The ‘Shaping Tomorrow’ Youth Jury addressed a recognised gap in young people’s influence on UK health policy: 15 paid youth researchers were trained over a 12-week programme, conducted peer research, deliberated across three structured days, and produced a 12-recommendation manifesto that the manifesto reports was subsequently endorsed by Hampshire and Isle of Wight health-governance boards, including the Integrated Care Partnership Joint Committee.

Problems and Purpose

Young people are systematically under-represented in the design of the health and social care services they themselves use. The ‘Shaping Tomorrow’ manifesto opens with the claim that young people feel ‘unempowered, unheard and forgotten’ and that they want and deserve to be involved in decisions that directly affect their health and futures [1, p. 3].

Three structural problems framed the project. First, many health and social care services rely on young people to actively seek them out, which itself creates a barrier to access [1, p. 19]. Second, young people have limited opportunities to influence decisions in their school or home environments, often because their age is treated as a reason to discount their lived experience [1, p. 19]. Third, the young researchers’ own peer research surfaced specific gaps: the prevalence of vaping, [1, pp. 21, 24] inadequate mental health support both in and out of school, [1, pp. 21, 23] and insufficient reproductive and sexual education within the PSHE curriculum [1, pp. 21, 25].

The Youth Jury was designed to serve four purposes. The first and primary goal was to increase young people’s involvement in, and influence over, health and social care policy and practice across Hampshire and the Isle of Wight, and nationally [1, p. 3]. A second, capacity- building goal was to equip 15 young people, through the Young Researcher Training Programme (YRTP), with the research skills and confidence required to produce credible, evidence-based recommendations [1, pp. 3, 11]. A third was to engage decision-makers and practitioners from the Hampshire and Isle of Wight Integrated Care Board (ICB) and Integrated Care Partnership (ICP) directly in the deliberation, on the rationale that collaborating with young people removes the ‘guesswork’ from policymaking and aligns implementation with actual needs [1, pp. 3, 19]. The final purpose was to deliver actionable solutions: 12 priority recommendations co-designed for ICP implementation [1, pp. 8, 17, 29].

Background History and Context

Three converging contexts made the Youth Jury both necessary and possible: a national youth- health crisis, a structural exclusion of young people from health policymaking, and a regional NHS commitment to engage them.

A worsening youth health crisis. NHS Digital’s 2023 follow-up to the Mental Health of Children and Young People in England survey reported that one in five children and young people aged 8–25 had a probable mental disorder (20.3% of 8–16 year olds, 23.3% of 17–19 year olds, 21.7% of 20–25 year olds), and that for 17–19 year olds prevalence had risen from around 1 in 10 in 2017 [2]. The Care Quality Commission found that demand for child and adolescent mental health services continued to outstrip supply, with rising referrals and many young people waiting months for support [3]. Youth vaping had become a second priority, with around 18% of UK 11–17-year-olds (about 980,000 children) having tried vaping by the 2024 ASH survey [4], a figure relayed by Isba et al. [5], who connect it to nicotine dependence, poorer mental health and broader inequalities.

Structural exclusion of young people from health decision-making. Despite this need, young people remained under-represented in the design of services intended for them. A 2024 article in Research Involvement and Engagement observed that youth voices are often undervalued in health inequalities research and that engagement typically begins after research questions are already set [6]. A 2023 scoping review of deliberative priority-setting reached a related conclusion: methods for power-sharing with young people do exist but have yet to be adopted by the organisations and institutions that set health policy [7]. (That review was co-authored by Mary Barker, who also drove the present initiative, so it is not an independent witness to the gap.) Existing UK channels, youth councils, consultations, and parliamentary events rarely extend beyond the consultative end of the participation spectrum.

A regional institutional opening. The local context made this national problem tractable. The Health and Care Act 2022 established Integrated Care Boards and Integrated Care Partnerships as statutory bodies; under that framework the duty to commission services and the duty to reduce inequalities rest with the Integrated Care Board (and, in parallel, NHS England), while the Integrated Care Partnership’s distinct statutory role is to prepare the integrated care strategy [8]. The Hampshire and Isle of Wight ICP has designated children and young people as one of its five priorities in its Integrated Care Strategy, alongside mental wellbeing, good health and proactive care, workforce, and digital. The strategy explicitly commits to working with local communities to understand their needs and reduce inequalities, particularly for those most disadvantaged [9]. This commitment created a receptive policy environment: an ICB and ICP that had publicly tied their strategy to youth health outcomes had structural and reputational reasons to engage with a credible, evidence-based youth manifesto.

