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Green Space Strategy Research Papers: Foreword

We are extremely fortunate to have a wealth of good quality

parks and green open space across the borough. Every day

thousands of people have fun at our local play areas, stroll

through our woodlands, play sports on our recreation

grounds, attend one of green space activities, grow fruit and

vegetables in local allotments, visit old friends and memories

in cemeteries or relax around in one of our natural habitat

sites.

Without green and open spaces, life for people living in our

borough would be very different. As a Council we want everyone to be able to

easily use and enjoy local clean, green and open spaces. We want the right

facilities and we want to encourage more and more people to use them.

We know a strategic approach is needed to help nurture and enhance our green

and open spaces in the right way. We want to build on the success of our first

Green Space Strategy to ensure they are managed in a sustainable way, which

will ensure they will still be around for future generations to enjoy.

Knowsley‟s parks and green spaces offer a significant, varied and unique

contribution to meeting many of the Council‟s and its partners‟ strategic

outcomes. To help refresh our strategy a series of research papers have been

written to understand how Knowsley‟s parks can be utilised to address the pressing

social, health and economic challenges the borough faces.

Our revised Green Space Strategy will provide the direction, priorities and

aspirations to achieve this and much more in years to come. We know we won‟t

be able to deliver everything included in our strategy alone. So working in

partnership with local people, our communities and partners will be key to

achieving our shared vision. From community actions, to partnership projects, local

people and partners will be central to delivering our strategy.

Sheena Ramsey

Knowsley Council

Chief Executive

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CONTENTS

Page

1. Purpose

4

2. Recommendations

4

3.

Background

5

4.

The Green Space Contribution to Improving Public Health

6

5. Knowsley‟s Green Space Strategy and Assets

10

6. Measuring the contribution of Knowsley‟s Green Spaces to

securing Public Health outcomes

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7. Next steps -

Health Commissioning through the Green Space Asset

22

8. Key Points for Discussion with Public Health Commissioners and

Practitioners

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9. Conclusion

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Reviewing Knowsley’s Green Space Strategy:

Knowsley’s Natural Health Service

1. Purpose

1.1 The quality and range of the Council‟s Green Space assets and associated

services create significant potential to impact on broader health outcomes

by providing an innovative, attractive and wide ranging preventative and

treatment focussed health activity. However, currently there is no established

direct commissioning pathway for Knowsley‟s Health and Wellbeing Board or

Clinical Commissioning Group and therefore their contribution towards

securing strategic outcomes is not maximised and to some extent is

unrecognised.

1.2 This paper seeks to remedy this position by providing a robust rationale and

clear route map by which the public health value of Knowsley‟s green space

assets can be maximised, fully, utilised and indeed measured. On this basis

the paper:

a) Recognises the policy context and requirement of the Public Health

Outcomes Framework for England and the associated role that the

Council has in improving the physical, mental health and wellbeing

outcomes for the people and communities of Knowsley;

b) Describes the current good quality and public accessibility offer of

Knowsley‟s green space asset and complementary services;

c) Identifies the in-formal contribution that these green spaces are currently

making to securing health and wellbeing strategic outcomes;

d) Outlines proposals for how this offer can be extended, subject to

investment, and readily tailored to directly contribute to securing the

Public Health Outcomes Framework in a manner that offers substantial

value for money; and

e) Proposes next steps to realise opportunities to demonstrate such worth

through formalising partnership working during the term of the revised

Strategy.

2. Recommendations

It is recommended that the contribution Knowsley‟s green spaces provide to

securing physical and mental health and well being outcomes is

incorporated as a key element in the revised Green Space Strategy.

The Green Space Strategy will:

a) Ensure health commissioners and practitioners are fully aware of

Knowsley‟s green spaces facilities and the range of activities that are

undertaken on them.

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b) Utilising the borough parks model to review the contribution Knowsley‟s

green spaces provide in contributing towards and indeed securing public

health outcomes.

c) Consider opportunities to extend Knowsley‟s existing green space health

offer to deliver against the Public Health Outcomes Framework.

d) Explore the opportunities and demand for green referrals with Knowsley‟s

Clinical Commissioning Group.

e) Develop green space health promotion campaigns to increase

participation through additional funding from Public Health commissioners.

3. Background

3.1 The Council is at the forefront in managing the impacts of the significant

reductions to local government funding. This austerity is particularly acute

when considered against the Council‟s responsibilities for promoting

economic growth and stimulating employment opportunities; embedding

Welfare Reform and managing its impacts; whilst meeting the needs of a

population that demonstrates significant health inequalities compared to the

majority of other parts of the country. Therefore the Council is developing

innovative ways to deliver against these strategic outcomes and as such an

example this paper highlights the offer that Knowsley‟s natural environment

can make to improving and then sustaining local people‟s health and

wellbeing through:

a) Providing places to enable the wider community to undertake physical

activity to help prevent obesity and related medical diseases; and

b) Bringing people close to the natural environment and through such

interaction helping their physical and mental health and in so doing

improving their sense of wellbeing.

3.2 Such offers sit alongside the social growth, educational, economic growth,

urban regeneration, crime reduction and climate change adaptation

benefits that Knowsley‟s natural environment offers; largely through a diverse,

high quality, readily accessible and free to use green space parks and open

spaces infrastructure. Complimentary briefing papers have been prepared in

respect to the contribution that green space can make to those other

agendas.

3.3 It is acknowledged that the mere presence of a park does not guarantee a

healthier population and although Knowsley‟s parks and green spaces have

certainly improved in quality, safety and accessibility over recent years,

largely through the proactive leadership of dedicated community volunteers,

it is essential in the current context that they offer more than simply a pretty

place to view for a minority of the population. Instead they must be seen as a

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vital resource which is valued by the community as a multi-functional asset

that can be utilised to address the pressing social, health and economic

growth challenges that the borough faces.

3.4 In line with the UK Chief Medical Officers‟ (CMO) guidelines outlining the

amount of exercise adults and children need to do to stay healthy, and in so

doing reduce the current and longer-term financial burden on the NHS, parks

offer a fantastic opportunity for GPs and Public Health practitioners to offer a

fresh and varied approach to engaging local people and encouraging them

to adopt and sustain more active lifestyles.

3.5 Appendix A provides information about the role local authorities now have in

directly improving the health of their population.

4. The Green Space Contribution to Improving Public Health

4.1 There is well documented evidence which demonstrates that contact with

the natural environment promotes good health, and participation in regular

physical activity generates physical, mental and wellbeing benefits. Physical

exercise in natural environments (e.g. parks and other green spaces) has

important implications for public health and the preservation of the

environment. Conservation volunteering, for example, is an activity which has

the potential to deliver dividends in terms of environmental conservation as

well as wellbeing and health.

4.2 Such evidence is highlighted below with more information provided in

Appendix B:

a) People living in areas with high levels of green space are three times more

likely to be physically active and 40% less likely to be overweight or obese

than those with low levels;

b) Green spaces improve air and noise quality in urban areas with trees

cutting pollution by 25% helping to reduce pulmonary obstructive disease

such as bronchitis and asthma;

c) The availability of green spaces within cities is linked to mental wellbeing

and physical fitness of the population;

d) Regular environmental volunteering produces significant improvements in

cardiovascular fitness;

e) Natural spaces benefit well being – the human response to nature includes

feelings of contentment and a reduction in stress;

f) Populations living in greener environments have lower levels of income

related health inequality;

g) Green spaces offer improvements in mental health, through recovery

from, or alleviation of, mental illness and stress and through helping to raise

a feeling of well-being among people;

h) A number of psychological studies have proven that the overall quality of

life can be enhanced by the addition of natural green spaces as distinct

therapeutic links exist between moods, health, recuperation time and

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nature. Thus, regular access to restorative, natural environments can halt

or slow processes that negatively affect mental and physical health; and

i) Trees in particular fulfil certain psychological, social and cultural needs,

they play an important social role in easing tensions and improving

psychological health e.g. one study has demonstrated that hospital

patients placed in rooms with windows facing trees heal faster and require

shorter hospital stays than those facing the urban environment.

