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Green social prescribing: call for expressions of interest

Updated 3 March 2021

Applies to England

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We recently invited Expressions of Interest (EOI) for a project which aims to test how to increase use and connectivity to green social prescribing in England to improve people’s mental health.

Applications have now closed.

Successful applications

The successful applications are:

  • Humber Coast and Vale Health and Care Partnership
  • South Yorkshire and Bassetlaw Integrated Care System
  • Nottingham and Nottinghamshire Integrated Care System
  • Joined Up Care Derbyshire Sustainability and Transformation Partnership
  • Greater Manchester Health & Social Care Partnership
  • Surrey Heartlands Health and Care Partnership
  • Bristol, North Somerset and South Gloucestershire Sustainability and Transformation Partnership

You can read the press notice announcing the final seven sites.

Successful applicants contact details

Humber Coast and Vale Health and Care Partnership

South Yorkshire and Bassetlaw Integrated Care System

Nottingham and Nottinghamshire Integrated Care System

Joined Up Care Derbyshire Sustainability and Transformation Partnership

Greater Manchester Health & Social Care Partnership

Surrey Heartlands Health and Care Partnership

Bristol, North Somerset and South Gloucestershire Sustainability and Transformation Partnership

Background

In July 2020, Environment Secretary George Eustice announced a new £4million investment for a cross-government project aimed at ‘Preventing and tackling mental ill health through green social prescribing’. The project will test how to embed green social prescribing into communities in order to:

  • improve mental health outcomes
  • reduce health inequalities
  • reduce demand on the health and social care system
  • develop best practice in making green social activities more resilient and accessible

Project set up is scheduled to begin in January 2021 and delivery will run from April 2021 to April 2023.

It will be run by multiple partners, including:

  • Department of Health and Social Care
  • Department for Environment, Food and Rural Affairs
  • Natural England
  • NHS England
  • NHS Improvement
  • Public Health England
  • Ministry of Housing, Communities and Local Government
  • National Academy for Social Prescribing

Expression of interest for local ‘test and learn’ sites

As part of the project, we invited expressions of interest from Integrated Care Systems (ICSs) and Sustainability and Transformation Partnerships (STPs) to become a ‘test and learn’ site for the project.

The project will develop 4 ‘test and learn sites’ in a variety of locations across England, which will establish what is required to scale up green social prescribing at a local system level and take steps to increase patient referrals to nature-based activities. Running alongside and in collaboration with, but distinct from, the local sites, we will also conduct experimental work at the national level to understand where and why there is potential for rapid growth, and undertake a robust evaluation to assess processes, outcomes, value-for-money, and help to address the current lack of evidence on designing and delivering green social prescribing to address mental health and wellbeing.

At local and national level, the project will help to learn lessons about shared policy and delivery, across multiple sectors and spatial scales, identifying barriers and enablers to improve outcomes and deliver better value for citizens.

This project is particularly important in the context of Covid-19, which has had a huge impact on the nation’s health and wellbeing and increased the public’s awareness of the value of spending time in green spaces.

Case for change

Mental ill health is a widespread, serious and rising problem. Approximately 1 in 3 people over 16 in the UK experience poor mental health over their lifetime [footnote 1]. COVID-19 has exacerbated health inequalities and levels of mental ill health and highlighted the value of accessing greenspaces, but also the inequalities of access to greenspaces.

People with existing mental health difficulties and risk factors for poor mental health are likely to be affected disproportionately by the pandemic, including people from Black, Asian and minority ethnic (BAME) communities [footnote 2]. Emerging evidence suggests that in general people who were experiencing inequalities and poorer health before COVID-19 are likely to be most adversely affected. Existing health inequalities are linked to a greater severity of symptoms – and likelihood of death – for those contracting COVID-19 [footnote 3]. People on low incomes, BAME groups and older people are likely to be particularly affected.

