Hello, I’m Harry Farmer, one of Involve’s two new policy researchers.
I’ve been here for over a fortnight now, getting my head around the various projects Involve runs and reading through documentation. Over this period, a lot of the thoughts about the role and value of participatory methods that have been percolating through my mind for a while have begun to crystallise.
One of the most satisfying things about starting at Involve has been seeing the relevance of deliberative practices to issues that I have been interested in for some time. In particular, it has been fascinating to be able to focus directly on problems the effects of which I have encountered in previous roles.
I join Involve having spent a year working for a policy consultancy specialising in health. A major part of my old role was helping patients with rare diseases understand and feed into the processes through which highly specialised medicines receive NHS funding.
Moving from helping people to get their voices heard by NHS England to working on a programme like NHS Citizen – focused on creating an NHS culture in which the patient voice is more prominent – is an exhilarating feeling.
Another example of the potential of deliberative methods to tackle problems I used to encounter a lot relates to the reasoning by which government bodies make decisions in health.
One of the most conspicuous things about NHS commissioning policy is the utilitarian approach to decision making adopted by bodies like NICE. Whilst this approach has some practical advantages from the perspective of a policy maker, it is by no means the only framework by which to arbitrate between policy options.
Regardless of the ultimate desirability of a utilitarian approach, its use is testament to how the system could be more accountable: Even in cases in which patients are able to inform the decision making processes, decisions are still made according to a set of premises that the public has had no say in determining.
One of the advantages of deliberative exercises is that they give the public the opportunity to challenge the bases on which decisions are made – as well as the decisions themselves. Deliberative exercises make this possible by taking ordinary people and providing them with the time, environment and background knowledge to come to considered judgements (crucially unencumbered by the professional considerations that influence full time policymakers). One consequence of this is that deliberative exercises allow the public to frame the terms of the debate to a far greater extent than would otherwise be possible.
While the case for the greater use of deliberative exercises extends far beyond these two issues, they are representative of problems that apply more far more generally. Governments seem increasingly keen to delegate controversial policy decisions to bodies that don’t answer directly to the electorate. If the system as a whole is to remain accountable, these bodies will need to adopt more deliberative approaches. Likewise, policy makers are facing a growing number of problems that demand a more nuanced approach than simple cost benefit analysis. In both of these respects, deliberative methods are only going to become more important over the next few years – making it a very exciting time to be joining the team at Involve.