Open Access

What does it mean to design democratic innovation from a deliberative systems perspective? The demand of the deliberative systems approach that we turn from the single forum towards the broader system has largely been embraced by those interested in designing institutions for citizen participation. Nevertheless, there has been no analysis of the practical implications for democratic innovation. Is it possible to design differentiated but interconnected participatory and deliberative settings? Does this better connect democratic innovations to mass politics? Does it promote greater legitimacy? This article analyses one such attempt to design a systems-oriented democratic innovation: the ambitious NHS Citizen initiative. Our analysis demonstrates, while NHS Citizen pioneered some cutting-edge participatory design, it ultimately failed to resolve (and in some cases exacerbated) well-known obstacles to institutionalisation as well as generating new challenges. To effectively realise democratic renewal and reform, systems-oriented democratic innovation must evolve strategies to meet these challenges.