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A Growing Voice: The Evolution of the South West Clinical Senate Citizens’ Assembly

“Patient experience must no longer be considered anecdotal and weighted least in the hierarchy of evidence-based medicine.” Baroness Cumberlege (First Do No Harm, 2020)


With ever-growing reputation and influence, and a dedication to ensuring patient and public voice is heard, the South West Clinical Senate Citizens’ Assembly has come a long way since its inception in 2014 and has achieved a unique position in patient and public engagement.

The Citizens’ Assembly is comprised of people from a range of backgrounds who work closely with senior clinicians to provide patient and public comment on the provision and development of health services in the South West.

“One of the things I really like about the Citizens’ Assembly is it represents the voices of real people,” current Chair Nick Pennell said. “Our members also bring real passion with them, as well as a diversity of experiences and views.”

“The Citizens’ Assembly is one of the jewels in the crown for the South West Clinical Senate,” Dr Sally Pearson, Chair of the South West Clinical Senate, enthused. “They bring enormous value to the conversations in the Council, both in deliberative sessions and clinical reviews.”

The Assembly is also positioned to stop Senate conversations from being purely clinical and refocus them from the perspective of patients.

“They’ve had a major role in shaping recommendations.” Prof David Halpin, Vice Chair of the South West Clinical Senate, stated. “And they’ve been very balanced at presenting patient views.”

The members of the Citizens’ Assembly also have a connection with Healthwatch, enabling them to use Healthwatch links to reach groups of people who are often seldom heard.

Beyond providing wider citizen (which can include patients, carers and other service users) voices to the Senate, the Assembly also considers issues of strategic importance raised by commissioners and links with the NHS England Citizens’ Assembly to provide a three-way communication channel for patient participation, locally, regionally and nationally.

The South West Clinical Senate Citizens’ Assembly is also something quite unique.

“We were the first of the Senates in England to establish a Citizens’ Assembly and reflect this in our constitution,” Dr Pearson explained. “As such, we have a well-developed conduit to patient and public perspective, which is a resource not only for the Senate but for other NHS organisations in the South West.”

“We’re the only Citizens’ Assembly that works this way with the Clinical Senate,” Pennell said. “We’ve established an incredible relationship as well as credibility in the South West.”

When members of the South West Clinical Senate have attended other Senate sessions throughout England, they’ve found others were very interested in the way the South West Assembly worked. This has prompted many Senates to want to establish their own Citizens’ Assemblies.

“It’s a great accolade to know we’re setting a scene that others want to follow nationally,” Pennell remarked.

The Assembly has also evolved significantly in the past seven years. It initially had a much more scientific approach in trying to capture patient and public involvement.

“That gradually shifted to giving the patient narrative and trying to bring the topic alive,” former Chair Joanna Parker recalled. “Patient voice is so important. I also really pushed for the use of plain English. Understandably medics need to have a shorthand, but it’s really confusing for patients.”

“It’s changed dramatically,” Kevin Dixon, another former Chair, agreed. “The initial representation wasn’t particularly good. People didn’t understand what the Citizens’ Assembly was. The Chairs have really raised the profile. We’ve gained much more confidence as a representative body.”

During his tenure as Chair, Pennell has also sought to bring in more outside speakers to keep members better informed of expert views.

The Assembly has faced a number of challenges over the years including those around the geographical distances of the South West, as well as recruiting members with the needed subject matter expertise. The Coronavirus pandemic also has been a hurdle, forcing members to adopt virtual meetings.

As for the future of the Assembly, all three Chairs look forward to its continuing evolution and good work being done.

“I’d like to see us continue to recruit high-level volunteers with skills and passion to see improvements in health care,” Dixon said. “I’d also like the Citizens’ Assembly to get recognised nationally.

“It’s an evolution. It’s increasing representation. It’s increasing involvement. We’re gradually building up our reputation and knowledge. We’re moving from being an operational body to a linking operation with decision making and a more strategic role.”

“It’s important Citizens’ Assembly members continue to put themselves in the shoes of our patients,” Parker stated, offering the previously noted Baroness Cumberlege quote about the need to recognise the importance of patient voice. “Also our input is always welcome by the Senate Council, but it can be difficult to measure our impact. I think we need to find a way to do that.”

“I’d like to see us continually developing and changing,” Pennell concluded.  “I’d like to see our relationship with the Clinical Senate maintained, but I’m also keen on enhancing the membership. One of the other things we’re keen to do is extend the composition of the Citizens’ Assembly. We want to make sure our doors are open to other organisations and individuals.”

Additional information on the South West Clinical Senate Citizens’ Assembly can be found here.