Evaluation of the Lamb Pilot Gardening For Health
2011 Gardening For Health www.TotnesHealthyFutures.co.uk The Lamb Garden, Totnes Mobile No. 07582125438. Info.TotnesHealthyFutures@gmail.com
Executive Summary The growing link between health and the environment is clearly evident, in both policy and practice; and a professional community is rapidly developing which can convert this link into practical processes which achieve real health improvements. Whether this inter-dependency is demonstrated in community allotments, school gardens, local food production, or as with the Totnes Gardening for Health project, the role of gardening for health and well-being is firmly established. Such provision has an essential place in the overall provision of health care for South Devon communities, where healthier lifestyles are a key priority. The Gardening for Health project at The Lamb Garden in Totnes has grown out of the community need for underused outdoor green spaces to be developed effectively and productively. In its first year, as a pilot, the Gardening for Health project has directly reached 69 people in the community via facilitated sessions on site and a complementary programme of outdoor workshops and activities. In the local community generally, a network of support has grown to over two hundred people. We need to build on this success. The challenge for this (second) year is to change from a support base rooted in local volunteer networks, to a fully functioning referral-based system, accommodating patient referrals from various regional health providers and partners. Such a service can become a key element in delivering regional health and well-being targets. Funding from the NHS will enable this extended pilot to take place.
The successful development of this service will be an important element in delivering a range of benefits covering social, economic, therapeutic, environmental and educational needs. We believe that in 2012 this service has the potential to be a milestone in the local delivery of health improvements.
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Contents Executive Summary
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Section 2.1.a Background
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2.1.b Introduction
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Section 3. The Lamb Pilot Project Management Participants Activities
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Photographs of The Lamb Garden
Section 4. Evaluation Activities Participants Case Study 1. Popular weekly outdoor Tai Chi classes in Leechwell Garden.
Section Evaluation Questionnaire Table 1. Resource access. Table 2. Age Range of participants. Table 3. Health and Well Being evaluation scores.
Section Other outcomes Social Case Study 2. Significant Mental Health Benefits through Gardening For Health.
Educational Case Study 3. Social, Community and Educational benefits are available.
Environmental Economics Food Production Produce. Food Produce Recipes Presentations
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Section Issues Management Funding Referrals from Leatside Surgery Access, Leechwell Garden Data Collection / Evaluation Issues
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Section The Future Outreach
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Section Summary
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Acknowledgments
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Further Information
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Appendices Appendix 1. Gardening For Health Summer & Autumn Programme 2011 Appendix 2. Participant Questionnaire
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Section 2.1.a Background The benefits of ‘gardening for health’ are strongly recognised. National case examples include schemes where the benefits of gardening and growing food for healthy lifestyles have been shown to lead on to opportunities for the unemployed and people with mental health problems, as well as providing an educational resource for the local community. ‘Gardening for health’ is viewed by some as an alternative option for people suffering from mild depression1; thus avoiding an initial routine prescription of a course of antidepressant medication, (Platform 51, ‘Women Like Me’ mental health campaign). Platform 51, is an organisations that works with women and girls, and suggest that “anti-depressants have a role to play in treating mental health issues” but “they should not be the catch-all solution,” (www.platform51.org.). National and Local Health Objectives: NHS health priorities in South Hams focus on four areas, with the need to address healthy weight a particular issue. This is in line with national objectives as 14.6% of Year 6 children and 23.2% of adults are classified as obese, (DoH, 2011). Compared to national statistics, the South Hams area is within average levels of measured obesity and has higher than average levels of healthy eating and active adults. However, despite higher than national levels of active participation in sports, obesity levels in school children for South Hams remain only just above the national average. This suggests a greater need to target healthy weight/eating. Priorities thus remain focused on “working in partnership to address healthy weight” (NHS Devon, Health Profile 2011, www.healthprofiles.info ), and this is true for not only the South Hams, but Teignbridge, Torbay, Plymouth and West Devon. National organisations such as MIND and RETHINK, have provided funding for communities to start up ‘gardening for health’ projects in their local communities. Projects, such as ‘Solent Mind’, West Norfolk Mind ‘Gardening 4 Health’ allotments garden and, ‘Diggin’ It’ in Plymouth, are all working against the stigma and discrimination of mental health and striving to restore confidence to service users. The recent NHS reforms and establishment of Wellbeing Boards provide opportunities for local councils and public health practitioners to work with third sector organisations in imaginative and creative ways to deliver these health priorities.
