Relational care: Precedent, practice and potential

Meeting the human need for mutually supportive relationships demands a different approach to the way society provides social care. 

People need people 

From cradle to grave, people need human interaction in order to thrive. We need to give and to receive, to be validated, to find meaning and purpose in life, to love and know ourselves loved. The relationships that underpin wellbeing are those of reciprocity, whether with a partner, a family, a community, or wherever we call home. This has been the case for time immemorial, so why is it not at the centre of social care?  

A progression from person-centred care 

An environment that encourages some people to be only ‘givers’ and some only ‘receivers’ of care, erodes the self-value of all concerned. This is one of the drawbacks of ‘person-centred’ care: an approach which, by putting people ahead of process or organisation, offers a significant advance on past practices, but which risks casting individuals as a collection of needs to be met, or a provider of services to meet those needs. 

Relational care represents a natural and positive transition from person-centred care. Several care providers have adopted this approach already, while aspects of it can be seen more widely. However, until a couple of years ago, this concept was based on unevidenced observation (mine and others’) of what appears to be best practice. 

Assessing and supporting the practice of relational care 

To gain traction, and be more replicable, the ideas on which relational care is based needed exploration by empirical research. This research has now been undertaken by an Open University team headed by Professor Mary Larkin and Dr Manik Gopinath.  

With funding from the Hallmark Foundation, we studied everyday life and undertook interviews in care settings where best practice had been observed. The research sought to define what was happening, the attitudes essential to relational care, and the environments that favoured it. The overall aims were to faciliate replication by producing models; and to use these models as the basis of learning materials. 

Including a rapid review of existing literature, the research period took just over one year. A field ethnographer visited five different settings, interviewed 19 people and analysed the transcripts. 

The resulting report was seminal in a number of ways. Not least, it produced the first ever definition of relational care. Rigorous analysis of interviews and observations indicated the key components of relational care to be:  

• An atmosphere of respect, trust and inclusivity that nurtures belonging. 
• A purposeful focus on relationships. 
• A physical environment that facilitates relationships and autonomy. 

Further analysis produced a model of relational care, showing the most important elements underpinning the manifestation of each of these three categories. We have developed these findings into the Making every relationship matter practitioners toolkit, which offers guidance through case studies, vignettes and specially commissioned illustrations. A free learning module on the University’s OpenLearn platform was launched in March. 

This work is not just about adding to the existing corpus of knowledge, but about effecting real change through disseminating the learning, and discussing it with organisations that directly or indirectly affect delivery. 

Embedding relational care: opportunities and challenges 

We are now looking at future activities. The toolkit is being trialled by providers, and can be refined depending on feedback – if you are in a position to use it, we would certainly like to hear from you.  We are also seeking research partnerships; in particular, we have been asked about the extent to which relational care practice could be relevant to domiciliary and unpaid care.  We can see great possibilities in this, but would need evidence of the extent to which it is already being practiced in these settings and how this might guide our existing advice and tools. 

The benefits of relational care arise from increased self-worth, autonomy and security, leading to greater wellbeing. With further research, issues such as improved mental and physical health, reduced medication and hospital admission, higher staff retention and satisfaction, could almost certainly be evidenced. We could carry out such studies, but meanwhile inaction is not an option given social care is under massive pressure right now. 

The opportunities are real and exciting. So, the challenge to providers, professionals and policy makers is this: while fully embedding relational care needs time and commitment, if more modest, common-sense changes can be made right now to favour relational care, why not?