Using the Outdoor Estate: The Natural Health Service

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‘A green vision for NHSScotland’s outdoor estate.’

Several studies in recent years have outlined the significant health benefits of using outdoor space. For most people this is a familiar concept and something that already permeates certain aspects of our lives through initiatives such as community garden projects.

Similarly, in our towns and cities – parks, gardens and allotments are prized spaces where people find refuge from the challenges of daily life. Within NHSScotland there is a lot of good work currently being undertaken to try and integrate some of this thinking and make better use of the outdoor estate. It is estimated that one in four adults are likely to experience mental health problems at some point in their lives and there is a growing evidence base for taking advantage of the range of individual and social health & wellbeing benefits that can be achieved through outdoor activity and contact with nature. Some of the key benefits include:

  • Improved mental health and wellbeing;
  • Improved physical fitness;
  • Reduction in aggressive behaviour;
  • Creation of a strong immune system;
  • Improved recovery and mobilisation
  • Reduction in length of hospital stay;
  • Increased patient and staff satisfaction;
  • Improved staff retention.


Good design of the outdoor estate can provide benefits such as improved sustainability and biodiversity, meeting climate change targets, reducing maintenance and providing a wider platform for treatment. All these aspects support the Scottish Government’s vision on health and the environment outlined in Good Places Better Health.


With the NHSScotland estate currently estimated to have an asset base worth around £5 billion and with health budgets getting tighter there is a growing need to exploit spaces around buildings to support the work of staff. This presents NHS Boards with an interesting opportunity on how best to capitalise on these spaces to provide real benefits for patients, staff and the wider community.

The following provides links to current legislative information on the integration of greenspace within NHSScotland, evidence of the health benefits of using greenspace, relevant organisations working in this field and some case studies and projects.

Legislative Guidance:

Good Places Better Health – The Scottish Government’s Strategy on health and the environment.


Background Evidence on the Health Benefits of Greenspace:

A Dose of Nature: addressing chronic health conditions by using the environment 2014 University of Exeter

Nature and Health 2014 Hartig et al:

The Great Outdoors: how a green exercise environment can benefit all.
2013 Gladwell et al

Great Outdoors: how our natural health service uses greenspace to improve well-being 2010 Briefing statement from the Faculty of Public Health in association with Natural England

Relevant Organisations:

The Green Exercise Partnership (GEP) – A joint partnership between NHSScotland, Scottish Natural Heritage (SNH) and Forestry Commission Scotland working with NHS boards to providing advice and potential funding for greenspace projects within NHSScotland.

Greenspace Scotland – A social enterprise and an independent charitable company working with a wide range of national and local partners to improve the quality of life of people living and working in urban Scotland.

NHS Forest – A UK based charitable organisation seeking to improve the health and wellbeing of staff, patients and communities by increasing access to green space and highlighting innovative ideas to encourage the use of green space for therapeutic purposes.

Mind – A UK based mental health charity supporting an Ecotherapy approach to health. Ecotherapy is the name given to a wide range of programmes that aim to promote good metal and physical wellbeing through outdoor activity in a green environment.

Case Studies and Projects:

Forestry Commission Scotland – case studies and demonstration projects

SERVICE: Health Design Advice

Our Health Design Advice service, delivered with Health Facilities Scotland, helps those who commission new, or substantially redeveloped, facilities.

Case Study: The Shields Centre

This community hub in Pollokshields, Glasgow integrates traditional GP services with local social work services and community initiatives. 

SCIM Design Statements

Description of SCIM Design Statements for NHS Scotland with links to project pages.

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