“In September 2022, nearly half a million working days were lost to anxiety, stress, or depression-related absences […] a 56% increase since 2015.”
Sky News

The NHS spends around £2.2 billion per year on agency workers to cover for sick staff. With staff absences on the rise, this amount is due to grow.

While anxiety, stress and depression are reported to cause a third of all NHS staff absences, the real figure may be much higher. Musculoskeletal disorders are the second biggest cause of staff absence; stress and trauma can contribute significantly to this issue. Staff may also be keener to state that they are suffering from back pain, than to admit to poor mental health.

Radiography garden created by staff at Mount Vernon Cancer Centre
Radiography garden created by staff at Mount Vernon Cancer Centre. Photo: Vicki Brown / Centre for Sustainable Healthcare 2021. Attribution 4.0 International (CC BY 4.0).
A member of staff volunteers at Southmead Hospital allotment during a lunch break
A member of staff volunteers at Southmead Hospital allotment during a lunch break. Photo: Vicki Brown / Centre for Sustainable Healthcare 2021. Attribution 4.0 International (CC BY 4.0).

The costs of ill health

Staff sickness is incredibly costly. As well as the cost of covering for absent staff, presenteeism – where unwell staff continue to attend work – has been estimated to cost the NHS an additional £6 billion. This is, again, often due to a perceived stigma around reporting mental health issues.

The costs are not just financial; poor staff wellbeing also impacts negatively on patient care and satisfaction. Indeed, “There is ample evidence […] that Trusts whose staff report high levels of satisfaction at work also receive the best feedback from patients, and their friends and families, about their experience in hospital.” [1]

The recent strikes by NHS staff have brought salaries and working conditions sharply into focus. Analysis by Sky News reveals that 10,000 staff quit the NHS in the year to March 2022, fuelled by long hours, poor work-life balance and high anxiety levels. The more staff that resign, the greater the pressure is on those that remain, compounding the problem. Currently, there are an estimated 133,000 vacancies within the NHS.

While the significant reduction in real-terms pay must be dealt with, there are many factors at play here. Staff wellbeing is a highly complex issue, and it must be addressed holistically. So where do we begin?

Green space and wellbeing

“Being a health professional […] entails a working life confronting things that human nature programmes people to avoid – such as infection, suffering and death. The inherent psychological burdens of care can combine with poor organisational culture and stressful working conditions to create compassion fatigue and emotional burnout.” The Health Foundation

Not all absences are avoidable, but a significant number may be, if we can find ways to positively impact the mental health of NHS staff. While interventions, such as Wellbeing Hubs, have been introduced in recent years, there needs to be focus on prevention, not just on treatment.

Wellbeing has been described as, “when individuals have the psychological, social and physical resources they need to meet a particular psychological, social and/or physical challenge.” While this can be interpreted in many ways, we do know that spending time in nature contributes to emotional resilience, which better equips people to face challenges – including those inherent in healthcare.

So – can the greening of the NHS estate really have the kind of impact on staff wellbeing that is so desperately needed right now?

The case for green space

There is a significant and growing body of evidence for the positive links between green space and wellbeing. At a glance:

The Centre for Sustainable Healthcare’s NHS staff wellbeing study showed that there is a strong appetite among staff to spend time outdoors. It revealed that workers who regularly spent time in green space during the working day reported significantly greater wellbeing than those who did not. Responding to this desire is important; the Health Foundation’s report, Fit for Purpose, states, “Working with the intrinsic personal and professional motivation of staff is likely to deliver faster and more sustainable change.”

Green space in the workplace really does have tangible benefits. While not focusing specifically on healthcare settings, Business in the Community found that employees with a view of nature take 23% less sick leave. This equates to an average of 11 hours fewer per year – or a saving of around £1,600 per employee. Given the high costs of cover for medical staff, as well as the higher amount of sick leave taken per employee, this figure could be substantially higher within the health service.

Staff enjoy the Secret Garden at Glenfield Hospital, Leicester
Staff enjoy the Secret Garden at Glenfield Hospital, Leicester, during a sunny lunchbreak. Photo: Dora Damian, 2022. Attribution 4.0 International (CC BY 4.0).
Wildflower ID session led by the ranger at Southmead Hospital
Wildflower ID session for staff, led by the ranger at Southmead Hospital. Photo: Vicki Brown / Centre for Sustainable Healthcare 2021. Attribution 4.0 International (CC BY 4.0).

At the very least, greening the NHS estate is a relatively risk-free endeavour. It is low-cost, particularly in comparison to other interventions, and if financial resources are suddenly withdrawn, trees will still stand. While labour and expertise are undoubtedly important, many hospital gardens are tended to – at least in part – by volunteers. Spending time in nature does not require the intensive input of specialists (such as with traditional talking therapies) or risk causing adverse side effects (such as with medication). And of course, the UK – and particularly our built-up city centres – desperately need more trees.

Creating spaces for nature and people

“There’s no point in trying to fix people from a health point of view, if the place is a concrete jungle, there’s no way for anybody to go and get any solace or respite or relaxation.” [2]

Our connection with nature has significantly decreased over recent decades. Natural spaces are in decline, and we are spending increasing amounts of time indoors, interacting virtually. Our workplaces play a big part in this: 85% of the UK population lives and works in urban environments that lack natural features.

Social support is one way to build emotional resilience and reduce stress levels. Creating a private and welcoming space encourages interaction, and if this is outdoors, it creates physical and emotional distance from the clinical working environment, where staff can disconnect from the stresses of work and connect with each other instead.

It is important to note that our disconnect from nature is not equal. Ethnic minorities are twice as likely to live in a neighbourhood without nature-rich spaces, and their health and wellbeing are impacted accordingly. The NHS employs around 1.2 million people; of these, around one in five is of a non-white ethnicity – a figure disproportionately larger than in the working age population as a whole. When it comes to medical staff, just 55% are white.

Greening the NHS estate, therefore, is an opportunity to address this imbalance, and to create more equitable access to green space for those who are least likely to have private gardens, or live close to parks and wild spaces. Incorporating green space into health sites needs to be encouraged – one way to do this is by including it in the NHS’s health and wellbeing framework.

The NHS Forest

When we supply trees to healthcare sites, we ask people why they are choosing to plant them. The most popular reason is to create a nicer place for staff and patients. The more complex an ecosystem – in terms of both visual and biological diversity – the greater its impact on our wellbeing. Trees add interest to any view, and offer shade, seclusion, colour and birdsong. You can request your free trees from us today.

To learn more about the benefits of green space, you can register for CSH’s Green Space and Health course.

[1] Workplace wellbeing strategic framework 2020-25, University Hospital Bristol and Weston: https://www.uhbw.nhs.uk/assets/1/workplace_wellbeing_strategic_framework_2020-2025.pdf

[2] Investigating Green Space and Wellbeing: Piloting a Wellbeing Assessment Tool and Development of a Green Space at an NHS Hospital Site. Phoebe Beatrice Nicklin, Cardiff University 2022

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