NHS Lothian is making history by becoming the first health board in Scotland to assess the biodiversity of its estate as part of a wider plan to reduce carbon emissions and improve health and wellbeing.

Working with Greenspace Scotland as part of a project funded by Edinburgh and Lothians Health Foundation; NHS Lothian commissioned research consultancy, Natural Capital Solutions, to conduct a Biodiversity Audit and Climate Change Assessment. 

This will help to realise the full potential of the NHS estate, not only as an environmental asset, but also as an amenity offering health benefits to the local community.  

The work also provides the health board with a means of identifying how best to manage its green spaces to meet its sustainability goals, including reducing carbon emissions across the NHS in Scotland to ‘net zero’ by 2045.

Combating climate change

Dr Jane Hopton, programme director and sustainability lead for NHS Lothian, said: “Climate change affects not only our environment, but also the health of our patients and communities.  

“Our green spaces make an important contribution to improving air quality, reducing the amount of carbon dioxide in the air which, in turn, is better for our health.

“Making the most of our green spaces is not simply a ‘nice thing to do’; it is an important part of our sustainability plan and sits alongside other priorities such as reducing emissions associated with medical gases, transport and travel, reducing waste, and improving our energy use.”

The health board’s current estate includes 81 hectares of green space across 94 sites and provides habitats for diverse species.

The plants, trees, hedges and scrub that are grown on these green spaces capture carbon from the atmosphere, offsetting human emissions and cleaning the air of pollution from nearby roads and car parks. 

Going green

The green landscape can also be used for nature-based health interventions such as gardening and walking activities, helping to improve the lives of patients and staff.

But the assessment revealed that much could be done to enhance these spaces.

The report states that 71.5% of habitats are in ‘poor’ condition, with 28.3% in ‘moderate’ condition, and just 0.2% rated in ‘good’ condition.

It adds that larger sites tend to have a greater range of habitats and significant areas of woodland and parkland; while smaller areas tend to be dominated by sealed surfaces, have less variety in habitats, and are more likely to comprise garden planting and introduced shrub.

And several small GP surgeries and dentists have no green space at all.

It states: “NHS Lothian has recognised the role it can play in a green recovery from the COVID-19 pandemic and is the first health board in Scotland to publish a detailed account of its green assets. 

“This has happened as the pandemic, in itself, has led to a widespread re-appreciation of outdoor space and its many values.

“Conserving and increasing biodiversity on its estate can help NHS Lothian fulfil its duty as a public body under the Nature Conservation (Scotland) Act. 

“And establishing a baseline for biodiversity, and using this to track increases or decreases, can enrich biodiversity reporting. 

“Enhancing the capacity of green space to sequester carbon can also be an important step on the path to achieving net zero carbon emissions, along with policies to deliver emissions reduction.” 

A roadmap for the future

The document provides a roadmap for the future, setting out plans to improve the quality, and quantity, of green space through widespread improvements and by replacing low-biodiversity habitats such as amenity grassland, common throughout the estate, with more-valuable nature-rich habitats.

The quickest win, it claims, is to identify lawns for more-relaxed mowing regimes. 

And community gardens will replace low-value habitats while sites will maximise continuous tree canopies and new trees and hedges will be planted to aid pest and disease resilience, biodiversity and carbon sequestration. 

The report also calls for green roofs and walls to be planted with shrubs and vegetation. 

And the NHS will also work with neighbouring landowners and managers to increase tree canopy cover in communities outside site boundaries.

A ‘spacial register and accounting tool’ will be used to help with decision-making, modelling potential changes for a site or across the entire estate and tabulating the implications for biodiversity and ecosystem service provision and value.

Reaping the benefits

This approach can become even more powerful as gaps in datasets are filled – through tree surveys, green space audits, site condition assessments and biennial biodiversity audits. 

Datasets could also be expanded by sharing data and expertise with partners like NHS Forest.

The report suggests that cost benefits of 350 participants a year taking part in gardening activities could be as much as £2 for every £1 spent. 

And for a single participant taking part in a nature-based conversation activity programme annual benefits of more than £3,700 could be realised through avoided prescription costs, a reduction in psychiatric consultation and community psychiatric nursing costs, and by avoiding the need for support workers.

St John’s Hospital in Livingston is earmarked for a number of improvements.

Covering 16.8 hectares, with extensive areas devoted to parking, the site has only 6.6 hectares of natural habitats. 

The asset register shows the natural capital assets are dominated by amenity grassland, along with broadleaved parkland around the eastern edges and broadleaved woodland on the south-west and eastern edges. 

Creating space

This green space adds up to 31.7 biodiversity units – a small total, since only 19% of the habitat was assessed as moderate condition. 

The other 81% was assessed as poor condition, but there are opportunities to improve the score. 

While the amenity grassland and introduced shrub habitats are of intrinsically-low biodiversity value, the poor-condition parkland, hedges and tree plantings could be restored to higher value. 

This alone could raise the biodiversity score from 31.7 to 42.3 units.

The report suggests a range of improvements, including replacing annual planting, reducing sealed surfaces, planting additional trees and hedgerows, creating a community garden, introducing a path, and incorporating the community garden and walking routes into social prescribing.