In brief

Through maritime metaphors and first-hand experience, Sarah Yardley, palliative medicine doctor and qualitative researcher, explores the paradox that healthcare systems depend on relationship every day while simultaneously struggling to recognise relationship as legitimate work. She argues that healthcare systems for people living with serious illness should be designed to cultivate solidarity rather than chase the illusion of control, and that safety becomes not the absence of uncertainty but confidence in relationships when uncertainty inevitably appears. Sarah then introduces the concept of ‘Rewilding Healthcare’: creating balanced care ecosystems in which structures serve relationship so relational care can grow. The accompanying comic reimagines healthcare as an open ecosystem of islands of care in a sea of relationship.

Sarah Yardley and Laura Copsey worked with Julia Briscoe and colleagues at Cody Dock on the River Lea to develop the ideas through creative public workshops – shown in images throughout this article. Olivia Sullivan joined the team to co-create the comic.

Image credit: Jon Massey

I’ve always been drawn to the sea. Buoyant and floating, I feel a right kind of small, a resetting of perspective: not safe, but good. 

My love of water and love of reading have always gone hand in hand, perhaps starting with Arthur Ransome’s Swallows and Amazons. Early in the story, an absent father is telegraphed to ask whether his children may go sailing. His response:

“Better drowned than duffers. If not duffers, won’t drown.” 

Arthur Ransome. Swallows and Amazons. Jonathan Cape, London. 1930

As a child, it sounded exciting and shocking. Learning to sail as an adult, I came to understand the wisdom within those few words. Sailing involves uncertainty. It demands judgement, preparation, respect for uncertainty and trust in other people. Yet those risks exist alongside adventure, purpose and joy.

The sea teaches lessons that are useful elsewhere in life. Given Britain’s island geography I have often wondered why maritime safety is so rarely used as a metaphor for how we navigate uncertainty beyond the water. Sailors understand that uncertainty is not the same as risk. A difficult passage through a stormy night reminds us that weather forecasts are imperfect, tides can surprise us, and decisions must often be made with incomplete information. The sea cannot be tamed or domesticated. Everything is contingent. Everything can change in a moment.

I have returned repeatedly to these lessons in my work with people living with serious illness, including complex mental health conditions and advanced incurable physical illnesses requiring palliative care. The longer I have worked as a clinician and researcher, the more convinced I am that the central challenge facing many healthcare systems is not uncertainty, it is the temptation to pretend all uncertainty can be reduced to quantifiable risks, and that these can be entirely controlled.

What is safe is not always good; healthcare systems for people living with serious illness should be designed to cultivate solidarity rather than chase the illusion of control.

Image credit: Sarah Yardley & Laura Copsey

David Jay defines relationship as:

“A shared understanding between people about the meaningful use of resources, and a willingness to change one another through genuine exchange.”

David Jay. Relationality: How Moving From Transactional to Transformational Relationships Can Reshape Our Lonely World. North Atlantic Books, USA, 2024.

Image credit: Sarah Yardley & Laura Copsey

For many people living with serious illness, this form of safety matters more than promises of control that nobody can genuinely deliver. I have learnt so much from people generously sharing their experiences, but three encounters have especially shaped my understanding. 

The first was a woman who described knowing, even when acutely psychotic, “who is on your side, who still thinks you are a person,” and the lasting impact of remembering those who did not. The second was a man who thanked my colleagues and me for “believing that we deserve care, because not everyone does.” The third was a carer who said, “you have to actually care to really be able to offer meaningful care to someone.”

Each described forms of safety rooted not in prediction, control or risk reduction but in relationship, recognition and solidarity.

Image credit: Sarah Yardley & Laura Copsey

Collective social safety can only be co-created through trust, dialogue, inclusion and shared responsibility. It grows when people believe that others will remain alongside them even when outcomes are uncertain. Safety becomes not the absence of uncertainty but confidence in relationships when uncertainty inevitably appears. 

Healthcare systems struggle to recognise this. I have repeatedly encountered the same paradox: healthcare systems depend on relationship every day while simultaneously struggling to recognise relationship as legitimate work. What we choose to measure tends to be activities, interventions and outputs rather than the human connections that make them meaningful and effective, including positive outcomes that cannot be transactionally predicted.

Serious illness frequently arrives like fog. Familiar landmarks disappear. Previously reliable maps cease to function. Plans that once seemed straightforward become provisional. The future becomes harder to see. Decisions must still be made, but under conditions of uncertainty. When cure is not available, uncertainty does not disappear. Instead, the challenge becomes learning how to live well despite it.

Image source: WikiArt.org (public domain)

The same is true in illness. Some people step into the circles of light surrounding someone in need while others step away. Circumstances become uncertain. Outcomes become unclear. Risk and vulnerability can no longer be avoided.

Every meaningful relationship involves the possibility of disappointment, grief, conflict or loss. Entering into relationship creates opportunities to be hurt. Yet when relationships are good, they are what creates good in the fog.

By entering relationships we choose the uncertainties of shared vulnerability while escaping the certainty of facing everything alone. The nature writer Michael Malay argues that solidarity is not merely about standing with creatures under threat but also about standing against the forces that decimate their lives. Humans need the same. We need people who accompany us through difficulty, but we also need people willing to challenge the assumptions, structures and practices that make suffering harder to bear.

