[00:00] If we have less immigration, then more of us are going to have to work. And your children are going to subsidise your care. The care sector's voice is not heard loud enough. He was paying less than the local supermarket for shelf stackers. And both parties are guilty of weaponising care costs. The state has not reacted as quickly or as urgently as it should have done. We keep more people alive. We keep more babies alive. This money has to come from somewhere. The point is most people's wealth is tied up in their house. We are all going to have to pay more.

[00:34] Voices of Care. The healthcare podcast.

Speaker3: [00:00:39] Damien, welcome to Voices of Care. Thank you for coming to see us. It's a pleasure to have you on here.

Speaker1: [00:00:45] I'm delighted to be here.

Speaker3: [00:00:46] Well, I want to start, if I may, by congratulating you on your appointment as chair of the Social Care Foundation. A lot of work ahead for you. And obviously, the foundation is very committed to raising the voice of social care, which is very close to your heart. 

Speaker1: [00:01:00] That's right. I mean, I've been interested in the topic, both personally, because my father sadly had dementia before he died. So I saw the care system, as it were, from that angle. But also for a time I had ministerial responsibility for it. And I would have loved to be able to have had the time to sort of carry it through and actually get further ahead than we are now. And it's slightly depressing that that was seven, eight years ago. And we're still in the throes of setting up a new commission on it. But yeah, the Social Care Foundation is going to try and keep the subject as high on the political agenda as we can. I mean, it's a cross-party organisation. I'm involving a lot of the big names in the sector deliberately so that there can be another, I hope, respected, dispassionate voice out there saying, these are the problems, here are some possible solutions. Not least to feed into Louise Casey's commission, because that's presumably where the action will be in the course of the next few years, and also at the same time encouraging them to maybe find the solutions at a faster pace than they're currently being set.

Speaker3: [00:02:18] Well, hope springs eternal on that. The foundation, as you said, it's an all-party, it's a cross-party. And you are, of course, chair of the all-party parliamentary group on social care. Now, I want to start, first of all, by getting your view on where social care is now. I think Care England's latest stats show something like 3 in 10 providers last year were either forced to close down or hand back work. And I think you've described it as a crisis that we can't afford to ignore any longer.

Speaker1: [00:02:49] I think that's right. And I think, you know, as it were, we've not been able to ignore it for some time. But simple demographics tell you that it is in crisis now. And the pressures are going to get worse. Partly because we will have an ageing population. And I know we're going to discuss more of that later. But also that, happily, we keep more people alive. We keep more babies alive. And so there are more people living in this country with disabilities who will need help, will need care. And so both halves of the equation just tell you that whatever the pressures on social care are now, and we all know what they are, then they can only increase. So therefore having a stable solution on funding. And through that the various other problems that the sector faces is not just necessary, but it seems to me to be urgent. And, you know, this is a non-partisan point because I would criticise governments of my own party as well as the current government on this. The state has not reacted as quickly or as urgently as it should have done. And in a way, the NHS problems post-COVID actually acts as a spur, because it seems obvious to me that you're not going to solve problems in the NHS unless you solve social care. And almost every week we now get new figures showing that, you know, somewhere between 10% and 20% of hospital beds are occupied by people who ought to be in a care setting. Now, that would not only be good for the system, it would be both cheaper and it would stop some of the problems in hospitals. But also it's much better for the individuals because we all know that the longer you stay in hospital, the more likely you are to pick up an infection or simply to get out of any kind of normal living.

Speaker3: [00:04:49] Absolutely. Now we've had, of course, in February, the Providers Unite March on Westminster. Grapes of wrath seem to be ripening amongst all voices. But there has been some positive developments I'm putting to you from the government. In January of this year, extra funding was announced, which no doubt you'd welcome. And going back to the commission, a dedicated commission to look into social care, Baroness Casey, wanted to get your comments on that. The time frame of spending a year delineating the problem seems interesting.

