Speaker1: [00:00:00] Hello, I'm Suhail Mirza and welcome to this episode of Voices of Care. My guest today I'm honoured to say is Professor Deborah Sturdy, Chief Nurse for Social Care in England.

Speaker3: [00:00:10] Voices of Care. The healthcare podcast.

Speaker1: [00:00:14] Deborah, thank you so much for joining us today on Voices of Care.

Speaker2: [00:00:18] I'm really pleased to be here.

Speaker1: [00:00:20] Thanks. It's an honour for us because social care is a topic that we've spoken about often on Voices of Care. I should congratulate you. It's been a hell of a ride for the last three years since your appointment. And just a little bit about the role itself, if I may ask you, because of course, it's about raising awareness and standards around social care nursing, but it's broader than that. It's to celebrate the sector, etc.

Speaker2: [00:00:43] It absolutely is. So, I think during Covid, Helen Whately, the Minister for Care thought, we've got a chief nurse for the NHS. Where's that voice for social care? And as you say, not just in terms of nursing but that wider workforce. So, I came into post in that second phase of Covid having left a kind of frontline operational job, it was a complete contrast moving from that, you know, completely recognise everybody's hard work during that period coming into that role. So busy on the Covid front in that first part. But trying to start establishing that kind of voice of leadership for social care, for that wider social care workforce during that time, including the really important thing about recognising the phenomenal workforce in social care. And so, we launched the Chief Nurse Awards. During that phase, it was one thing I was quite determined to make happen amongst the madness of everything else that was going on, because it was just so important that we really shone the light on the phenomenal things that people were doing, not just in terms of Covid but the wider contribution that the social care workforce makes to our health and social care system. 

Speaker1: [00:01:54] Absolutely. And the appointment was described by the minister as an important one. And the voices of social care, Martin Green, who you'll know, of course, Vic Rayner very much welcomed it. And I think Steve Jobs once said that when you look at life, you have to look back and see how the dots join up and in your case, your own journey as a nurse, as a clinician, the dots seem to have been there for social care, because I think it goes back to your days as a student nurse working on the elderly care wards.

Speaker2: [00:02:25] It does, and it's really interesting. You kind of walk through your career and sometimes you do things. You think, I don't know what I'm doing this, but there is a reason somewhere it's going to emerge in the future. So as a student nurse, you know, 43 years ago, a very long time ago, my community placement was actually spent in a week in a care home. And I remember every single shift of that, in Bristol. And it was just there was something that clearly resonated on some subliminal level with me about that. And then further in my career, after I had done that NHS clinical stuff and management roles, senior nurse roles, and I took some time out to do a master's degree full time and funded that by doing agency nursing.

Speaker1: [00:03:09] In social care.

Speaker2: [00:03:11] And so ended up, yeah, so ended up doing night shifts at the weekend, having been to university a week to fund myself. So, and did that in care homes around Bristol and Gloucester and Somerset. And I remember as a very senior kind of clinical nurse going into that environment and seeing some phenomenal care and actually recognising that nurses in those settings were often much maligned and were thought to be the place, your kind of career graveyard.

Speaker2: [00:03:40] And I saw fantastic nurses doing fantastic things. So, I got kind of intrigued by that. And when I finished my degree, I took a research job at the University of Kent at Canterbury, and that was looking as part of a kind of international collaborative, looking at standardised assessment in residential care settings. So there was starting to be a kind of thread emerging from my career, in my career around social care at that point, and then went on to work in a primary care environment, which I've not done before, but doing some commissioning work before we called it commissioning, finding beds in care homes as part of that intermediate care initiative, and then went into the Department of Health as the nurse adviser for older people. And again, interested in that kind of, you know, where social care in that kind of that world of older people nursing. So, and then kind of from that.

Speaker1: [00:04:36] Here you are.

Speaker2: [00:04:37] Here I am in, in social care, fully immersed.

Speaker1: [00:04:41] No, it's interesting, as you say, the narratives they connect, when you saw that, and you remember every shift. And let's just tarry a little, if we can on the role of nursing in social care. Now more and more of us, thank you for the great work that you've done and others, recognised that actually nursing is a really important part of social care. Now, I like the definition of social care is about not just provision of services. It's providing independence for people. But take us through a little bit about the ubiquity of nursing in social care. It's central to the entire sector, isn't it?