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Reference: http://inventorspot.com/articles/gardening_depression_doctors_prescription_needed
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Section 2.1.b Introduction The Gardening For Health [formerly Totnes Healthy Futures (THF)] Project is a partnership between Totnes Development Trust (the lead partner: http://www.totnesdevelopmenttrust.org.uk/), Leatside Surgery and the Faculty of Health, Education and Society at Plymouth University; supported by local authorities and other community groups. The project is based on the idea that healthy food, as well as its local production and enjoyment, is key to the overall wellbeing of individuals and their community. Therefore, the Gardening For Health Project has the following aims: • to promote the role of food for healthy futures • to support food security and sustainable communities • to provide a therapeutic opportunity, with local medical care practices, to develop communal and personal responsibility and health (mental and physical) to respond appropriately and effectively to change • to provide an accessible education/skills resource for the community • to involve in a communal activity all sectors of the community including children, young people, the elderly, and those with special needs, supported by volunteers and health / social care university students • to grow local food to sell to local people • to evaluate the project and assess the therapeutic and social benefits of the project. The beneficiaries of the project are local people including: patients at Leatside Surgery and other local healthcare practices; and local school children and other specific (disadvantaged and vulnerable) groups. The projected outcomes of the projects would include the following benefits: Therapeutic: Healthier produce and increased physical activity Replicable model for integrating food production, community and personal responsibility, Measurable benefits to emotional and mental health for specific groups Social: Stronger communal cohesion and involvement Higher levels of responsibility developed within the community: a physical space where local people can grow vegetables together and skill-share supported by experienced skilled gardeners and educational programmes / courses Environmental: Best use of scarce resources, based on organic principles Two-way healing process between people and nature Promote organic practices in recycling, composting and use of ‘renewables’ Educational: Accessible courses / opportunities for affordable food growing education programmes Placement opportunities for university students of health and social care Economic: Increased local food production: home-grown food is cheaper; transport costs would be reduced The garden would increasingly generate its own income, by selling excess produce locally.
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Section 3.The Lamb Pilot Following a feasibility study in 2009 to assess a range of suitable sites for the project, the decision was made to use The Lamb as a demonstration/information site and pilot for Gardening For Health. The Lamb is a small public space at the top end of the town owned by South Hams District Council (SHDC); (see photos, pg. 4). Project Management • Totnes Development Trust took the lead and secured the lease on behalf of the project. • A Steering Group was established, building on initial interest in the project and including representatives from the partner organisations and two horticulturalists. • The public consultation involved a number of stages. For example the Gardening for Health project team had a stand at Transition Town Totnes ‘Winterfest’ event. Some outline plans and draft drawings were available for discussion and comments. • An on-site consultation day was held where people passing through the garden could provide ideas and suggestions. This was supported by leaflets targeting local residents asking for their input. • Funding applications were made to local and national charities in order to raise the cost of equipping the garden and running activities on site. • Design and landscaping was carried out by local companies, with input and support from SHDC. This was aided by design input from people in the community with expertise in planting herbs and vegetables. • A co-ordinator was appointed part-time to co-ordinate the equipping, and launching of The Lamb pilot, and to facilitate the on-going activities and volunteer groups. • Significant input into getting the site ready and planning and running activities was provided by volunteers. Participants • Volunteers were encouraged to get involved in specific aspects of the garden, such as the herb garden, and to contribute to weeding and watering etc. Many of those volunteers, who had significant horticultural and/or health experience, approached the project to volunteer. • Referrals from Leatside medical practice were made by General Practitioners, focusing on people at risk of developing chronic illness. • Clients of other health care services, such as Rethink and, Catherine House Surgery, contacted the project with an interest in making a booking. • Students from the Faculty of Health, Education and Society at Plymouth University were encouraged to get involved. Activities Sessions focussing on specific plants / activities were held. For example every two weeks a two-hour session was organised by a horticulturalist. This focussed on different aspects of food produce, preparation, growing, and harvesting. Associated with the gardening was the production of leaflets that provided information on the nutritional content of the vegetables and suggestions for preparing and cooking.
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Photographer: Š Kim Sayer. Used with the permission of South Hams District Council.