Speaker1: [00:05:27] Well, I mean, Louise Casey's great. I should I should start by saying that she does provide practical solutions to intractable problems. That's what she's become known for. So I very much welcome the fact that she's chairing this commission. As I say, it's taking a long time asking her to spend the first year looking at what the problems are. I suspect a lot of the people you've had on this podcast could, you know, give them half an hour. They could tell...

Speaker3: [00:05:53] We can replay the podcasts.

Speaker1: [00:05:55] Yeah. Me, you, Wes Streeting, whoever. We know what the problems are. We know obviously funding is at the root of it, but also the workforce issues. Integration with the NHS. The technology issues and underlying that, the capacity of the system to cope with the added demand. So I would gently and politely suggest that it's not going to take a year to work out what the problems are in the care sector.

Speaker3: [00:06:25] Absolutely. And whatever solution does come up in, I think they're due to report in 2029, of course it has to be supported politically. Now, I wanted just to get your view because you've been on record when you were in Parliament and your distinguished parliamentary career, I think it was 2022, in a speech where which I found very noteworthy saying, because often the debate around amongst policymakers and everyone else, media, around social care tends to be in the cold calculus of costs, what it costs. But you have been on record as saying, actually, we need to look at the sector rather differently because it contributes very significantly.

Speaker1: [00:07:02] Well, yes, absolutely. And it contributes in two ways. One, as a basic civilised society, if people need help, they should be provided with it. And that's what the care sector does, whether it's domiciliary care or residential care. But beyond that, and I think the point I was making in that speech was the economic contribution. If you regard this as a necessity of something that an advanced, prosperous, civilised society should have, then you look for the benefits of it. And among the benefits are it is a significant provider of employment, and it's also people who, if you like, have to, you can't work from home in care. You've got to work either from other people's homes or in a care home. So therefore you are getting people out and about which supports individual local economies as well. I mean, there are various calculations as to how much benefit to the economy social care has, but it's, you know, 60 billion seems to be a sort of reasonably accepted figure. And perhaps above all, it's employing, you know, getting on for if you look ahead a few years, 2 million people, you know, a very, very significant employment sector in the economy. And so there are huge benefits to having a flourishing care sector in your town, if you like. I think you look at it from the bottom up, rather than quoting national figures, but actually having a lot of people working in care in your local area, you know, they are doing good work and also they are helping the economy. 

Speaker3: [00:08:38] And there's quite a big gap in terms of that gross value added. I think 68 billion is the number from Skills for Care and the level that local authorities pay. So it's actually a net contributor rather than a drain on resources. 

Speaker1: [00:08:50] Yeah, absolutely. I mean, you know, clearly people employed in this necessary work, you know, go out and spend money and do all the things that local economies like, and probably more so than people who are just working from home now.

Speaker3: [00:09:04] Let's focus on some of the solutions you've hinted at them in your conversation. And I want to tackle all of them or as many as we can, but I want to begin with the big F word, if we can call it that. Funding. You've been on record as saying that it's probably time to be brave now for the commission. But a little bit of history, I think, is useful sometimes in terms of context. And you'll know this, I think painfully more than we do. But political attempts to solve this challenge are not new. I mean, I remember a couple of attempts around at various elections in the last ten years, which have met with not great outcomes for the people who've tried to sincerely propose that solution.

Speaker1: [00:09:46] Yeah, absolutely. And both parties are guilty of weaponising care costs. In 2010, the Conservative Party created the concept of the death tax to scupper Andy Burnham's solution as health secretary for it. And you know, what goes around, comes around. In 2017, Theresa May's attempt again to solve the problem, a sincere attempt that you know, was quite sensible, was christened the dementia tax and that was it. And so, you know, you can see why politicians have not been very brave on this but underlying it is it's all hugely complex. But there is an underlying simple point that we don't spend enough on social care to have a system that is stable and can be confident about the future, and we don't do that because politicians and the public, perhaps particularly the public, are not prepared to face up to the fact that this money has to come from somewhere And people instinctively say, well, we'll just take it out of taxation. But, you know, governments don't have money. You know, they take taxes from people and businesses and businesses are people as well. So we are all going to have to pay more. How we pay it is clearly the difficult... 

