Introduction: from slow collapse to urgent crisis

In writing a book on adult social care policy in the four nations of the UK, we were researching systems that observers said were ‘in crisis’ (Dahl, 2021), at a ‘tipping point’ (O’Dowd, 2016) and ‘approaching collapse’ (Dayan and Heenan, 2019). Over the 25 years since different care systems developed in England, Scotland, Wales and Northern Ireland, they came to be seen as first, under strain and then, in crisis. This was a gradual collapse – a sense that things couldn't continue as they were – although somehow (through the heroic efforts of many people), they did. A government-commissioned care report in Northern Ireland – Power to people – used the language of ‘a system collapsing in slow-motion’ (Kelly and Kennedy, 2017: 66).

Then, in 2020, the COVID-19 outbreak happened, plunging the social care sector from slow decay into a rapid and deadly crisis. The pandemic highlighted the weakness of these care systems and the poor understanding of their complex organisation (Daly, 2020). Many deaths occurred in care homes, and the dire state of the formal system of home care delivery was brought to the nation's attention. Staffing shortages, intensified by Brexit (the UK's departure from the European Union), went from chronic to acute. Yet the pandemic also raised the profile of the care sector. The realities of providing unpaid care for family and neighbours became more prevalent in the national consciousness. Community support initiatives increased the visibility of people requiring care and support. As the perception of crisis in adult social care systems intensified, there was renewed interest in finding ways to ‘fix’ social care.

Content analysis around the phrase ‘care crisis’ reaps plentiful results (Dayrell et al, 2020). The use of the phrase has increased in recent years, due to a perceived lacuna in the quality of care and caring relationships for modern societies’ older people and disabled citizens (Keating et al, 2021). The framing of the care crisis as a once-in-a-generation challenge can be seen in New Labour's Building the National Care Service White Paper from 2010: