1. Deliberative methods: engaging citizens in collective decision- making ANDREW THOMPSON UNIVERSITY OF EDINBURGH

2. Conflicts of interest  Who has paid you to give talks? ◦My university pays my salary and my travel/subsistence costs  Who has paid you for advice? ◦No one  Who has funded your research? ◦My university through my salary  Who has paid for you to attend conferences? ◦My university  Any other interest that could be connected with your work? ◦None, apart from academic

3. Context  Government to governance  legitimacy and authority  complexity  stakeholder involvement  better decision-making?  Current practice in learning from citizens  surveys of opinions and evaluations of services  patient /carer stories / emotional touch points  focus groups  membership of committees / fora  largely reactive and individualised

4. Definitions Mini-publics (Dahl, 1989): assemblies of citizens, demographically representative of the larger population, brought together to learn and deliberate on a topic to inform public opinion and decision-making Deliberation involves talk to resolve political conflict and problem-solving, through arguing, demonstrating, expressing and persuading, rather than suppression, oppression, or thoughtless neglect. (Mansbridge et al, 2012) Two principles (Parkinson, 2004): 1. Reasoning between people, rather than bargaining between competing interests 2. A public act, rather than a private act (such as voting)

5. Purpose in decision-making  From: consumers shopping in the market of ideas through pre-formed individual preferences  often uninformed or unconsidered reactions  To: citizens negotiating the meaning of the public good through democratic and rational processes  more reflective engagement through learning, talking and listening

6. Stages of mini-publics 1.Planning and recruitment  stewarding committee (neutral and opposing views)  random and/or purposive selection 2.Learning  information sources and materials  witnesses/experts/activists/officials/politicians 3.Deliberation  small groups, face-to-face 4.Decision-making  reasoned recommendations or decisions 5.Follow-up  dissemination of outputs and outcomes

7. Characteristics of participants Participants in mini-publics are (typically):  randomly selected  to give everyone affected an equal chance of selection  stratified  to reflect a diverse range of socio-demography and any other pertinent characteristics  remunerated  exposed to differing viewpoints  enabled to cross-examine experts (partisan and non-partisan)  supported in all stages of the process by non-partisan facilitators

8. Forms of deliberation Mini publicsCitizen juriesPlanning cellsConsensus conferences Deliberative polls Citizen assemblies No. of citizens12-26100-50010-18100-500103-160 No. of meetings 2-5 days4-5 days7-8 days2-3 days20-30 days SamplingRandom + self-selection Random + self-selection ResultCollective position report Survey opinions + collective position report Collective position report Survey opinionsDetailed policy recommend- ations DestinationSponsor + mass media Sponsor + mass media Parliament + mass media Sponsor + mass media Government + public referendum Source: adapted from Elstub and McLaverty (2014).

9. Advantages  Allows citizens the time and resources to learn and to deliberate to reach an informed decision  Learn how citizens produce informed decisions and what affects their preferences  Engages and empowers citizens to take an active part in decisions that affect them and their communities  Places citizens in realistic dynamic and collective contexts, rather than artificial individual isolation

10. Challenges  Reflecting the population of interest  equity; diversity; involving the uninvolved  Inclusion of the activists  Prevention of agency capture by vested interests  Mitigating information bias (materials, media, experts)  Outputs are usually recommendations, not decisions  accountability to participants for outcome  Scaling-up / developing infrastructure

11. Impact  Public policy  involvement of ‘ordinary’ citizens (the ‘wise fool’ rather than the engaged activist)  rational process, rather than vested interests  testing arguments at the micro level before being made at the macro level  opportunities for learning new ways of working for all stakeholders  Participants  increased self-efficacy and empowerment in making complex decisions  Citizens more generally  seen by other citizens to offer proxies for the ‘general public’ (themselves)  Governance  can be combined with other forms of involvement/participation, including representation  increased legitimacy of decisions

12. Summary  Suited to complex and contentious problems  Generally seen as acceptable methods by citizens  A degree of independence from vested interests  Increased reliability and validity of opinions and decisions  Time consuming  Expensive  Experts and sponsors can manipulate participants  Usually one-off events, rather than continuous review

13. References Dahl R (1989). Democracy and its critics. New Haven, Yale University Press. Elstub S and McLaverty P (eds) (2014). Deliberative democracy: issues and cases. Edinburgh: Edinburgh University Press. Fishkin J (2009). When the people speak: deliberative democracy and public consultation. Oxford: Oxford University Press. Mansbridge J, Bohman J, Chambers S, Christiano T, Fung A, Parkinson J, Thompson DF and Warren ME (2012). A systemic approach to deliberative democracy. In: Parkinson J and Mansbridge J (eds), Deliberative Systems: deliberative democracy at the large scale. Cambridge: Cambridge University Press. Parkinson J (2004). Why deliberate? The encounter between deliberation and the new public managers. Public Administration, 82 (2), 377-395.

14. Potential contributions to health care Abelson J, Forest P-G, Eyles J, Smith P, Martin E and Gauvin F-P (2003). Deliberations about deliberative methods: issues in the design and evaluation of public participation processes. Social Science & Medicine, 57, 239–251. Gregory J, Hartz-Karp J and Watson R (2008). Using deliberative techniques to engage the community in policy development. Australia & New Zealand Health Policy, 5: 16. Carman KL, Heeringa JW, Heil SKR, Garfinkel S, Windham A, Gilmore D, Ginsburg M, Sofaer S, Gold M and Pathak-Sen E (2013). Public deliberation to elicit input on health topics: findings from a literature review. Executive summary. Publication No. EHC 13-070-EF-1. Rockville, MD: Agency for Healthcare Research and Quality.

15. Questions? If you wish to continue the conversation, contact me at: andrew.thompson@ed.ac.uk