Speaker3: [00:11:07] Multi-billion dollar question.

Speaker1: [00:11:08] Technical issue. Yeah. And either you can do it out of taxation or you can try and save individually. And I think one of the things that has meant that we're apparently as far away from a solution as ever is the problem that it's all got bound up with the fact that for, you know, two-thirds of the people in this country, when they talk about their wealth, they're talking about their house. And so perhaps too much effort has gone into saying, how can we stop people having to sell their houses, rather than how much money do we actually need to get in? And that I think is a key issue, which I tried to address in the past.

Speaker3: [00:11:50] I want to come on to that in a minute. And I think one of the other things to bear in mind there have been proposals around funding. Now Dilnot comes straight to mind, cap on cost. But I think, again, if we think that implementing Dilnot alone will solve all of this, it comes with problems implementing a cap on cost care contribution.

Speaker1: [00:12:09] Absolutely. I mean, Dilnot was passed into law in the 2014 act the Cameron government passed, was meant to lead to the installation of the Dilnot solution. And I mean, I have an issue with the Dilnot thing of, as it were, a flat cap across the country simply because, as I say, the point is, most people's wealth is tied up in their house. If you say to people, you will only have to pay x amount, whatever that X amount is, 50,000, 100,000, whatever. Then if you own and have owned for some decades a house in, say, London, then it may well be worth way above that. And that will be a relatively small percentage of your wealth. So you could be quite relaxed about that. If you own a house in Darlington or Middlesbrough, then that's a very significant proportion of your wealth. So I think there's genuinely a case of geographical equity to address in the Dilnot solution. But the other reason it, despite having been legislated for, was never brought in by successive governments and isn't being brought in by this one either is the sheer cost of it, because if you say, okay, you're limited in how much you as an individual are going to pay for your care, then the rest of it has to come out of taxation. At which point you look at the numbers needed and think that that's many billions. So how are we going to raise that? And it's not that. It's not as though we feel like we're an undertaxed society.

Speaker3: [00:13:43] No, definitely.

Speaker1: [00:13:44] I will put that as gently as possible.

Speaker3: [00:13:46] I don't think people are saying that. And on the tax issue, just briefly, I think there's been some work from the King's Fund, Simon Bottery's article a few weeks ago highlighting that actually councils, of course, raised tax locally to pay for services and that can be actually not be very fair because the least amount of tax is raised, council tax, is raised in areas with the highest level of dependency. The Resolution Foundation reported that it actually could burden lower-income families more. So if we're going to move away from tax, that's one opportunity of funding. You've said it and people will have to face the fact there will be a need for more tax. There are alternatives. Now, I'm thinking of one in particular that claimed that it was fair and fully funded, and it was written by you for the Centre of Policy Studies, I think circa 2019, akin to a pension tax. And what I found fascinating about it was a universal entitlement to care that you proposed. 

Speaker1: [00:14:44] Yeah. What we suggested, and as you say, that was 2019. So it's six years ago now. That everyone should have a universal entitlement. And for some people, people with no assets and no money, basically that will just be provided by the state. But that for many others and particularly of the older generation, because something like 70% plus of people own their own home and therefore have access to some equity, some wealth, that actually if you had to either voluntarily or compulsorily, that's to be discussed, had to save a proportion of that towards potential care costs. None of us knows how much care we're going to need. But nevertheless, you could set up an insurance system that would enable all this money to be pooled. The money would be available for the care system, and you yourself would think, okay, I'm insured against it the way you insure your house or your car or anything.

Speaker3: [00:15:44] I may never use it.