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Section 4. Evaluation A community consultation, held in 2011, gained initial feedback from the public. This ascertained the general level of awareness that the garden project was reaching. A questionnaire, handed to members of the public who attended, revealed that the project publicity was reaching both Friends of the Lamb network and new members in the community. In its first year, The Lamb network has grown from 60 to 200 people. One important avenue of publicity and awareness is attributed to the support of Transition Town Totnes as well as the South Hams Community Volunteer Service. An independent evaluation of the project was made in July 2011, by Andrew Rothery MSc. This report noted recognisable achievements in the physical environment, social and community and, economic viability. Activities • The Gardening For Health project pilot at The Lamb was launched in February 2011 with an official opening by Dr. Sarah Wollaston MP and supported by all project partners and SHDC and (see http://www.youtube.com/watch?v=baofCFKRulM). • By the end of July 2011 a total of nine two hour vegetable gardening sessions had taken place; and a total of 20 by the close of December 2011. These sessions were facilitated by two Horticultural practitioners and involved a range of activities from seed sowing to sharing the produce that had been harvested (see Appendix 1 for details of sessions). • Volunteer input into weeding and watering, in particular the herb beds, has continued over the past few months, responding to seasonal changes in required tasks such as extra watering in summer, or autumn seed saving. A total of 45 volunteer open sessions were held and, an opportunity for drop-in volunteering was available also, bringing in occasional, additional volunteers. • Other activities – A total of eight workshops were held at The Lamb Garden, which included workshops and talks; by local authors, herbalists and also a Tai Chi class in the larger garden of Leechwell. Talks were held on the topics of herb propagation, seed saving and preparation of herbal remedies. A children’s wildlife activity trail, co-hosted with Muddy Mums group, took place along the Totnes Garden trail, which included Leechwell and The Lamb gardens. Workshops included making rowan berry jelly and lavender bath bombs. Food-themed lanterns were made, for participants to carry in the Totnes Lantern Parade. A market stall was held at the Green Life anniversary event; Gardeners Question Time in Totnes and at the Leechwell garden sculpture unveiling; thus making the produce available to the public for purchase. The Lamb Garden also provided a space for a local Totnes festival project, ‘Where Are You From, Totnes’ to establish a Wishing Tree & Seeds of Change to represent hopes and concerns for people in Totnes. • Outreach – garden planters at the Leatside surgery were established and seasonal crops grown. Signs added, informed visitors to the health practice of the project at The Lamb garden. Additional information was provided in the reception area, with the garden session schedule and also a newsletter. Visits to local support groups, including the Totnes memory café, Manor House and Cabot House resident homes, RETHINK, the Job centre disability
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adviser and, the Anxiety and Depression service were undertaken to advocate the Gardening For Health. A regular newsletter with recent garden news as well as information on local schemes and events was compiled and distributed to Leatside and Catherine House surgeries, the Lamb outdoor information/ leaflet rack and sent online to Friends of The Lamb network and other volunteer networks for dissemination. Participants • Twenty-three volunteers have contributed to general garden and crop maintenance. Twelve participated on a regular, rota basis, including three young children [primary school age]. Forty of the 45 volunteer open sessions held throughout the spring and summer months, were attended. • One student (Nutrition and dietetics) from Plymouth University engaged in the gardening activities and contributed to the newsletters and steering committee meetings. Six professionals, of either a health and/or horticultural background, expressed an interest in assisting, some at a later date for 2012. • A total of sixty-nine people participated at The Lamb Garden; thirty-nine people attended a gardening session, twenty-three volunteered and thirty people attended a workshop on at least one occasion. Four persons booked onto a garden session, but did not attend. • People taking part in the activities were asked to complete a brief questionnaire for audit purposes each time they attended an activity session. Thirty-two people completed a questionnaire on at least one activity visit. Twelve participants completed more than one questionnaire, thus providing responses at different sessions. • Weekly Tai Chi classes in the Leechwell Garden attracted 40 people over a twelve week summer period, (see case study one). Case Study 1. Popular weekly outdoor Tai Chi classes in Leechwell Garden. Tai Chi class size ranged from four to 15 persons, with an average class size of 8 in attendance. Participants were from a range of ages including: early to late 60s, with the eldest attendee being 74 years old, who also attended more than half of the total classes. Twentyeight of the total 40 participants were female. Of the respondents who completed a questionnaire, all but one was currently registered at the Leatside surgery. Being outside in nature was consistently rated highest out of four factors: including healthy eating, being with people, or exercising. Only one male felt a significantly low level of health; mirrored by a low sense of happiness; though he recognised the importance of all four factors. One lady responded with a low sense of connection to nature; despite high rating of all factors other than that of being with other people.
