The First UK Citizens’ Assembly on Long-term Social Care Funding in England
In England, provision of and funding for adult social care has been subject to numerous reports, commissions and Government papers which have failed to produce agreement on how to tackle the urgent need for reform.
Involve was commissioned by two UK Parliamentary Committees to run a citizens’ assembly – a representative sample of the English public – to inform their joint inquiry on the issue.
It was the first time a UK Parliament has ever run a citizens' assembly to gather public views.
Social care provision and funding in England have been the subject of numerous reports, commissions and Government papers over many years. Despite widespread agreement on the urgent need for reform, their recommendations have not been translated into action and the social care system is faced with a dramatic funding gap.
A Citizens’ Assembly on Social Care was commissioned by the Health and Social Care Select Committee and the Housing, Communities and Local Government Select Committee as part of their joint inquiry into the long-term funding of adult social care. While Select Committees regularly reach out and engage the public, this Citizens’ Assembly was the first held by Parliament and probably one of the largest scale and in-depth examples of public engagement undertaken so far in the UK.
It brought together 47 randomly selected English citizens to consider the question of how adult social care in England should be funded long-term. Over its course, Assembly Members took part in approximately 28 hours of deliberation, equating to a total of 1,316 ‘people hours’ of learning, deliberation and decision-making.
Through two weekends of group deliberations, followed by individual votes, Assembly Members developed a set of conclusions and recommendations on: a. how adult social care should be funded, and b. how any decision should be taken. Assembly Members worked together to develop a list of values and principles that should inform any decision about how social care in England is funded. Assembly Members also considered and expressed their preferences on the best way to fund adult social care in England in the long term in terms of the balance between public and private funding.
The recommendations of the Citizens’ Assembly on Social Care have been considered by the Health and Social Care Select Committee and the Housing, Communities and Local Government Select Committee as part of their joint inquiry into the long-term funding of adult social care. Assembly Members hope that the government will also take note of their findings and recommendations in their efforts to address the social care funding gap.
The Liaison Committee in the UK Parliament is now running an inquiry on the effectiveness of select committees, with particular questions around public engagement methods of involving the public that have worked particularly well, such as this particular citizens’ assembly.
We are still awaiting the Green Paper from the Government outlining its plans for funding Social Care in England. This Paper is long delayed from when it was expected to be published in Autumn 2018.
More broadly speaking, using a citizens’ assembly to somehow break the deadlock around Brexit has also received cross-party support and was tabled as an amendment to legislation in Parliament recently.
What Makes Your Project Innovative?
The Citizens’ Assembly on Social Care brought together 47 randomly selected English citizens over two weekends to consider the question of how adult social care in England should be funded long term. Assembly Members took part in approximately 28 hours of deliberation, equating to a total of 1,316 ‘people hours’ of learning, deliberation and decision-making.
This was the first time ever that a UK Parliament has held a citizens’ assembly and probably one of the largest scale and in-depth examples of public engagement undertaken so far in the UK.
The Citizens’ Assembly on Social Care has demonstrated the role that the public can play in helping to resolve important but politically challenging issues. Assembly Members felt strongly that government and parliament should use citizens’ assemblies more often to inform their decision making.
Collaborations & Partnerships
It was commissioned by two UK Parliamentary Select Communities.
Involve organised, designed & ran the assembly, supported by two social care experts who were present for both weekends to provide impartial & balanced information.
An Advisory Panel supported preparations, helping to ensure Assembly materials were factually accurate, comprehensive, balanced & unbiased.
Two charitable foundations provided additional funding to support the Assembly but had no involvement in design & delivery.
Users, Stakeholders & Beneficiaries
Although the Assembly was commissioned by two Parliamentary Select Committees, the innovation was targeted to fulfil the objectives of the project, as well as influence the House of Commons further in using this engagement innovation more often. Since then, we have been approached by Other Committees about using Assemblies as part of their inquiries.
Furthermore, this innovation has been used to try influence Government directly to use such engagement methods at the national and local levels.
Results, Outcomes & Impacts
Many of the conclusions and recommendations of the citizens’ assembly have been incorporated into the joint inquiry abnd supported by the two select committees. The Assembly was mentioned 46 times in their joint-inquiry report.
