Chapter 3: What Do We Mean by Relational Services?
There's growing interest in relational services. But there's also growing confusion about what "relational" actually means.
Some use it to describe specific social care teams. Others use it loosely for any service where staff are encouraged to be "nicer." The word risks meaning everything and nothing.
Professor Rob Wilson, reviewing an earlier draft of this chapter, pushed back on that concern.
He argued that keeping the term open is actually the point. Nail it down too tightly and present it as the definition, and you risk what philosophers call a "view from nowhere": one group's perspective dressed up as universal truth. Keep it fluid, and different communities can bring their own meanings. The concept stays alive, adaptable, and owned by those who use it.
It's a fair challenge. And it surfaces a real tension in this work.
At a theoretical level, we agree. We don't want to close down meaning. Different communities will interpret "relational services" in ways that reflect their own context. Academics, practitioners, citizens. That richness matters. We're not trying to settle the debate or claim ownership of the term.
But our purpose is narrower.
We're writing this book to help people develop and sustain relational services. If you're trying to redesign a service, to shift it from transactional to relational, you can't work with a word that means different things to everyone in the room. You need enough shared understanding to make decisions together.
So we hold both views. We offer a definition, but we're clear about what it is: a working definition for a specific purpose. Not "the" answer. Not a claim to have captured the essence of "relational services" for all time. Just what we mean when we're helping organisations change.
Think of it as a compass, not a destination.
A direction, not a destination
This distinction matters.
A service doesn't "become relational" the way a project becomes complete. There's no finish line. No certificate. No moment where you can say "we've arrived."
Instead, there's a direction of travel. The question is always: are we moving in the right direction?
Framing it as a destination creates two problems.
First, it invites box-ticking. Organisations can claim to have "gone relational" by adopting a few practices. A "What Matters?" conversation here. A multi-disciplinary team meeting there. But the underlying logic stays the same. The label becomes a merit badge that means nothing to citizens.
Second, it gets in the way of learning. If "relational" is a state you either are or aren't, then once you've "arrived," what's left to figure out? But the whole point of relational work is that it's emergent. Adaptive. Never finished. The work is the learning.
So when we talk about relational services, we're pointing toward a direction. More integration in how we see people. Less fragmentation in how we organise work. Greater space for professional judgment. Deeper continuity of relationships.
Our definition is intended to help you know whether you're heading the right way. In the next chapter, we clarify further when relational services are required and in Chapter 5, we set out the principles that guide how they're designed and operated.
A purpose-based definition: Reducing fragmentation
We define a relational service by its purpose: to reduce fragmentation so that meaningful, relational work is possible.
This is the short definition. Toby Lowe and Mark Smith offer a closely aligned account of relational public services. Their work centres on sustained human connection, trust, and the professional judgment that becomes possible when practitioners have time and permission to work with people as people. They also make a distinctive claim: that relationships are not only the means through which support is delivered, but can be an outcome in their own right. Relational wellbeing matters, not just as a route to other goals, but as something public services should nurture and sustain.
Our definition makes a slightly different move.
Rather than defining relational services by the qualities of the practitioner–citizen interaction, we define them by what the service must do: reduce fragmentation so that those interactions become feasible, durable, and repeatable.
This reduction in fragmentation is needed in at least three areas:
In how we see the citizen
In how we work with the citizen
In how the organisation is designed
Let's take each in turn.
Reducing fragmentation in how we see the citizen
Relational work starts with how we see the person in front of us.
Services have a habit of chopping people into problem-shaped pieces. We see a "housing problem," a "debt problem," or a "mental health problem." Each of these pieces then gets referred to a different team. Before long, the whole person has disappeared into the referral logic of the organisation.
It is vital to be clear here: the fragmentation we are talking about is not in the citizen’s life. It is in our own gaze.
People with complex lives often have very coherent reasons for the things they do.
A mother might prioritise staying at home to protect her child over attending a debt advice appointment; to her, that is a perfectly logical choice based on love and safety. However, the system sees two "fragmented" data points: a "non-compliant" debt case and a "child at risk" file.