Speaker1: [00:15:45] And it may be dead money, which would be a shame. Well, but would it, you know, would you rather have needed care in the last few years of life, or would you rather, as it were, carry on in good health? You know, pretty much to the end, you know. I hope I never get any benefit from my house insurance, because I don't want my house burned down or be burgled or anything like that. And we could all do that. And everyone says it's all technically very difficult. And the Whitehall machine rather rejected it. And everyone reaches for tax solutions as well. But we've seen the problem is that, you know, there is not the political will to tax people even more for something that may or may not happen to them. And the other point. Sorry, just to continue with this is that of course, you're right, you and the King's Fund and others have identified the issue that because we've traditionally provided it out of local taxation. Basically, even apart from the distributional problems of the areas where you have the most need, they have the lowest tax base. You have a genuine issue that because of the inexorable growth of demand for this, then higher tier authorities, county councils at the moment will end up as basically adult social care providers, you know, with a couple of libraries attached. That's all they'll do.

Speaker1: [00:17:10] And you can see that some of their budgets, more than 50% of the budget is going on social care. That is not what we think local government is for. So I do think we need a radical approach here to say, in the end, this is a national issue as well as a very local issue. And so maybe the money aspect has to be done on a national level. And you made the point earlier that, you know, this government, as previous governments have done, have found a lump of money out of the national government to basically act as a sticking plaster. 

Speaker3: [00:17:38] Yes.

Speaker1: [00:17:39] That amount of money is never enough for the sector, and I suspect it never will be. And so therefore, you're in this impossible position where you claim it's a local service, you're overburdening local authorities. National government is having to find lumps of money every year to try and keep the show on the road, and altogether it's unstable. So I think actually, as I say, it's an argument I've been making for years that one of the successes in public policy over the past 20 years has been pensions. And it's been done on a cross-party basis.

Speaker3: [00:18:13] Going back to the Turner.

Speaker1: [00:18:14] Back to the Turner Commission in 2005, whenever that was, and the Blair government introduced auto-enrolment, it was, oh, they said they were going to introduce it but didn't. It was introduced by the coalition government. It was carried on by Conservative governments. And it has worked. We're still probably not saving enough for our pensions. But by and large, people who are in their 20s now will in 40 years time, nobody ever says thank you to politicians, but they ought to be saying thank you to a generation of politicians that actually treated the pension system in a sensible, adult way and have provided benefits for future generations, even though there's no immediate political benefit from it. Nobody has voted either Tory or Labour or anything else on the grounds of I'm glad they introduced auto-enrolment and I'm not naive enough to think they do. But nevertheless, it's a really successful public policy, and I want to use that analogy for care as well.

Speaker3: [00:19:07] Now, that is interesting. And the broader point that you've hinted at it, this is a national issue. You've sat on the all-party parliamentary group on social care from 2019 to 2024, and Ed Davey has asked for a national debate around this. There's still, I believe, a commitment from Mr. Streeting to a national care service. So I guess it's something that politically needs to be put aside because the ticking time bomb is if we don't change it and rely on taxation, you're asking for with an ageing population, a smaller group with dependency ratios and all those technical terms, but a smaller group of working people to fund their parents and themselves.

Speaker1: [00:19:46] That is the fundamental point about the fairness of it, that if you say it's going to be funded out of general taxation, then by and large it will be today's 25, 35, and 45-year-olds who will be funding not only their own care in the future, but you're also asking them to fund, frankly, my generation's care people in their 60s and 70s now.

Speaker3: [00:20:06] And altruism only goes so far.

Speaker1: [00:20:07] Well, also, you know, everyone wants their parents and grandparents to have as comfortable in old age as possible, but nevertheless, it does seem slightly bizarre that I am of the generation that has benefited from housing, the rising housing market for years, is sitting on a lot of equity. I mean, the figures I remember at the time, I used to quote. 

Speaker3: [00:20:32] It's over a trillion, isn't it?

Speaker1: [00:20:33] Oh, it's well over a trillion. I used to quote it was nearly a trillion. I look at it now and it's, you know, 2 trillion just extraordinarily large amounts of equity paid off their mortgages. To say to them, oh, and we're going to and your children are going to subsidise your care, just feels to me to be wrong and unfair. And I get that, as it were, mine is a generation that votes. So politicians are slightly more inclined to listen to the over-60s than the under-40s. All of that kind of thing. But it's just not right that that you should have that kind of generational transfer. And also, of course, it's a nonsense, because what happens at the family level is that this generation, the older generation, is frantically handing money to its own children if they've got the money, so that they can buy houses and live and do all those kinds of things.