4.3 The Council through its Public Health responsibilities and associated Health

and Wellbeing Board has the opportunity to collaborate with Knowsley‟s

Clinical Commissioning Group (CCG) to explore the natural health service

options that the borough‟s diverse and flourishing natural surroundings offer

to delivering the Department of Health‟s Public Health Outcomes

Framework (January 2012). Securing the headline outcomes of the

Framework of increasing healthy life expectancy and reducing differences

in life expectancy and healthy life expectancy between communities is

particularly challenging in Knowsley as seen in the borough‟s Joint Strategic

Needs Assessments. These identify heart and circulatory disease as the

biggest cause of death in the borough and a markedly lower life

expectancy for Knowsley residents when compared with the rest of

England. It is evident that a complex and diverse range of interventions

are needed to address this severe situation; however, both the Framework,

the Public Health Physical Review for Knowsley (2012) and the current

review of the Obesity Strategy recognise the contribution that green

spaces can make to address such matters.

4.4 The Public Health Physical Activity Review for Knowsley identified the following

recommendations that relate to maximising the impact of Knowsley‟s green

spaces:

a) Promote low / no cost opportunities across the borough for all through

walking and cycling; self-care and active play in parks and green spaces;

b) Create active environments by providing open spaces and facilities which

encourage physical activity for people with different needs;

c) Promote public parks, green spaces and facilities as well as more non-

traditional spaces; and

d) Support community networks and volunteers to provide opportunities and

promote physical activity messages (support friends of the parks group).

4.5 The Public Health Outcomes Framework references two key performance

areas where green spaces can contribute towards health outcomes:

a) Utilisation of green space for exercise / health reasons; and

b) Proportion of physically active and inactive adults measured by the

number of adults achieving at least 150 minutes of physical activity per

week and the proportion of adults classified as “inactive”.

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4.6 Utilisation of green space for exercise / health reasons

This indicator directly recognises the significance of accessible green space

as a wider determinant of public health through their beneficial impact on

physical and mental wellbeing and cognitive function through both physical

access and usage. The data to support reporting against this indicator is

taken from Natural England‟s Monitoring of the Engagement with the Natural

Environment (MENE) survey. MENE collects information about visits to the

natural environment which includes the type of destination, the duration of

the visit, mode of transport, distance travelled, expenditure, main activities

and motivations and barriers to visiting. The survey also collects information

about other ways that people engage with the natural environment, such as

watching wildlife and volunteering. Fieldwork for the survey started in March

2009 with around 800 respondents interviewed every week across England

using an in-home interview format. Since then every year at least 45,000

interviews have been undertaken using a quota sampling method to ensure

that results are representative of the English adult population (16 years and

over). Data is available at the England, regional and local authority levels

via an annual report and monthly updates.

4.7 Proportion of physically active and inactive adults

Lack of sufficient physical activity costs the NHS over £1bn per year and is one

of the top risk factors for premature mortality (with other unhealthy lifestyle

choices including alcohol consumption and smoking). Physical activity

provides important health benefits across all age groups, and participation in

sport and active recreation during youth and early adulthood can lay the

foundation for lifelong participation in health-enhancing sport and wider

physical activity.

4.8 This indicator reflects the four UK CMO physical activity guidelines Start Active,

Stay Active covering early years; children and young people; adults; and

older adults which were published in July 2011. These guidelines have

renewed focus on being active everyday and spell out the recommended

minimum levels of activity for each age group:

a) Under-fives - 180 minutes (three hours) each day, once a child is able to

walk;

b) Children and young people (5-18 year olds) - 60 minutes and up to several

hours every day of moderate to vigorous intensity physical activity, three

days a week should include vigorous intensity activities that strengthen

muscle and bone; and

c) Adults (19-64 years old) and older people (65+) - 150 minutes (two and half

hours) each week of moderate to vigorous intensity physical activity (and

adults should aim to do some physical activity every day), muscle

strengthening activity should also be included twice a week.

4.9 The indicator is measured using Sport England‟s Active People Survey which

has continuously measured the number of people taking part in sport across

the nation and in local communities since 2007/08 and its findings are

published every six months and can be scrutinised at a local authority level. It

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provides estimates of the number of people taking part in sport, how often

people take part in sport and what sports they do. Variations between

different regions are tracked which allows analysis by demographic factors

such as gender, social class, ethnicity, age and disability.

4.10 The key measure the survey uses is the „1 x 30‟ indicator. This is defined as the

percentage of the adult population participating in sport, at moderate

intensity, for at least 30 minutes on at least four days out of the last four weeks

(equivalent to 30 minutes on one or more days a week).

4.11 Knowsley‟s current performance against these indicators

Table 1 shows the current performance rates against these two indicators for

Knowsley in comparison with the North West and the rest of England. The

results for the utilisation of green spaces for exercise / health reasons relate to

the period March 2009 to February 2012, with results for the year March 2012

to February 2013 due to be published this autumn.

Table 1 – Current Performance against the MENE and Sport England Indicators Outcome Knowsley North West England Utilisation of green spaces for

exercise / health reasons 4.48% 12.03% 14.02%

Proportion of adults achieving at least

150 minutes of physical activity per

week 15.8% 17.7% 16.6%

4.12 There is a marked difference in the utilisation of green spaces for exercise /

health reasons in Knowsley compared to the North West and the rest of

England. Indeed Natural England has placed Knowsley in the bottom 10% of

local authorities where people use outdoor places for exercise / health

reasons; Appendix C shows Natural England‟s MENE Mapped Survey Results.

4.13 Therefore Knowsley‟s good quality and readily accessible green space

environment is being very much underutilised to improve public health.

Consequently it is proposed that greater emphasis should be focused on

utilising these green space assets in the commissioning of interventions

targeted at the prevention and treatment of disease, poor health and mental

illness. They would provide an attractive referral route for Public Health

practitioners, GP commissioning groups and most importantly the people of

Knowsley who are suffering the greatest health inequality. The details of this

offer, its projected reach and value for money are outlined in the following

sections of this paper.

4.14 It is important to identify that the Council‟s Activity for LIFE exercise and

lifestyle referral programme promotes a more healthy and active lifestyle to

the people of Knowsley. The programme is aimed at inactive adults over the

age of 16 who are looking to lead a more active lifestyle. Referrals onto the

programme can be via a GP or residents can self refer. Activities include tai

chi, gym sessions, health walks, swimming, cycling, organised social days out

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and weekly weigh in/support and advice sessions. The programme has two

strands:

a) A GP referral Cardiovascular Disease (CVD) programme that supports

people who are inactive with one or more CVD risk factors to increase

their activity levels in a safe and supported environment; and

b) A community programme that supports people to be more active with a

range of options for example using the gym, attending classes or joining a

local walking group.

5. Knowsley’s Green Space Strategy and Assets

5.1 Knowsley‟s Green Space Strategy

Knowsley‟s Green Space Strategy (2010-2014) describes the borough‟s

publicly accessible green space asset in terms of their quantity, quality and

accessibility across a variety of green space typologies:

a) Parks and gardens of which there are 28 urban parks, formal gardens and

country parks;

b) Natural and semi-natural green spaces including 28 woodlands,

grasslands, and wetlands with open and running water;

c) Children and young people‟s facilities which offer 39 equipped play areas,

multi use games areas and skate parks for different age groups;

d) Allotment gardens of which there are nine statutory sites;

e) Outdoor sports provision providing 20 natural and artificial sports provision

including playing pitches and bowling greens; and

f) Green corridors of which there are four.

5.2 The Strategy acts as a reference point for all matters relating to the freely

accessible green space realm and to provide a framework to ensure that this

important public resource is promoted so that local people utilise its wide

ranging offer and to ensure that it is managed in an accountable, sustained

and consistent manner. Good quality green spaces contribute to the

achievement of prosperous, vibrant and sustainable neighbourhoods yet

conversely low standard green spaces can be correlated with community

deprivation, poor-health and disadvantage. The Strategy provided the

foundations to address these challenges and so allow green spaces to deliver

their spectrum of benefits to communities and the natural environment.

