Green Social Prescribing – A Walsall Case Through Design-led Research

Green social prescribing (GSP) enables primary care professionals to refer people to nature-based activities, e.g. community gardening. GSP is a type of social prescribing scheme with a particular focus on nature. Within the specific context of COVID-19 lockdowns, local green spaces took on a new significance in many people’s lives. There is ample evidence of wellbeing pathways linked to nature, and growing interest in supporting GSP as a non-clinical intervention to support mental wellbeing and public health. These activities have been clinically recognised as valid options to address mental, psychosocial, or socioeconomic issues, and enhance community wellbeing and social inclusion. As a result of the pandemic, linkages between nature and health and wellbeing were rediscovered and widely promoted.

In 2020, Public Health England highlighted the importance of local green (and blue) spaces as critical assets for maintaining and supporting wellbeing in local communities, and in the same year, £4m was invested to support a cross-government project aimed at tackling mental health through GSP test sites. However, GSP provision, like many forms of social prescribing, is in an early stage of development; the seven test sites, for example, are still running and await outcomes and learnings.

Research to date has tended to focus on advocacy for the concept, evidencing outcomes and cost effectiveness of GSP, and, to a more limited extent, the barriers and enablers to its wider adoption. Little is known about the practice of, and socio-ecological constraints associated with, this practice in the UK. This is especially the case when putting the practice in the context of COVID-19 pandemic.

Using a design-led research approach, our study takes a fresh look at the challenges facing the mainstreaming of GSP, aiming to identify the opportunities for change and innovation within the processes of GSP and its wider systemic context.

This paper focuses on preliminary findings from a case study of GSP in Walsall, part of the ongoing Nature’s Way project. This project uses design as an action research method to co-create ways of accessing and sharing otherwise disconnected or not-readily-available knowledge, resources, and best practice in innovating nature-based activities for wellbeing. The goal is to empower communities, organisations, and individuals to innovate and engage in nature-based activities for wellbeing during and following COVID-19.

The project takes a ‘place-based approach’ and has worked intensely in Walsall, which has urban areas experiencing high levels of deprivation and health inequality.

We conducted 30 stakeholder interviews at local, regional and national levels. Insights from interviews were complemented by perspectives from Walsall through design-led research (including informal conversations, workshops and observations), where we engaged with social housing and other service providers, community organisations, and council staff. This included over 20 informal conversations/workshops with staff/volunteers at seven community gardens and allotments, site-visit of four parks, three nature-based activity schemes and two pocket gardens. This fieldwork generated in-depth understanding of the local realities, context, and impact.

The data were interpreted and presented in various visual formats, employing design’s specialism in conveying complexity in accessible ways. This includes (1) system maps of GSP in Walsall and its actors – their roles, relationships and interconnections; (2) user journey maps to explore challenges and opportunities for intervention through the lens of interactions by individuals/groups; (3) local stories and scenarios telling the experience of people delivering and innovating these activities for GSP.

We are translating on-the-ground knowledge into a comprehensive understanding of both the system and individuals’ experience as a case study, we are identifying the challenges and opportunities to deliver GSP and possible points of intervention.

 

Three social prescribing pathways existed in Walsall: primary care, Walsall Housing Association, and the Healthy Spaces Team at the Walsall Metropolitan Borough Council which was further divided into four geographical hubs. Each pathway had its own ways of working and networks of Voluntary, Community and Social Enterprise (VCSE) organisations. The three pathways had limited opportunities to share resources, knowledge and best practise, or to collaborate.

 

 

Local green and blue spaces are foundational in delivering GSP. In Walsall, these nature resources were overseen by the Healthy Spaces Team of Walsall Council. Local authorities themselves experienced budget cuts through years of austerity. The maintenance heavily relied on volunteers, and often a few key individuals. It was reported that cuts to funding, maintenance and management, compounded by the pandemic (increased visitors and anti-social behaviour), left many spaces in disrepair. This model became difficult to sustain during lockdowns.

The inconsistencies, tensions and gaps revealed through the design-led research makes it possible to understand the barriers and challenges to effective and widespread GSP innovation for health and wellbeing, and reveals the opportunities for service design to offer solutions.

Despite these challenges, we also found widespread agreement concerning the value and potential of GSP. We need more GSP but we need better governance beyond individual organisations, better funding pathways and better infrastructures (including the green infrastructure on which GSP relies). Our preliminary findings suggest that it is challenging for the existing system to respond to these needs. Existing health and social care infrastructure is a complex of entrenched practises patched with new concepts. Within this complexity it’s challenging to create new pathways for GSP. In particular, we have found that communication and coordination between GSP providers and the other organisations that make up the system is missing. There needs to be a co-operative mechanism that works across all the organisations involved to make space for GSP.

A holistic approach to understand the complexity of local systems is required, in contrast to a narrow sectoral focus. There is an emergent need to understand how siloed actions impact the whole system, including their effects on individual experience. The project has engaged a large number of stakeholders at both the national and local levels to unpack and visualise these complexities through system maps.

We have recognised the importance of a genuinely bottom up place-based approach that considers the totality of local assets, including the realities of the physical locality and local lived experience. The richness of local knowledge held by grassroots organisations is usually under-valued, and could be used far more effectively to connect people with their local natural environments.