Problems and Purpose
In 2013 the project team for NHS Citizen was commissioned to develop a blueprint of how citizens could take a more active role in the NHS decision making in England. The blueprints laid out the fundamental ideas for NHS Citizen which according to the NHS England websites aims to:
- “Give citizens and organisations a direct, transparent route for their voices to reach the heart of the NHS England decision making process
- Give the NHS England board and others a new source of evidence and opinion on the NHS
- Give the public an open accountability mechanism to feed back on the work of NHS England, and the opportunity to participate in every aspect of the organisation
- Establish a system that leads quickly to action.”[1]
Now twice a year citizens meet at an Assembly Meeting in order to deliberate over citizen-generated issues and encouraged to discuss these issues face to face with members of the NHS England board. Before the Assembly Meeting can take place issues must be generated and selected through the method of Gather which incorporates a number of stages: Pinboard, Issue Tracker, Deliberation Space, Roundup and Priority Ranking. After these stages have been completed the process then moves on to the final stage before the Assembly Meeting which is the Citizen Jury.
This case study will aim to provide and overall description of the Gather process before going on to outline and evaluate two of the most important aspects of NHS Citizen: Citizen Jury and the Assembly Meeting. This will be accomplished by looking at documents published by NHS Citizen looking at the NHS Citizen Assembly Learning Report for the meeting which took place 25th November 2015 and also the Citizens’ Jury Learning Report for the “first official NHS Citizens’ Jury which took place in Stoke-on-Trent on the 27th and 28th October 2015.”[2]
Phase 1: Gather
The first phase of Gather is pinboard, an online space that allows ideas to be connected and to find an audience before they are passed through into the main part of the Gather process. Ideas can come from individuals, organisations or community conversations that come from elsewhere. The NHS design website states that “the purpose of the pinboard is to allow ideas to be connected and to find an audience before they are passed through into the deliberation space. It acts as a filter to prevent conversations starting in Gather that duplicate existing issues.”[3]
Issue tracker is “the spine of the Gather process” as it is the only place that a user can find previous issues. Issue tracker is able to track issues that go beyond the Gather process, right into the involvement of the NHS and can also store feedback received.[4] The NHS Citizen design page outlines two main roles which the issue tracker performs:
- “When issues move from the pinboard to the deliberation space, there is a need to track them through and beyond the rest of the Gather process. The issue tracker keeps a record of the activity around an issue from the point at which it moves into the deliberation space.
- Issue tracker keeps a record of where issues have been directed to. This includes issues sent on to the Assembly Meeting, as well as issues that are directed elsewhere, for example to a clinical commissioning group or to a health and wellbeing board.”[5]
The next stage is the deliberation space where “discussions, evidence and contributions are collected as issues for deliberation.”[6] These issues will leave the deliberation space when the time limit is reach or when a majority of participants are ready to move on to the next stage which is the roundup phase. The deliberation space consists of three elements: the library, conversation and the participant list. These all aim to promote topics and also allows the public to follow the conversations and participants involved in the process. After the deliberation space a summary and record of all deliberations which have been approved by those who have took part is provided in the roundup phase. In this phase the discussion support team is expected to create the first summary of the deliberations, giving a fair and proportionate reflection of all the views expressed up until now. The benefit of this is for participants who have not followed the issues all the way through the process or for those who are new to the deliberation. It provides them with a clear and consistent understanding of what has happened and any key information. We then move onto the final stage of Gather which is called priority ranking, designed to give the public a view of which issues have been perceived to be of high ranking. The issues declared high priority will be the issues discussed at the Citizen Jury where the final issues for the Assembly Meeting will be selected. This ranking therefore acts a means of filtering issues and makes sure that the issues selected are important to the every-day people rather than committees or NHS board members.
Phase 2: Citizen Jury
The Citizen Jury is the next step after Gather. A jury meets before the Assembly Meeting to look over the issues produced by Gather in order to come to an agreement of the five issues which will make it onto the Assembly Meeting agenda. The jury consist of between 12-18 members who all meet for a space of two days in order to make their decisions. In order to evaluate the Citizen Jury, it is important to look at their NHS Citizen Citizen’s Jury Learning Report which looks at the first NHS Citizen, Citizens’ Jury which took place in Stoke-on-Trent. The repost uses the immediate feedback received received on the day regarding the event including what worked well and also what could be improved for the future.