Living in urban areas with more green space in the UK is associated with lower mental distress and higher wellbeing [footnote 4]. The quantity of green space in the living environment is associated with improved mental health including reduced stress, fatigue, anxiety and depression [footnote 5][footnote 6]. People who visit nature regularly feel their lives to be more worthwhile after controlling for other factors [footnote 7]. The relationship is similar in children, with access to green space being associated with improved mental wellbeing, overall health and cognitive development [footnote 8]. There is also emerging evidence of a positive association between greater exposure to outdoor blue spaces (lakes, rivers etc) and benefits to mental health and well-being [footnote 9]. People in socio-economically disadvantaged groups generally have less access to good quality greenspace and visit the natural environment less often than their more affluent peers [footnote 10]. However, for those in deprived groups with good access to green and blue spaces, the inequality in mental wellbeing is narrower, compared to those with less access [footnote 11].

Despite recent record investment for mental health over the next five years as part of the NHS Long-Term Plan the current service model is struggling to meet people’s needs:

  • whilst 1 in 10 children have a diagnosable mental health problem [footnote 12], only around 1 in 4 are accessing treatment services [footnote 13]
  • one in five older people living in the community and 40% of older people living in care homes are affected by depression [footnote 14]
  • community based psychological therapies (IAPT) services consistently meet the required treatment standards, but people’s experiences of community-based mental health services have deteriorated and waiting times can be extreme [footnote 15]
  • there remains extensive unmet need for mental health care, with an estimated three quarters of people with mental health problems receiving no support at all [footnote 16]
  • failure to address the mental health of people with long-term physical health problems costs the NHS in England more than £11 billion a year [footnote 17]
  • as many as 40% of primary care appointments are about mental health [footnote 18]
  • starkly, today, people with severe and prolonged mental illness are at risk of dying on average 15 to 20 years earlier than other people [footnote 19]

What is green social prescribing?

Social prescribing and community-based support is part of the NHS Long-Term Plan’s commitment to make personalised care business as usual across the health and care system. Personalised care means people have choice and control over the way their care is planned and delivered, based on ‘what matters’ to them and their individual strengths and needs [footnote 20].

Social prescribing enables all local agencies to refer people to a link worker. Link workers give people time and focus on what matters to the person as identified through shared decision making or personalised care and support planning. They connect people to community groups and agencies for practical and emotional support. They also collaborate with local partners to support community groups to be accessible and sustainable and help people to start new groups. In the Long Term Plan, NHS England committed to building the infrastructure for social prescribing in primary care with:

  • 1,000 new social prescribing link workers in place by 2020/21, with significantly more after that, so that
  • at least 900,000 people will be referred to social prescribing by 2023/24

Green social prescribing links people to nature-based interventions and activities and includes both green and blue environments. Activities are varied and may include green exercise, such as local Walking for Health schemes and dementia walks, active travel (such as walking or cycling), local Park Runs, care farming, community gardening and food growing projects, as well as conservation volunteering, green gyms, and arts and cultural activities which take place outdoors.

Why get involved in this project?

Some of the reasons why systems might want to consider applying include:

  • this project provides an opportunity for local systems to work with partners to systematically embed green prescribing into local social prescribing schemes at an individual, community and whole system level
  • the systematic use of green spaces for improving the health and wellbeing of individuals is currently under-utilised. There is growing evidence that connecting people with green space can deliver positive outcomes through the prevention of mental ill-health and support the management of mild to moderate mental health conditions. England has a network of mostly free to access green spaces, including in urban areas.
  • there is an opportunity for cross system leaders to consider and reframe how green spaces and nature-based activities can support health and wellbeing. This will require a cross sector, community based and citizen-centred approach.
  • scaled up provision of green social prescribing could improve mental health and wellbeing, help to reduce health inequalities and alleviate pressure on health services. This project will support recovery from the pandemic, helping those whose health and wellbeing has been disproportionately affected by Covid-19.

What will the green social prescribing ‘test and learn’ sites be expected to deliver?

Four system ‘test and learn’ sites will be set up in different locations across England, which have been disproportionately affected by Covid-19.

