My last few posts have been trying to explore how the NHS long-term plan could have been developed and published with a wider frame than one that reflects the NHS itself. Yesterday I discussed how I think the NHS has a special responsibility for reaching out to the left behind that comes with its respected national status.
Today I want to investigate how some of the ideas being discussed within the process politics of Brexit could help the NHS long-term plan both achieve its goals and make much better contact with left behind communities.
Over the last few weeks the idea of ‘deliberative democracy’ has been discussed as a way of getting through the Brexit impasse – not to replace parliament or a referendum as the decision-making process, but to play a role in that process.
Over the last few years deliberative democracy has found a renewed voice in discussions of how we make decisions. It is based on the belief that discussion between citizens can enable consensual decision-making which has legitimacy. There are different forms of deliberative democracy. They usually depend upon three main principles,
• Those involved should be willing to listen and talk with respect.
• Those involved should be a representative sample of the local population with a full range of backgrounds.
• Discussions should be informed and based around a full range of different arguments.
(In recent years citizens’ assemblies have been involved in providing advice to the Irish Parliament about the nature of the questions to be asked with the equal marriage and abortion referendums. They don’t make the decision but advise on the question itself).
Back in the mid-1990s I was involved in what were then called ‘citizen juries’ where, over a couple of weekends, a representative group would be provided with information and expert witnesses to question before discussing the issue.
How would this help the NHS, the long-term plan and making connections with those left behind?
As I said yesterday, if the long-term plan wants to hit its improved mortality targets it will need to make enormous strides in improving cancer survival in left behind areas. And the problem for the NHS is that considerable improvement will need much greater and earlier involvement of groups of the population that are not at the moment involved with either their health services or any other major institutions.
This is where the interests of the NHS (if we want to improve cancer survival rates we need to get millions of people who feel left behind and outside of the NHS to present their worries and pains a lot earlier) and the interests of the nation (we need to find ways of involving millions of people in the institutions of our society) seem to intersect and, given the potentially good relationship between these millions and the NHS, it is one of the major institutions that could involve people in our society.
How could this work?
The NHS knows the towns and cities where the cancer survival rates are worst. These are very likely to also be locations where other health inequalities are considerable. And it is very likely that much of the population in these towns and cities will feel left behind. If the long-term plan is to work people in these towns and cities will have to become more involved in their health and their health service.
Let’s have a citizens assembly in each of these towns and cities over two weekends. Select a representative sample of 99 people from each town and city and over the two weekends locate the activity of the assemblies sequentially in two areas of the town or city that have been left behind. Holding the assemblies here – rather than in the town hall – would be counter-intuitive and would pique the interest of local and regional media.
If the question under discussion was something like “How can more people in our town survive cancer” it would both grab real attention and give the NHS the opportunity to provide local and clinical information for the deliberations.
Obviously the process is important here, but the NHS really does need very localised citizen help if it is going to improve health and healthcare in these areas.
The process could be repeated say 20 times over the first few months. The NHS would learn how to listen and talk to people about something that it thinks it knows a lot about and it would gain real cultural knowledge of towns and cities.
Of course, on its own this won’t bring left behind communities into much greater involvement, but it’s a good start and it’s using the NHS, an institution which enjoys enough respect, to do it.