The jurors are a stratified sample of individuals recruited from the general population by a market research company in order to produce a diverse selection of individuals which broadly represent the population by gender, age, ethnicity, disability and work/social economic status. Jurors are given an incentive for both days, for the Stoke-on-Trent jurors were offered £200 to attend the event. For this Citizen Jury 18 people were recruited in order to produce an overall number of 15 jury members. Allowing room for a 20% drop out rate the method was successful at producing 15 members for both days. The strategy of recruitment was also successful at producing a mix of people who had no previous involvement with NHS Citizen and also reflected the following characteristics:
- “20% were non-white British
- 60% were female
- 40% were ages 18-34
- 33.3% were ages 35-54
- 26.6% were aged 55+”[7]
The process is designed to take place over two days in order to allow for different tasks to take place each day. Day one allows for introductions and allows the participants to learn about the different issues. Day two, questions, discussions and deliberations being to take place relating to the issues and also the decision of what five issues will be on the Assembly Meeting agenda is finalised. The report which was intended only for the NHS Citizen team outlines some issues faced with the first Citizen Jury. The report states that “recruitment of citizen and NHS England presenters was quite rushed and did not leave enough time for briefing before the event” as there was only three weeks between the closing of the public vote and the Citizen’s Jury.[8] Another issue raised in the report was that of the recruitment method and how the jury was recruited to reflect the demographic in age, gender, social and ethnic background and disability. According to this report there were difficulties by the recruiting company to achieve the correct balance in the Stoke-on-Trent and surrounding area coming to the conclusion that “if this approach was used again it would be best to choose an area that more closely mirrors the national demographic.”[9]
Phase 3: Assembly Meeting
The final process of NHS Citizen is the Assembly Meeting, a space where 200 members deliberate over the final issues which have emerged from the Gather process. This meeting takes place twice a year in order to provide the opportunity for citizens to go over these issues with members from the NHS England board. 200 citizens will be recruited for each Assembly Meetings through various different methods: voluntary members, elected or nominated representatives, random stratified sampling or purposeful sampling. Members for the meeting are selected ensuring that they broadly represent the population of England, therefore selection is carried out according to gender, age, socioeconomic background, ethnicity and disabilities. New members will be recruited for each new Assembly Meeting however spokespeople who have been nominated will participate in the latter part of the meeting in order to discuss progress. Specialists and lay experts will be invited in order to give evidence during the learning part of the assembly. These include for each issue: the person who flagged the issue on Gather, expert patients, specialists and policy specialists.
Similar to the Citizen Jury Report, NHS Citizen also published a Learning Report based upon the first official NHS Citizen Assembly which took placed this time in a bigger location in London on the 25th November 2015. Again the report is based upon feedback on the day of the event such as evaluation forms, monitoring data, contributions to a learning wall and also comments from the team. The report outlines the Assembly Meeting which was attended by 250 people from a range of backgrounds, some with little experience in sharing views of influencing decision-making, the criteria were as followed:
- “69.4% of registered attendees had never attended an NHS Citizen event before.
- 42.5% of registered attendees has never participated in any other NHS meetings, forums or workshops.
- Registered participants were more diverse than the national average in terms of ethnicity.
- Over half of registered attendees were female.
- There was representation of all 8 age groups (under 20, 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+), with no one group representing more than 20% of all registered attendees.
- 38% of registered attendees identified as having a disability, long-term illness or health condition.”[10]
In order to recruit the number of individuals needed 100 places were made available on a first come first served basis then the other 150 places were offered to people in order to deliver a mix of people who had no previous experience in the NHS Citizen process. The Assembly Meeting experienced the same issues which risen at the Citizens’ Jury which was that of recruitment. The report states “recruitment became easier once the 5 issues had been identified but this meant that recruitment was quite rushed. It would would be easier to get a diverse mix of people in the room if there was longer between the Citizens’ Jury and the Assembly.”[11] These reports despite being intended for NHS Citizen team members only are still great sources of information to use while evaluating the NHS Citizen process and they have been created to provide accurate data in order to improve the process rather than report for the public.
The whole NHS Citizen is based around this idea of getting everyday citizen involved in NHS decisions and this also is reflected in the design of NHS Citizen. While anyone can get involved via the Gather process there is also a huge aim at getting people involved online via twitter and other media forms such a videoing the meetings in order for others who were not involved to still understand what is going on. The Learning Report mentions that the Assembly was put online via a live webcast and could be watched via social media. Also stated in the report is that each workshop had a team of social reporters who were responsible for tweeting in real-time the events of the say. This was to stimulate a wider online conversation about the events and discussions taking place as the Assembly. The areas to be improved were how comments would be received and fed back into the real time discussions without interrupting too significantly the process. This follows through to another issues bought up by members of the Assembly and also an important question to pose, does the event have any real impact on NHS policy and decision making? According to the report “a number of participants would have valued a recap and update on what was decided at the last Assembly” in order to judge how the decisions and progressed and been implemented.[12]
Analysis and Lessons learned
From the report one reads that a number of learning activities shall be conducted which will look back at this NHS Citizen process in order to pin point what was effective and also what could be improved within the process. Looking back at the aims of NHS Citizen stated at the beginning one can see how all of these have been incorporated into the NHS Citizen design and how these aims have followed through to the Citizens’ Jury and Assembly Meeting. The conclusion drawn from the reports provided by the NHS Citizen team portray both areas which were successful at meeting these aims but also areas which fell short of reaching expectations.
