The Citizens’ Assembly on Social Care was the first of its kind to be commissioned by parliament in the UK. It builds on the work Involve did with the Constitution Unit on the Citizens’ Assembly on Brexit last September. Over two weekends 47 members of the public deliberated on how adult social care in England should be funded long-term. The recommendations will feed into the joint inquiry by the Health and Social Care Select Committee and the Housing, Communities and Local Government Select Committee. As Dr Rebecca McKee explains, this is another example of how the public are capable of engaging in complex topics and producing well informed and workable recommendations.
How should we pay for social care? This question has been the subject of much debate, with numerous proposals by successive governments, thinktanks, and others being published but never successfully implemented. Although there is consensus on the need for reform, exactly how to do it has fallen into what former Cabinet minister Charles Clarke has labelled the ‘too difficult box’. Later this year the government plans to publish its Green Paper on funding social care for older people. Ahead of this, the Commons Health and Social Care and the Housing, Communities and Local Government Select Committees are conducting a joint inquiry to develop a cross-party consensus on ideas for reforming the funding of this sector.
The Citizens’ Assembly on Social Care asked the question of how adult social care in England should be funded long-term. Assembly members were asked to look at adult social care for both people of working age and older adults. They reflected on questions such as how much individuals should have to pay themselves, how much should be covered by public funding, and whether personal assets, such as houses, should be included in calculations of what they might be expected to contribute.
What is a Citizens’ Assembly?
A Citizens’ Assembly brings together members of the public, giving them an opportunity to make informed recommendations on often complex topics. Assembly members have space to consider a diverse body of evidence, reflecting a range of views, their own opinions and perspectives, and the opinions of others in the room. In making their recommendations, Assembly members are asked to consider any trade-offs between different options.
The deliberative approach that characterises Citizens’ Assemblies makes it possible to give voice to the multiple views that exist around controversial policy issues. The emphasis on deliberation is crucial. Assembly members are asked to express, develop, question, and then re-examine their views in light of what they have learnt. This process delivers informed citizens who have acted together to make workable recommendations.
The recent Irish Citizens’ Assembly is an example of this approach. By considering Ireland’s abortion legislation, it broke with the tradition of kicking the can down the road and its recommendations were key to reigniting the debate. Whereas, previously, debate on liberalisation of the law had focused on extreme cases such as fatal foetal abnormality or rape, 72% of Assembly members voted to support legalisation of abortion in multiple different circumstances, including socio-economic issues. After five weekends of learning and deliberating, the Assembly recommendations succeeded in opening up the political space. As Kate O’Connell of Fine Gael said: ‘I think this issue, in Ireland, could never have gotten to the point we’re at today, were it not for the citizens’ assembly’.
Who were the Assembly members and how were they recruited?
The Assembly on Social Care brought together a group of 47 people, broadly representative of the English population. We followed a phased recruitment model similar to that used in the Citizens’ Assembly on Brexit, initially approaching 5,501 potential participants through an online survey conducted by ICM. The group was filtered to include people who were fairly or very interested in attending, who consented to their details being passed on to us, and who were available to attend on both weekends. After removing incorrect contact details, this left us with 1,382 people we could contact.
We drew a sample based on six criteria to ensure the group of Assembly members would broadly reflect the characteristics of the English population. These were: age, gender, region, ethnic background, social class, and people’s attitudes to a big or small state. As the table below shows, the group of Assembly members was broadly representative of the English population as a whole.
