By Houda Davis, Involve
Over the last Sprint, I have been on a journey through academic and practice literature on deliberative public engagement with a focus on popular assemblies. I have been particularly interested in what NHS Citizen might learn about how to form a broad, inclusive and representative membership, which actively supports participation beyond those that are already actively engaged, whilst ensuring connections are made with existing structures (for example existing local and regional patient voice groups). The live test Assembly Meeting at NHS Expo, where ‘accessibility’ emerged as a theme from Gather, also helped the NHS Citizen team consider what support different people might need to participate fully.
From these explorations a clearer picture of what the Assembly Meeting might look like, as well as some clearly defined questions to take to the next development workshop in May, have emerged (this is outlined in the latest version of the System Document, available very soon). The next design workshop will help us test this emerging model. Who takes part in the Assembly Meeting is one of the first questions we need to address as it will shape other aspects of the Assembly design, for example how breakout sessions might be facilitated to ensure people with different needs have equal voice.
So back to literature…No single selection process reviewed solved our concerns around representation and linking to a wider system. Broadly speaking there are four commonly used selection processes, and each has its own benefits and tensions:
- An open assembly, where anyone who wants to participate can, obviously has appeal in that it is likely to attract highly engaged and informed participants. However, it might also create a self-selected membership dominated by special interests and those with higher than average income and education.
- Random selection stratified by socio-economic demographics is likely to create a membership which is more representative of the wider population. However, such an approach will not make strong links with existing local and regional NHS engagement structures and patient voice groups, or with Discover and Gather layers of NHS Citizen.
- Purposive recruitment involves inviting specific stakeholders which is likely to attract highly engaged participants, but they may have strong pre-held positions.
- Electing or nominating individuals to participate is a less common form of selection, and while this method may add legitimacy and accountability associated with re-election, it is likely to amplify the problem of self-selection and attract participants with strong pre-held positions.
Taking these tensions the emerging model proposes active recruitment of participants to ensure a broad range of interests and views. In practice this means including a proportion of members from stakeholder groups, a proportion of randomly selected people from a pool of participants from Gather, and a proportion of people from traditionally marginalised groups. This will impact on structure and process design decisions. In particular special consideration will be needed around how to create a balanced playing field where ‘specialist’ and ‘non-specialist’ voices are equally represented. We look forward hearing your ideas at the May workshop!