There are many critiques of health and care services, but few that go on to describe an affordable, politically achievable alternative, partly because, as Shared Lives and the related models described in Chapter Six remain under-researched and easy to overlook, no such model was seen to provide a substantial enough evidence base. That evidence trap remains and many will dwell on the risks of rapidly adopting practices that have not been thoroughly researched. Meanwhile the risks of continuing with the same model manifest themselves in increasingly bleak realities.

In this chapter I will outline the transition I think we need to make and the long-term support system that will result from making it: what kinds of interventions and relationships it will create and contain; how it will be resourced (not just with money but also with time and creativity from those currently seen as recipients or customers), what it will value and what its rules and expectations will be.

Wellbeing: aligning public services around a single goal

It is astonishing that, despite constant talk of ‘integrating’ health and social care, you will never hear anyone suggest that health and care, much less other public services, should share a unified goal. How services could become ‘integrated’ when they have different goals and pay provider organisations for different things escapes me.