In the autumn of 2018 a representative group of 24 Scottish Citizens gathered over three days to make recommendations on shared decision-making in health and social care.
Problems and Purpose
The Chief Medical Officer’s 2014-15 annual report, Realistic Medicine, called for changes in the way care is delivered in Scotland. This included reducing harm and waste, managing risk better, reducing unnecessary variation and making care more personalised. A key focus was on shared decision making, where decisions about a person’s care or treatment are made jointly between health or social care professionals and the individual, or others supporting their care.
The follow up 2015-16 annual report, Realising Realistic Medicine, set out the Scottish Government’s plans to hold a citizens’ jury which would explore the issues further.
Background History and Context
In partnership with Shared Future CIC the Our Voice team convened an Our Voice Citizens’ Jury which looked at the issue of shared decision-making. A literature review was carried out in May 2017 to find out how juries have been used in Scotland and in other countries.
Work on the jury process started in June 2018. An Oversight Panel – including policy leads from Scottish Government, health and social care as well as service users from third sector organisations – ensured the process was rigorous, and an Implementation Group helped guide the project logistics.
Organizing, Supporting, and Funding Entities
The Scottish Health Council supports healthcare providers to engage meaningfully with people and communities in the design and delivery of services.
Participant Recruitment and Selection
Recruitment was done using a letter sent to a random stratified sample of Scottish Citizens, using a market research company. Recipients were invited to indicate if they wished to take part. Incentives of £100 per day were paid, and over 200 people applied. 24 participants were selected to join the inquiry. All 24 attended all 3 full days of deliberation and many also attended the launch event in February 2019.
Methods and Tools Used
This event used the Citizens' Jury method which brings together a diverse group of between 12 and 25 members of the public to work through an issue, share ideas, and come up with a set of recommendations. The participants are helped by experienced facilitators who ensure everyone has a fair say and that the task is achieved.
What Went On: Process, Interaction, and Participation
In the autumn of 2018 a diverse group of Scottish citizens gathered over 3 days to consider shared decision-making in health and social care. The 24 citizens shared ideas, opinions and experiences and questioned expert commentators before attempting to reach a consensus.
The Our Voice Citizens’ Jury on Shared Decision-making: Final Report documents the process followed and lists, in the participants’ own words, their recommendations on the following question:
What should shared decision making look like and what needs to be done for this to happen?’
The process was based on the model of the citizens' jury. Deliberations were led by experienced facilitators who help make sure everyone has a fair say and that the task is achieved. As part of this deliberative process, there is also input from external commentators who offered particular insight or expertise.
The Citizens’ Jury presented its 13 recommendations at an event in Dundee on 6 February 2019 to the Chief Medical Officer and other key stakeholders in health and social care. These stakeholders discussed the implications of the recommendations, and a summary of the discussions is included in this report.
Influence, Outcomes, and Effects
The Scottish Government committed to carefully consider each of the Jury’s recommendations and reply to them all, either with a commitment to action or an explanation as to why that recommendation could not be taken forward. The Scottish Government's response to the recommendations has been published on the Realistic Medicine website.
On Wednesday 6th February 2019 the Scottish Health Council and Chief Medical Officer’s Realistic Medicine Team launched the Recommendations from Scotland’s Citizens Jury on Shared Decision Making
At this event, held in the Steeple Centre, Dundee participants explained the recommendations and the rationale behind them. Conversations began to look at how the recommendations could be taken forward by changing how services are delivered or to inform policies that encourage people to take an active part in maintaining their health, thereby contributing towards both preventing and treating illness.
The Scottish Government's response to the recommendations was published on the Realistic Medicine website in June 2019.
Analysis and Lessons Learned
An evaluation of the jury process and its impact is in progress.
Final Report: http://scottishhealthcouncil.org/our_voice/idoc.ashx?docid=ebb8c59d-628f-4e1f-a312-917edfab0d93&version=-1