Over the last couple of weeks I have talked about the importance of meaningful relationships and suggested 6 principles for an approach to tackling social isolation that involves fundamentally rethinking how our community works. I explored the first three and suggested some things that might change. This time I am going to consider principles 4 to 6.
4) We all need help at some point in our lives. Some need more than others
If I want my holiday jabs in a busy working day I‘ll be happy with a 7.00 appointment and a clinician I don’t know. If I need regular treatment for a chronic condition that keeps me housebound and alone for days on end I will want a doctor I trust and time for a conversation. This is the difference between a customised service and a personalised one. The first has often been displaced by the second but it shouldn’t be either / or. Different people at different times in their lives need both.
What might change?
· Caseloads should be segmented paying doctors more for patients who need more time. Those who want quick jabs and online appointments have one service, those who want a conversation have another. And Health Trusts and local authorities should be required to include loneliness in their health and wellbeing strategies. It is currently, absurdly, optional. Just last week the Chair of the Royal College of General Practitioners. Dr Helen Stokes – Lampard stressed the importance of the issue“Social isolation and loneliness are akin to a chronic long-term condition in terms of the impact they have on our patients’ health and wellbeing,”
· Supermarkets should distinguish between quick shopping sessions and slow ones; optimising speed for the busy buyer, replicating the values of the old high street for those who shop for companionship. Sainsbury have trialled the idea. And, like Asda, big stores should particularly review the use, and thus the management, of their cafes. Isn’t the typical afternoon customer, one per table, telling us something?
· Door step services should collaborate for those who need more real relationships. The Jersey Postal service does it now, working in partnership with the health and social care services and calling daily on those who are, potentially, most isolated.
5) It is easiest to form relationships with people who are near to us.
There are sound reasons why some services are centralised. It is clear, for instance, that the regional stroke unit can provide care that the cottage hospital could not. However many services are wrongly centralised without regard for the diseconomies of scale and at the expense of the relationships which are integral to the quality of the provision.
What might change?
· Learning from the successful Buurtzog model in the Netherlands, social care services might be delivered by small local teams trained and trusted to allocate their time at their discretion,
· Public services should never be commissioned without demonstrating how they will enable relationships to flourish. Better still they should never be commissioned full stop. There is a path dependency about existing models which predetermine outcomes. Instead they could be built from the ground up by service users, families and expert providers working together and with strong relationships as the operating principle.
· The diseconomies of scaling public services can apply equally to the private sector as customer loyalty is lost along with the personal connection. We might see the traditional branch model of, for example, banks reinvented with detached staff running regular money advice sessions alongside Councillor Surgeries or sharing premises with complimentary services so restoring relationships with customers that want them but without the costly back office.
6) Digital connections shouldn’t be the enemy of real relationships. They should be the beginning.
Banning phones or limiting the use of social media isn’t sustainable even if it is occasionally tempting. We have to fathom out how the digital world can better serve the real one.
What might change?
· Informal networks now enable some school and college students to stay in touch. With systematic management all the leavers of every institution might be connected to one another in networks that serve both a social and an economic purpose connecting plumbers to apprentices, builders to customers, artists to mentors, carers to clients, friends to friends.
· Look around the other commuters on the train, the students walking home, the cabbies in the rank – the whole world is on the phone. Might there be a better way of spending a little of this time? Someone who could use a call? It would need to be reciprocal. Generating mutual value from this idling resource could become as much a part of our shared lives as checking the little screen every two minutes.
· Every pound spent on driving the technologies should be matched by another reimagining our world in the light of our new capacities. This isn’t about mitigating the downside but about expanding and connecting the thinking behind What’s App, TaskRabbit, Future Learn, FaceBook, and the rest. How do we use the insight and the application for everybody. Tinder is a good example – almost 25% of new relationships are now kindled online. A marginally amended app with alternative branding could also be connecting new parents or unsupported carers.
I was talking to a social worker a while back. She told me about an elderly woman who was living independently until a nasty bout of the flu. The woman stopped eating properly and taking her medication and within months moved into permanent residential care. A second woman in apparently similar circumstances was taken ill at the same time. She belonged to an allotment group and had done for many years. When she was sick group members took turns to share their meal with her, checking on her daily “for a chat”. The arrangements were in place until their friend was back on the allotment.
The first woman is not happy and she has become a cost to the state. The second is happy and costs nothing. No one was asked, trained or paid to support the second woman. No one would even call themselves a volunteer. They were “doing what anyone would do.”
We can build organisations and processes which design out the human instinct, we often do. Or we can build structures and systems which embrace and sustain our second nature in a society where meaningful relationships aren’t a bolt on, an exceptional act of charity or an emergency response to a crisis but are nurtured naturally and embedded over time – the new normal. In my fourth blog I will share some of what I have learnt about this so far and begin to suggest some next steps. Do please continue to contribute to the conversation.