Speaker3: [00:21:23] It's a bit of a doom circle.

Speaker1: [00:21:25] Well, it's just a nonsense that in private you're handing money from the old to the young, and then in public you'd be handing money from the young to the old. This is just a circulation of money, which is just ridiculous. And as I say, unfair because of course people who haven't got the money don't benefit. So, you know, young people who are paying all the taxes they're paying. If they're not getting anything back from their parents, then they suffer both ends of this. So anyway, I think the traditional way of looking at this is wrong. And I hope that Louise Casey comes up with some radical solutions.

Speaker3: [00:22:00] Dusting off the Centre for Policy Studies paper from 2019 might be something they look at in their discussions. Let's wait and see. 

Speaker1: [00:22:06] I will be urging them to do so. 

Speaker3: [00:22:08] Absolutely. A couple of other quick points. Again, focusing on solutions around social care funding is there. That's the context. You've talked on other occasions eloquently around the fact of capacity. And there is still a large level of vacancy, about 130,000. It's come down over the last couple of years because we've had 185,000 people internationally join the social care workforce. Can we talk about that? Because I think given the current zeitgeist around immigration policy, an area you know well from your ministerial career. We can't rely on international recruitment to build that workforce, which is going to be needed to grow significantly.

Speaker1: [00:22:45] No. And in a way, I mean, apart from the general funding problem, this, I think, is the most intractable one. Where do we find an extra? I mean, it's whatever it is.

Speaker3: [00:22:53] 540,000 in the next ten years.

Speaker1: [00:22:55] Yeah. That's right. All those figures. That's a colossal number of people. And I mean, it feels to me like if we all want to do that at the same time as there's massive pressure to reduce immigration, quite rightly so. Therefore, we're going to have to persuade British people to go into this. And there are various suggestions that have been made about raising the status of the profession. Maybe there should be a Royal College. There are various things you can do, if you like, that would make it clear that this is not just a minimum-wage job. This is a profession which you can go into and have a career in. I think that would be a significant step forward. But we do have to bite the bullet. It seems to me that if we are going to say this is a respected profession that you want to go into, then we can't treat it as a minimum-wage profession. And again, this is another demand for money, because if we pay people more, then I get that money has to come from somewhere. But if we don't then we'll get if I can resort to an anecdote from a provider who told me, this was one of the nonprofit charitable providers who said he was thrilled that he'd persuaded his board to increase the wages they were paying. So they were not paying the minimum wage. They were paying a couple of pounds an hour above that. And he was delighted by that until literally the following day he walked into his local supermarket and saw they were advertising. And actually, even under his new increased rate, he was paying less than the local supermarket for shelf stackers.

Speaker3: [00:24:31] Which can't be right.

Speaker1: [00:24:32] Yeah, exactly. For all sorts of reasons that anyone listening to this will know that can't be right. But also, it can't be stable if you can not only leave care to go into the care sector to go into the health service, which is a characteristic thing to do because the NHS is paying a lot more than the care sector. Well, you know, that's within the power of government to change. And you make sure that if you're doing the same job inside or outside the NHS, you should be paid more or less the same. But also if you're not competing with the supermarkets, then you've had it. So that I think is another big change and I accept how difficult that is to achieve. But it's got to be achieved if we're going to have a stable workforce.

Speaker3: [00:25:14] Absolutely. And one of the points specific to policy and practice of provision that you've highlighted, we've had in the last couple of years now, a statutory basis for integrated care systems and bringing health and social care together. And the idea that this should be a voice across health and social care was great in theory, but I think you've been on record saying social care has voiced perhaps needs even more presence on those boards.

