Book contents
- Frontmatter
- Dedication
- Contents
- Acknowledgements
- Prologue
- Introduction
- one How we divide the world into community and asylum
- two How we create problems by trying to fix them
- three Why failure pays, but success costs
- four Risk aversion and risk indifference
- five The humanisation experiment
- six Shared Lives
- seven Designing a new national health and wellbeing service
- eight Delivering the national health and wellbeing service
- Can we escape?
- Notes
- References
- Index
- Frontmatter
- Dedication
- Contents
- Acknowledgements
- Prologue
- Introduction
- one How we divide the world into community and asylum
- two How we create problems by trying to fix them
- three Why failure pays, but success costs
- four Risk aversion and risk indifference
- five The humanisation experiment
- six Shared Lives
- seven Designing a new national health and wellbeing service
- eight Delivering the national health and wellbeing service
- Can we escape?
- Notes
- References
- Index
Summary
Paul moved in with Shared Lives carer Sheila and her husband just before his fiftieth birthday. Sheila helped Paul to get a bus pass, to learn to use public transport and about road safety. Paul started to access dental services to address long-standing dental health issues, which has improved his overall health and bought his first bicycle, biking with Sheila and her husband to the countryside. He joined several clubs and got to know shopkeepers, library staff and even bus-drivers. Sheila encouraged everyone to ‘look out for Paul’ whenever he is out and about in the community on his own. Paul doesn't have a lot of speech, but when asked if he understands what ‘independence’ means, he smiles and says ‘walk’.
(Story provided by Birmingham Shared Lives Scheme, 2015)The first half of this book outlines why I believe that nearly every aspect of how we design, fund, deliver and monitor public services for adults who need long-term support is flawed, and how our public service culture remains steeped in the thinking that once built prison-like institutions. It chips away at compassion, which is the very reason good people decide to dedicate their working lives to helping others, and at the capacity and potential of the increasing number of families living with one or more long-term conditions. Meanwhile the media and half-informed politicians rant about failure from the sidelines, while big business licks its lips.
That critique is only of value if there is a realistic alternative. There is plenty of agreement about what must be done: we need to integrate services, innovate, focus on outcomes, share best practice, value the workforce and shift resources to prevention. All could be true, but all are exactly what public service managers have tried to do for decades without success.
It is also important to say that the immediate crisis in health, care and other services would be mitigated through committing a greater percentage of our GDP to them. Following the 2008 crash, two governments shrank the relative size of the state for long-term, ideological (as well as short-term, economic) reasons. An injection of public money would reduce the current crisis, but we have no reason to believe it would end it.
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- Information
- A New Health and Care SystemEscaping the Invisible Asylum, pp. 109 - 142Publisher: Bristol University PressPrint publication year: 2018