What would it take to help people to have a good life at home for as long as they choose?--
Testing an Inverted Citizens' Inquiry: The Challenge of Care at Home
Jam and Justice wants to work with people who can influence care at home (including social care commissioners) to test how we make design and decisions more participatory. We want to test a policy development ‘method’ that engages on an emotional and practical level as well as technical or commissioning one.
Evidence and policy suggests that including a wide network of expertise, particularly those with lived experience of needing care at home for themselves or family members, and giving voice and agency to people who receive care, alongside exploring the emotional aspects of health, can create produce better services. “Better services” in this context means for the person (their outcomes), the tax payer (more cost effective), and society (more inclusion, greater equity and the nurturing of community assets), by dealing with the whole person. This includes seeing individuals not as a ‘patient’ but a person rooted in their social context (place, family, the things that make them feel most alive and happy).
Yet too often the outcomes for particularly older people are not good. There is a significant lack of properly connected services to enable often very vulnerable people stay safe, connected and well at home, or return home after a hospital stay. The challenge, given our aging population is huge, and the costs increasing. New approaches are urgently needed. Our suggested approach is a model of collaborative service redesign, using the principles of the citizen Inquiry, but inverting it. In the usual model, the citizens hear from ‘expert’ witnesses, and are able to ask them questions, over a number of sessions before a report with citizen led recommendations is produced.
Our proposed ‘Inverted Citizen’s Inquiry’ would work in a similar but different way. Our Inquiry members will be technical specialists, professionals and the usual ‘experts’, who will hear from citizen witnesses. We want to learn if new forms of facilitated deliberation create more open decision-making processes or challenge the hard boundaries between people’s personal and professional roles, or ways of understanding a complex topic like care at home. The lessons could inform other areas of policy development.
This Jam and Justice project is premised on the idea that the expertise in this policy area is ‘unbalanced’ and needs re-balancing. We see a need for both a professional, detached, specialist viewpoint, balanced by a rounded, holistic, and emotionally connected perspective. Both are needed; aspects are currently missing. Our ‘Inverted Inquiry’ members will be drawn from across a range of relevant professions (OTs, nurses, GPs, social workers, carers etc) and at different levels of professional hierarchies. We aim to recruit as diverse and wide a group as possible. Facilitation of the Inquiry aims to help people enter the conversation as citizens or not dominated by their professional roles. Partly the Inverted Inquiry aims to see if we can re-mould conventional power hierarchies (where they inhibit creativity and new thinking) and see if we can get people into this space on an equal footing, open to new inputs.
To find out more about the ‘usual’ Citizen Jury model that we are adapting, see the review of citizen led deliberation processes produced by Shared Future, who will be helping to facilitate the project. Also the testimonies of citizens and professionals who were involved in one of Shared Future’s inquiries into community orientated primary care in Blackpool.