Co-production and mental health: the ‘ideal ward round’ in acute settings

By James Shutt, advocacy service manager and advocate

Times are changing

A question that's bothered me for a long time: could a co-produced project between patients, carers and willing professionals – a real group of ‘outsiders’ – make a tangible difference to the experience of being on an acute mental health ward? Well, I realised it was bothering quite a few other people too.

The “Ideal ward round” project set out to do just this

It brought people with current and recent experience of mental health services, including carers, together with professionals working in and managing those services. We took from the start the meaning of co-production as: "The voluntary efforts of individuals or groups to enhance the quality and/or quantity of services they receive. (Parks et al, 1981*). 

In this spirit, we got all these people together in a room with tea, decades of combined experience, a blank piece of paper and three unwritten rules: 

1. Everyone’s opinion holds the same weight
2. Wherever we go in terms of methodology or outcomes, we decide together 
3. Whatever this turns out to be, it has to make a real difference, especially for patients.

How did this all start? An idea and a conversation, then another conversation. Where did it go? Over two and half years, it included a literature review (ward rounds in mental health settings generally get a bad press!) - plus development of questionnaires for patients, ex-patients, carers and staff, data analysis, findings, focus groups, presentations, recommendations, buy-in from Trust senior managers and now pilots on real life wards and evaluations with a Russell Group University. 

It feels like we’ve come quite far… I feel like I’ve forgotten something… 

Oh yes, and lots and lots of meetings were held in between. And lots of conversations. Some tangential, some experiential, some abstract, but all relevant! And then lots of voting.

And this is the crunch I suppose from our experience 

Co-Production requires voluntary effort, quite a bit of voluntary effort from everyone, which in turn requires little more in essence than patience, trust and a sense of purpose. People have come and gone (and often come back) during the lifetime of the project but all of them claim the same credit. They have come from every pay grade and from a lifetime’s lived experience through to a first-time episode and admission. It has felt at different times frustrating, exhilarating, insurmountable and unstoppable. We continue now with the purpose we started with, and perhaps more importantly, the same rules.

‘The Ideal Ward Round’ started as a project in 2014, with the first meeting set up by James Shutt Jonathan Wright, Involvement Centre Manager for Nottinghamshire Healthcare NHS Foundation Trust. The Ideal Ward Round is due to be piloted by Nottinghamshire Healthcare NHS Foundation Trust in Summer 2017.

*Parks, R. B., Baker, P. C., Kiser, L., Oakerson, R., Ostrom, E., Ostrom, V., Percy, S. L., Vandivort, M. B., Whitaker, G. P. and Wilson, R. (1981), CONSUMERS AS COPRODUCERS OF PUBLIC SERVICES: SOME ECONOMIC AND INSTITUTIONAL CONSIDERATIONS. Policy Studies Journal, 9: 1001–1011. doi:10.1111/j.1541-0072.1981.tb01208.x