Interview material with project architect Professor Matt Ryan gives an additional causal account [10, 0:26–7:27]. The cross-disciplinary collaboration was driven by Professor Mary Barker, who had worked on citizen-science approaches and believed that empowering young people could directly improve their health [10, 0:53–1:20]. The earlier NextGen programme had taught school students how to design research, but its organisers were frustrated that the resulting work never translated into policy [10, 3:26–3:51]. ‘Shaping Tomorrow’ was conceived to close that gap by combining NextGen training with UKRI Rebooting Democracy funding, additional policy training, and a structured three-day session modelled on citizens’ assemblies [10, 4:28– 5:55].

At this intersection of need, methodological gap and institutional opening, the initiative was set in motion by the MOTH (Motivating and Sustaining Engagement of Young People in Improving their Health and that of their Communities) team [1, p. 9]. To learn how to support young people as policy advocates, the team first worked with Bite Back 2030, the UK’s largest youth- led NGO, drawing on its youth board to inform the training framework [1, p. 10].

MOTH collaborated with LifeLab (a Southampton facility that has worked with over 16,000 young people) and Pathways to Health to develop the Young Researcher Training Programme, designed to equip participants with research skills capable of legitimising their policy recommendations while raising aspirations and wellbeing [1, p. 9]. The team worked closely with the Hampshire and Isle of Wight ICB and ICP from the outset, since the ICB allocates NHS resources and sets regional strategy: the relationship was constructed so that the cohort’s research could translate directly into policy rather than sitting in a report [1, p. 10]. For the final deliberation, the project partnered with the UKRI Rebooting Democracy project at the Centre for Democratic Futures, which specialises in engaging marginalised groups; it designed a bespoke Youth Jury in which participants could cross-examine experts and finalise their manifesto [1, p. 9].

Organising, Supporting, and Funding Entities

Organising entities: Five organisations co-led the initiative. The MOTH team set the project in motion [1, p. 9]. LifeLab hosted the YRTP at its purpose-built facility and co-developed the programme with MOTH [1, p. 9]. Pathways to Health co-developed the YRTP alongside MOTH and LifeLab [1, p. 9]. The UKRI Rebooting Democracy team, based in the Centre for Democratic Futures, designed and delivered the bespoke Youth Jury [1, p. 9]. The University of Southampton partnered in delivery and, in April 2024, formally employed the 15 young people as researchers [1, pp. 3, 10].

Supporting entities: The Hampshire and Isle of Wight ICB and ICP supported the project from the outset. Representatives from both bodies attended the Youth Jury as expert witnesses; the manifesto reports that the recommendations were subsequently endorsed by regional health- governance boards and taken into joint committee action plans [1, pp. 10, 29]. Bite Back 2030 informed the design of the training programme by sharing the experience of its youth board, leaders and operations team [1, p. 10]. Public Policy Southampton and the youth charity No Limits are listed as official partners in the manifesto [1, p. 34].

Funding entities: The project was jointly supported and funded by four research and health programmes: the UKRI Rebooting Democracy project, the ARC Wessex MOTH project, the NIHR EACH-B (Engaging Adolescents in Changing Behaviour) programme, and the UKRI Pathways to Health through Cultures of Neighbourhoods project [1, p. 9].

Participant Recruitment and Selection

The project targeted a narrow demographic by design. Candidates had to be aged 16–17 and had to live, study, or work in Southampton [1, p. 10]. Selection was deliberately rigorous, in part to legitimise the cohort’s later policy claims. Prospective participants completed a formal application, took part in a discussion-group activity, and sat an online interview [1, p. 10]. Fifteen young people were chosen to form the 2024 cohort and, in April 2024, were formally employed as researchers by the University of Southampton [1, pp. 3, 10]. The use of paid employment, rather than informal ‘youth voice’ volunteering, is itself a notable design choice: it materially recognises the participants’ labour and expertise and signals that their work is treated as research rather than consultation.

