Involvement of Lay Assessors in the Inspection and Regulation of Public Services: A Systematic Review

Abstract

Public services have increasingly sought to use lay assessors (often known as "experts by experience") as members of inspection teams in health, social care, and education settings. This involvement has been credited as giving more influence to users over how services ought to run. Yet, little is known about the process or outcome of engaging with lay assessors. We conducted a systematic review to understand the benefits and challenges of involving lay assessors in the inspection of public services. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched the literature in English using five bibliographic databases with the date of publication limited to 2000 onward. Across 27 eligible studies, results suggest that including diverse views and perspectives is a strength, yet little consideration is given to issues of "representativeness"of lay assessors or the power differentials within mixed groups that can shape which perspectives gain dominance. Despite a frequent rehearsal of the many benefits of involving lay assessors in inspections as a potential force to drive up the quality of inspections and inspected services, the impact of including lay assessors in inspections in terms of improving services was hard to determine. When designing training for lay assessors, services needed to carefully consider the tension between maintaining the assessor's "naive eye"versus becoming "professionalised."It was also apparent that expectations are often not clearly shared over how lay perspectives could be included in final inspection reports, thus risking disengagement. Involving lay assessors is still a fairly novel, yet rich and meaningful way to improve services, yet a lack of clear expectations, and typical exclusion of lay assessors in setting standards for regulation, can still act as barriers to meaningful involvement, preventing lay views from being heard and acted upon.