Negotiating Complexity: Challenges to Implementing Community-Led Nature-Based Solutions in England Pre- and Post-COVID-19

Abstract

Nature-based solutions (NbS), including green social prescribing (GSP), are sustainable ways to address health and wellbeing, especially since the COVID-19 pandemic exacerbated the strain on healthcare. NbS require national and local cross-sector coordination across complex, interrelated systems, but little is known about the specific challenges this poses for community-led NbS. We carried out a traditional literature review to establish the context and knowledge base for this study and interviewed 26 stakeholders. These came from environment, health and social care sectors at national and local levels, with local-level stakeholders from Bradford and Walsall: English cities significantly affected by the pandemic, with high levels of deprivation and health inequality. The interviews explored experiences of implementing NbS, both pre- and post-pandemic and the resulting renewed interest in the salutogenic effects of engaging with natural environments. We coded the interview transcriptions using NVivo to identify the challenges existing in the systems within which these stakeholders operate to create and manage NbS. By synthesizing what is known about the challenges from existing literature with findings from the interviews, we developed eight categories of challenges (perception and knowledge, political, financial, access to natural spaces, engagement, institutional and organisational, coordination, GSP referral and services) faced by multiple sectors in implementing community-led NbS in England. Furthermore, this study highlights the new challenges related to the pandemic. Identifying these challenges helps stakeholders in existing complex systems recognise what is needed to support and mainstream NbS in England.

Nature-Based Interventions Targeting Elderly People’s Health and Well-Being: An Evidence Map

“…Additionally, there is widespread consensus regarding the lack of awareness concerning the effectiveness and cost of nature-based solutions (which can include nature-based health interventions) among the general public and key stakeholders, including service users and healthcare professionals. Issues of sporadic and unsustainable funding, leading to a dependence on continuity and volunteer capacity, as well as challenges in offering and maintaining urban green spaces and access to protected areas, are highlighted [53].…”

Green Social Prescribing in Practice: A Case Study of Walsall, UK

“…Different types of naturebased interventions have been examined, including community gardening [48,49], bluecare or water-based activities [50,51], and general outdoor activities [52]. Some studies in particular explore GSP in the context of COVID-19 [53,54]. These studies have identified a range of challenges and opportunities for research and practice.…”

“…One of these is the lack of convincing evidence that the benefit from nature and community assets can be realised through GSP [57,58]. Another important consideration is the lack of consistent or standardised referral mechanisms, as schemes are funded, structured, and delivered diversely [53], and so the referral process is highly individual [54].…”

“…Furthermore, GSP operates within a complex Social Prescribing system made up of arrays of interconnected and interdependent actors, processes, and events [11,29,53,54,59,60]. The complexity and the lack of communication between different parts of the system create significant barriers for individuals and organisations to navigate through the system [50].…”

“…Meanwhile, across the entire system, funding and capacity are important constraints shared by majority stakeholders, including GPs, link workers, and VCSEs [29,51,57,58,[62][63][64]. This is especially the case for VCSEs, who are reliant on human resources-usually volunteers-to meet needs but face the challenges of a lack of recognition, capacity, and necessary investment [11,54,60]. Juster-Horsfield and Bell [51] question whether VCSE sectors in the UK may not be ready to accommodate growing demands for GSP, given no clear or sustainable pathway for meeting key funding, training, or staffing needs.…”