Methods and Tools Used

The research phase drew on both qualitative and quantitative approaches across a 12-week training programme [1, pp. 10–11]. Participants used interviews, focus groups, surveys and questionnaires to gather peer evidence, and applied formal data analysis methods to interpret the results [1, pp. 11–12].

The 3-day Youth Jury itself relied on group work, structured deliberation and debate to identify policy ideas and prioritise them [1, pp. 13–14]. A bespoke board game called Lemonade was used to break the ice between young people and adult professionals and to surface conversations about aspirations, life paths and inequalities [1, p. 15].

Expert interrogation structured the relationship between participants and policymakers: ICB and ICP members served as expert witnesses, and the young researchers cross-examined them to refine ideas into actionable, feasible policies. The session culminated in a formal ‘Jury’ in which the youth advocated for implementation [1, p. 15].

Structured decision-making narrowed an initial list of 56 recommendations to 30, then to 16, and finally to 12, through phased group review, clarification and merging [1, pp. 14, 16]. Creative communication and advocacy tools carried the work outward: in the three months following the Youth Jury, participants produced a written manifesto, films, and zines, and worked with Theatre for Life on presentation skills [1, p. 17]. Posters had been used earlier to communicate independent research findings to the jury [1, p. 12].

What Went On: Process, Interaction, and Participation

Independent research (12 weeks): The 15 young researchers formulated their own research questions and acted as primary data collectors, engaging directly with peers through interviews, focus groups, surveys and questionnaires [1, pp. 10, 12].

Youth Jury: Day 1 (16 July 2024): Deliberation and narrowing. Facilitators guided participants through the categorisation of their research findings and the systematic narrowing of 56 recommendations to 30, and then to 16 priorities [1, pp. 13–14].

Youth Jury: Day 2 (17 July 2024): Expert interaction. Members of the ICB and ICP attended as experts. Participants and professionals played Lemonade to open conversations about life paths and inequalities, then moved to formal expert interrogation in which the young people pressed practitioners on feasibility and refined their policies into actionable steps. The day closed with a formal Jury session in which the youth advocated for their ideas [1, p. 15].

Youth Jury: Day 3 (18 July 2024): Final decision-making. The cohort reflected on the previous day’s interrogation, merged overlapping recommendations, clarified arguments, and finalised the list of 12 recommendations along with an overarching vision [1, p. 16].

Creative finalisation (three months): Participants produced the written manifesto, filmed videos, designed zines and worked with Theatre for Life on presentation skills [1, p. 17].

Assembly and action planning (13 November 2024): The young researchers led an assembly in which they presented their manifesto to 70 representatives, commissioners and health service deliverers from the ICP. Round-table discussions translated the recommendations into concrete implementation plans [1, p. 29].

Influence, Outcomes, and Effects

The manifesto reports institutional uptake beyond advisory output. According to the manifesto, the recommendations were formally endorsed by the Integrated Care Board (6 November 2024), the Hampshire and Isle of Wight Children and Young People’s Partnership board (5 December 2024) and the ICP Joint Committee (22 January 2025), and incorporated into joint committee action plans [1, p. 29]. The health board subsequently produced an official Action Plan with named leads assigned to each policy area [1, pp. 30–31]. The same ICP committee paper recommended an annual youth assembly, with November 2025 proposed for the next event; if sustained, this would embed the Youth Jury as a recurring feature of regional health governance rather than a one-off engagement exercise [1, p. 32].

For the participants, the manifesto reports significant capacity-building outcomes: increased confidence, strengthened public-speaking skills, and shifts in career aspirations [1, pp. 5, 7]. The young researchers themselves articulated, in Recommendation 9, that future Youth Panels should ‘cover multiple public sectors such as healthcare, education, and politics, ’ an explicit ambition for the model to expand beyond health [1, p. 27].

Analysis and Lessons Learned

Several design choices underpin the design’s effectiveness. First, organisers prioritised structured capacity-building before formal engagement, recognising that young people would not contribute on an equal footing with professionals without sustained preparation. The 12-week YRTP equipped the cohort with research methods, public-speaking confidence and substantive knowledge of the policy landscape [1, pp. 3, 10–11]. Second, employing the young people as formal university researchers from April 2024 removed the economic barrier and signalled their contributions as professional work rather than tokenistic consultation [1, p. 10].

