Speaker1: [00:00:00] We're expecting a 43% increase in the number of people with dementia. It's completely overwhelming.

Speaker2: [00:00:05] It doesn't replace people.

Speaker1: [00:00:07] 5.5% of all jobs in England are in social care. That's huge.

Speaker2: [00:00:11] We haven't taken full advantage of what the third decade of the 21st century can offer us.

Speaker1: [00:00:16] People are very worried about AI. They're worried about its potential. 

Speaker2: [00:00:20] To boost the number of men from 21 to 25%. 

Speaker1: [00:00:23] We are going to be a fundamentally different population with fundamentally different needs. 

Speaker4: [00:00:30] Voices of Care. The healthcare podcast. 

Speaker3: [00:00:34] Oonagh, welcome back to Voices of Care, been a couple of years. Sir David, thank you for joining us today. I want to go back a couple of years. Oonagh, when we met last time, you talked about how fundamentally important social care is for all of our lives, but that hadn't quite really reached the public consciousness. I think that's changed with the election. New government, forgetting the policies for a second. Social care is on people's lips and on people's agendas. 

Speaker1: [00:00:59] Yeah, I think that's right. I think over the last few years, probably starting with Covid, people started to really understand the value and importance of social care and the fact that social care exists in all of our communities, in all of our streets. It's not just centred in one area of the country. And I think picked up by some of the television programs where people have started to get some sort of emotional connection to social care. So we are seeing it more in the public debate. Still not enough people still don't understand and value social care enough. But I think this is probably the beginning of a change rather than the end of a change.

Speaker3: [00:01:36] No, absolutely. And David, you've done a lot of work obviously as the chair with integrated care systems. So social care, a voice at the table, there's conversation. We're not going to go into the full detail. But National Care Services, new royal commission. So it's at least on the political agenda.

Speaker2: [00:01:50] Oh definitely. And I think what we know is that if people talk about other public services like the NHS and roads, everybody travels on roads and has experience with the NHS. Historically, people have bumped into social care at particular points in their lives, but I think it touches more and more lives across the country as our population changes and its needs increase, which it is exponentially. So it is a huge issue for both the country and the economy. Making a £68 billion contribution to the economy. So it's broader than care needs of particular people. It's about the essential ingredient to the health and wellbeing and the economic well-being of the country.

Speaker3: [00:02:35] That's an important point. I'd like to pick that up with both of you. You've obviously published last month the state of adult social care and workforce in England. It's a huge report. Can't go through all of it. But, counterintuitively to some of the narrative, there's some positives that have come out from that which we will touch upon. You've talked about the contribution. People tend to think of cost when they talk about social care. 68 billion. But there's in terms of the workforce, there were some positive indications in terms of vacancy rates and the number of people employed in the sector.

Speaker1: [00:03:04] Yeah. So when you look at the state of adult social care report again, that we published last month, and you look just on the surface it tells a positive story. So a reduction in vacancy rates to about 130,000, a reduction in turnover, so down from 29% to 24%. But a lot of that is caused by international recruitment. So we've had 185,000 international recruits over the last two years, but we've lost 70,000 domestic staff. And we can't keep relying on international recruitment both because it's a global, globally competitive labour market. And policy changes have seen a reduction in the number of international recruits coming in to social care. So a lot of the kind of positives are down to international recruitment, which we can't rely on anymore. So what it kind of masks are some systemic issues and even though it's a reduction in vacancy rates, it's still the third highest vacancy rate that we've ever seen in social care. And it's still three times the national average vacancy rate. 

Speaker3: [00:04:14] Yeah, and the fact that it's gone under 25% is quite significant because it's hovered around 29, 30% since 2017/18, if my memory is right. And one of the other things that I found noteworthy, and we'll look at some of the challenges underneath in a second, is that there's I think it's a welcome increase in the proportion of men in the workforce over 1 in 5, 21%. Now, I think something like that.