The aim isn't to analyse what we see as fragmentation in someone's life. It's to see them as a whole person.
Instead of treating someone as a "service user" to be quickly triaged into predefined "products," we try to see and meet them as a whole person: a citizen with a life, history, context, and relationships. Toby Lowe calls the opposite tendency the transactional gaze: looking at people primarily as units of need to be processed through a system.
A typical transactional response:
Mrs Jansen is lonely, grieving her husband, and often forgets to eat because she's depressed.
In a transactional system, this situation is quickly translated into standard service offers:
Daily meal delivery
Six weeks of grief counselling
The problem is broken down into service components, and the person disappears into the referral logic of the organisation.
A relational alternative:
A relational approach starts with a different question: "What matters in your life right now?"
This is the heart of the "What matters?" conversations used in Northumbria and promoted nationally in Wales. Instead of jumping straight to predefined interventions, the focus is on seeing the whole person, building a connection, and sometimes not rushing to a "fix" at all, but being present with what is happening.
Case Study: The Anglesey Bursar
We saw this in Anglesey with a woman supported by Medrwn Môn. A retired School Bursar, she was organised and helpful, but the sudden loss of her husband left her isolated and depressed. Rather than assessing her "deficits," the team asked what mattered to her. She revealed a desire to help others in her situation.
With support, she established a local grief cafe. While she still carries her grief, she has found purpose in a role she excels at. She has made new friends in the community and has even planned a ladies' road trip in France. The 'intervention' wasn't something done to her or for her. It was the space the team created for her to find her own purpose again through helping others
As Andries Baart, often described as the philosophical grandfather of the relational services movement in the Netherlands, puts it: care is not about "fixing" a problem but about sharing life for a moment. It's about being with someone in their messiness, not immediately trying to tidy it away.
Good care doesn't start with a goal ("Get him to stop drinking") or an assessment. It starts with a relationship ("Who is this person?"). It's not the application of a protocol to a problem, but the attentive alignment of the professional to the rhythm and dignity of the other.
This has a design consequence: the more tightly we bind professionals to protocols, the less able they are to truly see the person in front of them.
In other words, relational care requires structural freedom.
Baart summarises this as "Protocol vs Presence (Face)":
Protocol says: "This person is in debt. You have 10 minutes. Fill in the form so they can be assessed for a benefit. Get the signature."
Presence requires: "This person is crying. I need to sit down. They're exhausted and stressed, worried about being late for school pick-up. The form is irrelevant right now. Let's get a cup of tea, acknowledge the pressure, and reschedule with me, the same person, for tomorrow. The debt discussion can come later, once a relationship exists."
Relational services should be designed so that workers can choose the second response. There are many good examples of where organisations have designed their services in such a way that this is possible.
An often-told example comes from Buurtzorg's founder, Jos de Blok. A client needs compression stockings each morning. In a traditional homecare model, the worker comes in, quickly puts on the stockings, and leaves. In the Buurtzorg model, the nurse sits down for a coffee first and asks: "Why aren't you getting out of bed anymore?" That single question can open up the real issues in someone's life - issues no protocol would ever ask about.
In a recent interview, Helen Sanderson, the founder of Wellbeing Teams, explained how her homecare model deliberately paid staff for their travel time. In most commissioned contracts, travel is unpaid. This creates an invisible, frantic pressure for the worker to "get in and get out" as quickly as possible. Helen decided to pay for travel at the expense of the contract’s profit margin. This time made it possible for carers to be present and kind. They were encouraged to use their autonomy, to offer a hand massage or simply talk, opening up deeper issues that a rigid "time and task" protocol would never have uncovered.
The opposite is more common. Most services fragment the work so thoroughly that presence becomes nearly impossible.
Reducing fragmentation in how the work is done
Fragmentation doesn't only show up in how we see people. It also shapes how the work itself is organised.
