Abstract: This book attempts to solve two problems in deliberative democratic theory and practice: How can agreements reached inside deliberative forums be legitimate for those who did not take part? And why should people with strongly-held views participate in the first place? The solution involves rethinking deliberative theory, but also draws on lessons from practical experience with deliberative forums in Britain’s National Health Service. The book discusses the competing representation claims that different participants make, the pros and cons of different approaches to democratic accountability, and different conceptions of rationality and public reasoning. It concludes by rejecting the idea that we can have authentic, legitimate deliberation in any one forum. Instead, authentic, legitimate deliberation can only result from linkages between different kinds of institutions, drawing on different kinds of participants, at different points of a decision-making cycle. That is, it promotes a macro, society-wide view of deliberative democracy quite different from the micro, deliberative-forum view which dominates thinking on the subject in the UK. The book sketches the outline of such a deliberative system, suggesting how various institutions in civil society and elected government might link together to create public decisions, which are both more rational and more democratic.

Keywords: deliberative democracy, deliberative system, public involvement, patient involvement, legitimacy, National Health Service, participation, citizens’ jury, deliberative poll, motivations