5.3 The significant majority of the key priorities and projects within the Green

Space Strategy have been delivered providing a substantial step change

primarily in the quality and accessibility of all green space typologies. Such

success is demonstrated through:

a) An increase of 73% proactively supported green space community groups

from 30 in 2007/08 to 52 in 2012/13;

b) Additional 27,000 volunteer hours at an economic value of £0.310m per

annum;

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c) Over £6m of external investment secured for green space infrastructure

improvements between 2008/09 and 2012/13;

d) Significant wider citizen involvement and increasing civic pride;

e) Substantial increase in capacity and skills amongst groups and individuals

secured through the delivery of successful and highly valued Green Space

Assets;

f) 100% increase in participation in green space events and activities from

35,000 in 2007/08 to over 70,000 for 2012/13;

g) A 100% increase in Green Flag Awards from six in 2008/09 to twelve in

2013/14 with such a park being readily accessible to all of Knowsley‟s

communities; and

h) A 100% rise in the average quality score of parks from 32 in 2007/08 to 64 in

2012/13.

5.4 These achievements coupled with the compilation of a new Green Space

Audit (2012), as part of the evidence base to support the ongoing

preparation of the Council‟s Core Plan, make a review of the Green Space

Strategy timely and this work is scheduled to take place on this during the

remainder of 2013/14. This review will focus on identifying how the borough‟s

now largely good quality green spaces and functions can contribute to the

Council‟s Corporate Plan Strategic Objectives. Key to this work will be

correlating specific neighbourhood health, child poverty, joblessness and

other key challenges set out in the Council‟s Joint Strategic Needs

Assessments against the green space assets in these areas to ensure that

green space offer and associated services align appropriately to addressing

these local trends and needs. Appendix D provides an overview on how

green spaces could address such JSNA issues.

5.5 The Council is committed to utilising existing assets to promoting health and

wellbeing. An important part of developing an asset based approach was

the production of a Joint Strategic Asset Assessment (JSAA) which aims to

identify the key physical and community (people) assets in the borough and

how they can be best utilised to address key health and wellbeing issues. The

JSAA sits alongside the JSNA approach to inform public health in planning

commissioning and service delivery. See Appendix E for more detail.

5.6 Knowsley‟s existing green space assets and their offer

Knowsley‟s green space assets have been proactively developed to

enhance their quantity, quality and accessibility so as to maximise their use

and the programming of events / activities. The latest Green Space Audit,

undertaken in 2011, provides a thorough overview of the progress made at

them all. The audit identified 735 sites based on the definition of public open

space in PPG17 each of which have been assessed individually. The number

of sites that fulfil the PPG17 definition of a park have increased through recent

investment in enhancements prioritised in the Green Spaces Strategy from 16

in 2008 to 34 in 2011. The Audit and further quality monitoring for 2013 has

been utilised to provide up to date standards data for parks and green

spaces within Knowsley and is provided in Research Paper 2. This data will be

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utilised to provide strategic priorities for the ongoing improvement of green

spaces in Knowsley.

5.7 Significant attention has been placed on providing a readily accessible, safe

and welcoming environment to those using Knowsley‟s parks and green

spaces. Furthermore, it is recognised that by providing a variety of facilities

and different spaces layered onto a park enhances their popularity with

people with diverse interests and skills. This in turn encourages a well used,

active park that self-generates community engagement, pride in the local

area and therefore ownership and care of the facilities on offer. It is on this

basis that the Council has invested in Knowsley‟s green space infrastructure

which are now arguably the best in Merseyside, if not further afield.

5.8 Such improvements have included provision of new and refurbished play

equipment for all childhood age groups; walking and cycling infrastructure;

attractive and Disability Discrimination Act compliant entrances, footpath

and play areas; enhancement of natural features; improved landscape and

park furniture including directional signage; benches; and interpretation

boards. Appendix F provides examples of such site improvements.

5.9 Green space management actions are targeted through Knowsley‟s Green

Space Asset Management Plan (AMP). The AMP is nationally a first of its kind

management tool that establishes the cyclical maintenance and

replacement costs of green space assets over a 25 year period. The AMP

defines four main works categories: maintenance operations; asset renewal;

augmentation and asset disposal. Work categories are then assigned to a

variety work programmes and resource options including: external funding

procurement; volunteer tasks; training scheme providers and social justice

schemes. This groundbreaking system has influenced the Council to invest

£0.500m in green spaces over a five year period which commenced in

2012/13. This also ensures that volunteers are adequately resourced to

undertake maintenance and enhancement operations.

5.10 Knowsley‟s Green Spaces Team is made up of Parks and Cemeteries

operational staff (34fteGreen Space Development (3fte) officers and the

Rangers (5.8fte). The Parks team are responsible for the grounds

maintenance and specialist horticulture works across the borough‟s green

spaces. There has been a continual renewal and investment in skills at

management and operational levels, for example in order to provide a

dynamic, responsive and reliable customer focused service, the Team have

implemented a quality system achieving ISO9001:2008. Maintenance

schedules are in place for each site and are managed through the CONFIRM

asset management system.

5.11 The Green Space Development Officers and Green Space Rangers have a

primary remit to establish and support green space community groups

including friends of groups, allotment associations, residents groups, walking

clubs, sports clubs, athletics organisations and voluntary play organisations. In

addition, a broad range of other partnerships are proactively fostered with:

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training providers; businesses and charitable organisations. The Ranger

Activity Programme delivers a range of activities with a focus on health and

well being, education and training, family/community activity and supporting

volunteering.

5.12 Health and Wellbeing Campaigns

The creation of safe, attractive and active green environments has

encouraged both supported and independent use of the borough‟s green

spaces. The Green Spaces Team has undertaken a number of initiatives to

promote these green spaces under the health and well being agenda. These

include the development, production and distribution of A5 postcards

branded „Your park; your place‟ which have been tailored for each area of

the borough and they map the key parks and green spaces within each

location. The back of the postcards provide a series of nudges or prompts

regarding the healthy pastimes that parks and green spaces offer: walk;

explore, learn, cycle, play, relax, volunteer and conserve. These ideas reflect

the national research regarding the market segmentation of park users. The

leaflets were distributed to colleagues in Public Health, NHS Knowsley Health

trainers, Activity For Life staff and were available to pick up from Council

buildings such as the one stop shops, libraries and health centres; see

Appendix G for an example of this promotional material. A Walking Booklet

for group or independent use is currently being produced for launch in

autumn 2013 which will map 16 green space walks throughout the borough,

each with measured distances and numbers of steps.

5.13 Physical Activity

Knowsley‟s green spaces facilitate improved physical activity levels in terms of

supported use / health products; independent use / self care; and mass

participation and sports. There has been a 100% increase in participation in

green space events and healthy activities from 35,000 participants in 2007/08

to over 70,000 participants in 2012/13. The Rangers collect this data by

recording the number of participants attending each event / activity. This

provision enables a range of opportunities for all people and provides a

pathway of use. Examples of the range of activities include:

a) Walking (including supported health walks and „Nordic‟ walking);

b) Cycling (including supported „Pedal Away‟ schemes);

c) Running (including cross country events);

d) Children‟s Play (including a range of organised events);

e) Sports (facilities include football league standard pitches, bowling greens,

cricket pitches); and;

f) Organised events with physical activities.

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6. Measuring the contribution of Knowsley’s Green Spaces to securing Public

Health outcomes

6.1 Knowsley‟s green spaces are making an informal contribution to the

borough‟s health and wellbeing outcomes (albeit they are being

underutilised for this purpose). However, in order to ensure that this added

value is appropriately captured and measured a framework has been

devised that directly links current green space infrastructure standards and

associated resources / activities with the Public Health Outcome indicators

identified in paragraph 3.5. Against this baseline position a range of scenarios

have been modelled to assess how this contribution can be enhanced

through additional revenue and / or capital investment. This approach has

been designed to instigate discussion over measuring public health outcomes

and can be readily tailored as such engagement develops.

6.2 To demonstrate this impact the model focuses on Knowsley‟s four Borough

Parks but it could be extended to all of Knowsley‟s green spaces to assess

their individual or combined current and potential future contributions to

tackling neighbourhood specific health and wellbeing needs.

6.3 Modelling Knowsley‟s Borough Park‟s Contribution to Public Health Outcomes

The Green Space Strategy identifies four Borough Parks within Knowsley these

are large in size with the capacity to provide a broad range of recreational

facilities, formal and informal activities and can contain a variety of green

space typologies e.g. children and young people‟s facilities, outdoor sports

provision and areas of natural habitat. These parks also offer facilities such as

environment centres which act as a hub for community events and the

Council‟s Green Space Ranger service. Their catchment is on a borough

wide level with people often travelling within and into Knowsley to visit them.

