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

Background:
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.

Aim:
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.

Methods:
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.

Results:
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).

Conclusion:
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.