WHEN Glasgow Royal Asylum’s brand new premises opened in 1843, they reflected nature’s therapeutic power by offering exercise, sunlight, fresh air and even agricultural labour to patients.

But the picture began to change from 1968 as work on the site, now home to Gartnavel Hospitals campus, saw grounds swallowed up by wards, labs and car parks.

More than half of the original landscape area would later be tarmacked or built upon – and medicine’s relentless advances, alongside the ever-growing need for specialist clinical facilities, have ensured it is far from the only Scottish healthcare site to experience such a loss.

But now, thanks to a nationwide greenspace restoration drive, a turnaround is on the horizon, with hopes high that the impact on healthcare will be transformative.

“Hospital greenspace is a huge, underdeveloped resource,” says Anne Lumb, a landscape architect and ecologist who is among those working to bring back a focus on nature and its healing power. Simple features such as trees, for example, can improve building micro-climates, reduce heat loss and save energy, reduce stress levels, clean the air.

“Historically, the outdoors was seen as fundamental to the health of patients at Scottish hospitals. Gartnavel was really known for its advanced treatment of psychiatric patients. It’s typical of our old hospitals in that they were designed with a proper outside estate and designed landscapes.

“You would have parks, seating, gardens; they were often next to working farms. But this connection has been gradually lost over time through new development.”

The pattern is one which has been seen time and again across the country.

New facilities and medical developments mean the benefits of patients spending time in the natural environment have become largely overlooked, leading to a gradual reduction in use of hospital grounds and withering maintenance budgets.

Consequently, much of the extensive greenspace resource has suffered neglect, fallen into disuse or been sold off.

A change in approach, Lumb adds, is long overdue.

“It’s not that the advances in medicine and treatment were wrong – of course not. But maybe we’ve lost sight of benefits of providing that important connection with the outdoors and nature – and that could so easily be addressed, even just relatively simple things such as changing way the outdoor NHS estate is managed. If you can help to stop people getting ill in the first place, it’s better than treating at the point of illness until the end. Access to quality useable greenspace has an important part to play in this.”

Lumb, of Scottish Natural Heritage, has been working with the Scottish Government-supported Green Exercise Partnership (GEP) to deliver improvement projects in a £3 million project aimed at demonstrating what can be achieved in the grounds of hospitals and health centres.

According to a new progress report, four therapeutic gardens have been created, dozens of acres of woodland brought back into sustainable management, thousands of trees planted, and several kilometres of new or upgraded pathways laid down.

Among completed projects are the restoration of Ninewells’ original arboretum after it had fallen into disrepair, construction of a striking pier with seating not far from the main entrance at Forth Valley Royal, and conversion of derelict ground behind Glasgow’s Possilpark Health Centre into an urban garden with small “starter plots” that can be adopted by local residents or organisations.

At Gartnavel, something of the old 19th-century emphasis on using the outdoors to boost recovery has also re-emerged, with a six-sided summerhouse and walled garden restored as a “therapeutic” all-weather venue accommodating greenhouse space, art workshops and social activities.

The impact of such an overhaul on the health and wellbeing of patients is potentially huge, as those receiving treatment get better more quickly thanks to direct contact with high-quality outdoor spaces.

GEP’s progress report says that evidence suggests benefits will be “collectively significant” – not only through quicker patient recovery times but also factors such as “biodiversity gain and financial savings realised from lowering maintenance costs”.

In addition, surveys of NHS Scotland staff before and after the interventions have recorded growth in the awareness of greenspace, with a 10% jump in use at some sites hailed as an indicator of increased activity levels and reduced stress.

For Fiona Sinclair, voluntary services manager at Gartnavel Royal, the benefits are obvious and extend well beyond the hospital grounds.

“I think having the importance and confidence to move away from the ward can only be a good thing,” she says.

“What I have observed is patients who use the Gartnavel Royal Walled Garden and the Summerhouse asking questions about the gardens – things beyond themselves and which connect them with the natural world and their recovery.

“The greenspace project has helped us bring back to life what was already there and make it visible again. I have seen an increase of up to 300% in the number of our neighbours and staff members using the garden spaces and the wider site during lockdown – making the most of the natural pathways to walk and cycle, and taking the time to sit and enjoy the views.”

Having enjoyed success in the demonstration phase, the Green Exercise Partnership – which, in addition to SNH, comprises experts from Scottish Forestry, NHS National Services Scotland and Public Health Scotland – is turning its focus to the future.

Already, additional projects have progressed since 2017 thanks to Scottish Government funding, while pilot schemes at Ailsa and Ayr, Gartnavel, New Craigs and Royal Edinburgh hospitals will show how the use of new greenspace can be sustained.