An evaluation questionnaire was developed by the Green Exercise research team at the University of Essex who have given permission for us to use it, (Appendix two). A questionnaire was given to those participating in the Tai Chi and gardening sessions at each session. Questions looked at how participants felt about four essential factors that relate to a sense of over-all well-being. One questionnaire respondent, who had recently been in hospital for treatment, explained how the decision to do Tai Chi was because: “it was the best gentle, healthy exercise available to him, that he could cope with for an hour on a weekly basis and with others for mutual support.” 6
Section Evaluation Questionnaire Of the 32 people attending the activity sessions who completed the evaluation questionnaire 12 were male and 20 were female. One woman also took her one year old child to the sessions. Most people completing the questionnaire had access to a garden for growing vegetables and most were registered with Leatside Surgery, (Table 1.) Table 1. Access to garden of growing vegetables
Yes 24
No 8
Registered with Leatside Surgery
21
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[or Catherine House Surgery]
Participants in the activity sessions were from a wide range of ages, (see Table 2), and included an 86 and 99 year old as well as a 1 year old child who accompanied her mother. Table 2. Age range. 18 – 30
31 – 40
41 – 50
51 – 60
61 – 70
71 +
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6
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3
4
3
Participants had heard about The Lamb activities through a number of routes: Leatside Surgery primarily; the local volunteer service (3); THF group (6); Schumacher College (1); friend / word of mouth (2) and other participants (3); Internet (1); library (1); Leechwell notice board/poster (2); leaflet through door (1); local charity (2); Transition Town Totnes [TTT] (3); Totnes Times/Totnes Directory (3) and, passing through the garden (1). The evaluation questionnaire asked participants to respond to a number of statements related to their health and wellbeing, scoring how they felt ‘at the moment’ on a scale of 1 to 10. Participants were asked to complete this questionnaire at each gardening activity session in order that we could assess any changes in these perceptions over time. Twenty-seven of the 32 participants completed a questionnaire at the start of their engagement with the project and 15 of the 32 participants completed questionnaires during or at the end of their engagement (some of these completed questionnaires at each session). In order to get a base-line measure, responses for participants completing a questionnaire at the first session have been collated. The participants starting to engage in this project mostly rated their health, connection with nature and how happy they felt as positive, (see Table 3.).
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Table 3. Health and wellbeing scores: where a score of 1 is not very healthy, connected to nature, happy; and 10 is very healthy, connected to nature, happy.
Score
Healthy
1 2 3 4 5 6 7 8 9 10
0 0 1 2 1 6 6 8 1 2
Connected to nature 0 0 1 1 0 4 7 7 5 2
Happy 0 0 2 1 0 5 7 4 4 4
Participants were also asked how strongly they feel they belong to their immediate neighbourhood or community. The predominant answer was ‘fairly strongly’. Two felt ‘not at all strongly’, 7 felt ‘very strongly’, and 17 felt ‘not very strongly’. Of the ten participants who completed more than one form, all but one noted a change on their response in a positive direction. On the importance scale: being outside in nature; being with other people; taking part in exercise or activities; eating healthy food; 92.1% of participants felt these to be important or very important. Five respondents felt being with other people was less than ‘very important’ or ‘important.’ Three respondents felt exercise was not very important or important. One respondent felt that healthy food was less than important. Only 14 participants completed more than one questionnaire. This is insufficient for a ‘before and after’ evaluation as this number would not have statistical validity therefore this analysis was not undertaken.
Section: Other Outcomes Recognisable achievements are identified in the physical environment, social and community and economic viability, [A. Rothery 2011]; thus meeting our initial objectives – as outlined by the 2009 Feasibility Study undertaken by Sue Holmes. Social – anecdotally participants reported a range of social benefits such as there being an opportunity for young families to get out into the fresh air and, being active either during the week or at the weekend. It offers a chance to meet new and other local people/residents, and for children to find peers and older, garden ‘buddies’ acting as good role models, as revealed in case study two. 2 The project can be a stepping stone, in between a lack of employment to gaining further education or work; a chance to learn about gardening and may be also put in to practice existing skills, e.g.: Forest School skills; enjoy outdoor space, especially if where a participant is without their own garden or space at home to do so. 2
All case study names of participants have been changed for the purpose of this evaluation report.
