Creating a relational welfare state
The topic for this meeting of our Putting Relationships First Cell on 2nd March 23 was to consider; why we need a relational welfare state, one that is about health and wellbeing within the community and to consider what we need to do to make it happen.
The concept is not a new one:
Geoff Mulgan wrote about a relational welfare state over a decade ago.
Hilary Cottam in ‘Radical Help’ (2018) explored how we need to move away from transactional models of state delivered welfare services to focusing on helping each other and building strong relationships.
More recently, there appears to be a real shift towards this way of thinking but it as yet has not taken hold as a way of thinking at the systems level.
The topic was introduced by David Robinson from The Relationship Project, our thought leader for this cell, and David suggested that how we can think about this topic and might address it in two ways:
We can talk about work we are engaged with and how we learn from one another; some of the bright spots; tease out the principles and explore what relationships with the Welfare State might look like OR
We can look at it as a big picture and explore how we might re-found the welfare state if we had that opportunity.
In practice, we planned to look at this from both ends of the telescope in this session but, focusing on the second, he said that the initial giant evils set out by Beveridge in his report were: idleness; ignorance; disease; squalor; and want, and they became the structure for the ideas that followed, which was an organising system for a relationship between citizens and the state, where the state identified the problems and the solutions.
David posed the question; ‘If we were to go back to Beveridge with a blank sheet of paper what might be the 5 pillars that would underpin the development of the Welfare State now?’
He asked the cell to think about what good foundational assets might look like and to imagine the welfare state not as a relationship between government and citizens, but instead as relationships to each other, as communities to be nourished and not as a problem to be fixed.
David suggested that the 21st Century giant assets could include:
Our relationship to each other, maybe as prime responders, neighbours, family.
A community aggregated of one to one relationships.
Our diversity and breadth and depth of experience, celebrated rather than drowned out.
Artificial intelligence and the magic that technology that can facilitate; and how to use the technology to release people and time to focus on where real relationships matter most.
Love - this is never talked about in the context of public services but this is the key ingredient.
Building on David’s introduction, our first presenter, Laura Seebolm, who through her work with Changing Lives and the Maternal Mental Health Alliance has a lot of experience with the welfare state, shared the following highlights:
The Welfare State traditionally looks after the health of citizens but in 2023 it is not working for many people and has not been for many years.
Recent years has shown crisis for example with racism, poverty and Violence Against Women & Girls, and whilst there are some people who would expect to have a good service from our public services and are able to navigate for themselves and for family and friends, this is not the case for so many who do not expect to have a good experience and accessing some parts of the Welfare State is impenetrable.
For lots of people they are poorly understood, not supported, over-scrutinised and have little power and so the Welfare State can feel brutal for people and the outcomes devastating.
The tide is turning and talk about kindness, compassion and love is seeping into the mainstream narrative and policy documents are referring more to relationships, but this is hard to do in practice as it is not getting under the skin and structures.
Many people go into public service because of the difference they want to make but the services are inhumane, examples include Police Officers, Care Workers and Midwives.
The Welfare State operates on othering, paternalistic and western notions that are about saying we know what is wrong with you and we have the clinical expertise to respond - this is the medical model. There is also the commercialisation of public services and the individual becomes the object of an intervention. For example, in homelessness services, people have to go through a gateway and they are described as customers as if they have choices - but they don't.
Laura asked, how do we help bring about a culture, at scale and at population level, where people feel they belong as active and valued in our community and where there are feelings of love and care, both in the civil sphere and at the population level.
Laura concluded by saying that she felt optimistic and there is a massive momentum to change towards a new Moral Era (beyond the current Thatcherite/Blair era of standardised public services) but she cautioned that we are not there yet but a Better Way is integral to designing what is going to come next.
Olivia Field, from the British Red Cross (BRC), then followed on from Laura, providing what she described as a more ‘subjective feel’ and she focused on loneliness. Olivia reflected that everyone feels lonely some of the time and that BRC has been looking at how loneliness can be prevented for those who feel lonely a lot of the time. The work she has been engaged with highlighted the following:
Responding to emergencies has shown that connected communities are the most resilient and the most isolated and lonely are least able to recover from a crisis.
Strong relationships and being connected can help people after an emergency and grow emotional resilience.
People think loneliness is about older people but it can impact anyone - including children.
Loneliness can be exacerbated by long term health conditions, career changes, unemployment, by people feeling discriminated against and other key life changes.
Feeling lonely isn’t good for us or our communities as there is evidence to show that loneliness impacts negatively on health and wellbeing and productivity, and it has been linked to a range of health conditions with people more likely to attend GP, hospitals and public sector residential care.
