Picture of a sun and a moon

Edward Andersson reflects on the first day of a meeting to develop the new NHS England Citizens’ Assembly. He identifies the key themes for exploration in day two. For more information on the Assembly see the DemSoc Site: http://nhscitizen.demsoc.org/



The first day of our meeting on the future NHS England Citizens’ Assembly was a whirlwind of interesting conversation and great ideas. It was an intense day and summarising it is, in many ways, an impossible task. Nevertheless I spent last night looking over our notes and pulled out the key points in preparation for day 2.

This blog post does not replace fuller notes of the day which will follow later.

The following topics are those we need to do more thinking about today:

Ensure participation by marginalised and ignored voices

People believe that a Citizens’ Assembly should be as inclusive as possible. One quote was “How do we ensure that the Citizens’ Assembly accurately reflects concerns of NHS user. How do we avoid a ‘filter’?” We need to explore how we listen to a cross section of society, avoid exclusion or interest group capture in practice.

How will speaking truth to power work?

In his contribution yesterday Tim Kelsey stated that the Citizens’ Assembly would contribute by “speaking truth to power”. People seemed excited by this prospect and we need to explore further what this might look like.

Involving NHS Staff

The potential involvement of NHS Staff in the Citizens’ Assembly was raised a number of times. This is an exciting and underexplored possibility.

What could the pilot assembly look at?

Yesterday it was suggested that the Citizens Assembly should start off with a quick Pilot activity to get moving. Today we will provide the space for a small group to prepare a proposal for outlining what that might look like in terms of activities and focus.

What is, or must be, new about the Assembly?

Many participants are concerned that the Citizens’ Assembly could duplicate the work of existing organisations or become another layer of NHS Bureaucracy. Today, we need to articulate what is new about the assembly.

What do we mean by co-creation in the context of the Assembly?

On numerous occasions yesterday people used the terms ‘co-creation’, ‘co-design’ and ‘co-production’ to describe how they believe the Citizens’ Assembly should run. These words have differing meanings and there isn’t a shared understanding of what they mean in the room. We need to develop an easily understood language to talk about the Citizens’ Assembly.

Today we need to rewrite the ‘co-creation’, ‘co-design’ and ‘co-production’ portion of the proposal, using this new language.

How might the Assembly and Healthwatch (and others) work productively together?

Many people are worried that the Citizens’ Assembly will duplicate existing structures in the NHS. Yesterday a Healthwatch representative indicated that there could be a useful and complementary role for the Citizens’ Assembly.. It would be great to explore how Citizens’ Assembly will work with and be of benefit to existing organisations.

What does must the Assembly do if it is to model good participation practice?

Yesterday participants mentioned that the Assembly is an opportunity for NHS England to lead by example in the field of engagement. Today we need to look at how the assembly to be a visible example of good practice for others to follow.

How does the ‘Gather’ layer actually prioritise issues? The triage system

Many people mentioned that the assembly structure needs to gather information from the local level, some spoke about a “triage system” prioritising issues for further investigation. We would like a  group to look at how to prioritise issues and revisit them.

There are many topics from yesterday which require further work, but that need to be  handled outside of the meeting:

  • The document will need to be rewritten to be more accessible
  • Making online engagement work and communicating this
  • Mapping where participation is already happening
  • Evaluation for success
  • What would a labelless event look like?
  • How can the Assembly engage with structures dealing with health but outside NHS England control, for example social care?
  • What can the Assembly do to make citizens feel like they are being supported to engage at the same level as the Chief Executive; the ‘Catherine Riddle’ test

As day two begins I want to say a big thank you to everyone for their hard work, enthusiasm and ideas. The first day was intense, day two is even more hands on and practical. We’ve come a long way since the event started yesterday and I am very excited to see where we are by this afternoon.