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Case Study 2. Significant Mental Health Benefits through Gardening For Health. Roland attended one of the very last Gardening for Health sessions, after leaving hospital for an extended period of mental health therapy. He was keen to get involved in some form of outdoor activity and was already aware that gardening could be of great assistance for his health recovery. Several participants had health issues of a mental health nature. Cara was encouraged by a close friend, who also joined in, to garden at The Lamb; recognising that Gardening for Health could offer important social benefits. A team member took on a mentor role to ensure further support was available for Cara, whose bi-polar personality disorder was socially prohibiting. We were delighted to see Cara return on several occasions, taking an active and independent role.
A number of events where food that has been grown has been shared as a meal together have taken place and these have proved to be very successful.
The Lamb garden, with its public right of way access through the garden, also has provided a new and good use of open space for local residents, visitors and lunchtime workers to relax and enjoy being outside. This has been important, for a town such as Totnes, where space available for public as well as private gardens is in strong demand. Educational – participants have gained basic knowledge in seasonal planting including preparation, planting, and cropping / harvesting and, especially organic and recycling approaches including seed saving and composting procedures. They have also been introduced to seasonal healthy eating through the linked recipes and 9
details of nutritional content of what has been grown. Furthermore, two participants have subsequently decided to train in horticulture and, one participant went on to apply for land to grow food on with his family: “Coming to the garden has helped me make friends and given me the confidence to start a horticultural course,” Peter noted, (See case study three). Case Study 3. Social, Community and Educational benefits are available. On the advice of his local G.P. at Leatside Surgery, Peter, aged 30, joined the Gardening for Health programme; also bringing along his young son to additional volunteer sessions. At the beginning, Peter was an unemployed and started by helping out with the Lamb garden and Ticket Office renovations. He then went on to join the School Farm volunteer day, to gain further experience and activity on a weekly basis. At the end of this first year, Peter enrolled on to a certified Horticultural course at the local Schumacher College and, furthermore was taking on plans to manage a small piece of land for the purpose of growing vegetables. Peter, a local resident, encouraged his partner to join the Gardening for Health sessions also and Angela has now joined several classes and contributed to the recipe postcards with some delicious, healthy recipes. Her leaving comments before Christmas were that this change in activity for Peter had been the making of him!
A number of Schumacher College students studying Level 2 and 3 Sustainable Horticulture have visited the site and/or participated in activities at the site. As part of the Sustainable Horticulture course students are required to carry out a research project and a garden design project. We are currently looking at the possibility of students carrying out some of this research and design in conjunction with the Gardening For Health project. This could present a ‘win-win’ situation for both the students and the Gardening For Health project and prove to be a valuable long term relationship. Along with a short film produced - for educational and funding purposes for the project - the Lamb Garden has been incorporated on the Totnes Walk & Talk scheme and was also part of the Devon walking festival tour in 2011. Environment – the hard landscaping and structural work carried out at The Lamb has made a significant contribution to what was a neglected public space. Additional seating provides a quiet and peaceful space for the local residents to meet and socialise. One bench has already received sponsorship for a ‘memorial / remembrance’ plaque. Thus far there has been very limited evidence of vandalism and crops have been left to be harvested by those involved in the project. Economic – participants have had the benefit of access to free, seasonal vegetables, thus making savings on their weekly food bills. Income generation from food produce as well as sales of plants has been undertaken; selling at a Green-Life market stall, the Gardener’s Question Time at KEVICCs, at the Leechwell sculpture unveiling ceremony and, the South Devon Totnes garden walk. This raised almost £150. A regular link with The Walled Garden has also been set up, to sell herb salts at the Friday market. The addition of recipe postcards, for sale at various outlets, has also opened up a new avenue for income generation. The project has aimed, from the outset, to support the local community. Local contractors were used onsite and most of the equipment and resources purchased