The BRC, in partnership with others, has been working on loneliness for the last 5 years and exploring how to meet non-clinical needs within health care systems and encouraging conversations about relationships and support networks in the same way the system asks about diet, smoking, exercise etc. The programme has been developing mechanisms to link people to non-clinical support e.g.social prescribing link workers. These programmes have community connectors who work with people who have been referred and who have self-referred to co-develop a tailored plan of activity, with small achievable goals and flexible one-to-one support over a three month period. This work has helped people to learn how to trust other people; has shown them what is good about humanity and helped them to reconnect with people they have lost connect with. Two thirds of those involved felt less lonely at the end.
Community connectors are now rolled out right across the NHS and are one model to incorporating relationship-building into the welfare state. She also described another model they were pursuing which involves working with young people who are frequent users of A&E, defined as 5 or more visits a year, though some people attend hundreds of times. These high intensity users make up 16% of A&E attendances and 29% of ambulance visits, which often occur because of gaps in community support and relationship breakdown. Again, they work intensively with individuals, seeking to de-medicalise and de-criminalise the issue and find out ‘what is right with them’.
The cell then considered what they had heard and explored how we could move towards a more relational Welfare State. Here are some of the points coming out of the discussion:
Many people were increasingly recognising that we live in a social world, we give to ourselves when we give to others and solidarity is important. Building the ethical foundations of society is important and is being neglected, for example by faith organisations, and this can be done regardless of the state.
There is a disconnect between common sense and how services are actually delivered and so the consequence is an overarching system that is constraining the nature of what it should be delivering, for example standardisation of services and treating people as consumers. But many practitioners are trying to work in a different way, sometimes in multi-faceted teams, and some have never stopped treating people as individuals and building on their strengths, what someone described as ‘old fashioned social work’.
The public sector is not always the right answer. The public sector asks people and communities what they need but they know that they do necessarily have the resources to deliver. There is a lack of proximity between decision makers and the problems - they are so far removed from it, it is unrealistic to expect them to find the solutions. An alternative perspective could be to consider what we can lever from social entrepreneurs & innovators, anchor organisations and those who have it within their gift to do things differently and think about how we link what is being done to those who want to do things differently.
Community is not a homogenous entity and in unpacking it we might see that it is fragmented, perhaps in a way it wasn’t in years gone by.
It was acknowledged that there are local authority areas with the inclination to do things differently, but we can do more to help them to connect with others in the space to learn how to do it and then keep reflecting and learning.
There is a movement happening around these ideas both UK and worldwide and as part of this there is lots of innovation and challenge.
There is a real lack of appetite for risk and a lot of fear and this impacts on designing and delivering new ways of working.
There is beauty and strength in animating the voice of the community through storytelling - but how do we capture it and respond to it? Storytelling can enable a long-term relationship that allows individuals and communities to process the trauma. The power of the story is very important as the language of management cuts out the individual, but if you can bring them into the story this can be transformative in encouraging people to create change. Story-telling can also help to cut through to the public, who in general seem more attached to services as they currently are than to a relational welfare state.
Caroline Slocock, the then co-convenor of a Better Way, concluded the session with the following insights:
Creating a relational state requires a change both to how services are currently delivered, as all the speakers had highlighted, and to how we relate to each other in society. The Big Society, which had ended up in an offloading of some state responsibilities to communities and the voluntary sector, failed partly because it did not change how the state itself operated in its core services.
Although there is a lot going wrong at the moment, the discussion created grounds for optimism. We may be entering into a moral era due to the fact that people are talking about this and, as we heard in the discussion, a lot of the academic disciplines, which are training the front-line workers of the future, are recognising the importance of relationships and relating to people.
At the Annual Gathering of the network at the end of 2022, members debated whether we were at a positive or negative tipping point and wanted to build wider momentum for change. Building a relational welfare state is a key area and storytelling might be one way to build momentum.
Putting Relationships First: making relationship-building the purpose of our work
Summary of key points
The disruption caused by Covid-19 had led to more relationship-building in some cases, and we need to find ways of sustaining and building on this.
For relationship-building to become the central operating principle, it needs to be woven into everything we do: not just seeing it as our role to facilitate good relationships between people within the community, but also building better relationships with peers, clients, contractors and between funders and funded, for example.
The quality of relationships matter: equality, curiosity, kindness and listening are all important. We need to build up this lexicon and develop the language.
Organisations should be built around relationship-building rather than tasks. Processes, rules and regulations should be re-designed to support relationships, rather than the other way round.
Funders have an important role, not least to invest in relationship-building and measure this activity and its impact on outcomes, rather than looking at projects and outputs.
Cultural as well as systems change is needed. We need to start a different kind of national conversation in which we ‘uphold our human space’ against attempts to commodify human beings or de-personalise services.
Leaders, perhaps especially in the social sector, have an important role in achieving that cultural change, starting that national conversation and demonstrating ‘relational leadership’.
There are good examples of putting relationships first, and we should look for them where you might least expect to find them, and promote them to show what is possible.
In more detail
Caroline Slocock, co-convenor of a Better Way, began by recapping what the network had learnt so far on putting relationships first. As explained in Time for a Change, three things had stood out:
Designing relationships in, not out, generates ‘relational power’.
