While many words make me go hmmm, there are some that make me squirm the most, either due to what they reflect about the way we think about people (like ‘case’ and ‘non-compliant’) or about the way we do things to people (like ‘placement’). There’s one word that I feel is increasingly prevalent and is rising quickly to the top of my hmmm list, and that’s ‘demand’.

Dictionary definitions of ‘demand’ include “something that someone insists on having” and “to ask for something forcefully, in a way that shows you do not expect to be refused”. Synonyms include ‘order’, ‘dictate’ and ‘challenge’. And demanding means “not easily satisfied or pleased”, and “making difficult or irksome demands on one’s resources, patience, energy, etc.” 

It’s a loaded term that implies imposition or threat. 

And many of our references to ‘demand’ blame older people and disabled people. It’s as if we view the fact that people require support as an inconvenience. Indeed, our narrative suggests we view older people and disabled people as an inconvenience full stop.

“Demand for social care is not driven exclusively by an ageing population; the prevalence of disability among working-age adults has increased over recent years.”

“Demand for care is growing, driven by changes in demographics. Demand from working-age adults, in particular, has increased by 22% since 2015/16 ‒ partly due to the increase in the number of adults with disabilities as more people with severe disabilities survive childhood. There are also more older people as a result of the post-war ‘baby boom’, and until recently, life expectancy had been increasing.”

Increased survival rates and longer lifetimes are framed as a burden and a drain rather than a cause for celebration, repeating and reinforcing age-old assumptions and stereotypes about contribution and value. 

This narrative implies that these ‘increasingly complex’ people are the problem, not the attitudes, environments, policies and priorities that continue to divide and exclude.

And the ‘problem’ is framed as a problem for services and ‘the sector’, not a problem for the people and families left without the assistance they need to live the life they choose to lead.

“As the population grows and ages, rising demand for treatment, care and support, plus increasingly complex needs, are putting further pressure on the health and social care system.”

“Rising costs and demand are a huge strain on council budgets and services face ‘intolerable pressures’.”

In fact, people and families are increasingly absent from a story that disconnects ‘demand’ from any sense of individuals.

“Increases in the volume and complexity of demand is becoming more and more of a concern across local government and the wider care sector.”

“Demand continues to pile onto the breadth of health and care services.”

“We looked at all our demand and where that came in from, and what types of demand they were.”

“Some of that demand has now come back.”

These are human beings. 

This is us.

Demand for…

So, what are we suggesting all this ‘demand’ is for? 

Choice and control? Equality? A place to call home? Dignity? Respect?

Ha! Of course not.

It’s for assessments. Placements. Beds. Packages. Services. Care.

• “The demand for social care assessments is rising.”
• “A higher proportion of future demand will be for specialist accommodation placements.”
• “We can expect an increase in demand for specialist care home beds over the next decade.”
• “Learning Disability packages of care have shown a consistent demand.”
• “Demand for homecare remains high.”
• “A growing demand for care services.”
• “The rising demand for long-term care.”

Remind me again what the purpose of adult social care is?!?

Once again, we’re viewing the world through the serviceland lens and forgetting what matters most to people.

Don’t we all want to live in the place we call home with the people and things that we love, in communities where we look out for one another, doing the things that matter to us? [1]

A life, not a service.

Failure demand

Local authority market position statements contain multiple references to ‘current demand’ and ‘growing demand’ and ‘increasing demand’ and ‘future demand’, along with plans for ‘managing demand’ and ‘reducing demand’ (which frequently employ those tricky terms like ‘prevention’, ‘independence’ and ‘strength-based’).

There is, however, a term that doesn’t get as much of a look-in, and while it’s not a term I particularly like, it describes a reality that I’ve witnessed time and time again.

Failure demand.

John Seddon describes failure demand as “demand caused by a failure to do something or do something right for the customer” and suggests that “failure demand routinely runs at 40 – 60% of total customer demand. In some organisations, particularly health and social care and utilities, it can be as high as 80% or more.” Vanguard [2]

This thinking recognises that the problem is the system, not the person. Our hierarchical, siloed, bureaucratic, standardised, industrialised approach where people seeking support become ‘cases’/ ‘users’/ ‘complex’/ widgets and employees become robots – doing things right instead of doing the right thing. Where the computer says no (or ‘come back when things get worse’), and ‘those’ who aren’t screened out and signposted away join waiting lists to be triaged and RAG rated and prioritised and re-prioritised as the waiting list becomes the work and the greens become the reds and the queues become the news. Where calls aren’t returned and letters aren’t sent or don’t make sense and boxes aren’t ticked and ‘I have to ask my manager’ and ‘it was denied at panel’ and ‘it’s not my job’ and ‘there’s nothing more I can do’ and referrals are ‘inappropriate’ or closed due to ‘refusal to engage’ and nobody is listening or asking the one question that really matters.

What really matters?

“The system is driven by cost which paradoxically drives more cost into the system. Run the system on what matters and you only do what matters – it’s cheaper and better.” Vanguard [3]

Demanding better

Dictionaries also define demand as “to need something”, “to require something” and “to claim as a right.”

Our dehumanising, deficit-based focus on demand shifts attention from what people need, require and have a right to.

The need for something to be different. A requirement for assistance. The right to a good life.

We should be demanding better. Demanding more.

Demanding that care and support helps people “to achieve the outcomes that matter to them in their life.”

Demanding that people’s wellbeing is always promoted.

Demanding there are “no assumptions as to what matters most to the person”. No “judgements based on preconceptions” about their life.

Demanding that decisions aren’t made about people without them.

Demanding that people are “considered in the context of their families and support networks, not just as isolated individuals with needs”.

Demanding that any restrictions on people’s rights or freedoms are kept to the minimum necessary.

Demanding that “people have the information they need to take control of their care and support and choose the options that are right for them”.

Demanding that “people are safe and that their care and support is on a secure footing”.

Demanding “a focus on the person, not the process”.

This isn’t extreme or revolutionary. This is the law – the language of section 1 of the Care Act 2014 statutory guidance. [4]

Instead of all the conversations about demand, it’s time to demand a different conversation.

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References

[1] Social Care Future

[2] Failure demand, Vanguard, Beyond command and control

[3] Written evidence submitted by Vanguard [SOC 068], Vanguard, UK Parliament, August 2016

[4] Care and support statutory guidance, Department of Health and Social Care, GOV.UK, Updated 18 February 2025