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for the Lamb Garden project, came from within the local Totnes business area. Volunteers helped with the renovation work of the ticket office and aspects of infrastructural maintenance in the garden throughout the year. Food production – Produce from the garden has been harvested and gone to participants on the gardening project. Produce was used on site as part of an ‘Al Fresco Lunch’ where participants brought a dish made with ingredients from the garden; we ate together and celebrated the harvest. Surplus produce has been taken along to a local homeless soup kitchen. Some produce has been left at Leatside reception area for people to help themselves. Produce has been sold at local outdoor events and some crops have been used for making the chutneys to sell on. An abundance of chard meant that a contribution to a TTT community lunch was possible. In addition, a hamper of produce was put together and donated as a prize to the Torquay based, Rowcroft Hospice Auction of Promises [held in Totnes, the hamper raised £40]. Produce: The following produce has been grown and harvested at The Lamb garden by participants of Gardening for Health: Runner beans, courgettes, lettuce, onions, potatoes, sweet corn, raspberries, rowan berries, broad beans, parsley, coriander, rocket, cress, mizuna, mustard, leeks, purslane, corn salad, beetroot, radish, turnips, carrots, tomatoes, rhubarb, sorrel. Flowers planted included cosmos, calendulas, violas, nasturtiums and borage. Crops planted for future harvest were gooseberries, redcurrants, blackcurrants, apple tree. Food produce – Runner Bean Chutney and Rowan Jelly were both successfully made by workshop participants and sold. Herbs from the garden were dried and added to make culinary herb salts and herbal bath bombs. Fruit berries were collected from The Lamb garden, dried and fruit leathers produced and also sold. Many of the seeds from the garden plants could be saved and the most popular, productive plants were selected for seed saving and swapping.
Recipes – the recipes produced by the Gardening For Health group for The Lamb ‘Al fresco’ lunch, have been so well-received that these were collated and developed into recipe postcards, with a set of images provided by a local photographer. The project now sells these both online via the project website and through TTT and the Tourist Information Centre in Totnes. As well as generating income, the postcards help to promote the project and advocate for healthy eating. Presentations: A number of people have visited The Lamb to hear about the project and the Gardening For Health project team have given talks at a number of local events. Further afield, a presentation about the project was given in Sydney at a seminar on community gardens facilitated by the University of New South Wales.
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Transition Town Totnes (TTT) regularly bring groups of visitors to the site, including students from the language school, as part of a cultural exchange day out. Coverage of the project has been made by local newspapers, the local radio station and by BBC Radio Devon. The project also has a regular feature article in the monthly, Totnes [business] Directory. A follow up film is being produced by a local film-maker. Use of social network platforms, has helped to ensure that the project maintains visibility and further interest with an online media audience, including on Twitter, Facebook; combined this adds 70 followers of the project online.
Issues Piloting the Gardening For Health project at The Lamb has enabled us to assess the feasibility of this project and the extent to which it could be rolled-out on a larger scale should appropriate land be identified and made available. This evaluation just 6 months into the project provides us with valuable information regarding the running of the activities, likely attendance, methods of communicating and advertising the project and, significantly, allows us to calculate on-going running costs and potential volunteer input. Management - The project has been managed by Totnes Development Trust with significant input from volunteers. Over the course of the first ‘pilot’ year, the daily management for the project has been handed over to a working team. A health professional on the committee has taken on the liaison role with Leatside surgery. A new manager at Leatside surgery has taken on the responsibility of key person for the project. Mentoring of participants, attending a gardening sessions, has been initiated. Another issue for the on-going management of the project relate to a regular network of people being available to help care and maintain the garden. Several good volunteer networks exist in Totnes and could be accessed and linked; the Transition Town Totnes network as one example. Funding - The pilot has enabled us to assess the ongoing funding requirements to maintain a project such as this. Although we have significant input from volunteers, ongoing funding will be required to purchase seeds and equipment, and to provide us with a paid part-time co-ordinator and horticultural input for the co-ordinating of events and communication etc and running the activities. We estimate that for this we require an annual budget of £10,000. Expected income from produce and other activities is around £1,000. The referral process from Leatside Surgery – Due to management changes at the surgery, surgery re-location and NHS re-organisation, we have not been able to effectively target an appropriate population that could benefit from THF activities at The Lamb. This has been disappointing and we are currently engaged in discussions with the new Practice Manager to find more effective ways of engaging people who might benefit. Our evaluation thus far suggests that participants currently engaged are relatively healthy (according to their own perceptions). It is, therefore, likely that we are not engaging those with unmet need, or reaching disadvantaged groups. One
