eight - Reframing citizen deliberation

Summary

NICE's Citizens Council aimed to bring the voices of ordinary citizens into the centre of a key governmental decision-making process in healthcare. Politicians, civil servants, officials and many of the experts associated with the Institute already accepted that in giving advice to ministers about which drugs and treatments should be made available to the NHS, science alone could never be entirely decisive. In each case, there was a value judgement to be made. The Institute's process of stakeholder dialogue already acknowledged this to an important extent; patient groups, clinicians, managers and the pharmaceutical industry had a say. Creating an independent group of citizens bringing the diversity of their own experience alongside this would enable the Institute to keep in touch with the thinking of ordinary people, helping to ensure that the values which underpinned decisions reflected those of health service users as a whole. ‘Deliberation’ was a procedure which had been gaining in popularity – a process whereby citizens would have access to relevant information, and have the opportunity to discuss and debate and to set out the reasoning that enabled them to come to some conclusions. Coming together for joint reflection in this way would be a different experience for citizens from logging a preference in a survey or via a vote, and the outcome of such informed and shared reflection might well differ significantly from the results of opinion polling. Theorists, furthermore, had advanced some ambitious claims for deliberation – that it had the potential to broaden the range of considerations in a debate, and to generate novel solutions, that it could both enhance citizen capacity and prompt greater legitimacy for decisions in contentious areas.

The Council certainly had an impact both on the citizens and their hosts. Large numbers of citizens came forward to be members. Interviewed after the first four meetings, those selected reported that they had enjoyed the experience – so much so that several were taking steps to find new forms of citizen participation in the future. The Institute, at first unclear, found ways of using the first four reports to develop its thinking and its practice. And yet, a reader looking to these reports for an account of the values of ordinary citizens, set out and reconciled through deliberative reasoning, would emerge disappointed.