Every sanctuary has the potential to become prison-like, and it is hard to escape from a prison you cannot see, or refuse to see. I have never been in doubt of the achievements of our public services. Those achievements are often miraculous, if frequently unnoticed, whereas the problems are deep-rooted, contestable and constantly spun into political yarns. Start looking closely at health and care services and you are quickly tangled up in byzantine service structures, jargon and acronyms. But the arcana obscures some simple divisions which were built into our concept of support from the beginning: who is a citizen and who is a ward of the state; those who need fixing and those who fix. As we live longer, but spend longer within service systems, we will all find ourselves on the wrong side of those divisions, where ‘home’ becomes ‘care home’, everyday choices become risks to assess, and the gap between the life we are living and want to live becomes ‘presenting need’.

Those of us involved in public services in some way, whether as people who use support, family carers, front-line workers or managers and leaders, face a corrosive choice: ignore those divides and the dissonance they create or rail ineffectually against them.

The gains of social care's ‘personalisation’ hint at the value of scaling things down to the individual level, and also the limitations of our power to effect change as unconnected individuals. The quiet, slow and patchy growth of Shared Lives demonstrates the power of joining back together, not to form new bureaucracies, but into new kinds of household, community and even national movements.

If we escape the invisible asylum rather than continually patching it up, our crumbling services will not just be more saveable, we will feel more passionate about saving them. Even more remarkable than the technological or medical miracles are the unnoticed miracles of caring that thousands of underpaid or unpaid people achieve every day, within systems they cannot fully see or comprehend, but whose crushing embrace they feel all too well. That instinct to care for one another is the beginning of everything good that happens within our public services; we imprison it at our peril.