A NICE approach to combining micro and macro conceptions of deliberative democracy

Abstract

Deliberative democracy is a model intended to produce rational and well-reasoned decisions by bringing together those affected by decisions to deliberate about the issues. There is a growing interest in how deliberative democracy can be institutionalised however there are challenges associated with this. The primary challenge for deliberative democracy relates to scale (Parkinson, 2004). At a macro level, it is practically challenging to involve all those affected by decisions in meaningful deliberation in an equal and inclusive manner (McLaverty, 2014, Chappell, 2008, Young, 2001). Even at a micro level, these challenges still exist due to inequalities in complex societies. As a response, Hendriks (2006) argues that by combining micro and macro conceptions of deliberative democracy, standards of deliberative democracy can be better achieved. One institution which could practically combine the two conceptual approaches is governance networks. This is because they can use deliberative approaches (Papadopoulos, 2012, Dryzek, 2011) in decision making and some embody the principles of deliberative democracy (Atkins, Smith, Kelly and Michie, 2013, Daniels, 2008, Gutmann and Thompson, 2002). Networks are used by governments to help solve complex problems by bringing experts and those with specialist knowledge to the process. However, some networks lack democratic accountability because they are often elitist (Hendriks and Boswell, 2015, Papadopoulos, 2012) and as a result suffer from legitimacy problems. Through case study research, this thesis will explore if governance networks can combine micro and macro conceptions of deliberative democracy to enhance their democratic governance. In doing so, the research will measure the quality of deliberation that takes place in the National Institute of Health and Clinical Excellence (NICE) which is a quasi-autonomous national government organisation and operates as part of a large healthcare network. Through interviews with committee members the research will also assess how networks deliberate at a macro level. The committee meetings in NICE has been described as high-quality expert deliberation (Moore, 2016). However, the meetings were exclusive as members were largely experts from the medical field with little citizen or patient involvement. There were some instances of macro deliberation taking place outside NICE PHAC meetings but it lacked wider public deliberation inclusive of a variety of deliberative spaces. Moreover, there were very few examples of micro and macro deliberation being integrated. The research concludes that NICE do have the potential to build on the deliberative foundations by being more active in integrating micro and macro deliberation through designed coupling (Hendriks, 2016) and using bridge-builders as aids to coupling. By applying some of these recommendations, NICE could become more deliberative, democratic and accountable. This might also apply to similar networks who are interested in institutionalising deliberative democracy and overcoming their democratic short-fallings.