The more we delve into the details of NHS Citizen and the Assembly Meeting, the more we find ourselves rethinking overarching questions and the very purpose of the Assembly.
Testing the Assembly plenary with the Board at the Leeds’ design workshop was a sobering reality check, as it showed us how we risk falling into the “public meeting format” trap if we fail to address clearly what type of relationship we expect and want between the Assembly members and the Board. The participants in the workshop agreed they want to encourage a more collaborative and less hierarchical relationship, but what does that mean in practice and how does it change the role of the Assembly Meeting?
To me there is one key issue to consider before we move forward: what is the role of the Assembly Meeting within the NHS Citizen framework? That is: do we envisage the Assembly Meeting as an instrument to enhance the legitimacy of the whole NHS Citizen architecture before the Board? Is it where (national level/ systemic) problems (and solutions) identified in Discover and discussed and clearly framed in Gather are debated by citizens in a face-to-face deliberative environment with the aim to develop advisory recommendations for the Board?
Or is it a space where citizens co-design with the Board actual solutions to problems? In this latter understanding it might be more appropriate to have stakeholders already engaging with NHS England.
The way we understand the role of the Assembly completely alters the dynamics between the Assembly and the Board. I have tried to capture the difference in this simple table (obviously this is quite stark categorisation and we can think of a few hybrid solutions in between).
In the first case the Assembly Meeting would function mainly as instrument of gaining public insights on systemic issues and ensuring accountability from the Board. This would be a role similar to other cases of Citizens’ Assemblies, which are often randomly selected. Here people, broadly representing the country’s socio-demographics, deliberate and develop recommendations (after a thorough learning phase) on 1 to 3 issues/ questions, clearly and concisely framed in Gather (offline and online). The Board participates in the Assembly but cannot deliberate; it takes the final decision and should be expected to justify publicly any rejections and be accountable on implementations of agreed recommendations.
In the latter case, the relationship between the Board and the Assembly is more collaborative and solutions are co-planned with stakeholders with direct experience and/ or knowledge of the issue at stake. In this case we should reflect upon a few important questions:
There are also some practical considerations:
Irrespective of the role we envisage for the Assembly meeting, a clear understanding of the issues for discussion is crucial to choosing the right format of collaboration.
We’d really welcome your feedback and comments; this is not something that a small team can design alone. Do you have examples of where this kind of collaboration at a high-level has worked well before? Which kind of collaboration will add most value within the NHS England system? What will we need to do to make it work well?