6.4 Knowsley‟s four Borough Parks are outlined below and these have been used

to model their existing and potential future contribution to securing the

borough‟s public health outcomes:

a) Mill Dam Park (Kirkby);

b) Stadt Moers Park (Prescot, Whiston and Huyton);

c) Court Hey Park (Huyton); and

d) Halewood Country Park (Halewood).

The model is provided as Appendix H.

6.5 Section A of the Model

The first section of the model identifies the current contribution the Knowsley‟s

Borough Parks are making to Public Health outcomes; this is measured in

terms of the number of people visiting these sites and the reason for their trip

(activity). These indicators have been divided into three different types of

headline Activity Areas against which examples of this activity are referenced

(e.g. walking, cycling, running, play, angling, community and conservation

activities), the current levels of public attendance are recorded against each

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example activity and the resource inputs provided via the Council are

provided (both revenue and capital).

6.6 The three Activity Areas are described below:

a) Self Care / Independent Community Use

Knowsley‟s green spaces provide a wealth of opportunities for

independent use and self care including; walking cycling, horse riding,

children‟s play and sports such as football, bowling and cricket.

Independent use of Knowsley‟s green spaces is monitored for some assets

through a process of periodic head counts, collection of anecdotal

evidence from green space staff and the installation of cycle counters.

However, participation rates are estimates based on a range of different

sources such as head counts (see Appendix I for the methodology used)

and therefore is not 100% accurate;

b) Supported Use / Health Products

Knowsley‟s Green Space Rangers currently provide a range of health

products or supported use activities. These include; walking, cycling, forest

schools, conservation volunteering, geo-caching, munzee and

orienteering. Key performance indicators have been collected and

collated by the Rangers since 2003/04 and include the numbers of

activities and numbers of participants for a range of green space service

including health provision so these figures are relatively accurate; and

c) Mass Participation and Sporting Activity

Knowsley‟s green spaces also provide opportunities for a range of

supported mass participation events including cross country, cycle cross,

equestrian events and fun run events. Key performance indicators on

numbers of participants are also collected for these activities. In addition

to the collection of Council organised events, external event organisers

such as „Race For Life‟ provide their data on the number of participants in

attendance. Thus these figures are relatively accurate.

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6.7 The range of activities against which each Activity Area‟s participation figures

are measured against listed in Table 2 below with an explanation of each also

provided.

Table 2: Activities measured for public participation in each Activity Area Activity Type Description Walking This includes independent walking, dog walking and

walking in groups such as health walks, guided walks,

nordic walking and orienteering. Cycling This includes independent cycling and group cycling

such as pedal away and cycle cross. Running This includes independent running as well as organised

group running such as running clubs and cross country

running. General Sport Activity This includes a range of both independent sporting

activity as well as group sports such as football, cricket,

and bowling. Geo Caching &

Munzee Geocaching is a real-world, outdoor treasure hunting

game using GPS-enabled devices. Participants navigate

to a specific set of GPS coordinates and then attempt to

find the geocache (container) hidden at that location. Munzee is a real-world scavenger hunt game where items

are found in the real world and captured using a

smartphone with points obtained by capturing other

people's munzees. Munzee is based on the fundamentals

of geocaching and adds another layer of fun to the hunt. Play This includes independent play within parks using the

range of playgrounds as well as general play activities

within parks and green spaces. Angling This relates to angling across the borough park ponds. Education with Health This captures Ranger led activities such as forest schools,

play activities, bat walks, mini beast hunts, nature trails

and pond dipping. Community Activities This includes fun days, sports days, shows and gala‟s. Conservation Activities This includes conservation task days, bulb planting,

wildflower sowing, clean-up activities. Other Activities This captures those who use the parks to relax, to seek

peace and tranquillity (i.e. mindfulness).

6.8 Participation figures have been calculated in accordance with the approach

outlined in summary below and provided in more detail in Appendix I.

6.9 In order to extrapolate the public attendance figures into participation figures

the model uses the Activity for Life programme indicator which records one

participation when an individual has undertaken a particular exercise on six

separate occasions. This formula is based on the assumption that after six

sessions they have:

a) Gained the skills to undertake the task;

b) Developed the confidence to do the task (potentially on their own);

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c) Created social links with other participants;

d) An individual has established a habit (and could potentially continue on

their own); and

e) Seen a small positive impact on their health.

6.10 Therefore, if each participant accesses a green space for an activity in any

one of the identified three Activity Areas on six occasions then a record of

one participation in health and wellbeing activity is measured in the model.

This method of measuring participation rates is provided as a starting point to

demonstrate the potential for green spaces to contribute to Public Health

outcomes and they can be readily amended to align with public health

commissioner / practitioner requirements.

6.11 The current Resource Inputs highlighted reflect staff, maintenance, marketing

and infrastructure costs to support the Activity Areas and are based on

2013/14 revenue budgets. This section of the model also references the

capital investment that each Borough Park has secured since 2005/06 and

identifies the infrastructure improvements this investment has delivered.

6.12 Section B of the Model

The second section of the model identifies a number of opportunities for

enhancing the offer of the three Activity Areas and the revenue and capital

investment needed to secure these. It should be noted that extension of the

model across all parks in Knowsley would enable further interventions and

extension of the health product to be aligned fully to local population trends

and community needs in line with the Joint Strategic Needs Assessment.

6.13 The revenue investment opportunity examples provided in the model differ

between the Borough Parks, however, they are listed and defined below

along with a summary of the key benefits they offer:

Volunteer development – this will include supporting existing volunteer

groups and friends group and new groups to promote, attend and deliver

health sessions, by providing training and accreditation to empower them

to utilise the green space assets to bring added value and resources

contributing the public health agenda;

Supporting partners – this will include engaging new and supporting

existing third sector partners (such as pedal away, the national wildflower

centre) along with sporting groups to deliver more diverse health

promotion activities for Knowsley‟s residents;

Staffing – By retaining / increasing the number of Green Space Rangers,

more residents will be encouraged and supported to undertake healthy

activities;

Marketing – Knowsley‟s green space assets and the facilities they provide

need to be advertised to attract new visitors to the sites and to encourage

them to participate in the Activity Areas depending on their preference;

Activity facilitation – this will make it easier for Knowsley‟s to participate in

health promotion activities by extending existing Ranger activities,

creating new activities and ensuring that the green spaces are suitable for

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that activity (i.e. grounds maintenance, opening times of the environment

centre and visitor guides); and

Evaluation – to capture accurate participation data and key performance

data as required by health commissioners to evidence health impacts and

outcomes.

6.14 This section of the model highlights the projected annual revenue costs of

providing these Activity Area enhancements to allow a comparison against

the 2013/14 Resource Inputs shown in Section A. The model also highlights the

additional capital investment requirement required at each Borough Park

and provides a projected cost for each item.

6.15 As recognised in Knowsley‟s Green Space Strategy the asset condition of a

park has a direct correlation with the site‟s ability to deliver the activities

associated with each Activity Area. This is the reason why great attention has

been paid and associated success secured in working with the community to

secure external grant funding to make capital investment improvements in

the borough‟s green spaces. However, outstanding capital investment

requirements are still apparent if these sites are to offer their full potential to

the public health agenda; so these requirements must be considered in

addition to the revenue costs highlighted in the model. They do significantly

add to the resource levels required to secure the outcomes presented,

however, external grant funding and developer contribution opportunities do

exist for such works and are being pursued. Furthermore such applications for

external funding can be directly correlated to supporting the public health

agenda then their chance of success is regarded as being high.

6.16 Capital improvement works significantly improve the appearance of a green

space making it more attractive to residents. Many improvements include

enhancing the existing infrastructure or creating new facilities thereby

attracting new park users. Examples of capital investments include:

a) Installation of signage and way markers;

b) Improving / creating new entrances and pathways;

c) Woodland management works;

d) Pond improvements;

e) Installation of new play equipment;

f) Creation of car parking areas; and

g) Building improvement works.

As an example Appendix J highlights the £0.600m of capital investment that is

required at Stadt Moers Park if it is to offer its full potential. This cost represents

the infrastructure improvements that would ensure that the park has a positive

public profile in the surrounding community and can be marketed as a leisure

destination across the Liverpool City Region for each of the three Activity

Areas.

