GREEN WAYS TO HEALTH Case study New Craigs Hospital

GREEN WAYS TO HEALTH Case study New Craigs Hospital

The GREEN EXERCISE PARTNERSHIP is a joint venture between Forestry Commission Scotland, Scottish Natural Heritage, NHS National Services Scotland and Health 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. The new signs are in marked contrast with standard hospital signs. They create a more parklike feel, and encourage a sense that you are welcome and have permission to walk around. NEW CRAIGS HOSPITAL, INVERNESS. New Craigs Psychiatric Hospital, on the western edge of Inverness, has a total of 234 beds. Its wards specialise in acute admission, intensive psychiatric care, and secure rehabilitation. Two dedicated wards provide dementia care, and there is a learning disability assessment and treatment unit. Various outpatient clinics are held on the hospital site. New Craigs opened in July 2000, and was the first psychiatric facility in Scotland funded through a private finance initiative scheme. It occupies the site of the former Craig Phadrig Hospital, and also replaced nineteenth-century Craig Dunain Hospital, whose buildings are nearby. Robertson Group built the hospital and manage the estate, with NHS Highland repaying the cost over a 25-year contract.

A LOST TRADITION In common with many other psychiatric care institutions founded in the nineteenth-century, the hospitals that New Craigs replaced had a tradition of outdoor-based therapeutic activities. Patients worked in the grounds, and there were football and rugby pitches. Angus McPhee, a long-term resident, became famous as the weaver of grass : he created sculptures in the form of clothes from grass stems he gathered in the grounds. At first, that tradition of contact with greenspace continued at New Craigs. But more recently, services that connect patients with the outdoors, such as Art Therapy, have been drastically cut. The new hospital buildings may be more efficient and better suited to their purpose, but their setting is stark Creative activities outdoors were once an important part of therapy at New Craigs. The new setting and the support of a dedicated project officer will help to reintroduce such work. The design for the central hub will create an attractive place to meet and spend time, as well as offering space for growing plots. designed for trouble-free maintenance rather than the health benefits that more varied environments can bring, and for easy vehicle access rather than pedestrians. At the rear of the site there are superb views across Inverness, but there is no hint of them from the main entrances and there was no encouragement to explore. The overall effect was a classic green desert. Now, through a scheme funded by the Green Exercise Partnership and NHS Highland endowment fund, New Craigs is having a major makeover. Substantial landscaping work has been done, and a Project Officer is working with hospital staff to establish new uses for the grounds.

SOWING SEEDS IN A GREEN DESERT Developing the project took a good three years of discussion, planning and fund raising. A steering group looked at options for how the grounds could be improved, with representatives from: NHS Highland staff ward staff at the hospital Scottish Natural Heritage Forestry Commission Scotland The Conservation Volunteers Robertson Group HUG (Action for Mental Health) Local Community Woodlands, including Abriachan Forest Trust Highland Council University of the Highlands and Islands, who helped to facilitate and evaluate the group s work. The group drew up a brief for what improvements to the grounds should cover, before Landscape Architects erz were commissioned in 2013 to develop a master plan. Their proposals aimed to: open up the site, so that walking routes around it and between buildings are legible, and so patients, staff and visitors are encouraged to explore enable access by improving the physical surface and condition of paths create an attractive hub at the heart of the site, which will act as a space where people might sit for a while, and be a base for activities that can link the site with its local community develop green spaces close to selected wards that offer therapeutic natural environments, designed to suit specific clinical needs change the scale of the spaces around the buildings, giving them a more human context through tree and hedge planting. The designs were adjusted following consultations on clinical priorities, and a major first phase of groundwork was done between March and December 2016. Birch trees have been planted to create avenues through the site, while hedges guide people towards paths as well as creating a sense of territory around the buildings. A new, wide path runs around the main building, giving access to the greenspace and to the impressive views behind it. Attractive signing aims to draw people towards routes they might not otherwise use and moderate the functional but rather harsh hospital signs. The hub area has been planted with fruit trees and sown with a wildflower seed mix. The space has been called Cala a Gaelic word meaning resting place, harbour, or place of safety. The trees are planted on top of ridges that run across the space, guiding views down the hill towards Inverness or up to the The dementia garden has replaced a green desert with an attractive, sunlit courtyard. nearby forests on the edge of the city. A large space outside the dementia unit has been transformed into a colourful garden, designed to suit the care of patients on the ward. DIFFICULT CHOICES The proposals in the master plan are all designed to work together. But it wasn t possible to deliver all of them within the budget available for the first phase of work. This is often the case with such ambitious projects, and it means making tough choices on priorities, leaving some elements to be completed as and when further funding becomes available. At New Craigs, this meant leaving out some seemingly minor but important features, such as dropped kerbs and speed control measures where paths meet the main road through the site. With additional funding, these key details will form part of a second phase of work. They should help people use the paths more confidently as well as changing drivers behaviour. It s also important to recognise that creating attractive, accessible greenspace is very different from building a house. Landscapes take time to bed in, and it will often be two or three years before the space looks as it was designed to. Work may be needed to deal with faulty materials, which might include plants that don t grow, or with unforeseen difficulties such as drainage. A typical landscape project includes a 12-month defects and liability period, during which the scheme is suitable to be used as intended, but the contractor is still responsible for making good any problems.