When services are broken into narrow, transactional units like a task list to be completed as efficiently as possible, or a call to be wrapped up within an allotted time, we lose the ability to build meaningful relationships.
This short-term efficiency undermines the long-term purpose of the service, deprives the worker of an understanding of what's going on, and removes professional judgement.
James C. Scott argues that large organisations, especially public ones, have a strong tendency to simplify the messy complexity of real lives so that it becomes "manageable." The unintended consequence is often harmful and results in large amounts of “failure demand” and services that don't fit people's actual situations.
"The Parade of Strangers"
Consider a typical day for an 80-year-old citizen receiving care provided under a traditional homecare contract. Let's call her Mrs Thompson:
08:00 – "Stocking nurse": A junior nurse arrives. Her defined "product" is to put on compression stockings and help Mrs Thompson out of bed. She’s rushing to another appointment and in practice, has about 7 minutes. She notices Mrs Thompson looks sad, but has no time to ask why.
09:30 – "Domestic assistant": Another person arrives to make breakfast and coffee. She notices an open wound on Mrs Thompson's leg that looks red but assumes "the nurse must have seen it" and says nothing. It's not her job.
11:00 – "Wound nurse": A specialised nurse arrives to dress the wound. She treats the leg correctly but doesn't realise Mrs Thompson hasn't eaten because she feels nauseous. She leaves when the task is done.
14:00 – "Cleaner": A fourth person arrives to vacuum. She finds Mrs Thompson crying. Her role, however, is to clean, and she is in a rush. She cleans around her, quickly says some comforting words, and leaves.
On paper, everything is fine: stockings on, breakfast made, wound dressed, floor clean.
In reality, Mrs Thompson is feeling low and nauseous. Four professionals have visited, yet nobody saw the whole person.
A relational alternative:
A relational homecare model, such as Buurtzorg, looks very different:
One district nurse comes at 08:30. She puts on the stockings, makes the coffee, dresses the wound, and notices the nausea while chatting. She suspects this might be caused by the new medication Mrs Thomson started taking last week. She calls the GP, and together they adjust her medication. Without the nausea, Mrs Thompson is about to face going out doors and goes to meet her friends in the neighbourhood.
One person. One relationship. One coherent response.
Relational services deliberately reduce the fragmentation of support:
Fewer professionals involved in someone's life
More continuity and ownership of relationships
More freedom for the professional to respond to what is needed in the moment
To do this, the worker needs scope to exercise what has been called practical wisdom: the ability to judge what is right, for this person, in this situation, at this moment. You can't write practical wisdom into a protocol, but you can design services so that it can be used.
Reducing fragmentation in the organisation of work
If we want to see the whole person and do less fragmented work with them, we also need to reduce fragmentation in how roles and teams are designed.
Most large organisations are built on two assumptions:
A separation between managers and workers
A division of authority, responsibility, skills, knowledge, and activity into narrow parts (or silos)
This leads to jobs that are tightly defined around fractional tasks. The system is built on the assumption that for work to be efficient, workers must operate within narrow boundaries and be closely controlled.
But this structure has an unintended consequence. Work becomes less meaningful because people no longer see the whole context of what they're doing. As Burkart Sievers argues, artificial motivation (targets, incentives, performance schemes) must replace intrinsic motivation.
Relational services move in the opposite direction. They:
Design broader, more generic roles, so workers can respond to the full situation, not just one slice of it
Build small, self-organising teams with genuine autonomy
Develop a wider organisation that supports these teams and enables them to work with more freedom.
Trust practitioners to use their local, context-dependent knowledge, built through experience
Value intuition and judgement (what the Greeks called phronesis)
The generalist problem
This means valuing generalists over specialists. Or at least, valuing the generalist capacity within people.
David Epstein's book Range makes the case that generalists often outperform specialists in complex, unpredictable environments. The specialist knows one thing deeply. The generalist can connect across domains, adapt, see patterns. In relational work, where every person's situation is different, the generalist mindset is essential.
