How many times have I heard this objection? You are a manager delivering health / social care services. You put out an expression of interest to recruit a number of community members to be a part of your group - your "council" or "panel". This group will most likely - if facilitated well - provide good input during discussions of the various health topics.
I have had some wonderful experiences with Consumer Councils. They are usually made up of extraordinary people who have a passion for volunteering and getting involved in health improvement activities and can really make a difference. Unfortunately, in some bureaucracies, what that group recommends may not be what the bureacracies want to hear. It is not uncommon to hear the criticism "But it's not representative!"
And mostly it's not. This becomes a way of shutting down or ignoring the outcomes from discussions of your Council.
One way of ensuring "representativeness" is through Deliberative Democracy. One application is the "Citizen Jury" methodology. A random sample is selected from a population of interest then stratified to ensure the sample does reflect the population profile. It's representative.
What is even more powerful is if this Citizen Jury becomes a permanent "Citizen Assembly". Permanency is important because it gives the local population enough time to develop trust in this powerful way of tapping into local well-informed intelligence.
One-off citizen juries can be amazing for everyone. However, they often have little impact on policy or decisions more broadly. For example, despite a one-off citizen jury in Ontario in 2007 making a well-considered recommendation that the voting system should change, a referendum for change later that year failed. Subsequent analysis found that:
“This experience underlines a major drawback of ad hoc assemblies. They do not have enough time – enough history – to generate broad understanding of their role and purpose, hence their recommendations lack the power and influence we might expect of permanent institutions” [1].
However, in Europe there is a permanent assembly linked by legislation to the government.
In February 2019, the parliament of Belgium adopted a law establishing a permanent citizen assembly (called “Citizen Council") into the political landscape [2,3], reporting to the parliament. This model is considered unprecedented anywhere in the world [3]. This permanent organisation has 24 members who have previously participated in a time-limited citizen jury. Their tenure is for 18 months, with a third of the group being rotated at a time. The citizen assembly’s task is to set the agenda once each year, routinely follow up the parliamentary response to the citizen jury recommendations and to monitor preparations for upcoming citizen juries. Although they decide the topics to be considered by the citizen juries, they do not make recommendations themselves.
I believe Australian Primary Health Networks could realise multiple benefits by institutionalising permanent Citizen Assembly in each region. They would have deep relationship with a representative Council of community members, enabling immediate access to community insights. Secondly, the outcomes of Citizen Juries from time to time can inform and contribute to the Needs Assessment which is required by the Commonwealth. In that process, the need for external consultants would also reduce.
The sky is the limit!
References
1. Patriquin, L., Permanent citizens’ assemblies: A new model for public deliberation. 2019: Rowman & Littlefield Publishers.
2. Deutschsprachige Gemeinschaft. The Ostbelgien Model: a long-term Citizens' Council combined with short-term Citizens' Assemblies. 2019; Available from: https://oidp.net/en/practice.php?id=1237.
3. Niessen, C. and M. Reuchamps, Institutionalising citizen deliberation in parliament: The permanent citizens' dialogue in the German-speaking community of Belgium. Parliamentary affairs, 2022. 75(1): p. 135-153.