Insight piece from Halima Khan, PPL Senior Advisor

Mentioning relationships in the context of public services can feel almost awkward. Especially when there are such significant and sustained pressures on public service budgets and workforces. The response can be a sense that there’s no time or that the focus needs to be on the ‘real’ issues at hand. But people are the lifeblood of public services – the people working in them and the people they serve.

A focus on relationships in public services isn’t new. The term relationship-centred care, for example, was developed in the United States in the 1990s by a task force set up to review whether the American health care system could meet the health challenges of the future[1]. The task force concluded that the current individual, disease and cure based system was inadequate and, instead, proposed a model where ‘the interaction among people [is] the foundation of any therapeutic or healing activity’[2]. A conclusion with relevance far beyond the walls of healthcare.

Relationships are also important for the public service workforce. Public service leaders who focus on people and relationships to achieve a common goal have happier and more productive workforces than those who use transactional leadership styles focusing on achieving tasks[3].

Beyond public services, we now have the conclusions from the 80-year-long Harvard study on adult development. This longitudinal study shows that the relationships in people’s everyday lives – with friends, family, neighbours, co-workers and beyond – create happier, healthier, more fulfilled lives[4].

So relationships do matter – in public services and day-to-day living. In fact, relationships are vital drivers of productivity and wellbeing. The challenge, then, is to bridge from the theory to the realities of public services in the UK.

At the centre of that is the issue of funding, investment and resourcing. The NHS in England is experiencing vacancy rates at a 5-year high[5]. While the number of vacant posts in adult social care in England rose 52% between 2020/21 and the following year[6]. Relational practice is far more difficult in these circumstances. But, it could be argued, all the more important. From my experience working in government during the Covid pandemic, the most effective leaders – in the NHS, local government and the voluntary sector – managed to sustain a focus on the wellbeing of their workforce and the citizens they were serving even in very challenging conditions.

What is sometimes missing are frameworks that can help translate to concrete actions. A helpful example is the Senses Framework[7], which was developed in the context of working with older people with dementia, but can be adapted elsewhere. It is based on the idea of six senses which are essential for good relationships in the context of care and service delivery[8]:

A Sense of Security

For citizens this is about feeling safe and free from threat, harm, pain and discomfort. For staff it is feeling free from physical threat, rebuke or censure; having secure conditions of employment; and having the emotional demands of work recognised and working in a supportive culture.

A Sense of Continuity

This is about citizens feeling their personal experience and past is recognised and valued. For staff this is about positive career pathways, role models and good working environments.

A Sense of Belonging

For both, the opportunity to form meaningful relationships and feel part of a community or group that recognises your contribution – whether in a team at work or a group of people in the community.

A Sense of Purpose

The opportunity to engage in purposeful activity and pursue goals and challenging pursuits – whether in a professional context or in your everyday life.

A Sense of Fulfilment

This is about opportunities for citizens to achieve meaningful and valued goals and feel satisfied with one’s efforts. For staff, the ability to do a good job and feel satisfied with one’s efforts.

A Sense of Significance

For both, feeling recognised and valued as a person of worth and that you ‘matter’.

Not all of these sense will be possible at the frontline given the acute pressures on public services. But leaders, managers and staff can use them to inform how they go about their daily interactions with one another and with members of the public.

As we know from the #MyNameIs campaign, something as apparently small as introducing oneself can make a big difference. The tone of voice used, the ways in which a question is answered, giving someone the benefit of the doubt. All these things add up to good relationships. Good relationships help people feel valued. And, in turn, this can boost the productivity of public services. Even, indeed especially, in challenging times.

Halima has joined PPL as an Associate having had ten years’ experience as a policymaker in national, regional and local government, including the Prime Minister’s Strategy Unit, London City Hall and Camden Council, and nearly ten years supporting innovations in public services at Nesta. She is also an Affiliate of the Bennett Institute of Public Policy at the University of Cambridge, a member of the Public Policy Committee at the British Academy, a board member at the Mayday Trust and a member of the Relationships Collective, which is seeking to contribute to the field of relational practice.

A note of thanks to Nick Andrews at Developing Evidence Enriched Practice at Swansea University for introducing me to the Senses Framework.

[1] Tresolini and the Pew Fetzer Task Force (1994), cited in Nolan, M. et al (2006) The Senses Framework: improving care for older people through a relationship-centred approach. Getting Research into Practice (GRiP) Report No 2. Project Report, Sheffield, University of Sheffield

[2] Cited in Nolan et al (2006)

[3] Cummings, G. et al (2010) Leadership styles and outcome patterns for the nursing workforce and work environment: A systematic review International Journal of Nursing Studies, Volume 47, Issue 3

[4] Waldinger, R. and Schulz, M. (2023) The Good Life: Lessons from the World’s Longest Scientific Study of Happiness Rider

[5] https://www.health.org.uk/news-and-comment/news/nhs-vacancy-rates-point-to-deepening-workforce-crisis

[6] https://www.skillsforcare.org.uk/adult-social-care-workforce-data/Workforce-intelligence/publications/national-information/The-state-of-the-adult-social-care-sector-and-workforce-in-England.aspx

[7] Nolan et al (2006)

[8] The following list is adapted from the list in Nolan et al (2006)