The conclusions of the assembly are expected to indirectly influence the Government Green Paper on the topic. The Government has yet to publish this Paper, but there have been media reports which indicate some of the conclusions and recommendations are being considered by the UK Government. The Government has even mentioned it is parliament.
There has also been interest in the assembly from devolved UK parliaments as well as UK political commentators and academia.
Citizens’ assemblies have received greater public awareness in particular for dealing with the Brexit deadlock in Parliament.
Challenges and Failures
The largest challenge for the Assembly was the very short turn around time from the proposal to its implementation, because the Select Committees wanted to ensure their report was published in time to influence the expected publication of the Government Green Paper on the topic. Despite this, the project went fine, but there was no contingency time available if a problem had arose (we would recommend ensuring such buffer time).
While the Assembly took place without any problems during the two weekends, we did need to adapt the second weekend at the ‘last-minute’ to include presentations from people with lived-experience of social care in England. This was because, despite having an advisory panel, we missed a set of stakeholders who should have been represented in the initial design.
Beyond the duration of the Assembly itself, the greatest challenge is ensuring Government adopts or considers the Assembly conclusions and recommendations.
Conditions for Success
The politicians and officials who commission such assemblies need to be truely bought in to the process from the start and willing to take on board its conclusions and recommentations. In this case, the cross-party representation in the Committee chairs and the perception of them as major select committees made it a more impactful and successful process. They supported the method, and took on board what was concluded and recommended in an active and visible way.
Processes of this size and importance need skilled and experienced facilitators. They also need adequate resources and ideally enough time to prepare.
Such processes need clear objectives and outcomes that draw upon agreement between participants as a group, but also reflect their preferences as individuals.
It is also important that these processes are used particularly when there is a perception of a problem that is really stuck/unsolvable. If they want to resolve it, there is more appetite for this kind of innovation
Since the Citizens’ Assembly on Social Care, a similar-sized citizens’ assembly has been held in Northern Ireland on the provision of health and social care.
A citizens’ assembly has been proposed to overcome the obstacles to the Brexit deadlock in parliament. This even led to an amendment supported by over 40 cross-party politicians being voted on in Parliament (although did not receive a majority of votes).
Processes very similar to local citizens’ assemblies are also expected to be trialled in 8 local English authorities across the UK, supported by a UK Government fund, along with expertise from Involve and other civil society groups.
Other Citizens’ Assemblies have been held in the Republic of Ireland on a running basis to deal with constitutional issues. This predated the UK examples of citizens’ assemblies, although it had a number of differences, such as in size, scope, and duration.
There were three broad lessons learned from the Citizens’ Assembly on Social Care.
The first was around media and press work. We learned that when publicising the impact of the assembly that, despite close cooperation, the committees themselves were more interested in pushing the conclusions and recommendations more so than publicising the democratic open government innovation. We learned therefore that it is important to work on this messaging element much sooner into the process including preparation time for media in order to make the most of opportunities to create impact not only on the topic itself and conclusions of the assembly, but also on the process too. We also could have worked with committee chairs more closely to further raise the profile of this democratic innovation, with specific media pieces and articles.
We found that politicians – particularly the chairs of the two select committees in the UK Parliament – found the exercise to be incredibly useful in their inquiry. They took close account of the views expressed by the Assembly members and the way they voted on key decisions. They found the process to be invaluable in gauging informed public opinion on the difficult questions facing social care and helped them as they debated the recommendations set out in their own report. In particular, hearing Assembly members express strong support for social care free at the point of delivery and for the transparency and accountability that earmarked taxation would bring to spending on social care closely informed their proposals on these key issues of reform.
They also took into account the Assembly call for reform to lead to provision of high-quality care and the pooling of risk among individuals and for it to be underpinned by cross-party political consensus.
This level of consideration by committee chairs is due also to their active involvement in the Citizens’ Assembly. We learned also that this is crucial in ensuring the process is able to get the necessary political buy-in. The two committee chairs were keen to observe the process, and came by on the second weekend to speak with participants to find out about how they felt about the process. This positive – but not intrusive – level of engagement has been hugely useful in advancing our design and delivery of citizens’ assemblies.
We did also learn that we need to ensure that officials are closely informing politicians of the outputs and design of the process. This would have been useful sooner in the case of the Citizens' Assembly because the Chairs of the committees raised a couple of questions with us about this in the second weekend, meaning we needed to slightly tweak the outputs for that second weekend.