Speaker2: [00:04:36] That's right. Well, that's a fantastic development. And one of the things that we looked at in terms of the workforce strategy was how can we boost the number of men from 21 to 25%? And if we were able to do that, that would make a significant difference. So clearly this has been boosted by international recruitment as well, because there's a higher proportion of men coming from have been coming from overseas. So there's no room for complacency. But there are some fantastic champions and examples of men coming into social care who have absolutely loved it, got the bug, hugely committed to supporting their fellow population. So we just need to build on that.

Speaker3: [00:05:19] Now let's touch upon the, as you say, some of the positives mask. I'd like to go back to the 68 billion for a second because we've just thrown that number. It's a big number. It's a significant number. So the social care sector, it's normally the poor cousin of the NHS. And it shouldn't be. That's a tremendous contribution that we should celebrate for the sector surely.

Speaker1: [00:05:41] Absolutely. I mean I think we need to start thinking about and talking about social care as a fundamental part of our community and economic infrastructure. It supports people every day to live their lives. It's a significant economic contributor, and it's a significant presence in all of our communities. And interestingly, it's only quite recently that I think social care has been involved and included in some of those broader labour market conversations. So last week, I was invited to a call with the Minister for Employment talking about the Employment White Paper. And it was alongside construction and retail and that's only happening quite recently where social care is seen as a significant industry in itself. We employ about 5.5% of all jobs in England are in social care. That's huge, you know, bigger than the NHS. And there's so many opportunities within social care because of the scale of that workforce. So I do think we've got to start to change that narrative about social care. We're not a net drain on society, actually. We're a fundamental part of infrastructure. 

Speaker3: [00:06:52] Absolutely. And David, you talked about the international agreement you both have, which has been welcome and made a big contribution going forward. The policy environment is not going to allow that to be relied on. I think the projections are we need 540,000 new workers within social care. So no place to be complacent. So I guess that leads us nicely on to the idea of having a workforce strategy for social care. And this was I mean, congratulations on the work in July. I think the workforce, you are both deeply involved. Can you just give us a brief background because it was a really pan-sector initiative?

Speaker2: [00:07:33] Well, Oonagh rang me up in about August 23 and said, David, we're going to do a workforce strategy. We think we want to try. 

Speaker3: [00:07:42] And this is a month after the long-term workforce strategy for NHS.

Speaker1: [00:07:45] Yeah.

Speaker2: [00:07:46] And I said, great Oonagh. Good luck. I think, all power to your elbow. And she said yes but I want you to help me with it. And I couldn't think of anything. In all seriousness. I couldn't think of anything more important for the social care sector, for the health sector, and actually for the wellbeing of the people in this country, because the elements of that all need to go together. And of course, we know that the social care sector is very diverse. We've got 18,500 providers working in 39,000 settings, 153 local authorities. And so bringing everybody together to galvanise people for a workforce strategy that's got 70 recommendations and commitments, was just one of the most heartwarming and most important things I've done in my career, I have to say. And it can make a huge difference to the people of this country that we'll talk about this more. But one of the big issues for the government is the fair pay agreement. That's the most expensive thing that would happen. A lot of the other 69 recommendation commitments are relatively inexpensive for what they deliver. And so it's such an important thing to do. We feel passionately about it. And we want to work with the sector, work with government to ensure that this has the traction it needs in order to make a real difference in this country.

Speaker3: [00:09:07] And it was welcomed right across the sector, the voices of the providers, etc. you called it a turning point for the sector, and I just wanted to put it into context for us, please, the complexity around it, because the NHS is of course very local, but it has come forward within one jurisdiction and ultimately you've got so many providers here. So there was quite a big beast to try to control and put together for you. It was not straightforward. You like your challenges obviously.