Speaker1: [00:25:43] I think that's right. And I mean, to be honest, it's patchy around the country. Some do it better than others, but in my own experience, by and large, it has become a voice, became a forum for the loudest voices. And the loudest voices are, frankly, always the hospital sector. That's where health secretaries always feel the pressure. That's where the NHS always feels the pressure. And actually, even within the NHS, I suspect GPs voices are not heard loud enough. But I'm absolutely sure that the care sector's voice is not heard loud enough around those integrated care boards. And quite specifically, a lot of them say that the way they deal with the care sector to have a voice around the table is to have the local authority there. Now, of course, the local authority needs to be there for as long as they have the responsibility for providing the care, but also the providers need to be there. They don't have the same interests as the local authority fairly obviously. In some ways, they have opposing interests, though they work together. So I fear that this good idea of having integrated care boards is in danger of not leading to enough integration, and certainly not in my experience. It hasn't led to any notable improvements from the care sector's point of view. 

Speaker3: [00:27:03] So plenty to do then, I think again, I think all roads lead back to your earlier point and we have to get the funding discussion, a grown-up conversation around it. And I guess putting that into a contemporary context, there is not a little pressure on the Chancellor in terms of the fiscal rules that she has set and the vagaries of the bond market.

Speaker1: [00:27:24] Yeah, absolutely. I mean, you know, the public finances are running hot and we're now in what I think is completely absurd situation where the Chancellor is having to look at every weekly forecast from the OBR to see whether she's broken her own rules or not. This is, I think, no way to run an economic policy. But that's a wider discussion, not for this podcast, but in any case, the public finances have a problem. We have Covid. We spent hundreds of billions of pounds to keep people alive, basically, and not just in terms of fighting Covid, but also in terms of the furlough scheme and so on. And that's money that's been spent and we're not going to get that back. So there's a lot of pressure on public spending. Defence obviously is another one. And so therefore I think the idea that people have that you can just increase taxation is probably less viable now than it was ten, 15 years ago. And so therefore you have to find other solutions. I'm sorry to keep repeating the same point.

Speaker3: [00:28:22] No, no, it seems to me hopefully repetition will get us there. But I think it shows that that really underlies everything. I wanted to broaden the discussion in the final part of the podcast. One of the solutions you've recommended on record, and I think you chaired the all-party parliamentary group on longevity, is to really, as a society, look at the fact that we are living longer. I think there was a book written about a decade ago called the 100-Year Life, which looked at this as an opportunity rather than simply a challenge. And I just wanted to get your views, you put forward some very interesting recommendations in that group. 

Speaker1: [00:29:00] We did. We published two reports called The Health of the Nation and Levelling Up Health. And if you like, this will enable us to move on to sort of slightly more cheerful territory, because there is a huge dissonance, sort of cognitive dissonance in society where we all want to live healthily for as long as possible, and we all want our friends and relatives to live healthily for as long as possible. But at the same time, we regard having an ageing society as a burden.

Speaker3: [00:29:25] That's the narrative.

Speaker1: [00:29:26] This is sort of as I say, it's just dissonance. You know, if it's good for me, why isn't it good for society? So therefore, you know, it seems to me what we need is to ensure that people can live for longer and be happier and in control of their own lives and living in their own homes, all that kind of thing for longer, for as long as possible, while they're living longer. And therefore, the key to not least reducing pressure on the care sector is to improve the healthy lifespan of people. The health span, in the jargon, and the way to do that is, is levelling up health, because there are a lot of people in this country who do live entirely healthy lives way into their 70s and 80s. But there's huge inequality there. And, you know, the idea of levelling up. I was always very, very much in favour of and hope that a government can get back to it. Because when you look at, if you just divide it geographically, there are communities in this country where people have a healthy lifespan that's about 12 years higher than some of the lowest. There are places in this country where you statistically, by your mid-50s, you're quite likely to have a serious illness. That means you can't work.

Speaker3: [00:30:44] Economic inactivity and all of the challenges.