Speaker2: [00:05:14] It's not, I think, not entirely essential to the entire sector, but to the whole ecosystem of health and social care in this country, because those nurses, I think, have to be the most skilled and most confident and competent to, you know, because they're often left making very complex decisions on their own. There isn't a machine that goes bleep. The doctor's not going to come flying through the door when there's a crisis. They're having to make that kind of very acute decision, but also those nuanced clinical decisions about the deteriorating person. And when do you call in others to help? So, the complexity of clinical decision-making is immense. And I think that's not well represented amongst the profession itself in understanding that we need really competent nurses in social care. And I think we're starting to shift and challenge that. But I think, you know, I think there's obviously and will forever be more work to do about this. So, I just think it's an often maligned, again, a maligned kind of area of practice. And what we need to do is shift to that recognition of this has been a specialism of nursing because I absolutely think it is. And we have an incredibly skilled workforce, and I think people themselves don't recognise what they're doing. 

Speaker1: [00:06:40] Well, hopefully this conversation will be part of that. And it's also the level of autonomy that a nurse will have together with the colleagues, the social care professionals. And just very briefly, of course, you talked about complexity. The requirement for social care provision has changed a lot over the decades, partly because of demography. I mean, just looking at dementia. Just one example. I think we're estimated to have a million people with dementia in 2025, going up to 1.6 in not in a generation, 2040. So, tell us a little bit about that, that I think is the broader because the demands for complexity are not going to reverse.

Speaker2: [00:07:18] No, they're absolutely not. And I think the other thing that we need to challenge about the perception of nursing in social care, it doesn't happen in the four walls of a care home. It happens in those, you know, those domiciliary care providers where often the complex care of people at home is kind of commissioned out because the NHS can't provide that level of care that's needed. And I think the other thing we often forget is that we've got very skilled learning disability nurses, mental health nurses working in social care. So, you're absolutely right. When you look at that trajectory of people living with dementia in the future, we are going to need, you know, those really specialist skills. And I think people's expectation of what social what sort of social care they want and where they want that provider is going to change. So, I think that that kind of more community-based domiciliary care aspect of social care nursing is going to grow and grow.

Speaker1: [00:08:15] Absolutely. And I think taking that as part of a broader picture if I may social care has many challenges. I think we know that. And there are many episodes we've devoted to that and policy. I want to look perhaps the flip side onto that, because you've been on record as saying that social care is not just a concept, you know, it's about making a difference in people's lives and there's a need to change the narrative. Can you explain a bit more about that? Because for me, it's about everyone understanding. Let's take the complexity point. People with severe physical disabilities. I think you've been on record because you spend your time going to care homes, and you've seen incredible work that supports those people. That looks almost simple from an untrained eye, but the level of intensity and research behind it is profound.

Speaker2: [00:09:04] Absolutely. And yesterday I was visiting the service for younger people with acquired brain injury with a colleague of mine who's not a clinician, and being able to interpret some of the misperception that she was kind of taking from the conversations we were having with from the nurses and the care staff, there was really important. And in fact, we got into a really interesting discussion about the ethical dilemmas that often nurses in social care are facing in terms of where people have capacity, for example, want to eat a normal diet, but the professionals are saying that this person needs a modified diet. So, you know, how do you kind of marry that up? And again, when you're working in splendid isolation often that is a very challenging, professionally challenging for any accountable registered professionals. So that's a huge issue. And I think that we have to change the narrative because we need to talk about social care, nursing for what it is. And these are nurse led services. As I say, it's not the machine that goes bleeping the doctor and that whole MDT wrapping around instantaneously. So, I think that we need to describe it, what it is. And I think, you know, we are talking about nurse led services. And if we change that narrative, why wouldn't you want to work as an autonomous registered practitioner in that environment?

Speaker1: [00:10:30] And taking that a step further, I guess going upstream and obviously, you know the training and the education. There would be a strong argument then to make placements within social care, whether it's residential or otherwise, social care settings as part of the undergraduate curriculum and experience.

Speaker2: [00:10:50] It's absolutely vital that we do that, that for me, the ambition is not just for nurses, but I think every clinical undergraduate should have a placement in social care. How do we ensure that the doctors of the future understand the context and our therapy colleagues? So, for me, it's as broad as that. But for nursing is absolutely, I think, absolutely critical. It's not, and again, the perception of this is about learning the fundamentals of practice. It's the management. It's those ethical dilemmas. It's the commissioning environment. It's that regulatory environment. There is so much that you can learn as an undergraduate student nurse in that environment. So again, I think it would help to change the narrative and dispel some of the mythology that exists about what social care nursing is.

Speaker1: [00:11:38] And you've been very vocal and taken some great strides to support, I guess, the infrastructure, the educational infrastructure, because if we're going to make those changes of narrative, if you're going to give people the opportunity for placements at an undergraduate level, the education and research landscape has to change. And I wanted to touch base on some of the things we can't cover them all, that you've seen happen, for example, with the work of the RCN Foundation. So academically, social care nursing is beginning to stand on its own as a discipline.