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way to address this is to extend the outreach aspect of the project by running some activities at the surgery – this may be possible in the new accommodation now they have moved. Another option is to take a currently existing group who meet at the surgery (e.g. a specialist clinic run by the Practice Nurse or Health Visitor) to The Lamb for an introductory session. We are also exploring the possibility of taking referrals from Catherine House Surgery. The key issue: that of the difficulty in encouraging referral take-up is a welldocumented outcome of other health initiatives. Out of the 455 patients who from February to June, received information from clinic nurses and/or their G.P. at Leatside Surgery, fewer than 15% were booked on to a garden session at The Lamb site. To resolve the take-up issue, we will have 2 sub-groups, one focussing on the introduction of an improved methodology for referrals and the other focussing on new sites where potential users [and product consumers] are on site; i.e.: taking the facility to where there is need, rather than the reverse. The three new possible sites identified and, currently under further discussion, are: 1. The Totnes Hospital site with the adjacent Totnes Caring service and existing garden and conservatory. 2. Foxhole – A community garden (part of the Abundant Life project with the Dartington Trust). 3. An existing walled garden at KEVICC secondary school. These three existing sites offer a significant capacity and potential to support and extend the Gardening for Health programme; offering client based groups, for example, young schoolchildren/students; elderly and retired; patients requiring convalescence and/or recuperation. Leechwell garden - In addition because of proximity, it will be possible to use the new Community garden recently opened by the Trust as an additional facility, as there is regular and on-going garden maintenance. A structured programme will be prepared. Access - A transport link will also be considered, to encourage bookings by persons living outside of the immediate catchment area, or where access can be supported by the provision of a transport link. For patients with disabilities, where a wheelchair is required, activities could be offered at the Leechwell garden. Data collection / evaluation issues – evaluation is limited to the data we have been able to collect thus far and it has not been possible (due to low questionnaire numbers) to carry out a ‘before’ and ‘after’ evaluation. In any event the numbers required for such an analysis are likely to exceed the numbers of participants we can involve in the project. However, we could undertake a qualitative study to evaluate the experience of participants and this is proposed as an option for the future.
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Section:The Future Management The Lamb is a pilot project, and as such, was expected to identify problems to be resolved during the next stage of the project. To chair the next year, a new team member is being sought, bringing on board a professional with experience in both the voluntary and health sectors. Quarterly meetings at Leatside Surgery, to be held with a small focus team with Leatside personnel, will ensure that key issues can be addressed and responded to effectively. Recommendations, including those made by Rothery, have highlighted necessary improvements and steps to be undertaken. o To create clear operational procedures: develop onsite support for health related clients. o To develop a business plan: with details of economic viability for the project in the medium to long-term [3-5 years]. o To further strengthen the key role of contact and liaison between Leatside health practice with the working team. o To implement a more sustainable booking and referral system; which would offer the opportunity of paid referrals from 2013. Sessions and activities The pilot year provided a good grounding and framework for future foundations to be built upon; allowing a programme of activities and gardening sessions to continue in the second year. New as well as returning workshops are expected to take place, with skills and learning towards taking responsibility for one’s healthy lifestyles in the community as a core theme. Both the Lamb and Leechwell gardens are open and available for free public activities, by SHDC application. Volunteer input shall also aim to allow maintenance of the garden to be run independently, through the establishment of a Gardening club. Referrals – Leatside surgery will remain the primary partner organisation for client referral, with bookings on to the Gardening for Health sessions to be made on an individual and independent basis. Literature and publicity, to support this process and advocate the project, will be available at the health centre. Additional referral systems, with the Catherine House health centre, RETHINK Totnes, and other NHS services will extend and help to advocate complementary or alternative options for building healthy lifestyles. For example, the Anxiety & Depression Service, Robert Owen Communities, the Job Centre Disability Employment Service, physiotherapist referrals are all suitable candidates to explore further. Combining with local/regional services to facilitate and offer additional options for people needing health-focused activities, will also be explored. Outreach will extend and continue to bring in new and complementary features to the programme, as much as possible. A greater focus, for example, will seek to include school children and the retired and elderly population. Champions at each of the Totnes residential homes will be supported: advocating to fellow residents to engage in healthy and gardening activity.