Speaker1: [00:09:37] I mean I see Skills for Care as having a leadership role in the workforce and having a convening role. This is a workforce strategy that tries to join together all of the different levers in adult social care to pull in the same direction. Some of it costs money. A lot of it is, we can make a lot of change happen within the space that we all have currently, without any additional resource and without anything changing in terms of legislation or policy. It's just about pulling in the right direction. And I really believe that that's what we need. We have a lot of different levers in social care. There's not just one. It's not it's not a kind of national lever that you pull. And 18,500 providers and change something. So that really collaborative approach is at the heart of the workforce strategy. And we've already seen people then align their strategies and just the impact even within a couple of months. And maybe we'll get on to that. But I just wanted to say one more thing about the kind of driver for this. So, that 540,000 additional posts isn't just plucked out of the air. It's based on the population growth that we are expecting and Skills for Care do this calculation every year and it's a projection, not a prediction. But when we go back over the last ten years and look at that projection, it's been pretty accurate. And it's not just a growth in the number of people working in social care. We're going to need different skills and we're going to need to work together differently. So we're expecting a 43% increase in the number of people with dementia. 91% increase in the number of people over the age of 90 by 2040. So we are going to be a fundamentally different population with fundamentally different needs and those needs, that's going to happen anyway regardless if we do something about it or not. So I think it's incumbent on all of us to do something about it. And we can't wait around for, you know, it would be fantastic if government or when government support things like the Fair Pay agreement, but there's stuff that we can do as a sector and we can and should be doing that now. So that was kind of the starting point for us. What can we be getting on with within this current space that we have?

Speaker3: [00:11:52] Now, I want to come on to a couple of the specific recommendations that caught my eye amongst the 70. We don't have time to go through all of them, but I guess one of the big things you've talked about that is going to be good for the sector, for the society, for the wellbeing. But obviously one of the key drivers of having this strategy is to drive attraction for the workforce. So the sector is seen as some somewhere to work, particularly for younger people. There was a report very recently from the King's Fund about the experience of younger people, which had some fairly mixed responses, but also said that people found it very, very rewarding, albeit quite tough, and I just wanted to touch upon how important it is. I think, again, I think it's about 8% who are under 25 in the sector. So that's part of the drive is to make the sector attractive through the strategy. 

Speaker2: [00:12:38] Absolutely. And we know that beyond pay, things like having being paid above the minimum wage or the National Living Wage. Having a career progression, having the right training, having a qualification, and having guaranteed hours or indeed working full time are the package alongside pay that make things work for all ages. But also we know that if people are supported in the early stages and stay beyond the first 2 or 3 years, we've got an average expectancy of people staying for at least nine years, so what that proves is that actually, if we can get this right, we can reduce those rates of turnover and leaving the sector, albeit that there will be an interface with the NHS and people will progress in different ways, but we hope both ways actually, that there's some, you know, pretty important examples of people starting in the NHS and then having a career in social care. So it shouldn't be all one way. So thinking about young people, the importance of capturing people's imagination, supporting them with the right pay, the right training, the right hours is all part of helping people to feel valued and wanting to make this a career.

Speaker3: [00:14:02] Absolutely. Now let's go to one of the key recommendations. We've been very fortunate in one of our podcasts from the Care Show to have Doctor Jane Brightman join us, who obviously was very much involved. Now, it's not the only lever, but pay is important, pay in terms and conditions are very important, and differentials are quite important. Given the constrained budgetary environment now that we're in, we've had the budget. There's been some quite vociferous comments from the sector about it. That fact is going to be important in your strategy. You've modelled three different pay outcomes, and the numbers that they require are very different from the numbers that have been provided. How confident are you in that environment about that recommendation becoming a reality?

