Summary 

Restoration and promotion of active use of 70 ha of accessible woodland and greenspaces is providing multiple benefits to staff, patients and their families.

Timescale 

The brand-new hospital opened in 2011.

The NHS Forth Valley and the Green Exercise Partnership delivered the project. A part of the ‘NHS Greenspace Demonstration’ programme, it started in 2011.

The academic research took places between 2010-2012.

The project delivered the physical improvements over a 3-year period completing in 2014. The timber pier at the loch and all the abilities paths were completed in 2015.

The project is ongoing. The Ranger spends on average 2 days per week at NHS Forth Valley.

Location 

Stirling Road, Larbert, FK5 4WR; Falkirk District Council, Southern Scotland, United Kingdom

What problem did it address?

The average hospital bed costs £400 per patient per day, many times more for certain conditions. Both chronic, cardiac and mental health conditions are on the rise, leading to higher healthcare costs.

The hospital surrounds had suffered neglect over the past decades. The Scottish planning system required measures to maintain and enhance the natural environment.

How did it do it?

The project demonstrates the benefits of Green Infrastructure investments around hospitals.

The building design promotes good health rather than just treating illness. Garden courtyards run through the building. Visitor gardens welcome people at the entrance. Research found that patients are recovering better with good views of the outside world. So, the hospital is located within woodland and parkland.

The project considered scale, character and quality of the existing landscape a key asset. A landscape masterplan and design guidance informed ground work implementation. The project brought neglected and overgrown woodlands and a loch back into sustainable management.

A hospital ranger runs engagement activities in the outdoors. This includes health walks, bush craft, conservation activities and outdoor Tai Chi classes. This enables clinicians to take healing outdoors. It also combats sedentary indoor lifestyles amongst patients and staff and provides an opportunity to connect with the natural environment

Map boards, signs and leaflets, encourage using the path networks. Way-marked trails also promote physical activity.

A striking pier into the Loch is one of the most attractive destination points to motivate people to leave the hospital building. Staff, patients and visitors can relax and enjoy the views and recuperate in peaceful surroundings.

Who has benefitted and how?

Staff, patients and their families and the local Larbert community benefit from a holistic healing environment with natural green spaces.

The ‘Branching Out’ project supports mental health patients through a 12-week woodland activity programme.

A new Maggie’s Centre is the best UK demonstration of supporting cancer patients in high quality surroundings.

The hospital has the UK’s first outdoor, woodland-based recovery programme for cardiac patients.

What was the cost and how was it funded?

The hospital itself cost £300 million to build.

Original project investment was just £300k, or 0.1% of the overall hospital cost. Forestry and Land Scotland and the NHS Forth Valley made contributions. This levered in £200k funding from a ‘Woodlands in and around Towns’ grant.

The Arts and Humanities Research Council, Scottish Funding Council, Scottish Forestry and NHS Forth Valley funded a research project that reported in 2012.

Evidence of success

The project presents a low-cost preventative spend measure for improving staff, patient and visitor health and wellbeing.

The project transformed the neglected grounds into a Green Infrastructure asset. 70 ha of accessible woodlands and greenspace have increased levels of physical activity. Annual visitor numbers have increase from below 10,000 in 2012 to over 90,000 in 2018.

Larbert Woods provides outdoor learning opportunities for seven local schools and one on-site nursery.

The Community Ranger has run many events for families and educational groups to date.

Research found that every £1 spent on the Cardiac Branching Out programme created £3.86 worth of social value.

NHS Scotland benefitted from the interventions via future cost savings.

The redeveloped grounds attracted a local developer. He invested £13 million to transform A-listed Larbert house, and surrounds, into 57 dwellings.

Forth Valley Royal Hospital received an ’Excellent’ accreditation from the ‘Building with Nature’ standard.

To ensure the-long-term quality of the grounds, they are now managed by Forestry and Land Scotland with support from Central Scotland Green Network Trust and Falkirk Council.

Forestry and Land Scotland will maintain the NHS outdoor estate on behalf of NHS Forth Valley for 10 years.

The hospital has become a demonstration model for other NHS estates and inspired NHS Scotland policy development.

Difficulties

The design could have prioritised non-motorised transport more by not having an unbroken road circuit around the hospital. The circuit road may have created a psychological barrier to the green oasis and an “island effect”.

Security design and management means that patients with very restricted mobility are excluded from some parts of the outdoors.

Outdoor exercise equipment would have been very expensive. The project team decided to invest the budget on seating and picnic tables and making the path around one side of the loch fully accessible for wheelchairs users instead

Contact person

Kevin Lafferty

Access, Health and Recreation Policy Advisor

Scottish Forestry

Office: 01313705223

Mobile: 07920595231

E-mail: kevin.lafferty@forestry.gov.scot

Further resources

Green ways to health – Case study – Forth Valley Royal Hospital, Forestry Commission, SNH et al. 2015

https://www.nature.scot/sites/default/files/2018-02/Green%20Ways%20to%20Health%20-%20Forth%20Valley%20Royal%20Hospital%20Case%20Study.pdf

Unlocking the Potential of NHS Greenspace for Health and Wellbeing, the executive summary of the NHS Greenspace Demonstration Project, published by the Green Exercise Partnership, September 2019, https://www.nature.scot/professional-advice/contributing-healthier-scotland/our-natural-health-service/nhs-greenspace

Ian Whites Associates case study webpage

https://iwastirling.com/projects/forth-valley-royal-hospital-and-larbert-woods

Hospital Grounds Reimagined. Evaluation report for Forth Valley and toolkit for engaging stakeholders in the design, use and maintenance of hospital grounds greenspace , University of the Highlands and Islands , 2012 https://202020vision.com.au/media/41878/hospital-grounds-reimagined-greenspace-final-report-and-toolkit.pdf

NHS Greenspace in Scotland – Report to the Green Exercise Partnership, Forest Research, 2018, https://www.nature.scot/sites/default/files/2019-02/NHS%20Greenspace%20research%20-%20Royal%20Edinburgh%20Hospital%20-%20Forest%20Research%20report%20of%20stakeholder%20interviews%202018.pdf

Project partners and contractors

The Green Exercise partnership comprising Scottish Forestry (formerly Forestry Commission Scotland); Scottish Natural Heritage, NHS National Services Scotland and NHS Health Scotland.

Forestry and Land Scotland

Falkirk Council

Central Scotland Green Network (CSGN) Trust

Ian White Associates Landscape Architects Ltd

University of the Highlands and Islands, Centre for Rural Health