Our humanity is the most powerful change agent.
We need to stop talking about people as problems, and see them as solution.
She explained that today’s discussion was going to focus on the first of these, building relational power, and we were going to look at how to make relationship-building the purpose of our work, with everyone in an organisation seeing relationship-building as core to the job they do.
She introduced David Robinson from the Relationships Project, who is acting as ‘thought leader’ for the group. The Relationships Project have been operating an Observatory during Covid-19 and David said that they had discovered that relationships had in many cases flourished, despite social distancing, especially in the first lockdown where communities came together and many people had volunteered for the first time. The disruption had helped to change the normal ways of doing things. As we seek to recover from the pandemic, there is a real opportunity to learn lessons from this and put relationships first in how we work with others, he thought. However, as we come out of lockdown, people needed a period of recouperation and reflection. It was a ‘time to be slow’ and remain generous to each other.
Graeme Hodson, who is the Commissioning Manager for Adult Social Care at Cambridgeshire County Council and Peterborough City Council and also as a volunteer for Care Network Cambridge and a local community organiser, kicked off the discussion with some reflections. In his work, it emerged, relationship-building was happening in a number of different ways with different people, and all were important:
The councils are facilitating a stronger relationship between residents needing care and their personal assistants and communities, working in a variety of ways. For example, in East Cambridge they are seeking to change the situation where domiciliary carers often change from day to day and no real relationship is built up. Direct payments to people needing care are a standard option, but this comes with what can be a heavy and undesirable administrative burden as employer. So residents in East Cambridge are instead being offered Individual Service Funds in which a third party takes away the admin, but people needing care still retain direct control over who becomes their carer. The councils have also commissioned a Direct Payment Support Service to give advice for those who do want to take full budgetary control. They are also about to sign a contract with Community Catalysts to enable carers to become self-employed, so they are better able to develop strong, consistent relationships with those they care for, particularly in under-served rural communities.
The councils build relationship-building capacity in other ways, too, particularly through the social connecting role of community hubs and community organisers and mutual aid groups. For example, they have a network of Community Navigators who signpost people to local services and activities, with the aim of early intervention.
They build relationships with service users through co-production, for example through Healthwatch Partnerships Boards, and they work with providers at the very beginning of designing what they commission.
They also seek to build good relationships with central government, the NHS and other local authorities and, as a result of the trust this has created, they have been able to improve care, for example, directly providing PPE and vaccinations to personal assistants.
The council has also been looking at how to direct more resources to relationship-building and measure this, not outputs. They have moved from outputs to outcomes and to help them measure the right thing they ask service users: ‘What does good look like to you? What is it you want to do? How can we help?’ Graeme said he particularly likes the Social Cares Future’s definition of good care: ‘We all want to live in the place we call home, with the people and things that we love, in communities where we look out for each other, doing what matters most to us.’
Points coming out of the subsequent discussion include:
The quality of relationships matters: relationships can be good and bad and in places like Northern Ireland ‘relationship’ can have negative connotations. Equal relationships should be the aspiration, and qualities such as curiosity, kindness and good listening should be encouraged. There is a need to build up this lexicon and develop the language further.
Relationship-building is about a lot of different things all of which need to be done together if relationships are to become the central operating principle. It should be carried out across the whole spectrum of organisational activity, from forging good relationships with peers, clients, contractors and between funders and funded, to helping others to form strong relationships in the community. One-to-one conversations in which people get to know each other help create stronger bonds and space needs to be made for them.
A culture change is needed. We must ‘uphold our human space’ against attempts to commodify us or dehumanise services by putting relationships first. This requires a different kind of national conversation.
There’s an important role for leaders both nationally and locally to lead by example, especially in the social sector, and show ‘relational leadership’. Leaders should demonstrate human-centred values in which relationships genuinely are put first and create a different culture in which it is ok to talk about the importance of love. Relational leadership has to be reflected at the very top in order to change the culture, but it also has to permeate the whole organisation.
The system works against relationships. At the moment, relationship-building tends to be accidental but in future it needs to be intentional. Organisations should be built around the people, rather than the task; and processes, rules and regulations should be adjusted to fit with relationship-building, rather than aligning relationships to fit them.
Funders have a role in making relationship-building not just common sense but common practice, and should move away from measuring tasks and outputs to investing in relationship-building and looking at the impact on outcomes. Some contracts are already being expressed in this way.
This is happening in some places and you should look where you don’t expect to find it - for example housing allocations, benefit judgements and even evictions are being made with compassion in some areas. Let’s go looking for it and show others what is possible.
The disruption caused by Covid-19 over the last year probably helped to create new space for relationship-building. It showed what was possible and we need to find ways of sustaining and building on this.
The next meeting of this group will be on 6 May and we will be talking about:
Unlocking our humanity: how to turn organisations into communities, not machines. If organisations focus on internal relationship building, they can unlock creativity, and give front-line staff opportunity to build relationships externally too.