The objectives of the green social prescribing ‘test and learn’ sites are to:

  • understand and address system barriers to scale up effective green social prescribing across England
  • understand actions and behaviours required from different stakeholders to sustainably embed effective green social prescribing delivery models as part of the wider health and care landscape
  • develop four location specific plans which set out the activities, support and resource required to scale up green social prescribing and how this could be measured
  • implement targeted and co-designed interventions to scale up green social prescribing
  • increase patient referrals to nature-based activities to help people’s mental health
  • increase join-up, collaboration and shared learning between the health and environment sectors
  • inform the development of national and local implementation strategies for social prescribing

Local system sites will empower local leaders to design, test and refine local theories of change, processes and systems that embed green social prescribing in their localities. Four local project teams will identify and build relationships with key stakeholders in the health and environment sector to consider how green social prescribing could work sustainably at scale.

Each site will produce a plan which sets out who needs to be involved in the scale up of green social prescribing, in what way, how green social prescribing will be used to improve mental health and reduce health inequalities, the resources required to do so and how the impact of green social prescribing could be measured. Local teams will implement priority interventions identified during the development of their plan and fund local VCSE pilots to enable more people to be referred to nature-based activities. Learning will be shared between sites and at a national level to understand the transferability of opportunities identified and barriers for scaling up. Local pilot sites will be expected to demonstrate a strong commitment to evaluation and to work closely with evaluation colleagues and colleagues leading the national experimental work for the duration of the project.

Over £1million of funding will be available for regional expertise and support (resource/ local posts) and a further £1million+ for project delivery across the four sites. Each ‘test and learn’ site will also be supported by the national project team, the national experimental work and evaluation. Funding for the pilot sites will be dependent on the size/scale of the application and do not have to cover the whole ICS geographical area.

Project set up is scheduled to run from January-March 2021. Delivery will commence in April 2021, running for a 2-year period from April 2021 to April 2023. Funding is available for both the setup phase in January to March 2021, as well as across the core delivery period for the sites.

NHS England and NHS Improvement, who are leading delivery of the ‘test and learn’ sites, are responsible for the financial and commercial arrangements with ICSs/STPs. An NHS England Project Manager will have responsibility for coordination across the 4 pilots.

Call for expressions of interest

A letter was sent to all Integrated Care System/Sustainability and Transformation Partnership (ICS/STP) leads inviting expressions of interest. The geography and scale of the ‘test and learn’ site is flexible, however, it is expected that the learning and findings will be relevant to other areas and could be amplified across ICS footprints and the country. All ‘test and learn’ sites will require strong collaboration and partnership working at local and system level, across the NHS and with wider public and voluntary sector organisations.

Expressions of interest should have been made in partnership and involve ICS/STP leads, natural environment sector leads and other key stakeholders, such as local authorities, voluntary and community sector organisations and public health. The expression of interest should have stated the composition of the partnership and been signed by the ICS/STP lead. We will require signatures from all parties at the next stage of the application process.

To help ICSs in developing partnerships with the local natural environment sector we advise that they make contact with Natural England via ne.greensocialprescribing@naturalengland.org.uk.

If natural environment sector organisations (and providers of mental health-nature based interventions) wish to engage with the project and link with ICSs they are requested to email ne.greensocialprescribing@naturalengland.org.uk to maximise collaboration and not contact ICSs direct. All general enquires about the expressions of interest process should be directed to england.greensocialprescribing@nhs.net.

Who can apply?

ICS/STP leads were invited to submit an expression of interest on behalf of the ICS/STP to be a ‘test and learn’ site and to receive funding for over two years to participate in this national project. Project set up is scheduled to begin in January 2021 with delivery running from April 2021 until April 2023.

Applications have now closed.

We are aware of the impact COVID-19 could have on this project; as such, we will be monitoring the wider context closely over the coming months to ensure the project remains able to deliver its core objectives.