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6.17 The Council‟s Green Space Development Team have a good track record for

identifying and securing external funding for green space improvement

capital improvement programmes, securing £6million since 2008.

6.18 Section C and D of the Model

Section C and D of the model identifies the outcomes that are projected to

be secured following the investment made in the Activity Areas shown in

Section B. This is measured in public participation in line with the approach

outlined in paragraph 5.7.

6.19 The projected participation figures have been based on a increase in

participants undertaking healthy activities as a result of the improvements

made to the green spaces, for example, an increase in Rangers and their

ability to provide supported health activities. At this point they do not include

clinical interventions such as GP referrals which is certainly something that

would be welcomed and on this basis further discussions will be required with

the Clinical Commissioning Consortia regarding this opportunity.

6.20 What does the Model tell us?

Table 3 below provides a summary from all four Borough Parks‟ modelling of

current financial investment and associated participation outcomes and the

increase in participation that additional investment in each Activity Area

would provide. It also shows an average cost per participant based on

current arrangements and revenue costs against a new average

participation cost based on the additional revenue cost of the investment

options. At this point of time, nationally there does not appear to be any

other green space healthy activity offers to enable a benchmarking exercise

of costs.

Key points to note are as follows:

a) One participation = six individual visits;

b) The model relates to four parks only and can be readily extended to all of

Knowsley‟s publically accessible green spaces;

c) The Council‟s 2013/14 revenue expenditure on the four Borough Parks is

£0.158m which provides an estimated public participation figure of 21,592

in health related activities, therefore the average cost per participation is

£7.31;

d) An identified extra £0.148m per annum of revenue expenditure in these

parks will bring an additional public participation rate of 6,715;

e) Therefore using the 2012/13 revenue expenditure of £0.158m plus the

additional £0.148m a total annual revenue expenditure of £0.307m could

provide a public participation figure of 28,307, at an average cost of

£10.84 per participation.

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Self Care /

Independent Use

Health Products /

Supported Use

Mass

Participation /

Sport

Section A

2013/14 Revenue Resource Input (£) 70,501 63,589 23,760 157,850

Current Projected Participation Level 17,853 1,239 2,500 21,592 7.31

Section B and C

Proposed Revenue Resource Input (£) 96,075 169,865 40,860 306,800

Projected New Participation Level (from Proposed Revenue Resource Input) 21,813 2,474 4,020 28,307 10.84

Section D

Additional Revenue Cost on 2013/14 Input 25,574 106,276 17,100 148,950

Additional Participation on Current Participation (from Proposed Revenue Resource Input) 3,960 1,235 1,520 6,715

Note: One participation = six individual visits

Table 3: Model Outcomes

Activity Area

Total

Average

cost per

Participant

(£)

Section

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6.21 In analysing this information a number of options can be presented as set out

below.

6.22 Option 1 - Extended Self Care and Supported Use / Health Products Activity

Areas

If the Council secured an additional £0.132m of annual funding from 2014/15

this would enable additional participation rates of 5,195 within the four

Borough Parks; of which 3,960 can be attributed to self care and 1,235

supported use/health products. Therefore, with existing Council funding plans

and this new funding, Knowsley‟s Borough Parks would provide an overall

participation rates of 24,287, of which 21,813 can be attributed under self

care activities and 2,473 as supported use/health products.

6.23 Option 2 - Extended Self Care and Supported Use / Health Products Activity

Areas and Mass Participation

If the Council secured an additional £0.149m of annual funding from 2014/15

this would enable additional participation rates of 6,715 within the four

Borough Parks; of which 3,960 can be attributed under self care activities,

1,235 as health products and 1,520 as mass participation and sports.

Therefore, with existing Council funding and this external funding, the Borough

Parks would provide an overall participation rates of 28,307 (an overall

increase in participation of 24%).

6.24 This borough parks model demonstrates a cost effective and innovative

model of engaging the public in healthy lifestyle activities that are free to

access. Therefore, it is requested that Public Health and the CCG consider

funding the identified additional resources in order to realise the participation

rates projected and their contribution to the Public Health Outcome

Framework indicators.

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7. Next steps - Health Commissioning through the Green Space Asset

7.1 The utilisation of the green space asset in Knowsley offers Public Health and

NHS commissioners with a largely un-tapped, flexible and readily available

resource to deploy to meet their health and well being outcomes. Green

spaces are already making a good in-formal contribution to this agenda and

this needs to be recorded and promoted, yet as the model highlights with

further investment Knowsley‟s parks can offer much more to a wide variety of

participants in a cost effective manner.

7.2 Therefore, in line with the current Activity for Life Service Level Agreement

between the Primary Care Trust and Knowsley Leisure Services (that provides

£0.150m per annum to engage 4,000 people in Activity for Life programmes) it

is proposed that Knowsley‟s green space offer is considered as a

complementary offer to the health professionals that refer people to this

programme from 2014/15 and beyond.

7.3 Formally linking the natural environment to the health professionals‟ outcomes

is a matter being forwarded at the sub-regional level. The Liverpool City

Region Local Nature Partnership action plan places an importance on

embedding green spaces as priority to deliver health outcomes, specifically

to identify projects to help deliver Health and Wellbeing Strategies, to inform

the next round of Joint Strategic Needs Assessments and Clinical

Commissioning Consortia and advance LNP priorities. Whilst ChaMPs

(Cheshire and Merseyside Public Health Organisations) engaged in such

plans. Examples of this include the preparation of a business plan by the

Natural Health Service Consortium Business Plan (led by Mersey Forest) who

are working together to develop a co-ordinated offer of products to health

commissioners. The consortium members include organisations such as

Mersey Forest, TCV, Groundwork and Wildlife Trusts. They have agreed to co-

operate as a social enterprise that provides an access point for health

commissioning bodies.

7.4 Thus in light of the reputation Knowsley already has for health based delivery

via its green space assets and the fact that it is well placed to deliver the

health outcomes utilising its high quality assets, Knowsley has an opportunity

to support and drive forward the agenda with this consortium. Joining the

consortium would not exclude Knowsley from delivery outside of the

arrangement but may bring some opportunities in terms of GP links and

access to external grant funding. Therefore, it is proposed that the Council‟s

engages with the consortium to assess the value of a joint approach.

7.5 Given the breadth of organisations potentially seeking to commission

programmes on behalf of Public Health and Clinical Commissioning

Consortia, it is important to highlight and demonstrate not only the core

competencies of Knowsley‟s Green Space Health Services but also to outline

the unique selling points that can be provided. Therefore, during 2013/14

work will progress to promote a holistic green space service in Knowsley that

can fully align development, management, maintenance and community

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need in a cost effective manner. Critical to success will be formal

engagement with the Knowsley Health and Wellbeing Board and presenting

a business case to encourage Public Health and CCG investment in the

borough‟s green spaces.

7.6 The accomplishments of Knowsley‟s green space team to date is based on

establishing and fostering partnerships with public agencies, the private and

voluntary sector and directly with the community. Therefore, engaging with

the Health and Wellbeing Board is a logical next step that the team is ready

and keen to make and is confident that its contribution to meeting the

Board‟s objectives can be demonstrated and realised quickly.

8. Key Points for Discussion with Public Health Commissioners and Practitioners

It is recommended that the contribution Knowsley‟s green spaces provide to

securing physical and mental health and well being outcomes is

incorporated as a key element in the revised Green Space Strategy. In

particular the following topics should be considered further:

a) Ensure health commissioners and practitioners are fully aware of

Knowsley‟s green spaces facilities and the range of activities that are

undertaken on them;

b) Utilising the borough parks model, review the contribution Knowsley‟s

green spaces provide in securing public health outcomes;

c) Consider opportunities to extend Knowsley‟s existing green space health

offer to deliver against the Public Health Outcomes Framework;

d) Explore the demand for green referrals with Knowsley‟s Clinical

Commissioning Group; and

e) Develop green space health promotion campaigns to increase

participation through additional funding from Public Health commissioners.

9. Conclusion

Knowsley‟s parks and other green spaces are an underutilised resource with

great potential to offer a significant, varied and unique contribution to

meeting many of the Council‟s and wider Partnership strategic outcomes.

Now is the time to seek return on investment from the time and money that

the community, elected members, officers and funders have put in these

neighbourhood assets over recent years. Doing this requires an innovative

thinking and a partnership approach to identifying, securing and measuring

the outcomes such green spaces can offer.

