What is the NHS Citizen Assembly?

Introduction

The NHS Citizen Assembly Meeting is the space where 200 members of the public deliberate over citizen-generated issues that have emerged from Gather. It will happen twice a year and provide an opportunity for citizens to develop proposals and discuss them face to face with the NHS England board in a deliberative space and in the spirit of co-operation.

Young man and older man sitting  and discussing

Tom Yems, left, and Kerr Kennedy talking at an issue discussion for young people’s healthcare at the September 2014 Assembly test

While a number of issues might be resolved through deliberation in Gather or directed to the relevant body and decision-making level, the Assembly Meeting will specifically address issues over which the NHS England board has a clear remit and can respond to. See this accountability diagram for more information.

Who participates

Assembly member recruitment

200 citizens will be recruited for each Assembly Meeting to form the Assembly members. The literature review highlights a number of different ways of recruiting participants. For the NHS Citizen Assembly Meeting, we agreed that members are selected so as to ensure that they broadly represent the population of England. This means that the selection is carried out according to specific criteria to have a balanced mixture in terms of gender, age, socio-economic background, ethnic background, and disability.

The exact mechanism for this type of stratified selection will be determined in collaboration with a specialist recruitment agency. The rationale is to reach, and increase participation from, sectors of the population that normally participate the least in these types of processes. This will happen through oversampling of particularly marginalised groups to ensure their views and interests are well represented at the Assembly Meeting. To read more about different recruitment mechanisms and their pros and cons, see the Assembly Meeting Literature Review.

New members will be recruited for each new Assembly Meeting. However, spokespeople nominated by the Assembly will participate in the latter part of the next Assembly Meeting to discuss progress on previous recommendations with the NHS England board members.

Issue flaggers, experts and witnesses

Subject specialists and lay experts are invited to give evidence during the learning phase at the Assembly Meeting (see below). These include, for each issue:

  • the person who has flagged the issue on Gather, who will explain why the issue is important and help to unpick the problem/ question
  • expert patients, who act as witnesses and offer a first-hand experience of the problem
  • subject specialists who provide unbiased opinions
  • policy specialists from within NHS England

See the Assembly Literature Review on ways to involve experts so that Assembly members are provided with evidence and advice in ways that support their deliberations effectively.

All the collected themes from an issue discussion written and drawn, including: wellbeing, respect, participation, respect, influence, diversity

One of five broad issues discussed at the Assembly Meeting test in September 2014

NHS England board members

All of the NHS England board members join the Assembly members on the second half of day three. They hear the members’ reflections and work together to design proposals and solutions.

In the last plenary of day three, they provide the Assembly members with clear commitments, where solutions and recommendations have been agreed. They also offer feedback to the previous Assembly (represented by nominated spokespeople) on any progress on their proposals and recommendations.

Assembly dates will be in the diaries of all NHS England board members well in advance to ensure prioritisation and participation.

The agenda items

What issues does the Assembly Meeting discuss?

The answer to this question will depend on how Gather will work and the extent to which it is able to generate fully formed issues with answerable questions. There are two main types of issue that Gather could generate.

Issue type 1: clearly framed issues with answerable questions

Gather generates relatively clearly framed issues with answerable (even if multi-faceted) questions.

For example, how can we address increasing pressure on Accident and Emergency?

Issue type 2: wider issues

Gather generates a large number of less well-formed topics.

For example, how do we help youths with mental health conditions? Or, what are the impacts of merging health and social care budgets?

Thoughts and themes from the access to services discussion at the Assembly collected

One of five broad issues discussed at the Assembly Meeting test in September 2014

So through collaborative conversations between citizens and the board, the Assembly will manage two main types of issues:

  • Traditional, single problem questions
  • Broader, big topic issues

It is likely that Gather will produce a mix of broader and more focused questions. The citizens’ jury is solely responsible for prioritising five issues for the Assembly from the 10 issues (falling under NHS England’s remit) that have the most support in Gather.

While it is possible that the citizens’ jury will prioritize focused questions over broader topics (as the jurors might feel the latter are too complex), the reality is that the Assembly is likely to deal with a mix of broader and focused questions. There are different implications in each case.

How will the type of issue affect the discussion at the Assembly Meeting?

We know that citizens’ assemblies generally have time constraints; citizens are rarely able to spend extended periods of time working with the Assembly. This means that they work best when they focus on a small number of issues and can answer a similarly small number of clearly framed questions. This was one of the learning points from the Assembly Meeting test.

When issues are clearly framed and there are already answerable questions, the Assembly members can work on more detailed proposals, solutions and recommendations.

However, some issues that emerge from Gather are likely to be defined broadly precisely because there isn’t one easy problem statement or solution to hand. This clearly makes it more challenging to deal with in the Assembly Meeting.

For these big issues, the first task for the Assembly members will be to work together to start to better shape the problem statement in a way that clarifies it and helps to build understanding of how it affects different parts of the English population. The outcome of the deliberation may well be the actual framing of an issue, so that key components of the problem are identified and clearer questions can then be asked.

For the agenda items that emerge from Gather as a problem statement, the first stage of the Assembly’s deliberation will be to ensure that the problem has been correctly identified and that the issue raised is not a symptom of something else.

In the case of a broad topic, it is the Assembly’s responsibility to establish what the problem is, what the question is, and what success looks like. The Assembly will therefore:

  • Find or check a clear problem statement (and possibly a question that the system needs to answer).
  • Develop a clear description of how Assembly members would judge whether NHS England had developed a credible solution for dealing with the issue.
  • Ask the board for clear commitment to the type of collaborative process the Assembly members will institute to develop a solution.

The Assembly is likely to deal with a mix of broader and more focused questions. This will have implications for the Assembly’s deliberation. Members might choose to focus more effort on answering clear questions rather than unpicking complex problems. Good facilitation and a broad mixture of different views and interests among Assembly members will be crucial to ensuring the discussion is constructive, particularly in the case of broader topics that might require more creative thinking.

The Assembly Meeting’s agenda

The Assembly Meeting’s agenda has three broad phases:

  • Learning phase (day one) where members hear the evidence about the issues
  • Deliberative phase (day two and half day three) where members consider the issues
  • Deliberation and commitment phase (half day three) in the afternoon of the third day NHS England board members join the Assembly members to discuss problems and co-design solutions together. In the last plenary, the board members provide the Assembly members with clear commitments, where solutions and recommendations have been agreed. They also offer feedback to the previous Assembly (represented by nominated spokespeople) on progress on the commitments made at the earlier Assembly.

What next

We held the first full test of the Assembly Meeting on 18 September 2014. This was followed by a stocktake meeting on 25 March 2015 between the board and a number of participants from the September Assembly Meeting. The stocktake meeting will not happen in the future as Assembly Meetings will include a specific session for offering feedback on previous commitments.

We expect the next full Assembly Meeting to take place in September 2015. This will take place over the course of three days and involve members of the public recruited to represent the broad population of England. Issues for the Assembly Meeting agenda will be identified through the prototype Gather and citizen jury.

Outstanding design questions

As we run the first full three day Assembly Meeting, we will be particularly exploring the following questions:

  • How to define the criteria for recruiting members of the public to ensure that a broad set of views are represented?
  • How to ensure that the views of those often marginalised from public debate are included within the Assembly Meeting?
  • Does the process we have developed for the Assembly Meeting provide the right balance between collaborative conversations about the key issues while ensuring that the NHS England board is held to account for the commitments that it has made?