Using deliberative methods to establish a sufficient state of capability well-being for use in decision-making in the contexts of public health and social care

Abstract

Health maximisation is unlikely to be a relevant objective for social care, where service users and the workforce have distinct priorities and needs. NICE permit use of a small number of capability-based measures for the evaluation of social care, including ICECAP-A, a measure with five attributes, each with four levels. To establish a sufficient state of capability well-being, as defined by ICECAP-A, through public deliberation, and evaluate and critically reflect on the deliberative process. A series of one-day/6.5 h citizens' workshops were conducted, with recruitment from within purposively selected local authority areas. Workshops consisted of a mixture of background information, individual tasks, group discussion and voting. Representatives from each workshop were then invited to attend a 'consensus workshop'. Follow-up interviews facilitated evaluation of the deliberative process. 62 participants took part in deliberative work, across eight workshops. Participants actively engaged and provided positive feedback about their experience. Key considerations for participants included: the realistic ability of public services to enhance some areas of well-being; not removing incentives for self-help and avoiding state intrusion; building resilience and enabling people to 'give back to society'; ensuring that people are not left with a standard of well-being that is morally indefensible. The resulting sufficient state of capability well-being (defined by ICECAP-A) was 3,3,3,3,3 (where the best possible state is 4,4,4,4,4). Through a deliberative approach, representatives of the public were able to debate a complex social issue and reach a consensus decision on a sufficient state of capability well-being.