Relational Services Resources

Numerous Q members around the UK and Ireland are helping create a shift away from siloed and transactional services, towards relational services. These offer a more person-centred (rather than service-centred) and learning-orientated approach, with high continuity of care. National improvement organisations in Scotland and Wales were some of the first to take a lead.

Sometimes called Liberated (Public) Services or Human Learning Systems, this approach builds on the system analysis method of quality pioneer W.E. Deming that reduces unwanted failure demand/​waste.

For people with complex needs, for example, it was recently calculated that £37bn is lost annually due to the waste/​failure demand in fragmented conventional services, when compared to the lower cost of relational services. [ref]Lowe, Toby and Hesselgreaves, Hannah, Better outcomes for less money: the effects of working in a Human Learning Systems way (CPI/​PERU/​Civinet, 2024) [/​ref]

Relational services aim to supersede the supposed efficiency of today’s era of standardised pathways built on ​‘Markets, Management and Metrics’. More relational forms of leadership are also gaining increasing recognition, for example the book ​‘Systems Convening – a crucial form of leadership for the 21st century’ (which features case studies with multiple Q members too).

If you’re working in improvement and new to the topic of relational services, these resources are great places to begin:

This 2026 research report and accompanying opinion piece from Q members Catherine Harrison and Bryan Jones documents findings from their research with leaders from across local government, the NHS and social-purpose organisations. 

It explores what must structurally change to allow relational and transactional approaches to coexist at scale, as a durable, system supported norm that strengthens quality and productivity. The research was funded by the Health Foundation.

This paper, authored by Ben Glover, was published by the Future Public Services Taskforce at Demos in 2024. It sets out a new vision for public services, inspired by the new public services paradigm which has emerged locally in the UK in the post-financial crisis era. 

This Healthcare Improvement Scotland QI Connect webinar with Toby Lowe explains how creating a management environment which enables and supports continuous learning can drive improvement in complex environments. 

It gives a call for managers to focus more on learning and less on performance management; to scale the capacity for learning, not what is learnt. It was recorded in March 2023.

At ConfedExpo 2026, we hosted a session bringing together practitioners and leaders who are using or, are interested in using, a relational approach to connect and build their networks. 

Our two speakers, Catherine Harrison and Meadhbha Monaghan shared evidence for relational services. Their slides are below. 

• Community Nursing – the SAS of Integrated Neighbourhood Care (Diarmaid Crean; Sept 2025)
• Collection of Posts on Relational Public Services (Benjamin Taylor)
• A Hundred Origin Stories – an Unfinished History of Relational Public Services (Simon Parker, Becca Dove and Benjamin Taylor; 2025)

• Crisis and Resilience Fund: Guidance for local authorities in England (1 April 2026 to 31 March 2029), Ministry of Housing, Communities and Local Government. This includes a relational approach – Systems Convening – as part of new Government guidance and is supported by a case study (number 15).

• Radical Help: How we can remake the relationships between us and revolutionise the welfare state (Hilary Cottam, Virago, 2018)
• The Tyranny of Metrics (Jerry Z. Muller, Princeton University Press, 2019)
• Organizational Innovation by Integrating Simplification: Learning from Buurtzorg Nederland (Sharda Nandram, Springer, 2016)
• Reality Strikes Back: A Cartoon Guide to Complexity (Virpi Oinonen, 2026 in press)
• Systems Thinking in the Public Sector – the failure of the reform regime… and a manifesto for a better way (John Seddon, Triarchy Press, 2008)
• Systems Convening – a crucial form of leadership for the 21st century (Beverly Wenger-Trayner and Etienne Wenger-Trayner, 2021). Includes case studies from Q members. Downloadable PDF available

Laura Finucane and Adam Lent shared the story of how a physio service cut waiting list times by a third by using a strengths-based, community-orientated approach.

Chaired by GP Ben Allen, speakers Darren Altus, Elizabeth Reader and Kristian Astrup Nielsen talk about a rewarding case study using the Vanguard method in Lincolnshire. 

Brendan Martin, Suzanne Wilson and Peter Brook shared the results of a five year pan-European study into the opportunities and challenges for the pioneering Buurtzorg approach to care at home.

John Mortimer, Roxanne Tandridge and Eleisha Harrison, shared how a prototype integrated care team was designed through team experimentation. John highlighted their journey of discovery that led to service effectiveness and reducing resources. 

