Published on January 22, 2016

Reflections from NHS Citizen – It’s jurors’ approach, not their experiences, that’s important

NHS Citizen

By Harry Farmer

Harry Farmer is a policy researcher at Involve. He is fascinated by the power of deliberative processes to enable governments to negotiate controversial policy decisions - particularly those presented by emerging technologies and demographic change. He currently works primarily on the Citizens for Public Service programme.

Having successfully delivered the NHS Citizen Assembly and Jury as part of the NHS Citizen programme for 2015/16, now seems like an ideal time to reflect on some of the things these important parts of the programme have taught us.

Of course, as NHS Citizen is a learning process, much of this reflection will be undertaken by citizens as part of the Learning Programme.

But it’s also worthwhile to think about this from Involve’s perspective, and to consider what, if anything, can be learned about deliberative processes from the Assembly and the Jury.

With this in mind, the next few paragraphs are dedicated to a single thought, which was illustrated nicely by the NHS Citizens’ Jury, and serves as a useful reminder of one of the virtues of involving mini-publics in decision making processes.

Beyond its value as an accountability mechanism, it is generally assumed that citizen juries are useful to policy makers because the jurors have a diversity of backgrounds that enables them to shed new light on the issues in hand.

Specifically, it’s tempting to assume that this ability lies in jurors’ diversity of lived experiences, particularly when these relate directly to the issues in hand.

However, as became apparent at the NHS Citizens’ Jury, jurors are quite often reluctant to base their decisions on their personal experiences of issues. Instead, jurors were often vocal about wanting to base their decisions on statistics and evidence, and expressed dissatisfaction when they felt they did not have enough information to make a decision. If jurors are so willing to discount personal experience, this can’t be their chief contribution to the decision making process. (And if it were, there would be far easier ways for policy makers to learn about it than through deliberative exercises.)

What juries really bring to the table is suggested by another striking feature of the NHS Citizens’ Jury: jurors’ resistance to using a suggested decision making framework. Jurors protested that using a framework they had not devised would guide them in their thinking, predetermining their answers.

While there had been no such intention on the part of the event facilitators – who respected jurors’ wishes – it is easy to sympathise with the grievance. Decision making frameworks can be enormously useful in helping to clarify your thinking, but overreliance on them can reduce a jury’s role to that of feeding in information to a matrix and collecting the answers (in a de facto re-enactment of someone else’s thought process).

This suggests that the unique contribution of juries lies not in the information they bring, but in how they process the information, and the normative conclusions they draw from it. Decision making structures used by policy makers typically make some very specific, but tacit, value assumptions. It is therefore vitally important, if policy making is to be representative, that decisions are considered by people who think more like the population as a whole. The real value of juries lies in their ability to approach policy questions differently to policy makers.

There is a cautionary note here that ties in neatly with an observation about public engagement and co-production expressed by an NHS Citizen in a recent meeting. He observed that people engaging with public bodies have to walk a fine line in getting close enough to an organisation to influence it, but not getting so close as to be assimilated – and to end up looking at the world in exactly the way the organisation does.

If we are to create participatory structures that enable people to “rock the boat without falling out”, it helps to remain acutely aware of why we need outsiders to rock the boat in the first place.

3 Responses to “Reflections from NHS Citizen – It’s jurors’ approach, not their experiences, that’s important”

  1. Highzenberg
    June 23, 2016 at 9:33 pm

    ”If we are to create participatory structures that enable people to “rock the boat without falling out”,… ”
    —–
    As may be seen in far to many cases, and with ‘NHS’ Citizen (paid for, but not run by, NHS England) it’s not so much that those who challenge the orthodoxy of those who consider themselves to have ownership rights on the boat who FALL out, they are PUSHED out.
    Fortunately, such ship Captains don’t yet hold sway everywhere, yet, otherwize ” 12 angry men” would have been a very short film indeed.

  2. Dave
    October 7, 2016 at 12:03 am

    Hi I’ve made a 6 question survey on NHS. Please complete and share thank you

    https://www.surveymonkey.com/r/GN7YMHR

  3. Highzenberg
    October 15, 2016 at 11:31 pm

    @Dave October 7, 2016 at 12:03 am
    Hi I’ve made a 6 question survey on NHS. Please complete and share thank you
    ———-
    1.0 This post has just entered my Inbox via Involve

    2.0 You state that you have :
    2.1 “made a 6 question survey”
    Wrong.
    You’ve thrown together a format to try to justify your own point of view;
    2.2 made a 6 question survey on NHS
    Wrong.
    You’ve thrown together a format to try to justify your own point of view on a minor aspect of the totality of the SERVICE which Our=NHS provides. And in the way it was set up to provide that service.
    You and your free market chums would have us all carrying ID cards to prove we were entitled to our (paid for) NHS treatments.

    3.0 You ask:
    Please complete and share thank you
    And yet give us no indication of :
    * who you are
    * which organisation you represent
    * what you will use these responses for

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