Table 1 – Stratification criteria: Comparison of the population of England and Assembly members
| Stratification criteria | Population of England | Assembly members | |
| Gender* | Male | 48.9% | 51.1% |
| Female | 51.1% | 48.9% | |
| Ethnicity** | White | 86.3% | 80.9% |
| BME | 13.6% | 19.1% | |
| Age* | 18-34 | 28.6% | 25.5% |
| 35-54 | 34.1% | 31.9% | |
| 55+ | 37.2% | 42.6% | |
| Region* | North | 27.8% | 21.3% |
| Midlands | 19% | 23.4% | |
| East | 11.1% | 17% | |
| London | 15.6% | 14.9% | |
| South | 26.5% | 23.4% | |
| Social Class† | ABC1 | 53.2% | 55.3% |
| C2DE | 46.7% | 44.7% | |
| Big/Small State†† | 0-3 | 6.96% | 10.6% |
| 4-6 | 40.2% | 40.4% | |
| 7-10 | 53% | 48.9% | |
| Source: * ONS mid-year statistics 2016; ** Annual Population Survey; † 2011 Census; ††British Election Study 2017 Face-to-face survey | |||
How was the Assembly run?
The Assembly took place over two weekends – from Friday evening to Sunday lunchtime – in April and March 2018. The first weekend served to set the scene, as Assembly members were introduced to the topic and presented with evidence from a range of experts on private and public funding models for adult social care. The second weekend was designed to consolidate what Assembly members had learnt at the first weekend, followed by deliberation at tables of 6-7 people. After deliberating, they voted on a set of recommendations on how adult social care should be funded. More information on how the Assembly worked can be found here.
Conclusion
The Citizens’ Assembly on Social Care was a huge success. The 47 members worked hard, giving up two of their weekends and coming to reasoned and informed recommendations. The speakers were impressed with the questions that were asked and the feedback from them and the other experts was overwhelmingly positive. Feedback from the members themselves was also incredibly positive. At the end of weekend two the members scored the following on average (out of 6):
The weekend as a whole – 5.7;
The lead facilitators – 5.8;
The table facilitators – 5.8.
By the end of the second weekend, 98% felt that they had learnt a lot during the assembly about adult social care and 96% felt that they had enough information to participate effectively. An overwhelming 100% of Assembly members felt that assemblies like these should be used more often to inform political decision-making. We hope that the success of the Citizens’ Assembly on Social Care can pave the way for more public involvement in decision-making in the UK.
The work of the Assembly in the members’ own words
We were hugely impressed with the effort and dedication of the Assembly members, who gave up two of their weekends to deliberate on the complex issue of adult social care funding. I would like to leave you with some words and feedback from them.
How have you found taking part in the Citizens’ Assembly?
‘I have enjoyed being part of something so important. It has been interesting to hear so many ideas and opinions.’
‘Very interesting and engaging. I have enjoyed learning more about these issues and interactivity with others to discuss them. The whole experience has been excellent.’
What do you hope the committees and government do with the findings?
‘Don’t ignore them as with previous Royal Commissions, Green Papers etc. Be brave and take appropriate action to safeguard the future funding of Adult Social Care, even though it may lose you votes. Do the right thing!’
‘I really hope all of our discussion and findings are taken seriously and acted upon positively and proactively. Social care cannot be set aside any longer, it’s a very important aspect of so many people’s lives.’
Do you think government and parliament should run more assemblies like this on other topics?
‘Definitely, it promotes discussion. It can change opinion, often for the better, and introduces everyone to the opportunity to be educated and enlightened. The participating members can pass knowledge on to friends and family thus widening the enlightenment.’
‘Absolutely, the decisions and issues are for the public, for the citizens, so ask them and include them in policymaking and change.’
The recommendations from the Assembly will be published in the Committees’ report on Wednesday 27th June.
A set of FAQs for the Citizens’ Assembly on Social Care can be found on Involve’s website
For more information contact Sarah Allen, Head of Engagement at Involve and Project Lead on the Citizens’ Assembly on Social Care (sarah@involve.org.uk)
About the author
Dr Rebecca McKee is a Senior Project Officer at Involve working on the Citizens’ Assembly on Social Care, leading the recruitment and participant liaison. She was previously the Research Associate on the Citizens’ Assembly on Brexit at the Constitution Unit, UCL.
The success of citizens’ assemblies depends on transparent and well-designed processes, including providing participants with access to relevant information and expertise. Your blog was beneficial; I learned a lot.