Several areas need development. The cohort was small (15 young people) and regionally recruited, limiting demographic representativeness and raising scaling questions. There is also a gap between the cohort’s strong agenda-setting and option-selection power and the more diffuse process of long-term implementation, which depends on multiple ICB/ICP leads translating endorsement into delivery. The proposed annual youth assembly from November 2025 would, if held, offer ongoing accountability, but its effectiveness will depend on whether the model survives commissioner turnover and political cycles [1, p. 32].

The case supports findings in the democratic-innovation literature that structured deliberation can produce considered, evidence-based outputs when participants have genuine resources, time and influence rather than being slotted into pre-set consultative frames [11]. It also corroborates the wider evidence that conventional youth consultations are critiqued as tokenistic and that genuine co-production better elevates marginalised voices [6]. The combination of formal employment, long-term training, peer-led research and institutional endorsement is unusual in UK youth-participation practice and offers a template that other Integrated Care Systems could adapt.

Ryan’s own evaluation sharpens these reflections. He identified two principal areas for improvement. First, recruitment: a more random or stratified process would reduce the bias toward medical-career-interested students, combined with explicit quota sampling, an approach Southampton City Council has since adopted [10, 13:07–13:26]. Second, cost: the current configuration depends on four experienced professors and a wider team, and future replication should aim to ‘train people to train young people’ so delivery is not dependent on the original academic leads [10, 38:28]. He also flagged the absence of a control group as a methodological limit: without a comparison cohort, it is difficult to ‘robustly infer’ the precise democratic value added [10, 39:10–39:38]. These honest acknowledgements reinforce, rather than undermine, the case that the model is a serious and reflexive attempt to extend young people’s voice in health policy.

QUALITATIVE ANALYSIS ON DEMOCRATIC GOODS

INCLUSIVENESS

Fairness of selection rules and procedures:

Smith argues that inclusiveness depends first on rules establishing political equality through presence, who is allowed to participate [11, p. 21]. ‘Shaping Tomorrow’ did not employ random or stratified sampling; instead, it recruited 15 young people aged 16–17 who lived, studied or worked in Southampton, the published participant biographies indicating a range of backgrounds [1, pp. 4–7]. The approach prioritised a traditionally marginalised demographic over formal demographic representativeness, reflecting what Goodin, cited in Smith, terms ‘constituting the demos’ to counter elite bias [11, p. 21]. The cohort remains small, however, and the absence of stratified sampling risks reproducing intra-group inequalities.

In the interview, Ryan was candid about the limits: recruitment relied on the LifeLab schools’ network, which biased the pool toward students interested in medical careers, and the 2024 cohort was ‘very female’ in gender balance [10, 12:13–13:07]. The inherited application-and- interview model was ‘checking that they have the kind of attitude to fit in’ rather than testing competence, and ‘there’s always a bias if you use that kind of selection process, over one that’s a bit more random’ [10, 36:30–36:50]. Subsequent iterations have moved toward quota sampling: Southampton City Council’s later Youth Voice commission set out explicit recruitment expectations, including home-schooled young people and those with learning disabilities or special educational needs [10, 13:26]. The design is being continuously refined against the inclusiveness criterion rather than treated as fixed.

Fairness in making contributions / Equality of voice:

Inclusiveness also requires equality of voice, since inexperienced participants often self-censor [11, pp. 21–22]. The design addressed this through extensive capacity-building: the 12-week YRTP provided research methods, debating skills and a ‘solid understanding’ of how to apply them [1, pp. 3, 11]. Participants like Willow, who had initially struggled with the scientific content, developed ‘great confidence in public speaking’ and the ability to articulate their points clearly to policymakers [1, p. 5]. On Day 2 of the Youth Jury, the board game Lemonade was used to equalise the power dynamic between youth and adult professionals, opening conversations about life paths and inequalities before formal deliberation began [1, p. 15].

Fairness in generating outputs:

Participants exercised substantial control over the manifesto’s substantive content. Recommen- dations were generated, debated and refined by the cohort across three days, narrowing 56 to 30 to 16 to 12 [1, pp. 14–16]. Outputs were not pre-drafted by organisers; they were the cohort’s own product, presented to 70 representatives at the November 2024 assembly [1, p. 29]. Creative outputs (manifesto, films, zines) were produced by the participants themselves with support from Theatre for Life [1, p. 17].

