At the end of October I took part in two design days to develop the new NHS England Citizens’ Assembly. The idea is to bring citizens’ voice directly to NHS England Board, and these two days intended to further develop a model for the Assembly.
Design day participants included a range of ‘experts’ and facilitators who co-produced a whirlwind of thought provoking ideas and discussion (see Edward Andersson’s and Curious Catherine’s blogs for excellent summaries). I was one of the social media rapporteurs, which provided me with the opportunity to follow both the online and offline conversations.
There was a great deal of energy around developing the idea of a Citizens Assembly and it was exhilarating to be part of a truly iterative process where the description of the aims transformed throughout the two days. Besides the potential the participants saw in this model, some concerns and challenges were expressed as well. Here are the three most pressing questions that particularly stuck out for me:
1. Will a Citizen’s Assembly duplicate other existing avenues for citizen voice? There are already a lot of initiatives out there that attempt to include citizens’ voice in health services, for example, Healthwatch and Health and Wellbeing boards. This raised questions about the place of a Citizens Assembly. There was consensus that the Citizens Assembly should not duplicate other structures. Rather, all avenues for citizen voice should be mapped. One possibility is that there is a role for the Citizens assembly to aggregate these voices to take a more strategic conversation to the board.
2. This is a complex model – how will it be made accessible? I was struck by the level of expertise in the room. However, I found the discussions sometimes tended to be rather abstract and high level. The participants were experts on the systems in which a Citizens Assembly would operate and are therefore able to understand and navigate ideas which citizens with limited time and confidence may not. In the further development of the Citizens Assembly, strong consideration must be given to the accessibility of the process, structure and purpose, to make it understandable to those with less formal experience.
3. Will digital by default ensure representation and capture conversation? Digital technology is already transforming governance, but this alone will not ensure broad representation. Race, ethnicity, age and social class are factors which determine peoples’ access to the internet creating a digital divide between those who have access and those who do not. In the development of the model, thought must be given to how more marginalised voices are heard. In addition to this, there will be many conversations that occur outside of the digital sphere – how will these be integrated?
While it is clear that people were excited about the potential of an NHS Citizens Assembly, there are these, and other issues to bear in mind in the next stages of development. That said, this is intended to be an ongoing conversation which is open for people to critically engage with and shape over the coming months.
You can find out more about the Citizen’s Assembly here and contribute to the conversation on Twitter using #NHScitizen.
Image: Edward Anderson