Citizens’ Jury

A cartoon of a person in a wheelchair saying "my experience"

Cartoon from the Birmingham Design Workshop

Introduction

Gather is the element of NHS Citizen that gives people opportunities to come together to discuss and develop the issues that members of the public or third party organisations think are important. NHS bodies can also use it as part of their consultation and public participation strategy.

Some of the issues that get raised in Gather may go on to the Assembly Meeting. The priority ranking process in Gather will create a shortlist of these issues. Then the shortlist will be considered by a citizens’ jury who will select the issues to be discussed at the next Assembly Meeting.

This section describes how the citizens’ jury process will work.

What is a citizen jury?

A citizens’ jury is a small group of citizens (usually between 12 and 18 people) who meet for two days to make decisions on issues. The juries are normally made up of people who are randomly recruited from the general population, and this is done in a way that produces a diverse jury that is broadly representative of the population. The aim is to have a group of people who don’t have a stake in the issues and who can take an informed and independent decision. For further information about the background to citizens’ juries please see the literature review.

What will the jury do?

The citizens’ jury will meet before an Assembly Meeting to look at the shortlist of issues produced by Gather and decide which five issues should be on the Assembly Meeting agenda. It is important that this agenda-setting process is seen as fair and robust by everyone taking part in NHS Citizen.

How is the jury recruited?

The jury will be recruited by a market research company with experience in this work. Juries normally meet close to where the jurors live (for example, in the same city or county), and the recruitment will ensure that the jury broadly reflects the diversity of the local population by gender, age, ethnicity, disability, working status and socio-economic status. An NHS Citizen test jury was run in March 2015 and showed that it is possible to recruit a diverse group of citizens in this way.

How will the jury work?

The jury will run over two consecutive days. It will be guided throughout by an experienced facilitator. The process is outlined below.

Day 1

  • Introductions, getting to know each other, finding out about NHS Citizen and the role of the jury (this will be quite a short session).
  • Learning about the issues from witnesses and having an opportunity to ask questions (this will take up most of day one). 

Day 2

  • Discussion and deliberation on the issues.
  • Deciding which five issues will go on to the Assembly Meeting.

Jurors are given a payment (normally £80 to £100 a day) to attend the jury, which covers their expenses and is some compensation for giving up two days of their time (attendance at the citizens’ jury is voluntary). This is normal practice with citizens’ juries.

The witnesses (one per issue) would be people with living experience of the issues being discussed or advocates for the issue, and typically will include the people who are advocating the issues in Gather. It is likely that the jury would want to ask some broader policy or resourcing questions, and policy experts should also be available to help with this.

There are a number of challenges with this jury process that need to be addressed in the next stage of NHS Citizen.

The number of issues

Cartoon of two lightbulbs which  says "ideas"

Taken from the Leeds Design Workshop graphic

The priority ranking process in Gather is expected to produce a shortlist of 10 issues. It will be difficult for a jury to handle this many issues in two days, given the learning and discussion required. There are a number of ways that this could be managed:

  • Giving the jury some clear, accessible, short and easy-to-read information about each of the 10 issues in advance, so that they can start to learn about the issues before they meet. This could be the written output from Gather, and a common format would help ensure that some issues don’t dominate because they have more information. This material could be posted on a ‘citizens’ jury’ page on the NHS Citizen website to which everyone (not just jurors) would have access. Care needs to be taken in the amount of information provided in advance to avoid putting the jurors off from attending.
  • Planning the two days carefully so that enough time is given to learning about and discussing all the issues and making decisions. In the test jury in March 2015, a significant proportion of day two was given over to webcasting the jury explaining their decision and learning from the test. For the jury to get through 10 issues, the whole of day two needs to be available for deliberating and deciding. This has implications for transparency and this is addressed below. An alternative option would be to extend the jury to three days, but this has significant resource implications.
  • Preparing a way of making decisions (for example, priority ranking or preference voting) in advance. In the March 2015 test, the jury were invited to design and agree their own process for making a decision and, although this was a good thing to do, it took too much time away from the discussions. At the next citizens’ jury (to be held before the September 2015 Assembly Meeting) the decision-making method could be tested and refined (or changed altogether). If more work is needed, a subsequent NHS Citizen design workshop will be held.
  • Some of the test jurors said that they would like guidelines to help them choose the issues (not all the jurors agreed). This will be discussed at the next stage of design (see What next section below). The test jury would have liked information on the resources and benefits associated with addressing the issues as this would have helped to prioritise issues.

Diversity of issues

The test jury found it quite difficult to compare and balance issues that were very different in nature, particularly comparing issues that affect very small populations with issues that affect much larger populations. The jury recognised that issues affecting small populations can be severe. They also made the point that all the issues being considered are important, including those not selected for the Assembly Meeting agenda. The test jury raised questions about how NHS Citizen should deal with this diversity of issues and more thought will be given to this at the next stage of the NHS Citizen design.

Transparency

An important principle of NHS Citizen is that the whole process should be open and transparent so that it can command the confidence of everyone taking part, whether citizens, staff at NHS England or staff from other organisations.

Webcasting the citizens’ jury was discussed at the NHS Citizen Bristol design workshop in July 2014. Here people felt that it would not be a good idea to webcast the jury discussions but that it would be helpful to have a different way to make the process transparent. The test citizens’ jury in March 2015 incorporated a webcast element after the discussions when the jury were asked to briefly explain their choice of issue. Even though this element did not last long, it took time beforehand to help the jury become comfortable with the idea of being webcast. This took valuable time away from the core of the jury process which is to discuss and decide.

One alternative would be for an independent citizen journalist to be present throughout the two days and to publicly report (perhaps in real time) the work of the jury, summarise the discussions and explain the decisions. Time and money saved by not doing a webcast could be used in other areas, such as expenses for the issue witnesses.

The role of the jury

The role of the jury is to select the five issues to go forward to the Assembly Meeting. There may be scope for the jury to add more to this role, for example by explaining why each of the five issues were chosen. This might help the deliberations at the Assembly Meetings.

What next

A number of issues and actions will need addressing in the next phase of NHS Citizen:

  • designing the jury process, and the lead up to this in Gather, so that the jury can manage the expected number of issues (10)
  • preparing a decision-making methodology and guidelines to help the next citizens’ jury choose five issues
  • giving thought to how the diversity of issues can best be managed by the citizens’ jury
  • ensuring that issues affecting a minority of people are answered by NHS England
  • working on a cost-effective and citizen-friendly way of making the jury process transparent