The failure to create stable systems of support is causing harm, extra cost and institutionalisation.
Author: Vinesh Kumar
Systems describe people as complex. The reality is that it's not people who are complex, it's the instability of the system itself that creates crisis and the breakdown of support. In turn this creates harm, trauma, confusion, extreme cost and increasingly institutionalised responses.
This paper offers a powerful diagnosis of a problem that persists across our health and social care systems. It is based on over ten years experience of supporting the people who have been treated as complex and hard to support and bring people out of institutions into homes of their own and a life of citizenship. In order to bring stability to systems we need to pay attention to 5 key things:
This is an approach that works. When conditions around a person become stable – even imperfectly – life often becomes calmer and more ordinary again. Nothing fundamental about the person changes. The system around them does.
As Vinesh says:
“I have spent a decade supporting people that systems often describe as complex. What I have learned is that the complexity almost always sits in the conditions around someone, not in the person themselves. This essay is an attempt to put that into words, not as theory, but as something I've seen again and again in the ordinary work of supporting people to live in their own homes. If the system around someone is unstable, their life will be too. That's not a complicated idea, but it's one we keep getting wrong.”
The essay also outlines 8 Signals—the factors which commissioners, social workers and anyone concerned with someone's wellbeing should pay attention to. Currently the system is not looking at the right things and when things go wrong it is too often a surprise.
Taking these ideas seriously would open up a whole new way of thinking about regulation, quality and safety.
Read and download the essay (pdf) in your browser, link below
The essay has also been published on Vinesh Kumar's website here.
The publisher is Vinesh Kumar. Complex People Don't Exist. Unstable Systems Do © Vinesh Kumar 2026.
Deinstitutionalisation, Inclusion, social care, England, Northern Ireland, Scotland, Wales, Paper
