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Purpose: In this chapter, we examine the National Health Service (NHS) and Adult Social Care (ASC) in England, focussing on policies that have been introduced since 2000 and considering the challenges that providers face in their quest to provide a high standard and affordable health service in the near future.

Methodology/Approach: We discuss recent policy developments and published analysis covering innovations within major aspects of health care (primary, secondary and tertiary) and ASC, before considering future challenges faced by providers in England, highlighted by a 2017 UK Parliament Select Committee.

Findings: The NHS and ASC system have experienced tightening budgets and serious financial pressure, with historically low real-terms growth in health funding from central government and local authorities. Policymakers have tried to overcome these challenges with several policy innovations, but many still remain. With large-scale investment and reform, there is potential for the health and social care system to evolve into a modern service capable of dealing with the needs of an ageing population. However, if these challenges are not met, then it is set to continue struggling with a lack of appropriate facilities, an overstretched staff and a system not entirely appropriate for its patients.

Post-diagnostic dementia care is often fragmented in the United Kingdom, with great variation in provision. Recent policies suggest moving towards better community-based care for dementia; however, little is known on how this care is delivered. This study aimed to map the post-diagnostic dementia support provided in England a decade after the introduction of a National Dementia Strategy.

A mixed-methods e-survey (open Nov 2018–Mar 2019) of dementia commissioners in England recruited through mailing lists of relevant organisations was conducted. The authors descriptively summarised quantitative data and carried out thematic analysis of open-ended survey responses.

52 completed responses were received, which covered 82 commissioning bodies, with representation from each region in England. Respondents reported great variation in the types of services provided. Information, caregiver assessments and dementia navigation were commonly reported and usually delivered by the voluntary sector or local authorities. Integrated pathways of care were seen as important to avoid overlap or gaps in service coverage. Despite an increasingly diverse population, few areas reported providing dementia health services specifically for BME populations. Over half of providers planned to change services further within five years.

There is a need for greater availability of and consistency in services in post-diagnostic dementia care across England.

Post-diagnostic dementia care remains fragmented and provided by a wide range of providers in England.

The purpose of this paper is to address the following question: In times of permanent connectivity, what forms of freedom need to be considered to prevent permanent availability as an unintended consequence? By using the Hegelian perspective on freedom, the paper categorizes three forms of freedom to transfer them to a common, contemporary understanding of freedom relating it to freedom through human-to-human digital communication. The aim is to show that freedom is not only about independence and realizing choices but also about embedding and committing oneself.

This mainly conceptual paper derives implications based on the Hegelian theory. This is supplemented by an interdisciplinary approach, whereby categories of other philosophers, ethicists, economists and sociologists are applied. The analysis of the contemporary perspective on freedom is enriched by referencing empirical studies.

Digital communication offers new freedom such as working with fewer restrictions from time and space, especially for knowledge workers. It is theoretically possible to work 24 h per day from anywhere (independence), as well as to decide on the final location and timing of one’s work (realizing choices). When solely focusing on these – seemingly advantageous – forms of freedom in times of permanent connectivity, unintended consequences such as the expectation of permanent availability develop. The key message of the paper is that considering one’s temporal and social dependencies (embeddedness) is an indispensable part of actual freedom to avoid unintended consequences.

Organizations need to invest in moral discernment to understand unintended consequences, as well as to cope with them.

Applying the Hegelian theory on freedom based on digital communication to better understand social dynamics of digital communication is a largely unexplored avenue in the existing scientific literature. The decision to undertake this venture resulted from the identified necessity of understanding freedom better. It is often not clear what is meant by freedom through digital communication. Although freedom is a complex construct, it is often reduced to independence/having a choice and realizing choices. When solely focusing on independence and realizing choices, unintended consequences such as permanent availability often go unnoticed. It is exactly because of these issues that this paper endeavors to examine the (deep) meaning of the powerful, yet complex, term of freedom.