Can the initiative overcome differential participation across social groups?:

Recruitment did go beyond the typical youth council demographic, including working-class, minority-ethnic and previously non-engaged youth [1, pp. 4–7]. The small cohort size and regional focus still leave broader asymmetries unresolved (for example, rural island communities and young people not in education, employment or training). The proposed annual youth assembly from 2025 may help widen the participant pool over time [1, p. 32].

Conclusion:

Within a deliberately defined demos, the design addressed the major practical barriers that silence inexperienced participants through targeted recruitment, capacity-building, formal employment and creative facilitation. The cohort is small and not formally representative, but the design represents a well-resourced attempt to extend genuine voice to a group routinely excluded from health policy.

CONSIDERED JUDGEMENT

Acquiring technical knowledge:

The 12-week YRTP emphasised practical knowledge before any deliberation. Participants learned primary and secondary research methods, interviews, focus groups, and questionnaires through hands-on application [1, p. 11]. Information sessions covered the ICB, ICP and wider Southampton policy landscape, ensuring participants understood the institutional context for their recommendations [1, pp. 10–11]. This was not an expert-led briefing model; participants conducted peer research and built knowledge through structured doing.

Appreciating other perspectives:

Smith, drawing on Arendt, describes considered judgement as the cultivation of an ‘enlarged mentality’, the ability to imaginatively occupy the position of others [11, pp. 24–25]. The design was built through two mechanisms. First, acting as peer researchers required participants to engage with health concerns beyond their own experience [1, p. 3]. Second, the Day 2 Lemonade exercise placed young people and adult commissioners in shared experiential play, forcing each to reflect on the trade-offs the other faced [1, p. 15]. This mutual perspective-taking shaped the cross-examination of ICB and ICP members, in which the cohort pressed practitioners on feasibility and refined recommendations into actionable steps [1, p. 15].

Ryan identified long-term capacity-building as the ‘main insight’ of the design, contrasting it with shorter assemblies in which ‘you turn up and you just learn a bit from a few PowerPoint presentations about some topic’ [10, 32:55–33:14]. Because participants had conducted their own peer research, they entered the cross-examination of policymakers ‘a lot less deferential... a lot more confident in how they can actually behave in front of adults with expertise’ [10, 22:31]. Ryan reported policymakers were repeatedly struck by issues the cohort raised that older participants would not have anticipated, including ‘culturally sensitive meals in schools’, vape-shop siting near schools, gyms in which young women felt able to participate, and how reproductive health is taught [10, 26:40–27:13]. Deliberation drawing on a genuinely distinct demographic perspective generated substantive content that a process restricted to professional commissioners would not have produced.

Developing an enlarged mentality:

The final recommendations show this enlarged mentality at work. Rather than focusing narrowly on the 15 participants’ immediate concerns, the manifesto addresses cultural and religious sensitivity, inclusive practices for neurodivergent young people, and co-educational sex and relationships teaching, reflecting the needs of peer groups outside the cohort’s own demographic experience [1, pp. 23, 25, 26]. The narrowing from 56 recommendations to 12 over three days reflects sustained reflective work rather than raw preference aggregation [1, pp. 14–16].

Institutional support for reflective preference formation:

The deliberative phase was structured to support reflective rather than impulsive judgement: a day of categorisation, a day of expert interrogation, a day of consolidation, then three months of creative finalisation before the November assembly [1, pp. 14, 17]. This iterative format gave participants time to revise their views as evidence accumulated.

Conclusion:

By combining technical training, peer-led research, expert cross-examination and iterative narrowing, the design moved participants well beyond raw preferences toward recommendations grounded in feasibility, evidence and reflection on the needs of others. The design satisfies Smith’s criterion that democratic innovations should cultivate reflective rather than untransformed preferences.

POPULAR CONTROL

Influence over stages of decision-making:

Smith’s policy-stage model locates popular control across four moments: problem definition, option analysis, option selection, and implementation [11, pp. 22–23]. ‘Shaping Tomorrow’ demonstrates strong control at the first three and partial extension into the fourth, unusual for a UK deliberative innovation in this policy area [1].