The linguistic connection between Luigi Russolo’s solidity and Michael Malay’s solidarity feels significant. Both words share a linguistic root, yet in contemporary everyday language they point towards different solutions. Solidity suggests certainty, firmness and control. Solidarity suggests connection, mutual responsibility and collective action.

Healthcare systems frequently seek solidity. People living with serious illness need solidarity.

Image credit: Sarah Yardley & Laura Copsey

The phrase Rewilding Healthcare was gifted to me during a conversation about my research on the role of relationship in care that was not just safe but good. Rewilding does not mean abandoning structure or trying to turn back the clock. Ecological rewilding is not the creation of chaos. It involves intentionally cultivating conditions in which healthy ecosystems can flourish. Creating balanced care ecosystems in which structures serve relationship so relational care can grow.

Policies, organisations, pathways and professional responsibilities remain important, but they exist in support of relationships rather than expecting relationships to adapt to the requirements of structures. It is about being not just safe, but good. It is about shared positive risk-taking. About living meaningfully. As C. S. Lewis wrote of his hero in The Lion, the Witch and the Wardrobe: “Safe? … Who said anything about safe? ‘Course he isn’t safe. But he’s good.”

If we reimagine healthcare as an open ecosystem of islands of care in a sea of relationship, with each island containing particular resources, expertise and forms of support, then what enables care is the sea of relationship that allows movement between them. 

Conventional system diagrams tend to focus on the islands. A rewilded healthcare system asks us to pay attention to the sea. The sea comes first. The islands depend upon it.

This perspective helps explain why so many people experience gaps between services as gaps in care. Often the problem is not that the islands are absent but that the waters between them have become depleted. Relationship has been squeezed out by the pursuit of part system efficiency, predictability and control rather than whole system effectiveness.

Investing in relational work allows people, resources and ideas to move across boundaries, creating an adaptive system for changing circumstances. Relationship is a mechanism to create whole system efficiency.

I continue to return to the sea when thinking about these ideas. There is a stretch of coastline I have visited throughout my life, bringing dreams, worries, hopes and sorrows to the shoreline. I love it best when I am there alongside people who have stood with me in the past, stand with me now, and will stand with me in the future.

Together we gaze out towards the horizon. We do not impose our perspectives on one another. We simply stand side by side, connected through our shared smallness in the face of something vast.

Life cannot be made entirely safe. Seawater slips through our fingers if we try to contain it. Sometimes the most important question is not how to make the fog disappear, but how to act with solidarity in it.

Rewilding Healthcare argues that the future of care lies not in increasingly sophisticated forms of control, but in cultivating the conditions in which relationship can flourish. It lies in recognising relationship and solidarity as essential resources rather than as optional extras. Particularly for people living with serious illness, we must strive not just for what is safe, but for what is good.

We have created a comic – Rewilding Healthcare: meeting the needs of people living with serious illness – based on these ideas and would love to hear your feedback including how you think we can create systems that support relationship rather than displace it. You can contact me by email: sarah.yardley@ucl.ac.uk

Yardley, Sarah; Copsey, Laura; Sullivan, Olivia; (2026) Rewilding Healthcare: meeting the needs of people living with serious illness. DOI:10.14324/000.ds.10221539

This work would not have been possible without the generosity of the many people who have participated in Sarah’s research, collaborated with her, and helped shape these ideas. Rewilding Healthcare grew from a large ethnographic study examining how challenges in healthcare for people living with serious illness emerge through the interaction of healthcare systems, organisational structures and the relational work of care. Building on these findings, Sarah Yardley and Laura Copsey worked with Julia Briscoe and colleagues at Cody Dock on the River Lea to develop the ideas through creative public workshops. Olivia Sullivan joined the team to co-create the comic.

The research was funded by THIS Institute at the University of Cambridge through the Health Foundation (Grant RHZF/001–RG88620). The creative workshops were funded by UCL Trellis.

Sarah Yardley is a palliative medicine doctor and qualitative researcher whose story-based research explores the hidden work of healthcare, particularly for people who feel they do not fit within healthcare systems. In 2024, she was awarded a Churchill Fellowship to further her work on reimagining palliative care for people also living with complex mental health conditions.

Laura Copsey is a London-based artist and arts educator with a background in occupational therapy, illustration and music. Her interdisciplinary and socially engaged practice draws on heritage, geo-poetics and hydrofiction, often in relation to particular places and bodies of water.

Olivia Sullivan is an illustrator, comic artist and experimental designer whose work explores graphic narratives through visual poetry and surreal storytelling. She is the author of Oracles, a graphic novel exploring grief and loss.

If you’d like to explore in more depth, the following resources provide different ways into the creative work, or you can contact Sarah by email: sarah.yardley@ucl.ac.uk

Rewilding Healthcare (UCL Trellis): An introduction to the creative workshops

Shipping Forecast: An audio piece bringing together voices from the Rewilding Healthcare crew. Using the maritime format of the Shipping Forecast, it reflects on experiences of serious illness, caregiving and healthcare.

Rewilding Healthcare Newspaper: Created through workshops with people drawing on lived and professional experience of serious illness, caregiving and healthcare delivery.

Are You a Carer? Exploring the Hidden Stories Behind the Role: A six-part podcast series developed with carers and drawing on research into the often-unrecognised work of caring for someone living with serious illness.