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Citizen Participation and COVID-19: How the English Mitigated the Second Wave

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Alexandra Mierzwa
August 11, 2021

Communities across the globe are reeling from the devastation imparted by COVID-19. Countries are experiencing unprecedented loss of life, significant economic declines, weakened healthcare systems and myriad social repercussions due to the rampant spread of the virus. Governments and their citizens are combatting this disease reactively and areadapting quickly to considerable changes. The uncertainty imposed by the pandemic creates a dynamic (and often swift) policy environment, resulting in policies citizens find confusing or are unlikely to follow, and consequently accelerating the spread. Accordingly, governments and their agencies are brainstorming viable solutions to encourage positive health behaviors among their citizens to stem the tide. England is at the forefront of crafting innovative solutions to managing COVID-19 with its deliberative engagement project. The country’s healthcare system, the National Health Service (NHS), identified an opportunity to devise collaborative policy solutions with its citizenry to evaluate its management of the pandemic in spring 2020 and provide guidance for preparations for a second wave in the second half of 2020.

England, like many other countries, has scrambled to quickly enact policies to mitigate the spread of COVID-19 and manage the ancillary threats to its overwhelmed healthcare system. Public health officials recognized summer 2020 as an opportunity to reflect on the management of the coronavirus during the preceding spring. Officials anticipated a new wave of coronavirus infections in the coming fall and winter months, requiring them to identify new methods to orchestrate a more effective institutional response and better prepare for a surge in cases. The NHS seized this moment of reprieve from a surge in cases to shift their perspective from trickle-down policy implementation to human-centered and participative policymaking. Specifically, the NHS sought to explore citizens’ concerns and views on the tensions and trade-offs related to measures that could have been enacted in response to the first wave, and what new policies might look like for the next one.

English citizens played a visible role in the country’s response to the second wave. To effectively reinforce its capacities in preparation for the next wave of cases, the NHS England invited Britons to participate in mid- and long-term planning for the healthcare response. It collected insights from citizens about their pandemic experiences thanks to successful audience engagement and feedback sessions conducted at the OneLondon Citizens’ Summit on uses of healthcare data. This conference also served as the source from which participants for the NHS activity were drawn. Of the 100 Londoners who took part in the OneLondon Citizens’ Summit, 61 were selected to participate in the NHS project, each of whom participated in each stage of the project and represented the full scope of London’s diversity.

The project consisted of two stages—a dialogue stage and a deliberative stage—both of which took place online. The first stage entailed two workshops during which participants: discussed their lived experiences during the pandemic and gained insight from health experts about the rationale justifying the decisions made during the first surge; and invited participants to engage in small group discussions to examine the NHS’s policies and consider modifications for a more effective response for the anticipated second wave. Participants also selected six areas to review in greater detail during the second stage of the project.

The second stage included four workshops during which participants discussed a plethora of ideas and policy proposals centered on the six previously agreed-upon topic areas: prioritization in planned care; deferring treatment due to COVID-19; consolidation of elective care services; self-isolation standards; telehealth; and access to urgent and emergency care. Participants scrutinized the NHS’s policies and procedures while, throughout the process, experts provided information on the topics—including sharing research, case studies and reference guides—as participants brainstormed how to improve policies to accommodate their fellow citizens’ needs. Finally, participants refined their expectations for the NHS to develop policy based on the proposed changes and discussed how these policies should be communicated to the wider public. This process culminated in an informed set of expectations to guide the NHS in planning modified responses to the pandemic. These expectations were transmitted to senior healthcare officials.

This workshop series illustrates the importance of community involvement in crafting efficacious public health policy. The project enabled health officials to integrate citizens’ feedback as they shaped national health policy to reinforce institutional capacity as the country was preparing for another spike. Since the workshops, NHS policy has evolved due to changing circumstances, but has maintained the core ideals discussed in the workshops. As the world continues to grapple with the deadly coronavirus and its momentous consequences, this case demonstrates how governments and affiliated agencies can craft efficacious policies that are responsive to citizens’ needs.

To learn more about this case, visit https://participedia.net/case/7162. To read about other innovative applications of public participation, visit www.participedia.net.


Author: Alexandra Mierzwa is pursuing a Master’s degree in public administration (MPA) with a specialization in international and development administration and a certificate in advanced studies in conflict and collaboration at the Maxwell School of Citizenship and Public Affairs at Syracuse University. She is passionate about collaborative governance to empower citizens so they can make institutions more responsive to their needs. Prior to Maxwell, she worked in advocacy communications for a public affairs firm in Brussels, Belgium and performed work related to corporate social responsibility communications for Disneyland Paris.

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The American Society for Public Administration is the largest and most prominent professional association for public administration. It is dedicated to advancing the art, science, teaching and practice of public and non-profit administration.

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