Toby Lowe and Gary Wallace share the pioneering Human Learning Systems approach of Plymouth’s Health & Care system.

This 2026 BMJ podcast recording from Maureen Bisognano and Bob Klaber (and their associated opinion piece with Don Berwick) makes the case that an imbalance has developed between the rational (efficiency, data, and metrics) and the relational (human connection, empathy, and listening) modern medicine. 

They also share how simple changes, like asking ​“What matters to you?” instead of just ​“What’s the matter”, can put humanity back into healthcare.

This presentation is from Hamish Dibley at the European Healthcare Design 2025 Congress. He discusses a vanguard-inspired, relational improvement of NHS systems and avoiding ​‘Activity Obsession Disorder’.

• DoWith – discuss the values, practices and movement behind ​‘doing with’ rather than ​‘doing to’ in public services.
• Human Learning Systems global community – started in response to the Human Learning Systems Insights Launch event. Supports events insight sharing and connections. 
• Test, Learn & Grow – connecting individuals who are curious about, or part of, the Test, Learn and Grow programme.

• Relational services meet-up WhatsApp group. So far it has supported meet-ups in London, Brighton, and Manchester. Contact Matthew Mezey via LinkedIn to join.

The following organisations and initiatives are leading work in relational services. 

A Better Way – a network across different sectors committed to changing the way things work for the better.

Camden Centre for Relational Practice - a research and practice centre dedicated to creating relational cultures in public services.

Community Health and Wellbeing Workers - Inspired by Brazil’s successful family health strategy, community health workers visit residents in their homes on a monthly basis. They build personal relationships, rather than delivering transactional care – allowing the service to identify health and social needs early and personalise support.

Compassionate Mental Health – working with a network of people across the UK and internationally to transform mental health services, and radically change the conversation around mental illness.

DoWith – a network of people and organisations calling for a radical shift in the public sector from ​‘doing to’ to ​‘doing with’.

Human Learning Systems Collaborative - Human Learning Systems is an alternative approach to public management which embraces the complexity of the real world to enable us to work effectively in that complexity.

Kinship Works – supporting more human ways of improving our lives together.

Liberating Structures – 44 varied group tools that build relationships and shared improvement in organisations.

Local Area Coordinators – Local Area Coordination is a ​‘strengths-based’ approach (building on what’s strong in people’s lives and communities), originating in Australia that has developed globally over the course of 30+ years. Local Area Coordinators are employed by councils, based in communities and are recruited together with the input of local people.

Make Every Adult Matter – a national charity supporting practitioners, policymakers and people with lived experience to transform services and systems for people facing multiple disadvantage.

Mutual Ventures – aiming to make public services better, more sustainable and more connected to communities.

National Academy for Social Prescribing – Many things that affect our health can’t be treated by doctors or medicine alone; like loneliness, debt, or stress due to financial pressures or poor housing. Social prescribing connects people to non-medical support to address these issues and other unmet needs.

Plymouth Octopus – a grassroots champion and system convener to influence decision-making and increase collaboration in the city; their CEO is Q member Matthew Bell.

Public World – supporting the development of self-organising teams and better staff involvement to create learning organisations – including over 50 British and Irish health and social care organisations that moved to a Buurtzorg-inspired way of working.

Relationships Project – making relational practice common practice, with networks, insights and practical resources.

Relational Practice Movement – a collective response to the isolation and dehumanisation experienced by both staff and users in public service. Committed to replacing financially-driven and disempowering practices with revitalising and enabling approaches that prioritise genuine relationships and human well-being.

Social Care Future - a growing, people-powered movement for change, reimagining and shifting the narrative around social care. 

Scottish Approach to Change – Developed by Healthcare Improvement Scotland; brings together different change methods for NHS renewal – including Human Learning Systems – into a single approach and translates theory into a practical tool.

Test, Learn & Grow – a Cabinet Office initiative to embed evidence, feedback and adaptation into everyday practice so that learning is continuous and decisions are grounded in real-world insights. Involved in relational public services approaches too. 

Think Local Act Personal – a government funded partnership of people and organisations working to make health and social care more personalised, so that more people can live their life their way.

Help us keep this page up to date. If you’re aware of further resources relevant to the topics of relational services, email us at qcomms@thenhsalliance.org