Speaker1: [00:30:47] And all the other problems that increase, you know, A, you're leading a miserable life and B, you're putting pressure on public spending because you're having to live off benefits. So actually a big effort on, I mean, all the obvious things and sort of smoking and obesity. 

Speaker3: [00:31:02] So prevention and diet.

Speaker1: [00:31:02] Yeah, absolutely. It's prevention rather than cure. Everyone pays lip service to it. But we don't do enough of it. And I mean, the challenge I've always made to, if you like my own party or some of the people in my own party, the Conservative Party has been we all instinctively say we don't want the nanny state. But actually, if what you're doing is encouraging people to lead more healthy lives so they have happier lives for longer, then that's worth doing. And maybe educating people about diet or I mean, the example I would use is the sugar tax, which everyone said, oh, ideologically we're not in favour of this. Actually it's worked. And actually the drinks industry hasn't been hit by it. They've reformulated their drinks, there's less sugar going in. So people are healthier. And that, I think, should be seen as a model for how to use the tax system actually for beneficial social purposes.

Speaker3: [00:31:54] And there is actually and that's a great example. And there is an imperative for this. I mean, dim and distant memory. I think it's we're not that far off from 200 years since Disraeli wrote his book, Sybil, or the Two Nations criticising this divide across the country. So this is not just some sort of theoretical thing. It actually has huge economic impact.

Speaker1: [00:32:15] Yeah, absolutely. I mean, and, you know, it's where one nation conservatism comes from. He said there are two nations, the rich and the poor and sadly, there are still elements of that in society, as you say, not quite 200 years yet.

Speaker3: [00:32:30] But not far.

Speaker1: [00:32:30] We're getting there. That was a mid 19th century piece of analysis. That was radical then and is still apposite today.

Speaker3: [00:32:38] I think it was actually published in the same year as Engels' Condition of the Working Class. Now, this is more than a theoretical issue. It's a huge economic challenge. And you've been on record as talking about prevention. Yes, it can be lip service. Stephen Dorrell, who you all know very well, came on our podcast, and said public health, people tend to yawn, but it's so important. He was right. A couple of your recommendations, and one that struck me a lot from the parliamentary group, was the idea that actually business and health are not silos. They actually need to work very much hand in glove.

Speaker1: [00:33:10] And that was one of the practical effects of the all-party group on longevity, because we produced the report with a lot of input from people and launched Business for Health, which is now spun off and is doing well, precisely to encourage businesses to think of their staff as an asset. And one of, you know, and clearly, any business wants their staff to work as hard as possible and as successfully as possible. One of the bases you need is a healthy workforce. So actually, it matters to you as a business that you have a healthy workforce and that will feed through to obviously to the general population. The other point we made, which was provocative, but I think correct, was that we pointed out that of this vast amount of money we spend on healthcare in this country, 5% goes on public health, i.e. prevention. And we said that percentage should increase by 1% every year for ten years to get it up to 15%.

Speaker3: [00:34:12] That is provocative.

Speaker1: [00:34:14] But absolutely, that would that would do more good. If that was enshrined as a target, then by and large, Whitehall responds to that, and public bodies respond to that. And yeah, it would be difficult. 

Speaker3: [00:34:24] It's one of the missions of the current government, of course, to move to prevention. I don't think they've delineated it in the stats.

Speaker1: [00:34:30] I mean, it's been the mission of every government, as far as I can remember to say, we need to move for prevention rather than cure. In terms of health, well, do something about it. And the lever you have is the budget. And just make sure that the NHS spends more. And if you do that, and if you created a greater desire in the whole ecosystem for prevention rather than cure, then I'm sure entrepreneurs would come along with ideas saying, well, what we could do is this. And then they would come up with products and so on.

Speaker3: [00:34:59] And as a tangential to that, just before we move on to the final point, is that and again, you've spoken about it very passionately, is that looking at your work as a resource, really important, and that includes workers of any age going back to that 100-year life. We are going to have people who will be working at ages that perhaps when I was young, you didn't think you were going to work. And the economic cost of ageism, if I can use that term, is something that needs to be addressed as well. 

