Amidst the front page reports about cancelled surgery and creaking A&Es last week there was a less prominent story about the “unsustainable increase” in NHS compensation payments. £1.7bn was “diverted away” from those crucial frontline services last year, twice as much as the figure for 2010/11.
Health Service leaders and managers would do well to consider this remarkable study of US malpractice lawsuits. It examined the comparable problem devouring 2.4% of the US’ total healthcare expenditure and concluded that the “interpersonal aspects of care, such as the communication behaviours of physicians, are often cited as central to patients’ decisions to initiate malpractice litigation.” Ultimately, the study established, it was the failure or success of the relationships within healthcare that informed the lawsuits.
The numbers are striking and urgent but the underpinning principles are not a revelation. In Community Links’ “Deep Value literature review” we considered the role of effective relationships in health, employment services, education, and legal advice. We learnt that “patients who experience a good relationship with their health care professionals are more likely to engage in positive behaviour change” that “the relationship between the adviser and the client has consistently been found to be a key element in helping people into employment”, and that “pupils who develop positive relationships with teachers achieve better academic results”.
Wherever we look services are most effective, and most cost-effective when relationships are prioritised. They, and they alone, nurture trust, nourish loyalty, boost confidence, erode inequality, distribute agency and unlock potential.
Following the London disturbances the After the Riots report in 2011 reached a similar conclusion from a different angle and in a different field: the police need to “improve the quality of minor encounters” in order to “dramatically improve their relationships with communities”. De-prioritising relationships may have enabled the police to reduce numbers and make short-term savings, but the cost of the London riots alone was £113 million.
All this might seem like common sense. I think it is but I also think that with notable exceptions we are moving in the wrong direction. We network and transact now more than ever but meaningful time together is being systematically displaced by fast and shallow connections. Very largely positive advances in science and technology, the economics of globalisation and prevailing political and popular orthodoxies have all played a part in changing the ways in which we relate to one another and led to a common outcome – we have lost the human touch. The Young Foundation, in partnership with the Co-op, is also looking at this with they are doing to capture what ‘community wellbeing’ means which, as their emerging findings show, is more than the sum of individual wellbeing.
We cannot rewind the clock and I wouldn’t want to. But nor should we accept as the necessary cost of progress the three consequential sets of losses which are the price that we are now paying for a devaluation in the currency of relationships – a loss in the efficacy of our agencies and services, a loss in our collective capacity, resilience and readiness and a loss in the quality of our lives.
I will be exploring all this with social entrepreneur and former UK designer of the year, Hilary Cottam, and politician and political theorist Jon Cruddas MP in a public lecture at the LSE on March 12th. In particular, we will be thinking about what can be done to make meaningful relationships the central operating principle at the heart of all our services, neighbourhoods, businesses, everything, everywhere. No plot spoilers here but we will be talking about the lessons from AirBnB, Mont Pelerin and the Road to Serfdom, an Open Framework for Relationship Centred Design, a Ministry for Great Adventures and no doubt much more. Please join us!
David is a community worker in East London. He has been involved in lots of social innovations and has helped to set up several organisations including Shift (now co-chair), Changing London, Children’s Discovery Centre and Community Links where he now leads the national Early Action Task Force. David is currently exploring new work on social isolation at the Marshall Institute at the LSE where he is honorary Practitioner in Residence. He also chairs Shift and is a director of Social Finance. Contact: D.Robinson3@lse.ac.uk