BNG AND HEALTH The benefits of biodiversity net gain for the health care industry

Sowmya Shah

Sowmya is an environmental consultant at Mott Macdonald with over three years of experience in natural capital and ecosystem services. She has a strong background in environmental impact assessments and sustainability. Her career includes international field and lab work in Nairobi, Kenya, before relocating to the UK. In her current technical role, Sowmya is actively involved in biodiversity net gain projects and is expanding her expertise in the Nature Positive approach. She is also working on carbon sequestration assessments, demonstrating her commitment to advancing sustainable environmental practices.

Sowmya sets out a Welsh case study where small scale and practical initiatives improve nature and health: “if BNG is applied with skill, the end result will be beneficial for our wellbeing as well as for nature. And some – such as healthcare facilities – have more to gain than most”. 

“Nature itself is the best physician.” – Hippocrates. 

What is biodiversity net gain and how is it measured? 

Biodiversity net gain (BNG), simply put, ensures that when land is developed, natural habitats are not just preserved but enhanced, leading to richer biodiversity and healthier ecosystems. This has now become mandatory for most developments seeking planning permission in England. 

Understanding how BNG is measured is key, with the gain measured in “habitat units” that are calculated by the statutory biodiversity metric. This standardises the calculation and brings together data on habitat type, size, condition and location to quantify the baseline habitat. 

The introduction of this legislation means that development must achieve a minimum of 10% BNG. The minimum in the legislation is critical, as some local authorities are exploring local policies for higher gains, and other local authorities have specific guidelines on how BNG is applied. 

This change in legislation has catapulted the construction industry to build ponds, grassland, woodlands and scrubland too, alongside the traditional roads, hospitals and schools. As a result, how the construction industry creates and enhances wildlife-rich habitats must now be central to the feasibility stage of planning and design on new projects. 

While at first glance the requirements may seem challenging, if BNG is applied with skill, the end result will be beneficial for our wellbeing as well as for nature. And some – such as healthcare facilities – have more to gain than most, with studies showing that exposure to nature can help speed up recovery and provide better outcomes for staff too. 

The healthcare industry 

The benefits of biodiversity on healthcare were explored in the project Mott MacDonald (MM) undertook for the Aneurin Bevan University Health Board (ABUHB) and Powys Teaching Health Board (PTHB), which was to explore biodiversity enhancements across hospital estates in Wales. While not BNG, this project shows how connecting biodiversity enhancements with biophilic design can have tremendous benefits for staff, patients and visitors to health care facilities. 

Health boards in Wales have a statutory duty to maintain and enhance biodiversity. To meet this duty, the ABUHB and PTHB commissioned MM to assess the biodiversity value of various hospital sites and identify opportunities to enhance existing habitats, for example by changing estate management practices or by creating new habitat. 

Given that hospitals must meet the needs of staff and visitors as well as patients, our specialists recognised an opportunity for a holistic approach and worked with both health boards, to identify biodiversity recommendations that would enhance wellbeing and deliver historic landscape, net-zero and climate resilience benefits. 

The project aimed to support the boards to meet their biodiversity duty in ways that cultivated a deeper appreciation and understanding of nature. It was led by MM’s ecologists, with advice from our experts in

biophilic design, landscape, heritage, climate resilience and carbon. 

Biophilic design 

Biophilic design is to connect people with nature and, for this project, provided an opportunity to improve the experience for users of the health care buildings. Previous studies have shown that incorporating biophilic design elements in a healthcare setting contributes to more positive health outcomes, better pain and stress management and improved staff performance and wellbeing. 

The project also involved identifying wider opportunities from biodiversity enhancements at each estate. Early knowledge-sharing and guidance from MM experts focused on site survey work and shaped the biodiversity enhancements to maximise holistic benefits. Examples include: 

• Accessible paths throughout the estate at a mental health hospital to promote wellbeing, and which are designed to be in keeping with existing habitats 

• Brass rubbing trails and activity packs at a children’s hospital to educate and engage people in good ecological estate management 

• Restoration of historic orchard, parkland and ancient woodland habitats at a large estate to both safeguard heritage and improve biodiversity 

• Strategic hedgerow and landscape planting to screen views and strengthen ecological connectivity for wildlife, as well as increase biodiversity value 

• Miniature drain-fed rain gardens that reuse water at small urban estates 

• Community planting initiatives for biodiversity ‘gardens’ to encourage and support the local community to contribute towards the biodiversity enhancements 

• Long-term habitat management plans with climate resilience measures. 

A key success of this project was the innovative biodiversity solutions proposed to deliver enhancements on even the smallest urban estates; built on biodiversity and wellbeing initiatives already in place, such as the ‘pharmabees’ or wildflower planting schemes, or the ‘minute mile’ wellbeing walks. These solutions include repurposing spoil heaps to integrate invertebrate niches and incorporating drain-fed miniature rain gardens to filter water naturally. 

The introduction of information boards, activity packs and community planting schemes will help to improve the connection between people and nature. Further recommendations included the careful installation of remote cameras to broadcast footage of wildlife to nearby hospitals, providing an opportunity for patients, staff and visitors to connect with nature in a way that may otherwise be inaccessible. 

Collaboration across Mott MacDonald helped to shift the clients’ focus from fulfilling their biodiversity duty in line with Welsh government policy, to recognising the value of biodiversity in achieving a wider range of societal benefits, notably wellbeing and health, alongside environmental ones. 

Feedback and future programmes 

The feedback received from both health boards was overwhelmingly positive, with the Powys estates asking MM to produce design management sheets and an online GIS web platform to help implement the changes. Both boards were particularly excited about the possibilities of integrating wellbeing benefits with biodiversity improvement across the estates, which MM tailored for each one, with different recommendations for general hospitals, mental health facilities, and the children’s hospital. These biodiversity and wellbeing improvements complement the therapies and patient recovery programmes in place. 

This work highlights that no project is too small to accommodate biophilic design principles to connect people with nature; it should be a key component of considering how a development delivers BNG. 

While the focus of the new legislation is on new projects, BNG and biophilic design can be retrofitted to most developments, bringing benefits to biodiversity and wellbeing anywhere. Whether it’s working on a new build that falls under the mandate, or an upgrade project that does not, this project highlights an incredible example of adapting to improve biodiversity as early as possible, to directly improve the lives of its users too. 

The project was a pilot to demonstrate how measures to enhance biodiversity can be rolled out by health boards across Wales. The recommendations showed the success of this project beyond the brief, which can be rolled out to any hospital estate, and particularly shows that biodiversity and wellbeing benefits are achievable regardless of scale.