ABSTRACT
Systems of care around vulnerable people are societally based— that is, they represent a public interest— and are supportive to or alternative to this prototypical family model of social being. They may seem to fit with a family model or develop very different kinds of organizational behaviour. Different systems of care attempt to locate themselves at different points of the cycle—for example, claiming to be the “end of the line” even when they are not—and they are always likely to be caught out by the every-changing needs that they are facing. The NHS has experienced a succession of change initiatives. It seems a different age since we were saying to clinicians that they were managers— before the introduction of general managers, and then of ever more insistent and emotionally detached external systems of audit and control. There may be negotiated agreements to manage such boundary expectations between formal and informal systems of care.
