England's adult social care system has seen one of the most concerted and long-standing attempts at radical reform of a national public service in the Western world. Called ‘personalisation’, a term that never gained widespread understanding, it could be described as the attempt to ‘humanise’ the long-term support of disabled adults and to a lesser extent, older people.

Social care, which revolves around ongoing personal care and practical support for adults who either live in their own homes, or who live in service buildings such as care homes, is perhaps the least well understood public service. Most UK citizens, if they have any concept of it, believe, wrongly that it is part of the freely available NHS, and are stunned to find (usually at a point of family crisis as an elderly relative develops ongoing support needs, perhaps following a fall, stroke or dementia diagnosis), that their life savings and inheritance might be needed to fund care which in too many cases is both expensive and very basic. While most UK voters are deeply suspicious of any privately run provision in the NHS, they have not noticed that most adult social care has been privatised over many years, nor that this was followed by an even more radical set of reforms, giving people, in theory, complete control over the money spent supporting them. The thinking behind these reforms is now quietly being introduced for up to 100,000 NHS patients and is even being explored in sectors like criminal justice with little history of valuing its key ideas of choice, control and community living. So, this humanisation experiment is worth understanding. It also shares many of the aims of the new health and care model that I will set out in the second half of this book. And it was a partially successful experiment, demonstrating both what is possible and what, so far, was not.

Putting people first

A key goal for social care in the 1990s was to close the hundreds of large, long-stay institutions for disabled adults and people with mental health problems, which were widely recognised as failing to offer people the opportunity of pursuing ordinary life goals, as well as having been exposed as harbouring high levels of abuse and poor practice by the Griffiths Reports from 1988 into the 1990s.