THE HUMAN TOUCH Physical changes to the site are only part of the story. The other essential part of the project is the appointment of a dedicated Greenspace for Health project officer, who works four days a week and is employed through The Conservation Volunteers (TCV), the national community volunteering charity. GEP fund the project officer and support similar posts at Gartnavel Hospital in Glasgow, Ayr University Hospital in Ayr, and Royal Edinburgh Hospital (see separate case studies). The project officer s role is to identify and facilitate ways in which therapeutic work could use the outdoors. A key task at the start of their contract is to build collaborative relationships with, and between, staff and patients. Several staff and users have suggested a labyrinth feature as a possible future development. Two staff members are qualified in Qigong and are interested in running sessions with patients outdoors. The ancient Chinese combination of physical posture, breathing techniques and focused awareness would be an excellent complement to Green Gym style activities, which reflect established TCV programmes. The project officer has a small budget that will be used to support the range of activities developed. Initial conversations show clear priorities that include developing more garden spaces in the hospital s interior courtyards and installing seating to create resting places around the site. In the longer term, small growing plots could be created in Cala, the central hub area. They were part of the original scheme, with the idea that some would be tended by people from the local community a way of integrating the hospital with its surroundings and decreasing the stigma of mental illness. This exchange can work both ways: Dunain Wood, just next to the site, has recently been established as a community woodland, so activities for patients such as nature or art walks could well extend beyond the immediate hospital site. Fruitful partnerships are already in place with Scottish Waterways Trust and Dunain Community Woodland. In NHS Highland we are fortunate to enjoy an exceptional natural environment. We are committed to helping patients, staff, visitors and communities to gain a range of health benefits from being outdoors. We are continually learning about how our own facilities play a part in this, and New Craigs is an excellent example of bringing this vision to life. Professor Elaine Mead Chief Executive, NHS Highland People get that it s good to be outside. Not everyone wants to yet that s the next step. Dan Jenkins Health Improvement Specialist NHS Highland

KEY LEARNING POINTS Building personal relationships with hospital staff and patients is a vital part of any effort to increase the use of greenspace in healthcare. Maintaining good communication with all concerned throughout the life of a project is essential, even though projects can take a long time to develop. A project champion can make sure that everyone involved understands the vision for the project, even if they become involved later in the process. Work with existing skills and interests in the hospital staff team. Landscape changes take time to mature. Manage people s expectations about what the place will be like just after work finishes, and ensure contracts allow for essential snagging work. For more information about this project or the Green Exercise Partnership please contact: Kevin Lafferty Access, Health & Recreation Advisor Forestry Commission Scotland Silvan House 231 Corstorphine Road Edinburgh EH12 7AT Office: 03000 675 292 (Tues & Thurs) Office: 01698 368 539 (Mon/Wed & Fri) Mobile: 07920 595 231 E-mail: kevin.lafferty@forestry.gsi.gov.uk