Agenda-setting and framing:

Through peer research during the 12-week training, the cohort identified the priority themes themselves (vaping accessibility, mental health, extra-curricular wellness, sexual-health education, among others), rather than being given a pre-set list [1, pp. 12, 23]. This contrasts with consultations in which authorities define the question and participants merely ratify it.

Influence on outputs and their political weight:

On option selection, the cohort retained full control: the 12 final recommendations were chosen by participants through structured deliberation, not by organisers [1, pp. 14–16]. The 13 November 2024 assembly of around 70 commissioners and service deliverers translated the recommendations into implementation plans; the manifesto reports that formal endorsement followed from the Integrated Care Board (6 November 2024), the Children and Young People’s Partnership board (5 December 2024) and the ICP Joint Committee (22 January 2025) [1, p. 29]. The outputs were not received and shelved, but taken up by the regional health-governance boards responsible for the relevant policy areas.

Citizen involvement in implementation:

Control extended into implementation through the ICP and ICB & Stakeholder Action Plan, which assigns named institutional leads (including the Women’s Health Programme Board and the Hampshire and Isle of Wight Beewell Steering Group) to specific recommendations [1, pp. 30–31]. The committee paper proposed an Action Plan update to the May 2025 joint committee [1, p. 32], and recommended an annual youth assembly, with November 2025 proposed for the next [1, p. 32]. These mechanisms embed accountability and partially extend popular control into implementation, though final statutory authority remains with the health bodies.

Asked at which stage participants had most control, Ryan identified the assembly phase, when the cohort were ‘very much the people on the stage’, ‘organising the agenda, the setup, and presenting their research’, while organisers played a supporting role [10, 29:38–30:01]. He framed this explicitly: ‘so it was, in theory, proper co-production’ [10, 30:01–30:29]. He also acknowledged a developmental arc: less power early on with ‘a bit more of a teaching and learning dynamic’, gaining control as the cohort ‘felt more empowered’ [10, 30:29]. This phased increase, rather than a nominal equal voice from the outset, reflects the design’s investment in capacity-building before transferring decision-making authority.

Capacity to share power in co-governance settings:

The initiative is not co-governance in the strict sense, since final statutory power rests with the ICB and ICP. But a cohort-set agenda, cohort-decided recommendations, formal endorsement, named Action Plan leads, and annual repetition together constitute a more developed form of citizen influence than typical one-off citizens’ juries, approaching co-governance in practice if not in binding authority.

Conclusion:

The design achieved an unusually high degree of popular control for a UK deliberative innovation in a policy area dominated by professional commissioners: cohort-set agenda, cohort-chosen recommendations, formal endorsement, and a regional Action Plan with named leads. Final statutory authority remains outside the cohort, but the design embeds accountability through scheduled follow-up and an annual assembly. It demonstrates that popular control can extend meaningfully into option selection and implementation when authorities share both agenda space and institutional commitment.

TRANSPARENCY

Internal transparency (for participants):

Internal transparency was strong. The 12-week YRTP included explicit education on the ICB, ICP and wider policy landscape, so participants understood the institutional environment where their recommendations would land [1, pp. 10–11]. Direct Q&A sessions with policymakers during the jury demystified the bureaucratic structures of regional health governance [1, p. 15]. By making the boundaries and operational limits of the ICB and ICP transparent from the outset, organisers ensured the cohort was not debating in a vacuum and reduced the risk of proposing unviable policies.

External transparency:

External transparency was a clear strength. Rather than confining outputs to bureaucratic reports, the cohort used multiple public-facing channels: a published manifesto, academic posters summarising vaping data, films, and zines produced with Theatre for Life [1, p. 17]. The November 2024 assembly functioned as a high-visibility event presenting findings to 70 regional representatives [1, p. 29]. This multi-channel approach went well beyond the minimal external transparency typical of consultative health-policy processes.

Ryan qualifies this picture. He distinguished transparency in the strict sense (‘if anyone asks us what happened, we tell them’ [10, 31:01]) from broader public visibility, which he conceded is limited: ‘they’re not going to make the front page of the newspaper... It’s mostly academics and the university’ [10, 31:52–32:41]. He noted that ICB chief executives and the city council leader had attended events, and that an alumni network helps spread the work informally [10, 31:31– 32:12]. External transparency was strong relative to comparable health-policy consultations, but the cohort’s outputs reached a primarily institutional and academic audience rather than the general public.