Speaker2: [00:12:08] Absolutely. So, evidence is absolutely critical. That evidence base in social care nursing is sparse. We need to kind of fill and develop that space. So, there's a few things that I've done. The RCN Foundation have been absolutely fantastic in funding. The first ever professor of social care nursing in the UK, in Salford. So that person is going to be in place at the end of July and they'll be making their announcement about who that is. But I'm delighted they've appointed a really great candidate. And I know that they're going to make a real impact. And again, for me, that adds to the leadership that those senior people and I think that the interest in higher education institutes around this, around this particular aspect of nursing is growing day by day. We've got Northumbria who've got the first program approved through the NMC about that kind of specialist practitioner qualifications. So, we're starting to see, I think we'll get the ball rolling around that. On the research side of things, the National Institute for Health and Care Research, which my colleague Ruth Endicott has appointed again, the first time a nurse fellow for social care, who's scoping out what that future of research can look like. And I think that's really important. And I work with other colleagues. We've set up a whole series called the CRED talks, talking about clinical research for people working in social care. And it's vital that we develop that academic base and influence that education infrastructure. I also work with colleagues at the NMC talking a lot about this developing undergraduate curricula that actually reflect where nurses are going to be working in the future now. 

Speaker1: [00:13:52] And I think that's inspirational. And we'll see over the next few years how that actually translates to changing the misperceptions, etc., and enhancing the reputation. Going back at the other end of the spectrum, obviously part of your role is to champion the entire workforce in social care and the great work that's done there. There's been some very important developments there in terms of workforce and brilliant work being done by Oonagh Smyth, who's been a guest for us at Skills for Care. But I'm looking at the ten year vision, obviously People at the Heart of Care and the driving force now to have career pathways for those who are perhaps completely new to the sector, have worked in a role, so wanted to get your opinion around the career pathway and the Level Two Care Certificate because they're important initiatives.

Speaker2: [00:14:38] Very important. And one of the things I was saying, we've got a workforce in social care of 1.6 million. That's actually bigger than the NHS. I particularly like saying that to my NHS colleagues. And if you think of that workforce in a nursing context, 33,000 of those people are registered nurses and the rest are this phenomenal workforce of professional carers. So actually, developing pathways for them to attain qualifications for some people for the first time in their lives. And that entry point of that care certificate I think is a really important baseline for us. And I think you need baselines so that you can grow and develop. And giving people career opportunities at that level. It also then hopefully will engender some of those people to feel confident enough to go on to nurse associate and registered nurse programs in the future. And I think that we need to be selling that as a sector. Much more about not only can you come in and do something that kind of makes your heart sing every day, but there is a career opportunity of progress. And that's about people's life chances as well, how you change your life chances. And when I talk to people out in the sector and, you know, some fantastic individuals I met up in Cumbria, who talk about their children going to university because they went on to do a programme and they felt inspired, you know, that that changes communities as well. So, we have real opportunity, and I think we need to be investing more in how we get younger people to see this. And tell the stories. It's not just about, let's say, doing something that's really wonderful and great, but doing something that gives you opportunity as well to develop. 

Speaker1: [00:16:20] And as you say, there's a couple of benefits that will flow directly. I mean, the level two entry is an entry level, the career pathway, it I guess it inspires people to look at the sector. We're going to need to do that because we need 440,000 new people and professionals in the sector, according to Skills for Care. But I think ultimately this is about delivering person centred care and giving people the safety and the assurance that that level of skill and values is there. So, I guess you see this as very much part of this transformation of the sector and perceptions.

Speaker2: [00:16:52] Absolutely. You need both, you need skills, but you need people who kind of share your value base. And, you know, you kind of need to marry those up very skilfully. And again, just because I was visiting a service yesterday, but it's the nuance of actually social care that is often misunderstood. So yesterday there were young people going out on a trip. They were going to, you know, I think they were going out, I think were going to a pub, actually. And you think, well, that's very nice, isn't it? But actually, the complexity of, you know, taking people with very high needs on a bus, that risk assessment that needs to take place, the responsibility, how you're going to get somebody to loos, their accessible loos. I mean, it looks like a great day out. But there's a lot of complexity going on. And I think particularly, just thinking of another LD service I visited with people with incredibly high-level needs. And you might walk in and think, well, that's quite great, you know, doing a sensory story with somebody in an afternoon and flicking water at them, it was, everybody was laughing. It was great fun. 

Speaker1: [00:18:03] Playing with an elephant.

Speaker2: [00:18:04] Yeah absolutely. But you're doing that every day. And it is incredibly skilled work, incredibly skilled work.

