visitors and local people; greater familiarity with the woods and greenspace around the hospital; and an increased frequency of visiting the hospital grounds for fresh air, relaxation and exercise.

7.4 A proposal for in-depth interviews with key stakeholders is also in place which will be conducted by Forest Research in Spring 2017 and a footfall survey is planned for later in the year. Beam counters have also been installed on key paths to capture footfall data; and impact evaluations of specific interventions with patient groups such as Green Gym and Branching Out are being planned. 

7.5 Evaluation findings, as well as demonstrating the impact of changes on knowledge, attitudes and behaviours, are informing the development of further work on site in addition to identifying opportunities and barriers for mainstreaming the GEP principles on other sites.

[1] Croucher et al. (2007) Transforming urban spaces: the links between greenspace and health: a critical literature review. Greenspace Scotland. 2007

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