Conclusion:

The design performs strongly on both dimensions of Smith’s transparency criterion: participants entered with a clear understanding of the institutional context, and outputs were communicated through a deliberately multi-channel strategy. This combination is one of the clearer strengths of the design and a useful template for similar UK youth-participation processes.

EFFICIENCY

Civic costs for citizens:

The civic cost was substantial: a 12-week training programme, a 3-day jury, and months of finalising the manifesto [1, pp. 11, 13, 17]. At this scale, a time burden would normally pose a serious opportunity cost for disadvantaged participants and reproduce the elite bias Smith warns of. The design addressed this through a key mechanism: the 15 young people were employed by the University of Southampton as formal researchers from April 2024 [1, p. 10]. Remunerating participants as employees rather than treating them as volunteers eliminated the economic barrier and transformed an unacceptable civic burden into a viable employment and educational opportunity [1, p. 10].

Ryan gave approximate figures. The total wage budget was ‘something like £14,000 or £15,000’, with each participant earning around £1,000 [10, 41:37–41:54]. The cohort was paid hourly for two hours of in-person time and one hour of homework per week across what Ryan estimated as roughly sixteen weeks of paid engagement covering training, the three-day jury and finalisation; he gave the programme length variously as a 12-, 16- or 19-week run and said he could not recall the exact figure [10, 21:26][10, 41:54–42:23]. Ryan emphasised that ‘we really strictly didn’t pay them if they didn’t do the work’: ‘there was an essence of: this is a job, you’ve got to take it seriously’ [10, 43:03]. This framing reinforces the design’s departure from the volunteer-based model typical of UK youth voice initiatives.

Administrative costs for public authorities:

The project was delivered by a consortium of funded research and health partners (UKRI Rebooting Democracy, NIHR EACH-B, the ARC Wessex MOTH project, UKRI Pathways to Health, and the University of Southampton) [1, p. 9]; on the project lead’s own account the administrative cost was substantial [10, 34:15–34:33]. These costs are justifiable in cost-benefit terms: the authorities gained 12 rigorously researched, peer-evidenced recommendations tailored to a hard-to-reach demographic, alongside an Action Plan with named leads [1, pp. 30–31]. Preventing crises through targeted, youth-endorsed public-health policy is more efficient for the NHS than treating the delayed consequences of poor public health [1, pp. 20–25].

Ryan estimated that this cost is concentrated in staffing more than consumables. The headline consumables budget was ‘probably around £40,000’, with staff costs adding approximately a further £100,000 [10, 34:15–34:33]. The current configuration is not financially sustainable at scale: ‘I think we need to make it cheaper’ [10, 37:41–38:00]. Ryan identified the ‘sweet spot’ between quality and cost as the central question for replication, and the team has begun exploring whether they can ‘train people to train young people’ instead of relying on senior academics [10, 38:00–38:51]. The model produced high-quality outputs, but its cost-per-cohort would constrain replication unless lower-resource versions can be developed.

Comparing costs and benefits with alternative decision-making patterns:

No direct comparison was made to non-deliberative alternatives, but a standard consultation would be unlikely to produce the same evidence base, cohort ownership, or scale of institutional endorsement. Proposed annual repetition from November 2025 would, if sustained, amortise the high set-up cost across cohorts, improving long-term efficiency [1, p. 32].

Conclusion:

The design imposed a high civic time burden but addressed it through formal employment, a choice that extends Smith’s efficiency criterion by treating participants as paid contributors rather than volunteers. Administrative costs were substantial but appear justified by the quality of outputs and their translation into a formal Action Plan, with annual repetition further improving efficiency over time.

TRANSFERABILITY

Scale (local to global adaptability):

The design exhibits considerable transferability across scales. Participants argue for scaling: ‘Programmes such as LifeLab have developed the skills of over 16,000 young people... LifeLab can be a model to other organisations’ [1, p. 27]. The combination of long-term training, paid employment, structured deliberation and institutional endorsement is replicable in other UK Integrated Care Systems and other deliberative contexts. The cohort itself recommends extension: ‘These new Youth Panels would cover multiple public sectors such as healthcare, education, and politics’ [1, p. 27].