Focusing our analysis on the two main areas of the NHS Citizen process: Citizen’s Jury and the Assembly Meetings we can see how effective the aim of citizen involvement is. After the Gather process which aims to generate issues and broadly narrow these issues down the Citizen’s Jury is useful in getting everyday individuals in in order to select the issues which are of interest to the wider population. As the design is based around the idea of everyday citizens taking an active role in NHS England decision making it is important to focus our attention on how effective their method of selection and make-up of members is in order to judge whether or not these methods will succeed at their aims or is the whole idea flawed. Overall from the information provided and evaluated it is clear that the issue is not with the selection method itself but rather the timing of it. From the data one can see that the selection methods succeed at selecting a range of individuals who reflect the national population in age, gender, social/economic background and disability. Both reports state however that this is a rushed selection which may cause issues in the future if not corrected.
From the Assembly Meeting it is clear from feedback that not only the wider public but also participants struggle to see the connection between their involvement and the influence on any actual NHS decision making. In order for this process to work NHS Citizen must clearly show the link between the Assembly Meeting and the influence it has had on NHS England. Overall the process it well designed to provide the most democratic method of selecting issues however the areas for improvement picked up by NHS Citizen needs to be address in order for it to remain a process in which individuals want to participate in.
References
[1] NHS England. (2016) NHS Citizen.
[2] NHS Citizen. (2016) NHS Citizen: Citizens’ Jury Learning Report.
[3] NHS Citizen. Pinboard NHS citizen
[4] NHS Citizen. Issue tracker NHS citizen – design.
[5] ibid
[6] NHS Citizen. Deliberation space NHS citizen – design.
[7] NHS Citizen (2016) NHS Citizen: Citizens’ Jury Learning Report.
[8] ibid
[9] ibid
[10] NHS Citizen (2016) NHS Citizen Assembly Learning Report.
[11] ibid,.p5.
[12] ibid
Secondary Sources
Citizen, N. (no date) Pinboard NHS citizen – design. Available at: https://www.nhscitizen.org.uk/design/what-is-nhs-citizen/gather/pinboard/ (Accessed: 9 April 2016).
England, N. (2016) NHS Citizen. Available at: https://www.england.nhs.uk/ourwork/patients/public-voice/citizen/ (Accessed: 10 April 2016).
Involve – programmes – NHS citizen (no date) Available at: http://www.involve.org.uk/blog/programmes/programme-nhs-citizen/ (Accessed: 10 April 2016).
Latta, S. (no date) Viewpoint: A year of learning from NHS citizen. Available at: http://www.lgiu.org.uk/2015/09/07/viewpoint-a-year-of-learning-from-nhs-... (Accessed: 10 April 2016).
NHS Citizen (2014) NHS citizen vision. Available at: https://www.nhscitizen.org.uk/design/wp-content/uploads/NHS-Citizen-Visi... (Accessed: 10 April 2016).
NHS Citizen (2016) NHS Citizen Assembly Learning Report. Available at: https://www.nhscitizen.org.uk/wp-content/uploads/2016/03/Assembly-learni... (Accessed: 10 April 2016).
NHS Citizen (2016) NHS Citizen: Citizens’ Jury Learning Report. Available at: https://www.nhscitizen.org.uk/wp-content/uploads/2016/03/Citizens-Jury-L... (Accessed: 10 April 2016).
NHS Citizen (no date) Deliberation space NHS citizen – design. Available at: https://www.nhscitizen.org.uk/design/what-is-nhs-citizen/gather/delibera... (Accessed: 10 April 2016).
NHS Citizen (no date) Issue tracker NHS citizen – design. Available at: https://www.nhscitizen.org.uk/design/what-is-nhs-citizen/gather/issue-tr... (Accessed: 11 April 2016).
NHS Citizen (2013) NHS citizen on Twitter. Available at: https://twitter.com/nhscitizen?lang=en-gb (Accessed: 11 April 2016).