‘It’s all about relationships’ was one of the first things I heard upon entering this wonderful world of Local Area Coordination in 2018 – a phrase that has proven to hold true. Everywhere I look in Local Area Coordination I see relationships, not least those within our amazing Network itself with all the incredible shared learning, challenge, and peer support across areas. In our work, relationships are not a ‘nice to have’; they are the fundamental mechanism for change and supporting better lives. As we expect the imminent birth of the new 10-year plan for the NHS (which will reference broad concepts like ‘neighbourhood health’ and ‘integrated neighbourhood’ working), it is perhaps worth making the case again for proactively designing relationships and relational practice into our systems of health and social care.

In making this argument, I think it is important we call out a distinction between our systems of health and social care ‘on paper’ and our systems ‘in practice’. By this I mean that there is a difference between what we aspire to theoretically (neat organisational charts and referral pathway diagrams etc) and real life. Whilst thoughtful integrated service design is obviously critical, our lives are messy, complex, and peculiar to our individual circumstances. Humans tend not to respond as expected to theoretical pathways, but we almost always respond as expected to people taking the time to listen and care. Local Area Coordination is accepting of this and therefore attempts to reframe support by putting relationships first and the system second.

Numerous Local Area Coordination evaluations have pointed to relationships and relational practice being core to the success and distinctiveness of the approach. For example, Lunt, Bainbridge, and Rippon (2020) describe Local Area Coordination as a model grounded in direct, relational engagement rather than administrative service delivery. And Mason et al. (2021) who conducted a realist evaluation found that the effectiveness of LAC stemmed from relational mechanisms such as trust, mutual respect, listening, and collaborative meaning-making. These mechanisms were directly linked to outcomes like wellbeing, confidence, and independence – a ‘golden triangle’ of listening, trust, and time.

In our view, the shift from transactional to relational changes everything and the evidence behind that is clear. Approaches like Local Area Coordination work because they invest in people, listen deeply, and foster relationships that lead to real outcomes. If we want public services that genuinely build power in people and communities (and I hope that we’ll see some of that explicitly written in the aforementioned NHS plan), then it is crucial that we design relationships into our service systems and offers.

Nick Sinclair,
Local Area Coordination Network Director