Every Wednesday morning, a group in Sheffield meet in the foyer of a sports centre, before engaging in a ‘nature-based activity.’ They are part of an emerging social movement in health: Green Social Prescribing (GSP). Natural Health England, an executive body, defines the practice as ‘supporting people engaging in nature-based interventions and activities to improve their mental health.’
The Government is keen on the idea. In March, a two-year pilot programme, which saw seven areas trial GSP, concluded. The Government is analysing the data to determine the clinical benefits, before it rolls out the project across the country. So far, the results are encouraging. The test sites recorded ‘significant improvements’ in participants’ mental health.
Officials may breathe a sigh of relief. The Government’s Environmental Improvement Plan (EIP), published in January, commits it to expanding GSP by embedding it ‘across multiple healthcare pathways’, as part of a holistic programme for mental health patients.
The Government also sees GSP as an opportunity to reduce health inequalities, and support its levelling up agenda. The EIP outlines the Government’s intention to create a network of shared green spaces, such as parks and allotments, in deprived areas in the North of England. The pilot programmes, it should be noted, were located in communities hardest-hit by the Covid-19 pandemic.
Further political advantages exist. Pressure on the NHS is immense. The Prime Minister has declared cutting waiting lists a priority of his premiership. Public Health England, another executive body, estimates that in England, £760 million would be saved in avoidable medical costs if individuals had one or more active visits to green spaces per week. Green activities could therefore relieve some of the burden on the NHS, as a preventative healthcare measure.
Despite the promises of GSP, there are several things holding back its rollout. Government commissioned research found that clinicians currently lack knowledge of available local GSP opportunities. This is where link workers come in; NHS professionals, they build relationships with local community organisations. A GP may refer their patient to a link worker, who will spend time with the patient, as part of a ‘personalised healthcare plan.’ With an understanding of their patient’s needs and motivations, the link worker may then connect them to a GSP activity in their area. As GSP proliferates, increasing the number of link workers will be crucial to the success of the programme.
Evidence on this front is encouraging. The NHS met its target, set out in its long-term plan, of recruiting 1000 trained social prescribing link workers by the end of 2020/21. It plans for this figure to rise further by the end of 2024, though has not said by how much. However, others in the health service who interact with patients, but are not a GP, cannot access the services of a link worker, potentially limiting the number of prescriptions.
Since GSP is usually run by community and voluntary organisations, health workers, and the people in their care, need confidence that appropriate safeguarding is in place. Providing such an assurance could be included in a quality accreditation, which some in the Service have called for.
To meet its commitments on GSP, the Government should address these challenges, namely by continuing to recruit link workers, integrating them effectively into the health service, and introducing safeguarding and quality-assurance measures. The emerging data on the benefits of GSP makes the case for its expansion. The Government should take the opportunity to ensure people can access it.
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