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.