One such approach is through opening a dialogue with health commissioners

and practitioners so as to recognise and then realise the multi-faceted

contribution a local, good quality and popular park makes to improving the

health and wellbeing of the majority of people living and working in Knowsley.

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JOHN FLAHERTY

Director of Neighbourhood Services

Contributing officers:

Rupert Casey, Head of Environmental Services Tel. 0151 443 2411

Caroline Davies, Public Open Spaces Manager Tel. 0151 443 2829

Fiona Mather, Green Space Strategy Manager Tel. 0151 443 2443

Appendices:

Appendix A: Changes in Public Health

Appendix B: Evidence Base (Green Spaces and Health)

Appendix C: Natural England‟s MENE Mapped Survey Results

Appendix D: How can Knowsley‟s green spaces address issues identified in

the JSNA?

Appendix E: A Joint Strategic Asset Assessment for Knowsley

Appendix F: Example of Infrastructure Improvements

Appendix G: Example of Health and Wellbeing Campaigns

Appendix H: Borough Parks Model

Appendix I: Methodology for Quantifying Participation Rates for Self Care

and Independent Use

Appendix J: Stadt Moers Capital Investment Requirements

References:

Public Health England – Priorities for 2013 and 2014

Department of Health (2011), Chief Medical Officers „Start Active, Stay Active‟

Natural England (2009) „Our Natural Health Service - The role of the natural

environment in maintaining healthy lives‟

Department of Health (2005) „Choose Health White Paper‟

Marmot Review (2010) „Fair Society, Healthy Lives‟

National Institute of Health and Clinical Excellence (2009) „Promoting physical

activity, active play and sport for pre-school and school-age children and young

people in family, pre-school, school and community settings‟ Guidance 17

Mitchell R & Popham F (2007) „Green space, urbanity and health: relationships in

England‟. Journal of Epidemiology and Community Health 61: 681-683

Kaczynski A & Henderson KA (2007) „Environmental correlates of physical activity: A

review of evidence about parks and recreation‟. Leisure Sciences 29: 315-354.

Coombes E, Jones A & Hillsdon M (2010) „The relationship of physical activity and

overweight to objectively measured green space accessibility and use‟. Social

Science and Medicine 70: 816-822

Zlot AI & Schmid TL (2005) „Relationships among community characteristics and

walking and bicycling for transportation or recreation‟. American Journal of Health

Promotion 19: 314-7.

Synovate (2009) The Royal Parks in-park research report 2009 – All parks combined.

Takano T, Nakamura K & Watanabe M (2002) „Urban residential environments and

senior citizens‟ longevity in megacity areas: the importance of walkable green

spaces‟. Journal of Epidemiology and Community Health 56: 913-918.

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Natural England (2009) „Green Space Access, Green Space Use, physical activity

and overweight‟: a research summary.

Kaplan R & Kaplan S (1989) The experience of nature: A psychological

perspective, Cambridge University Press

Guite HF, Clark C & Ackrill G (2006) „The impact of the physical and urban

environment on mental well-being‟. Public Health 120, 1117-1126

Grahn P & Stigdotter UA (2003) „Landscape planning and stress. Urban Forestry and

Urban Greening‟ 2: 1-18.

Taylor AF, Kuo FE & Sullivan WC (2001) „Coping with ADD: The surprising connection

to greenplay settings. Environment and Behaviour‟

Kuo F E (2001) Coping with poverty: impacts of environment and attention in the

inner city.

Ulrich RS (1984) View through a window may influence recovery from surgery.

Coley RL, Kuo FE & Sullivan, WC (1997) Where does community grow? The social

context created by nature in public housing.

Sullivan WC, Kuo FE & DePooter SF (2004) The fruit of urban nature. Vital

neighbourhood spaces.

Kweon B-S, Sullivan WC & Wiley AR (1998) Green common spaces and the social

integration of inner-city older adults.

Seeland K, Duebendorfer S & Hansmann R (2008) Making friends in Zurich‟s urban

forests and parks: The role of public green space for social inclusion of youths from

different cultures. Forest Policy Economics 11: 10-17.

Kuo FE, Sullivan WC, Coley RL & Brunson L (1998) Fertile ground for community:

Inner-city neighbourhood common spaces. Americal Journal of Community

Psychology 26: 823-851

Leake JR, Adam-Bradford A & Rigby JE (2009) Health benefits of „grow your own‟

food in urban areas: implications for contaminated land risk assessment and risk

management? Environmental Health 8 (Suppl 1): S6.

Nowak DJ (1994) Air pollution removal by Chicago‟s urban forest, Chicago's urban

forest ecosystem: results of the Chicago urban forest climate project. United States

Department of Agriculture.

Bernatzky A (1983) The effects of trees on the urban climate. Trees in the 21st

century. Academic Publishers, Berkhamsted, 59–76. Based on the first International

Arboricultural Conference.

Centre for Ecology and Hydrology (no date) Trees and sustainable urban air

quality. CEH, Lancaster. Available at:

http://www.es.lancs.ac.uk/people/cnh/docs/UrbanTrees.htm

Tiwary A, Sinnett D, Peachey C, Chalabi Z, Vardoulakis S, Fletcher T, Leonardi G,

Grundy C, Azapagic A & Hutchings TR (2009) An integrated tool to assess the role

of new planting in PM10 capture and the human health benefits: A case study in

London. Environmental Pollution 157: 2645-2653.

Fang C-F & Ling D-L (2003) Investigation of the noise reduction provided by tree

belts. Landscape and urban Planning 63: 187-195.

Coder RD (1996) Identified Benefits of Community Trees and Forests, University of

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Goode D (2006) Green infrastructure report to the Royal Commission on

Environmental Pollution. Royal Commission on Environmental Pollution.

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Appendix A: Changes in Public Health

The Role of Local Authorities

Since April 2013 local authorities have had a key role in improving the health of

their local population by working in partnership with clinical commissioning groups,

and others, through health and wellbeing boards in their localities. They are

responsible for commissioning and collaborating on a range of public health

services and advising the commissioners of local NHS services.

These new functions rest with Councils as a whole but are supported by the

specialist public health staff that transferred into the local authorities, including

specialist leadership from directors of public health supported by their teams,

including, in many cases, public health intelligence staff.

Local authorities will therefore be able to improve significantly the health of their

local populations, as measured by the Public Health Outcomes Framework.

To deliver the public health functions, local authorities will need to obtain and use

relevant data and evidence to both inform their public health advice to the NHS

and to shape their own strategic public health activities. While many

responsibilities for public health have transferred from the NHS to local authorities,

healthcare commissioning responsibilities have transferred to new NHS clinical

commissioning groups and the NHS Commissioning Board.

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Public Health England

Public Health England is the national public health agency which fulfils the

Secretary of State for Health‟s statutory duty to protect health and address

inequalities, and to promote the health and wellbeing of the nation. Public Health

England will support local authorities, and through them clinical commissioning

groups, by providing evidence and knowledge on local health needs, alongside

practical and professional advice on what to do to improve health, and by taking

action nationally where it makes sense to do so. Public Health England is therefore

the public health adviser to NHS England and their focus is on funding those

services that contribute to health and wellbeing primarily by prevention rather

than treatment aimed at cure.

Public Health England has identified five high-level outcome-based priorities to

shape its work in the coming year, namely:

1. Helping people to live longer and healthier by reducing preventable deaths

and the burden of ill health associated with smoking, poor blood pressure,

obesity, poor diet, poor mental health, insufficient exercise and alcohol;

2. Reducing the burden of disease and disability by focusing on helping people to

prevent or recover from the conditions with the greatest impact including

dementia, anxiety, depression and drug dependency;

3. Protecting the country from infectious diseases and environmental hazards

including the growing problem of infections that resist treatment with

antibiotics;

4. Supporting families to give children and young people the best start in life,

through working with health visiting and school nursing family nurse partnerships.

(This includes launching a national programme promoting healthy weight and

tackling childhood obesity); and

5. Improving health in the workplace by encouraging employers to support their

staff and those moving in and out of the workforce to lead healthier lives.