But here's the problem. The Service Factory has spent decades telling people that specialism equals value. To be a specialist is to be senior, expert, and respected. Whereas a generalist is seen as someone who perhaps hasn’t done their professional training, or who is a "Jack of all trades, master of none".
I (Dennis) learned this the hard way. Working with a South London Borough and together with their NHS counterpart, I argued for designing broader, more generalist roles. The pushback was immediate. Staff didn't want to be called generalists. It felt like a step down. I carried Epstein's book around. Made the case. And lost.
We eventually settled on the term "multi-specialist" as a compromise to acknowledge their existing expertise while broadening their scope. However, this shift revealed how deeply the cultural grip of the Service Factory actually runs. It became clear that a person’s professional identity is often inextricably wrapped up in their specialism; it is far more than just a job title. This created a profound reluctance among staff to actually leave the safety of their specialisation, and without that shift in mindset, the initiative simply could not last.
Sandcastles
Professor Rob Wilson warns of what he calls the "sandcastles effect." (see Baines et al, 2024) Good relational initiatives, often built through co-production and user-centred design, can look beautiful. They're handmade, thoughtful, and effective. But they exist within organisations still conditioned by New Public Management. So with a new manager, councillor or minister, the tide comes in and sweeps them away. Or a policy bully strides across the beach and kicks them over. The point is this: redesigning roles and teams isn't enough if the wider organisational logic stays transactional. The generalist team sits inside a specialist system. The relational practice gets measured by transactional metrics. Unless you work on the wider enabling conditions, the sandcastle won't last.
The definition
The longer definition of relational services, we offer, is therefore as follows:
Relational services reduce fragmentation in how we see people, how we work with them, and how we organise that work, so that meaningful, trusting relationships can form, and professionals can respond to what actually matters to the person.
This means trusting relationships can form. And as Lowe and Smith argue, those relationships are both the mechanism through which help happens and a valued outcome in their own right.
So, this isn't about adding a "relational element" to an otherwise transactional system. As the examples show, relational services are not just "friendlier" versions of existing provision; they are built for a different purpose.
It's about fundamentally redesigning services so that the conditions for relationships become possible. Without that foundation, everything else (the assessments, the interventions, the outcomes) rests on sand.
The next chapter addresses the practical question: when is a relational approach actually required?
References
Baines, S., Hardill, I., Ellison, N. and Wilson, R. (eds.) (2024) Harnessing Complexity for Better Outcomes in Public and Non-profit Services. Bristol: Bristol University Press.
Baart, A. (2001) Een theorie van de presentie [A Theory of Presence]. Utrecht: Lemma.
Baart, A. and Timmerman, G. (2023) Relational Caring and Presence Theory. Utrecht: Uitgeverij KokBoekencentrum.
de Blok, J. (2011) Buurtzorg: A New Perspective on Elder Care in the Netherlands. Available at: https://www.buurtzorg.com
Epstein, D. (2019) Range: How Generalists Triumph in a Specialized World. London: Macmillan.
Lowe, T. and Smith, M. (2024) 'Relational public service can tackle hardship in neighbourhoods.' York: Joseph Rowntree Foundation. Available at: https://www.jrf.org.uk/neighbourhoods-and-communities/relational-public-service-can-tackle-hardship-in-neighbourhoods
Lowe, T. et al. (2021) Human Learning Systems: Public Service for the Real World. London: Centre for Public Impact. Available at: https://www.centreforpublicimpact.org/assets/documents/hls-real-world.pdf
Sanderson, H. (2020) Wellbeing Teams: A Guide to Creating Wellbeing Teams. Stockport: Wellbeing Teams.
Scott, J.C. (1998) Seeing Like a State: How Certain Schemes to Improve the Human Condition Have Failed. New Haven: Yale University Press.
Sievers, B. (1986) 'Beyond the Surrogate of Motivation.' Organization Studies, 7(4), pp. 335–351. https://doi.org/10.1177/017084068600700402