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Other sites will provide an opportunity for developing and expanding the project and target audience, which would be expected to meet 200 people in the next year. Whilst The Lamb garden remains an information and demonstration hub for the project, new sites would incorporate a greater focus on special target groups. The possibility to develop the project with a view to it becoming sustainable financially would also be enhanced. Evaluation – With development of new sites, where there is scope for greater numbers of referrals and participants, qualitative studies can be adopted. It would be necessary to develop and improve the recording method for the qualitative and quantitative benefits that are available through the Gardening for Health project. This aspect of project development has, as Rothery observed, been lacking momentum in the pilot year. Social work students – First year undergraduates are being supported, to undertake a work placement, with second year undergraduates to be incorporated the following year. Students could help to capacity build on going outreach developments. Placements could support existing onsite roles, perhaps acting as observers - for research purposes - or as health mentors for participants. Section: Summary The Lamb is a pilot project, and as such, was expected to identify problems to be resolved during the next stage of the project. It has, so far, managed to meet all its original objectives; and there is a strong potential for new targets to be met, when and as they arise. There are good signs of increased user activity. Inter-linkages with local health and support groups have emerged. The role of the garden - as a public good and, site of information and demonstration – has been enthusiastically embraced by the local community in general. The positive knock-on effects already taking place will require additional capacity development and there are further opportunities potentially available to support educational, social & community and health goals. The links to mental, physical and community health are already being identified by the role of green spaces in improving health. On-going evaluation of the Gardening for Health Project will allow for issues arising to be addressed and responded to. Gaps in provision, which were related to management changes at the Health centre, are recoverable. Implementing the next stage sites will take the project to potential users and consumers of produce. Planning work, thus, is underway to take forward the Gardening for Health programme in coordination with three community sectors, identified as elderly/retired, school children, health patients in period of recovery. A greater focus towards these sectors could incorporate and meet societies growing needs for activity and exercise for the benefit of community health.
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Acknowledgements THF group (Steering Group etc), Volunteers, SHDC: Funders: The South Hams District Council
- £4,000
Greater Dartmoor Local Enterprise Action Fund [L.E.A.F.] - £7,343
Leatside Surgery, Totnes - £5,000 The Clare Milne Trust - £3,700 The Co-Operative - £1,600 The National Lottery BIG Fund [Awards For All] £9,497
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Further information http://www.totneshealthyfutures.co.uk/
Links to other schemes for case examples:
The Forestry Commission in Scotland runs Branching Out: an innovative development for adults who use mental health services within Greater Glasgow and Clyde. http://www.forestry.gov.uk/branchingout The Employers' Forum on Disability has published Branching Out as a Best Practice Case Study on disability at www.efd.org.uk/media-centre/case-studies. For further national case examples, go to i) http://www.green-space.org.uk/ ii) http://www.together4health.ca/workgroups/benefits-community-gardens iii) GreenSpaces, Scotland website: http://www.greenspacescotland.org.uk/
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Appendix 1. Gardening For Health Summer & Autumn Programme 2011
4th July
Anyone for Tea?
We'll make compost teas to feed the growing plants, and give the garden a Mediterranean feel with lavender and basil in pots. 18th July
Alfresco Lunch!
Bring a plate, knife and fork, a little bit of food to share,and celebrate with a feast of garden produce! (All your own work of course) 1st August
And now for something completely different...
Planning and planting for the Autumn 15th August
Mostly Munching (in between gardening!)
With a bit of luck the sun will be shining and lots of vegetables will be ready to eat By the way 5th September
NO SESSION ON AUGUST BANK HOLIDAY
Bulbs for Spring- now's the time to do it!
And come and harvest the fruits of your labours 19th September
Cabbages and Kings (of cabbages)
Winter greens and lovely lettuces to feed you through the rainy days 3rd October
Snip, snip, some pruning, some clearing, some digging , some shearing
A little bit of housekeeping goes a long way! 17th October
Feeding the beds that have fed us all year
Adding compost and manure for a healthy soil and healthy vegetables Narcissi planting in pots ready to bloom at Christmas! 31st October
HALLOWEEN!
Carve pumpkins and plant garlic to ward off the cold (and the vampires?) 14th November
Not Apple Turnovers, Apple Stepovers
Low slung fruit for growing in little spaces - and plant blackcurrant and gooseberry in the forest garden 28th November
Winter Celebration
Celebration Soup, all our own ingredients of course, followed by putting the garden to bed! Fleeces and wrapping up! Sessions will resume in February 2012
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Appendix 2 – Participant Questionnaire
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Appendix 2 – Participant Questionnaire
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