Can you commission friendship?
This year I took part in the 2021 Caring Places Festival, hosted by Buurtzorg Britain and Ireland. The day explored what a caring place can look like, and specifically what the health and care system’s role is in creating caring places.
It is already becoming a cliché to say that this question has become more pressing in recent months, given the spotlight the pandemic has thrown on the impact of health inequalities and wider determinants of health, and the power of communities taking charge to respond to people in need. But the role of the health and care system in practically creating caring places is still not obvious, no matter how many times we point out its importance in the abstract.
What is health and care’s role in creating those intangible but critical aspects of health and wellbeing that don’t sit well as key performance indicators, such as care, community connection, a sense of belonging, self-confidence and self-worth? One of the panel members on the day in put this brilliantly when she asked, Can you commission friendship?
A straightforward answer to this question is – yes, you can. Befriending services have proliferated across the country, matching people at risk of isolation with volunteers offering support. Social prescribing is another growing means through which the public sector matches people with companionship and community initiatives. Commissioning for connection and community goes on all the time.
But does it work? And what’s best practice? Many of the health and care systems I have worked with whilst at PPL have struggled with the need to support initiatives that work towards long-term health and wellbeing outcomes whilst tackling current pressures and balancing the need to measure and report on success. A person can’t develop better relationships with their community or a strong sense of belonging to any predictable timescale.
There also seems to be a fundamental tension between the formal, structured processes of health and social care, with requirements for safeguarding and policy, and the spontaneity and informality of a truly caring and connected place. There was also general agreement that in an ideal world there would always be a distinction between paid care and friendship and that the health and care sector can’t and shouldn’t replace a caring place.
The conclusion we reached in the discussion was that, whilst the public sector can’t literally commission or provide a friendship, it can work in partnership with communities to create the conditions in which meaningful, sustaining and health-creating friendships are possible. We heard some powerful testimony from people who have taken part in the Shared Lives scheme, which at a surface level matches people with spare rooms with others in need of care and support, and at a deeper level brings people into families that will value them and have space for them. We also heard from Camerados, which works to set up public living rooms where connection is needed, in spaces ranging from streets to hospitals. The conversations reminded me of South London Cares, a brilliant initiative that PPL supports locally in South London. What works well about South London Cares’ approach to tackling to loneliness is its model of pairing young professionals with older adults because both groups are at risk of isolation and both will benefit, rather than creating a “carer” and “cared for” dynamic.
This kind of work isn’t easy and the results might not be tangible. In the discussion at the Festival, we talked about secret ingredients, magic, the serendipity of connection between a well-matched group. This conversation was the first time, in a whole day of discussing care, that I heard anyone mention love.
I think this ambition – working to create the conditions for a caring place, in a way that allows for genuine human connection – is a helpful one for health and care systems to bring to the challenge of caring places.
The Festival also made me reflect on my role as part of a caring community. Previously I’d drawn quite a hard line between the volunteering work I do in my local area, and the care I “provide” as a friend, partner, sister, daughter, grand-daughter and neighbour. Taking part in the Festival made me reconsider this divide. It made the whole concept of a caring place feel a bit more real and connected to everyday experience, rather than an abstraction created by health and care policy. A caring place is a joint responsibility. Whilst it can’t be realised solely by the actions of a health and care system, health and care has a key role to play in creating the supporting conditions for those intangible elements of care like community connection and a sense of belonging.
By Rachel Lewis
Senior Consultant at PPL