In this Health and Wellbeing blog, Jen Hewitt, Health and Wellbeing Project Manager at VONNE, shares her highlights from the recent NHS Forest Conference, which examined the evidence for and experience of green spaces in healthcare sites. Jen shares examples of good practice that were showcased throughout the day, noting the impact on health, practical tips around delivery and making the case for nature and health in terms of sharing evidence.
VONNE's Healthy Communities & Social Prescribing team recently convened and is supporting a Nature for Health Strategic Network, which aims promote the greater integration of nature-based programmes into health and care services, work collaboratively to bring about long-term sustained change, and improve access to green and blue social prescribing and volunteering opportunities and information. At the first meeting a network member recommended attending the NHS Forest Conference - and I wasn't disappointed. A wealth of good practice and new initiatives were shared on the day exploring the impact of greens space on health. Here I’ve captured the some of the exciting initiatives discussed at the conference to share the learning more widely, with plenty of food for thought and projects that could be replicated closer to home.
Community gardens in small, hospital spaces
The day opened with Jinny Blom, who has a background in psychology and psychotherapy, but is now an award-winning garden designer and Artist in Residence for Chelsea & Westminster Hospital - a programme that features artists who use their skills to enhance the hospital environment and improve the well-being of staff, patients, and visitors. Jinny gave examples of gardens at Chelsea and Westminster Hospital designed in often small spaces featuring sleep pods for quiet breaks and curved lines to enable people to face each other if they wish or be sheltered by plants for privacy.
Jinny discussed the Greenhaven garden that was delivered in partnership with CW+, with the recognition that art in hospital improves people’s rate of recovery and their experience of being there. She also talked through the planning process for the Sky Garden next to an Intensive Care Unit, stressing that importance of identifying which plants to use in terms of hygiene, as well as the sustainability and cleanliness of the materials used. Jinny highlighted the difference these spaces made in battling sound and improving air quality, noting the requirement for total commitment from beginning to end for it to be successful.
Forest bathing
Next we heard from Gareth Howatson, the Natural Health Service Co-ordinator at Mersey Forest - one of 15 community forests across the country, looking to deliver better access to new woodlands, maintain ancient woodlands, and enable people to reap the health and wellbeing benefits when people do access woodland spaces. Their Natural Health Service has been operating for ten years, with five evidence-based products (health walks, horticultural therapy, mindful contact with nature, healthy conservation and forest bathing) that have the best impact on people’s health and wellbeing when they enter those spaces. Gareth noted they operate in the most deprived wards that are hardest to reach so that they can engage with green spaces. Self-referrals were possible as well as referrals via GPs and Social Prescribing Link Workers.
Gareth outlined how Mersey Forest incorporated forest bathing (immersing people’s senses in the woodland setting) into a health care setting, i.e. a hospital site in Liverpool, drawing on global and national evidence that demonstrates forest bathing reduces stress levels, lowers blood pressure, strengthens people’s immunity, and improves mood and concentration. Forest bathing pods were installed in Liverpool city centre and at Liverpool Museum, where real trees are planted within the pod, surrounding mirrors gave the impression of dense forest and people could close the door behind them and enjoy the space.
Gareth went on to describe the collaborative project between Mersey Forest, Journeys in Nature, The Centre for Sustainable Healthcare, Liverpool University Hospitals NHS Foundation Trust and Everton in the Community, which focused on Bluebell Woodland, attached to Aintree Hospital, looking at the effect on staff stress wellbeing. In 2024, the North West had the highest rates of staff sickness nationally and the main cause for that sickness was anxiety, stress, burnout and overwhelm in relation to their job. The project involved an hour a week of forest bathing for eight weeks, working with staff who were on sickness leave, as well as those who were permitted to attend during working hours, or could enjoy the space at the end of the day. Notably, for every £1 invested, £7.32 was generated in return on investment. For more information, see their Forest Bathing Impact Report, in partnership with Liverpool University.
Nurse-led community gardens and awareness sessions
Heather Jones, a Registered Nurse educator, gave examples of two nurse-led community gardens in Sheffield. One was located within an inner urban neighbourhood, where one nurse turned the fringe of the car park into a wildlife garden. She noted for patients with dementia or who were neurodivergent, having the garden made the space much easier to enter or exit as they would stop at look at the garden, and staff would use it as a respite space. The nurse leading on the project has since secured funding for a mural for the gable end of the practice building. The second example was a suburban, deprived area, where a nurse established a space for a gardening club. This was particularly important for older male patients, who had experience of managing an allotment in the past, where they could enjoy sitting in the garden or get involved in some of the activity. This approach is something the nurse in question is looking to develop across her Primary Care Network.
As part of the 12-month training programme for early career practice nurses, Heather introduced a wellbeing day. This was held at RSPB in Old Moor (near Barnsley), which subsequently has been offered to several cohorts of nurses and developed into a training day for qualified GPs, GP trainees and a multi-professional day. Delegates discuss their own personal association with nature, consider the evidence and theory of the health benefits of nature, and hear from a green social prescribing provider about the programmes on offer. They also consider inequalities in access, such as the tree equity index, reflecting on where the opportunities are in their communities and neighbourhoods for their patients and practice population to access nature.
Nature-based virtual reality (VR)
Dr Jordan Tsigarides, Senior Clinical Fellow in Rheumatology (Cambridge University Hospitals) and Doctoral Research Fellow at the University of East Anglia, shared how head-mounted virtual displays featuring nature-based content were used for those experiencing chronic pain. Jordan discussed the growing evidence of the positive impact of nature-based content and the effect it has on the brain. He highlighted many hospital patients, for example those who are bed bound, in critical care, palliative or who have chronic pain or fatigue, struggle to access to nature. Jordan collaborated with Greener Games to enable access to green spaces via virtual nature-based content.
Jordan outlined the Viper feasibility study, which involved using VR headsets with different nature-based environments for people with chronic widespread pain (fibromyalgia). Pain scores fell across the board and there was a 40% reduction in pain after using the headset for 20 minutes. The temperature of the virtual environment was also a factor, where a warm environment led to greater improvements in mood.
Subsequently, VR headsets were piloted in four hospital settings: pain management, palliative care, intensive care and staff wellbeing. Outcomes for palliative patients (the largest cohort) included feeling calmer and more comfortable, as well as reduction in pain and less breathlessness. Jordan stressed the importance of making this service prescribable, which they have also been able to achieve. There is now a pilot running for interstitial lung disease to see if using the VR headsets can reduce the respiratory rate and make people feel calmer. Personalising the experience, using VR in a home setting, and looking at a national rollout with Forestry England and the Centre of Sustainable Healthcare are also being explored. Moreover, participants currently have a solo VR experience, but the possibility of multiple people sharing in the same nature-based space is being considered.
Throughout the day, the evidence of the positive impact nature has on health came through loud and clear, and too many examples of innovative work were covered than could be contained in one blog. There were some fantastic ideas that the Nature for Health Strategic Network can consider, as well as broader implications for healthcare settings. I am excited to see what future developments come from these bold initiatives, and heartily recommend next year’s NHS Forest Conference to anyone who has an interest in nature and health.
If you'd like to learn more about or get involved with VONNE's Nature for Health Strategic Network, email: jen.hewitt@vonne.org.uk