Speaker1: [00:35:25] Yeah, absolutely. I mean, I don't know any 20 or indeed 30 30-something that doesn't assume they're going to work till they drop, basically. They have no faith at all in the pension system, unfairly, but never mind. That's what they think. And yeah, at the other end now, immediately I was struck that I used to hold regular jobs fairs when I was the MP for Ashford and in the last couple of them. So in the last year or so, I had people coming along who were, who were 50 plus and not the normal people you'd expect in the jobs fair. And I would ask them, you know, what are you doing here? They said, well, it's really difficult because I've got 25 years of experience. I'm reliable. I turn up, you know, I'm everything an employer wants, but my CV never gets beyond. They just there's clearly a cut-off point. And increasingly...

Speaker3: [00:36:13] That's an own goal, isn't it?

Speaker1: [00:36:15] It's an own goal. And also it's apparently being compounded by algorithm. Most people you apply for jobs and the first sift is done by computer, right? And if you set your computer to say, I don't want anyone over the age of 50, then these people can't get jobs. It's, you know, arguably illegal. Funnily enough, in the last couple of weeks, the Equalities Committee of the House of Commons has pointed out that this form of ageism is a sort of silent problem in society. But it is. And keeping people working for longer not only means, you know, if we have less immigration, then more of us are going to have to work. And out there, there is a market of older people who want to keep working, who recognise that not only for the money but actually in terms of keeping yourself active and alive and open to the world, then actually going out to work is a good thing. They want to work. We're short of workers. It is madness that we're not being able to bring them together. And that in itself would improve public health.

Speaker3: [00:37:16] Absolutely. One final point, if I may. I mean, that section there was really fascinating in terms of the role of entrepreneurship and business in health. We've got a ten-year plan afoot in the NHS. We've got a commission. I hate to remind listeners there was a ten-year plan for expansion of NHS hospitals and community care in 1962. And there's been a few in the last 20 years that are going back to the NHS plan of 2000, 2 or 3 key things that you'd like to see coming out of these policy initiatives from your perspective, going through all of the vast experience you have in this sector? 

Speaker1: [00:37:51] I would like the funding issue solved. I think unless you do that, you can't you can't solve anything else in care. I would like recognition in the system that the way to solve the winter crisis in hospitals is not to provide temporary extra beds in hospitals. One of the previous ministers, I won't name them, said they were horrified to be told, this was a minister responsible for social care that we're going to solve this year's winter crisis by creating more beds in hospitals. Now, if you provided more care settings, then you would you would achieve the same for much less cost per patient, and therefore you could probably double the number of patients you could actually get into an appropriate setting. So that would be a second big issue. And the third one would be and this, this may be a forlorn hope, actually, to recognise that this is an urgent crisis and that everyone can play political games about how you can push it through to the next parliament, and then it'll be somebody else's problem. But at some stage, we're not going to have a sort of slow and quiet decline into a crisis. Something is going to go pop. And you know what could be the worst thing we suddenly find large numbers of vulnerable elderly people with nowhere to live. At that point, it would be such a huge national issue that we would have to solve it in a hurry. Let's try and avoid that. Let's do prevention rather than cure. Let's actually address social care while we still have the last bit of time to do it, rather than wait until it is an intolerable national crisis.

Speaker3: [00:39:39] With that impassioned plea, Damian Green, thank you very much for giving us your time and your wisdom on Voices of Care.

Speaker1: [00:39:46] Thank you.

Speaker3: [00:39:46] My pleasure. If you've enjoyed this episode, please like, follow, or subscribe wherever you receive your podcasts. And if you want to learn more about how we are truly turning the dial on the health and social care debate, please visit newcrosshealthcare.com/voicesofcare. In the meantime, I'm Suhail Mirza. Thank you for joining us today and I look forward to seeing you on the next episode.

Speaker2: [00:40:06] Voices of Care, the healthcare podcast.