Health and Wellbeing Boards

Health and wellbeing boards are being established by local authorities in

partnership with NHS clinical commissioning groups and others. The boards are

responsible for preparing comprehensive Joint Strategic Needs Assessments

(JSNA‟s) and Joint Health and Wellbeing Strategies, and have a role in

commissioning activities that take these assessments and strategies properly into

account.

In particular the boards‟ will have strategic influence over commissioning decisions

across health, public health and social care. This will include recommendations for

joint commissioning and integrating services across health and care.

Membership of a Health and Wellbeing Board includes:

Local elected member representative;

A representative of local health watch organisation;

A representative of each local clinical commissioning group;

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The Director for Adult Social Services;

The Director for Children‟s Services;

The Director of Public Health.

The diagram shown below from Public Health England provides an overview of the

health and care system from April 2013.

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Knowsley Joint Health and Wellbeing Strategy (2013-2016)

The Joint Health and Wellbeing Strategy is the key strategic document to promote

health and wellbeing in the Borough. It is produced by the Health and Wellbeing

Board and influences the commissioning plans of the partner organisations.

The strategy has been based on a thorough analysis of the needs of people in the

borough which is shown in the Joint Strategic Needs Assessment (JSNA) for

Knowsley. The statistics identify what the biggest causes of death are in the

borough, what people are seeing their GP for and what services, including social

care, are being used.

The diagram below summarises the plan.

Four priorities have been identified as the key focus for the first 18 months. These

are:

1. Mental Health

2. Alcohol

3. Respiratory disease (breathing difficulties) / smoking

4. Appropriate, effective use of services

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Local Nature Partnerships

Local Nature Partnerships (LNPs) are partnerships of a broad range of local

organisations, businesses and people who aim to help bring about improvements

in their local natural environment. LNPs work strategically to help their local area

manage the natural environment. They aim to make sure that its value, and the

value of the services it provides to the economy and the people who live there, is

taken into account in local decisions.

In DEFRA‟s description of the purpose of LNPs, they highlight their potential to work

with Health and Wellbeing Boards as:

“Become local champions influencing decision-making relating to the natural

environment and its value to social and economic outcomes, in particular,

through working closely with local authorities, Local Enterprise Partnerships and

Health and Wellbeing Boards.”

The Council is a member of the Liverpool City Region‟s LNP, the group recently

highlighted Knowsley as being a good example of a local authority strategically

referencing green spaces and health. The LNP are particularly interested in the

Public Health Outcomes Frameworks wider determinants of health, where the

objective is „Improvements against wider factors that affect health and wellbeing

and health inequalities‟.

The Liverpool City Region LNP have recently written a discussion paper on how the

LNP can engage with the health sector and a key action in the LNP‟s action plan is

to identify projects to help deliver health and wellbeing strategies, inform the next

round of JSNA‟s and Clinical Commissioning Consortia, and advance LNP priorities.

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Appendix B: The Evidence Base (Green Spaces and Health)

Physical Inactivity

Physical inactivity is the fourth leading factor for global mortality accounting for 6%

of deaths globally. This follows high blood pressure (13%), tobacco use (9%) and

high blood glucose (6%). Obesity is responsible for 5% of deaths globally. Physical

inactivity is a serious and increasing issue for public health. The estimated annual

direct cost of physical inactivity to the NHS across the UK is between £1 billion and

£1.8 billion and for Cheshire and Merseyside is £44m as shown in Table 1 below.

Co of Physical

Space for Exercise

Research has shown that a higher the proportion of green space in an area was

generally associated with better population health. Living closer to parks is linked

to increased physical activity, such as walking and cycling. Whilst the majority of

the exercise in parks tends to be gentle (over 56% of park users in London simply

walk or stroll), it still has a positive impact on people‟s health. A study in Tokyo

shows that presence of walkable green space increases the longevity of the

elderly. In England, people who live furthest from public parks are 27% more likely

to be overweight or obese, and children able to play in natural green space gain

2.5kg less per year than children who do not have such opportunities.

Better Mental Health

Contact with nature in green space reduces stress and improves attention, whilst

unsatisfactory access to green space has been found to be related to mental ill-

health by a study in Greenwich, London. A study of Swedish town dwellers showed

that the more often a person visits urban open green spaces, the less often they

will experience stress related illnesses. Playing in green spaces and living in greener

areas can have a beneficial impact on concentration and the ability to focus

attention of children thereby improving their performance at school. Lower levels

of stress associated with the use of green space enables people do cope better

Cheshire and Merseyside PCT Cost (£m)

Liverpool 10.078

Central and Eastern Cheshire 7.478

Halton and St Helens 5.978

Sefton 5.947

Wirral 5.091

Western Cheshire 3.867

Warrington 3.509

Knowsley 2.209

Total 44.157

Table 1: Estimates of the healthcare costs (primary and secondary)

attributable to physical inactivity for PCTs in Cheshire & Merseyside.

(Source: Department of Health 2011)

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with major life issues, such as the effects of poverty. There is also an evidence for

synergistic physical and mental health improvements related to contact with

nature. For example, patients recovering from a surgical procedure were found to

heal much quicker and require less painkillers if they had a view of nature out of

their window compared to those without such a view.

Social Wellbeing

The contacts between residents in the same area develop mainly through outdoor

contacts with the natural environment attracting people together to use open

spaces; in neighbourhood open spaces in Chicago 83% more individuals engaged

in social activity in green spaces than in barren spaces. The use of green spaces

can positively influence the quantity and strength of social relationships of diverse

groups, including older adults, teenagers from different ethnic backgrounds and

female residents of social housing.

Space to Grow Food

Participation in food growing projects offers an opportunity to increase physical

activity and increase consumption of fresh fruit and vegetables. Moreover,

psychological benefits are possible, due to contact with nature, increased

serotonin through sunlight exposure, sense of achievement and enhanced social

networks.

Improving Air Quality

Trees are very effective at removing some harmful to human health pollutants from

the atmosphere. They absorb gases such as ozone, nitrogen dioxide, sulphur

dioxide and help to deposit pollutant particles smaller than 10 microns in diameter

(PM10). Up to 70% of air pollution in cities can be filtered out using street trees, for

example, is has been identified that doubling the number of trees in the West

Midlands would reduce excess deaths due to particulate pollution by up to 140

cases per year.

Reducing Noise

The effectiveness of vegetation in reflecting and absorbing noise depends on the

density, height, length and width of planting; dense shrubs combined with trees

are the most effective.

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Appendix C: Natural England’s MENE Mapped Survey Results

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Appendix D: How can Knowsley’s green spaces help address issues identified

in the JSNA?

The JSNA for Knowsley describes in detail 34 different health and wellbeing needs

with recommendations for how they could be addressed. Local organisations and

the public have prioritised these 34 needs and agreed that the top ten issues for

Knowsley are:

Alcohol;

Cancer;

Cardiovascular Disease (CVD);

Child Poverty;

Children with Disabilities;

Dementia;

Educational Attainment & Attendance;

Emotional Wellbeing of Children;

Employment / Unemployment; and

Smoking.

Heart disease and strokes are still the biggest killers in the borough despite the big

improvements that have been made, however, more than three quarters of CVD

cases are preventable (around 300 lives lost per year).

Knowsley‟s green spaces provide the opportunity to introduce behaviour change

and lifestyle improvements that encourage people to cease or adopt certain

behaviours, which in turn are likely to result in health improvement. Green spaces

provide opportunities for physical activities in easily assessable environments and

provide physical activities at a level for all abilities for example gardening at

allotments, walking on DDA pathways through to cycling activities and cross

county courses.

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Appendix E: A Joint Strategic Asset Assessment for Knowsley (JSAA)

Knowsley Council is committed to utilising its assets to promote health and

wellbeing. A JSAA has been conducted for each of the six Area Partnerships within

Knowsley. It outlines the key principles for conducting the JSAA and taking an asset

based approach. In addition, it outlines asset based working practice taking place

elsewhere across England.

This JSAA process identified several key approaches and techniques to make the

most of the physical and community/people assets in Knowsley. The following

represent 8 potential asset based working approaches and techniques to adopt:

Awareness, communication and promotion of assets;

Development of and signposting of community support pathways;

Linking community and physical assets together and sharing good practice;

Enhanced partnership and joint working;

Community involvement;

Commissioning powers to strategically support the use of local assets;

Social prescribing (linking patients in primary care with non-medical sources

of support within the community)

Community favours (e.g. time banking)

Several assets have been identified as „star‟ or priority assets in the JSAA, 21 green

space assets have been identified as priority assets. In addition green space

community groups such as Friends of Groups and Allotment Groups have been

identified as key community assets.

