Co-producing Urgent and Emergency Care Environments: Insights From The MHED Community of Practice

Synopsis

The development of a new Urgent and Emergency Care (UEC) model requires a fundamental shift in both clinical pathways and spatial design. In the absence of established guidance for this emerging typology, the project adopted an extended programme of stakeholder engagement and co-production to generate evidence, test assumptions and inform decision-making.
Early design development was informed by visits to three comparable UEC and mental health emergency care facilities. These visits were attended by a consistent core group of stakeholders, including clinical leads, estates and facilities, emergency care teams and service representatives, supported by weekly structured workshops to reflect on learning and translate insights into design and operational principles. Direct engagement with local project teams during these visits enabled honest discussion around referral models, spatial adjacencies and post-occupancy challenges.
An Expert by Experience was embedded within the process and attended the site visits and workshops. Their involvement was invaluable in shaping how questions were framed and directed during conversations with patients using the facilities, enabling deeper, more authentic insights into arrival, waiting, assessment, safety and dignity than would otherwise have been possible.
Building on this established knowledge base, FSA secured a research grant to analyse and compare international approaches to mental health emergency care, including the EMPATH model and European crisis care typologies. This research is being used to validate emerging principles and benchmark the evolving UEC model against international best practice.
Ongoing engagement involved patients, families and carers, Trust leadership, clinical teams (including Emergency Department clinicians, mental health liaison and crisis services), estates teams, and bed liaison and flow management teams. A key area of co-production focused on referral criteria and transitions between ambulance conveyance, ED referral and walk-in self-referral.
The impact of co-production is evidenced through tangible design outcomes, including revised arrival routes, improved ED–UEC interfaces, choice-based waiting environments and flexible assessment spaces supporting both escalation and de-escalation. Continuous feedback created a clear “you said, we did” loop, ensuring the final proposals reflect lived experience and operational reality.