Speaker1: [00:18:13] And one final quick point on this, the training that's going to be needed, the level two career pathway, we're going to also need to have some, I guess some transformation innovation, disruptive training pathways.

Speaker2: [00:18:24] Absolutely.

Speaker1: [00:18:25] Using digital immersive technologies.

Speaker2: [00:18:27] And creativity and being creative in that. And actually, you know, one thing we know about learning, everybody's got a different style. So, you can't one size is not going to fit all. And technology kind of works in that space. And again, you know services I've been to; they're using that virtual technology for teaching. I think that I still think because I'm probably quite old fashioned in my view, in some ways that can take you so far, actually, that, you know, actually being in them, kind of touching reality is really important too, I think the virtual space is incredible, but there is something about actually being with people. You can't teach it all through technology. It's got to be both.

Speaker1: [00:19:06] Now, one final point, if I may, because I know it's a subject close to your heart. And to get any of this done at a level and scale that you want to do this; we're going to need social care nurses and social care professionals to step into leadership. Now, the Messenger Review a couple of years back, some very important highlights. For me, there were two themes that came out really strongly and one was the importance of collaborative leadership. Now we've talked about social care. We've talked about the NHS. Can we just touch upon, we've got an integrated landscape now and we've got the Social Care Nursing Advisory Council. Expand upon that because I think that's potentially quite a big breakthrough.

Speaker2: [00:19:45] Yeah. I think, you know, with the advent of the integrated care systems, ICBs being set up, I've been around the block enough times to know you've got to be in at the start. Otherwise, you go six months down the line. Somebody's going to say, I've got time for that. So, I sit on Ruth May's SMT, senior management team. And so, I have that into those senior nurses in the NHS, which is really important. And being able to bang the drum for social care within that context. So, we set up the Social Care Nurse Advisory Councils. We're just we just kind of learning from the first year now and reforming those into broader councils that are going to sit within every region connected to every ICB nurse, so that we've got a kind of governance structure, we can kind of make sure that we've got proper communication going and linking with, you know, we talked a tiny bit earlier about actually needing to connect to other people and other things. So, we've got our regional Skills for Care colleagues connecting in with the RCN independent care sector leads so that we can be a stronger voice together than I think we are apart. But having those kind of chairs and co-chairs of those councils, those voices around the table, the representation of nurses from across the sector is really important in coming together collectively to bang the drum, to influence and inform.

Speaker2: [00:21:13] And I thought it was really important that the ICB nurses, who many of whom have come from acute sectors and perhaps don't understand the context of social care, there's an opportunity to where we can work collaboratively around education, you know, research and some of those leadership opportunities. So, I thought that was that was really important. And one of the other things that when I came into this post, I was not happy about was when you look at our kind of BME workforce in social care and nursing.

Speaker1: [00:21:45] 40%.

Speaker2: [00:21:45] Yeah, absolutely. But only representing 17% of leadership positions. And that is just fundamentally wrong. So, we've just had our second cohort of nurses come through the Florence Nightingale Foundation bespoke program around social care nurse leaders. And it's been fantastic watching people flourish and confident and challenging by the end of that program. Again, I hope in the future we will continue to support that. And I think that opportunity to again, to challenge and be involved in other programs and I'm forever encouraging people to put themselves forward for things.

Speaker1: [00:22:27] Well, you've I think you've encapsulated there that collaboration, inclusion. And I think you're on record as saying, when we look at the challenges of social care, as the final point I'd like to end with is we're all part of the solution.

Speaker2: [00:22:38] We're not, you know, and I always say to my NHS colleagues is and we're all looking after the same people, we're all looking after the same people on that care continuum. And actually, we're better doing that collectively rather than fighting about who should be doing what, because it's about real people's lives. And we're all in it to get the best outcomes. I hope for people.

Speaker1: [00:23:01] On that inspiring note, Deborah Sturdy, thank you so much for your time and your wisdom.

Speaker2: [00:23:06] Thank you.

Speaker1: [00:23:07] Pleasure.

Speaker2: [00:23:08] When people say wisdom, you know you're old.

Speaker1: [00:23:11] No, no, I meant it in its proper sense, proper etymological sense

Speaker1: [00:23:15] Thank you very much. If you've enjoyed this episode of Voice of Care, please like, follow, or subscribe wherever you receive your podcasts. And if you want to find out more about how we are truly informing the health and social care debate, please visit newcrosshealthcare.com/voicesofcare. In the meantime, I'm Suhail Mirza. Thank you and look forward to seeing you on the next episode.

Speaker3: [00:23:35] Voices of Care. The healthcare podcast.