Political system adaptability:

The model is tied to the UK Integrated Care System framework under the Health and Care Act 2022 [8]. Transfer to other political systems would require institutional adaptation, but the underlying design (capacity-building, paid participation, peer-led research, structured deliberation, formal endorsement) is in principle applicable in other liberal-democratic settings with cross-sector public-health governance.

Issue-type adaptability:

The case demonstrates issue-type adaptability. The 12 recommendations span vaping, mental health, sexual-health education, neurodiversity, co-educational relationships teaching, and cultural sensitivity, substantively distinct sub-domains handled coherently within the same deliberative structure [1, pp. 20–27]. The design suits multi-issue policy areas characterised by intersecting structural inequalities rather than narrowly defined single-issue questions.

Insights from policy transfer literature:

The model shows signs of transfer in time: the ICP committee paper recommended an annual youth assembly, with November 2025 proposed for the next [1, p. 32]. Such a shift from one- off project to recurring institution would, if sustained, be an empirical marker of temporal transferability. Wider replication will depend on whether other institutions are willing to commit comparable resources to training and paid participation.

Ryan’s account documents real-world replication post-dating the manifesto. The design had reached ‘the third or fourth iteration’, with the Health Determinants Research Collaboration (HDRC) in Southampton and Southampton City Council both commissioning versions for different policy domains [10, 6:43–7:03]. The city council’s Youth Voice commission extended the model beyond health into a broader public-policy area, directly supporting the cohort’s recommendation 9 that Youth Panels should ‘cover multiple public sectors’ [10, 7:03–7:27]. Asked whether the design could transfer outside Southampton, Ryan was explicit: ‘there’s no reason why it wouldn’t transfer anywhere else... we certainly think it’s a model that you could apply in any place’ [10, 10:17–10:46]. Repeated commissioning across distinct institutional bases and cross-domain adaptation provides empirical confirmation of transferability beyond the temporal step already documented.

Conclusion:

The design is highly transferable across scale, issue and time, with empirical evidence of concrete replication already underway. Its key features (long-term training, paid participation, peer-led research, institutional endorsement) are not specific to health policy and can be adapted to other public-sector domains. The principal constraint is the willingness of receiving institutions to commit comparable resources to participant employment and capacity-building rather than treating these as optional volunteer add-ons.

External Links

Shaping Tomorrow: A Call to Action (full manifesto, ISSUU): https://issuu.com/ university_of_southampton/docs/shaping_tomorrow-_a_call_to_action._nxtgen_ researc

UKRI Rebooting Democracy project: https://www.ukri.org/

Hampshire and Isle of Wight Integrated Care Board: https://www. hantsiowhealthandcare.org.uk/

LifeLab, University of Southampton: https://www.southampton.ac.uk/lifelab/

Bite Back 2030: https://biteback2030.com/

Notes

This entry documents the 2024 cohort of the Young Researcher Training Programme. The annual youth assembly scheduled for November 2025 will, if delivered, mark the first iteration of this design as a recurring institution rather than a single project. The case is presented here as a deliberative mini-public (Youth Jury) producing a co-designed manifesto, rather than as participatory budgeting in the strict sense, since no fixed financial allocation is voted on by participants; the influence operates through endorsed policy recommendations and the ICP Action Plan.

Declaration Form

I confirm that this assessment is all the work of the person or people (in the case of a group project) receiving credit for it. I have not obtained or attempted to obtain unauthorised input from another person or service, including the unauthorised use of GenerativeAI (such as ChatGPT), in the preparation of this submission. Y

I confirm that I have read and understood the University’s Regulations Governing Aca- demic Responsibility and Conduct and Academic Responsibility and Conduct Guidance. Y

I confirm that I have not used generative artificial intelligence (GenAI – including but not limited to ChatGPT, Gemini, DeepSeek or CoPilot) in the writing of this assignment except in ways that have been explicitly allowed by the module convener. Y

In cases where the module convener has explicitly allowed some uses of GenAI: I confirm that I have only used GenAI in the ways which are explicitly allowed, and that I have been honest and transparent about its use throughout the assessment. I have included details as outlined in the Academic Responsibility and Conduct Guidance. Y

I confirm that I am aware of the consequences which may follow if I am found to have breached the Regulations. Y

References

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