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Appendix F: Examples of Infrastructure Improvements

The below plans are examples of the type of infrastructure improvements

undertaken at sites. In this example new pathways were created, interpreattion

signs erected and new planting schemes undertaken.

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Appendix G: Example of Health and Wellbeing Campaigns

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Appendix H: Borough Parks Model

See Excel spreadsheet

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Appendix I: Methodology for Quantifying Participation Rates for Self Care

and Independent Use

The use of Knowsley‟s four Borough Parks has been assessed using a variety of

definitive and anecdotal evidence. This includes:

Periodic headcount undertaken by Green Space Rangers;

Performance Indicators for events and activities;

General Site Observations; and

Information regarding the size, catchment, and facilities within the Park.

Participation Data

The tables below identify the current participation for each Borough Park. This has

been calculated based on attendance and frequency of attendance for

example: how many people visit daily, weekly, fortnightly, each month, each

quarter and each year. It should be noted that visitors are not double counted.

Increased anticipated participation following the implementation of the health

model has also been provided. The anticipated increases have been based on a

combination of:

Improved independent use (mainly daily and weekly visitors);

Improved supported use (mainly weekly, fortnightly or monthly visitors); and

Improved use for mass participation events (mainly quarterly and annual

visitors).

Reasons for Visits

In addition to footfall information regarding the primary purpose of each individual

visit has been assessed and provided as a percentage breakdown. The

percentage breakdowns were in turn sense checked against market

segmentation research (People, Places and Their Green Spaces: Keep Britain Tidy

2010) that provided segmentation data on the types of green space users. It

should, however, be noted that the market segmentation research provided a

generalisation across all green space typologies including outdoor sports facilities.

The segmentation research provided the following user groups.

User Type Definition (primary reason for visit) Percentage of Users Great

Outdoors To enjoy exercise/fresh air 40%

Sanctuary Seeking peace and tranquillity 25% Team Spirit Socialising with friends and participation

in sports 15%

Playground Entertaining and sharing experiences with

children 19%

Resistors Never use green spaces due to lack of

interest or more quality of sites 1%

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Stadt Moers Park

Current footfall

1 per day 50 x 365 18250 1 per week 100 x 52 5200 1 per fortnight 50 x 26 1300 1 per month 50 x 12 600 4 per year 40 x 4 160 1 per year 20 x 1 20 total 25,530

4,255 used for the model

i.e. 25,530 divided by six

Anticipated footfall following implementation of health model

1 per day 70 x 365 25550 1 per week 120 x 52 6240 1 per fortnight 60 x 26 1560 1 per month 60 x 12 720 4 per year 44 x 4 180 1 per year 20 x 1 20 total 34,270

5,711 used for the model

i.e. 34,270 divided by six

User Segmentation

Reason for Visit Percentage of Visitors Walking 70% Cycling 10% Play 5% Angling 5% Running 5% Other 5%

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Court Hey Park

Current footfall

1 per day 75 x 365 27375 1 per week 60 x 52 3120 1 per fortnight 50 x 26 1300 1 per month 50 x 12 600 4 per year 40 x 4 160 1 per year 20 x 1 20 total 32,575

5,429 used for the model

i.e. 32,575 divided by six

Anticipated footfall following implementation of health model

1 per day 80 x 365 29200 1 per week 90 x 52 4680 1 per fortnight 70 x 26 1820 1 per month 50 x 12 600 4 per year 44 x 4 176 1 per year 20 x 1 20 total 36,496

6,082 used for the model

i.e. 36,469 divided by six

User Segmentation

Reason for Visit Percentage of Visitors Walking 60% Cycling 4% Play 14% Sport 6% Running 1% Other 15%

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Mill Dam Park

Current footfall

1 per day 30 x 365 10950 1 per week 40 x 52 2080 1 per fortnight 30 x 26 780 1 per month 20 x 12 240 4 per year 10 x 4 40 1 per year 5 x 1 5 total 14,095

2,349 used for the model

i.e. 14,095 divided by six

Anticipated footfall following implementation of health model

1 per day 40 x 365 14600 1 per week 60x52 3120 1 per fortnight 70 x 26 1820 1 per month 50 x 12 600 4 per year 44 x 4 176 1 per year 20 x 1 20 total 20,336

3,389 used for the model

i.e. 20,336 divided by six

User Segmentation

Reason for Visit Percentage of Visitors Walking 15% Cycling 5% Play 40% Sport 10% Running 5% Angling 15% Other 10%

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Halewood Park

Current footfall

1 per day 80 x 365 29200 1 per week 70 x 52 3640 1 per fortnight 50 x 26 1300 1 per month 50 x 12 600 4 per year 40 x 4 160 1 per year 20 x 1 20 total 34,920

5,820 used for the model

i.e. 34,920 divided by six

Anticipated footfall following implementation of health model

1 per day 100 x 365 36500 1 per week 90 x 52 4680 1 per fortnight 70 x 26 1560 1 per month 50 x 12 600 4 per year 44 x 4 176 1 per year 20 x 1 20 total 43,536

7,256 used for the model

i.e. 43,536 divided by six

User Segmentation

Reason for Visit Percentage of Visitors Walking 55% Cycling 20% Play 5% Running 10% Angling 5% Other 5%

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Appendix J: Stadt Moers Capital Investment Requirements

Overview of Current Facilities

Stadt Moers Park currently contains a host of diverse facilities and spaces

including:

Over 26 hectares of woodland;

17 hectares of natural meadowland;

1.87 hectares of wetlands, 3 ponds and a 600m watercourse;

4 designated Local Wildlife Sites and 1 Site of Local Geological Interest;

Nearly 32 hectares of amenity grassland;

Over 6.5km of footpaths serving walkers, cyclists and other users;

Links to a diversity of external green routes/public rights of way;

3 car parks providing over 100 parking spaces collectively;

2 formal play area facilities;

The Stadt Moers Park Environment Centre; and

New cycling hub.

Since 2009, £0.530m of capital investment has been made at Stadt Moers Park,

namely:

In 2009/10 £0.050m of Play Pathfinder funding was allocated to the Park for

the creation of new play space;

In 2011/12 £0.340m of SUSTRANS funding was secured for the Connect 2

project;

In 2011/12 £0.020m of Council funding was allocated to the play area in

West View;

In 2011/12 £0.050m of Community Spaces, £0.015m of Cory Environmental

Trust and £0.007m of Forestry Commission and £0.008 of Council funding for

the quadrants infrastructure and habitat improvements; and

In 2012/13 £0.40m of SUSTRANS and LSTF was secured for entrances at Ellis

Ashton Street.

Improvement Plans

The current effectiveness of Stadt Moers Park in achieving its maximum potential to

contribute towards local quality of life and health, social and economic

sustainability is limited by a number of physical and management factors. A Stadt

Moers Park Management and Development Plan has been prepared that outlines

the key objectives and actions that focus on removing these barriers by targeting

and prioritising investment in the Park, as well as tailoring management and

activity development.

Recent investment in specialist grounds maintenance equipment has enabled

activities such as the cross country races to take place and a maintenance

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programme has been established to ensure pathways are widened to

accommodate the number of visitors and participants that attend these events.

Below outlines a summary of the costs that have been developed in relation to

these elements.

£62,427 for entrance feature development works. This is crucial for attracting

people to the Park, yet also restricting unauthorised access;

£174,500 for creation and improvement of footpath networks, access, installing

interpretation boards, way markers and installing other infrastructure such as

seating; and

£224,300 for habitat development and management.

Therefore, the overall total for infrastructure works at Stadt Moers is estimated to be

£461,227 (£612,219 inc. preliminaries, contingencies and professional fees).

A report is being prepared which sets out a range of capital improvements for this

park to be funded primarily from the Council‟s Green Space Asset Management

Plan‟s budget of £0.152m for this site in 2013/14 plus secured external funding of

£0.060m and a developer contribution of £0.025m. This work is being planned to

take place during this autumn / winter and includes:

Pathway and entrance improvements;

Interpretation plan and site maps

Way markers and signage; and

Woodland management / maintenance.