Application stages

The application process has three stages:

Stage 1 - expression of interest

  • dates: 5 to 23 October 2020
  • initial light touch EOI submission

Stage 2 - full application stage (longlisted applicants)

  • dates: 2 November to 20 November 2020
  • we will ask a long list of applicants who submitted high quality EOIs to submit a more detailed application
  • this stage will build on the EOI to understand in more detail the system and partnership approach, relevant experience and potential for new learning

Stage 3 - virtual assessment day (shortlisted applicants)

  • date: 11 December 2020
  • shortlisted applicants will be invited to present their proposals at an assessment day
  • after this, the final four sites will be selected

EOI Assessment

A cross government evaluation panel assessed EOIs against the following criteria:

  • demonstrates a clear understanding of the project brief (weighting 25%)
  • clear explanation of how the project will help to address health inequalities and support Covid-19 affected populations (weighting 25%)
  • evidence of a whole system and partnership approach to project implementation (weighting 25%)
  • relevant experience and ability to deliver (weighting 25%)

In assessing EOIs the panel will be seeking to select four pilot areas with a geographical spread and a cross section of urban, rural and coastal sites, designated landscapes, and a range of demographic and other characteristics, to maximise learning for future scaling up opportunities. The panel will assess favourably those applications who are able to evidence action to support improved outcomes for disadvantaged communities and demonstrate a high level of innovation and ambition. The cross-government evaluation panel will consider applications of different size and scale.

  1. Bebbington and McManus (2019). Revisiting the one in four: the prevalence of psychiatric disorder in the population of England 2000–2014 ↩

  2. Covid-19 and the nation’s mental health: Forecasting needs and risks in the UK. Centre for Mental Health ↩

  3. Will COVID-19 be a watershed moment for health inequalities? Health Foundation ↩

  4. White MP, Alcock I, Wheeler BW et al (2013) Would you be happier living in a greener urban area? A fixed-effects analysis of panel data. Psychological Science 24(6):920-8 ↩

  5. Hartig, T., et al., Nature and Health. Annual Review of Public Health, 2014. 35(1): p. 207-228 ↩

  6. Van den Berg M, Wendel-Vos W, van Poppel M et al (2015) Health benefits of green spaces in the living environment: A systematic review of epidemiological studies. Urban Forestry & Urban Greening 14(4):806-816; van den Bosch M, Ode Sang Å. Urban natural environments as nature-based solutions for improved public health – A systematic review of reviews. Environmental Research. 2017;158: 373-84 ↩

  7. White MP, Pahl S, Wheeler BW et al (2017) Natural environments and subjective wellbeing: Different types of exposure are associated with different aspects of wellbeing. Health Place. 45:77-84 ↩

  8. McCormick R (2017) Does Access to Green Space Impact the Mental Well-being of Children: A Systematic Review. J Pediatr Nurs. 37:3-7 ↩

  9. Gascon M, Zijlema W, Vert C, White MP, Nieuwenhuijsen MJ. Outdoor blue spaces, human health and well-being: A systematic review of quantitative studies. International Journal of Hygiene and Environmental Health. 2017;220(8):1207-21. ↩

  10. Schüle SA, Hilz LK, Dreger S, Bolte G. 2019. Social Inequalities in Environmental Resources of Green and Blue Spaces: A Review of Evidence in the WHO European Region. International journal of environmental research and public health; 16(7):1216; Commission for Architecture and the Built Environment. 2010. Urban green nation: Building the evidence base ↩

  11. Gascon M, Triguero-Mas M, Martínez D, Dadvand P, Forns J, Plasència A, et al. Mental Health Benefits of Long-Term Exposure to Residential Green and Blue Spaces: A Systematic Review. International Journal of Environmental Research and Public Health. 2015;12(4):4354-79; Natural England. Natural England Access to Evidence Information Note EIN018: Links between natural environments and mental health: evidence briefing. 2016 ↩

  12. Mental Health Taskforce (2016) ↩

  13. NHS Digital (22 November 2018) Mental Health of Children and Young People in England, 2017 ↩

  14. Mental Health Taskforce (2016) ↩

  15. The Kings Fund mental health information ↩

  16. Mental Health Taskforce (2016) ↩

  17. The Kings Fund mental health information ↩

  18. 40 per cent of all GP appointments about mental health ↩

  19. Mental Health Taskforce (2016) ↩

  20. Social prescribing and community-based support: Summary guide ↩

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