Speaker1: [00:14:47] I mean, the Fair Pay agreement is a key part, was a key part of the government's manifesto, and the government is already working on what that looks like and, and modelling that out and what the arrangements would be. So I feel pretty confident that that will happen. And it's a core part of the workforce strategy. It can't just be about pay. If all we do in social care is pay, then other parts of the labour market will match us on pay. So the things that they can't compete with us on are roles that are full of purpose, that have massive potential in terms of development and flexibility. So that's why we really believe that this needs to be a comprehensive workforce strategy of which pay is a part. And then just in a broader sense, looking at the social care workforce more broadly, the biggest thing that a provider can do to attract people is be competitive in their local labour market. And so pay is definitely a factor. But it's not just pay, it's how you talk about social care. We hear particularly from younger people. Well, what I want is flexibility and I want purpose. Well, I can give you flexibility and purpose in absolute bucket loads in social care. So let's talk about that more. I can give you development in social care. Let's talk about that more. So the pay is really important when we're attracting people particularly and then when we're keeping them again quality of role has a massive impact. But learning and development as David said, is also really important. And culture and leadership. So that's why we've tried to develop, or it's been really important that we've developed a holistic workforce strategy that doesn't just focus on pay, that focuses on the full package.

Speaker3: [00:16:35] No, absolutely. David, just touching on that budgetary requirement. I just want to touch upon ADAS, who of course, you all know well, as a former president. A decade ago, I think if I got my memory right on that one, and now the autumn survey, this year talked about, I think 81% of respondents saying they were concerned about the financial overspend, etc.. So it's not the only driver, but I guess I just wanted to get your comments on this budgetary environment in which this workforce has to become a reality.

Speaker2: [00:17:00] Yes, we're in a difficult place, aren't we in public services in this country? And in terms of the overall financial context, we have to sort of face that. But it's fair to say that the Office of Budget Responsibility predicted that expenditure on social care, which is 1.3% of public expenditure, needs to go up to 1.5% over the next few years, and that to actually keep pace with inflation and need, there's about a year-on-year 3.1% increase needed. So we're not in that place at the moment. And I think obviously the government have said they want to stabilise public services, of which this is not entirely run by the public organised public bodies, but it's very much commissioned by. 50% of people have their funding supported by local authorities in the health service. So all of that has got to be put in the mix and that's got to be worked on. I suppose what I would return to is alongside the things that have been identified as priorities for the NHS, so hospital to community, illness to prevention, analog to digital, apply just as well to social care. They are absolutely the things that can help with that sustainability issue. But the other ingredient is none of that works unless you have a properly trained workforce where there is enough people with the right kind of skills, not just for today, but for the future. And this is where I think the workforce strategy could make a huge difference to the health and social care system in this country and in the deal that people receive.

Speaker3: [00:18:42] No, I'd like to expand upon that, because the other key recommendation that struck me was the social care career pathway, all the recommendations you make. As you've said earlier, once you're in the sector, if there is an environment where you can excel and develop. Wanted to get your views on that recommendation, the requirement, I think you said to continually invest in training. You are on record as saying you were disappointed with, obviously, the government's response back in July, beginning of the summer around the training fund, but just paint the picture of how important that pathway and the level two care certificate, which you expressly promote is for this development environment. 

Speaker1: [00:19:20] So, I mean, you just said it. Development of our workforce is absolutely fundamental, both to give people the skills but also to keep people. So when we look at retention, you are more likely to keep people longer if you train them. And the more you train them, the longer they stay. The evidence is so clear around that, and we are going to need different skills in social care in the future because all of our needs are changing. And so being able to give that career pathway and being able to link that with competency is really key. People often say we need career pathways in social care. We have unlimited career pathways in social care. You can start, you know, just out of school without any experience, without qualifications. We will train you up. We will develop you. You might have to move organisations because, you know, about 27% of our organisations have fewer than four staff. And so there's not that many development opportunities in small organisations. But you can certainly move about within the sector. And so having one more consistent career framework feels really important. The more that we can link that, I think is the spine for the workforce, linking pay so that people can see where they develop and how their pay develops along alongside it. So linking with the Fair Pay agreement, that all feels like a really important step to get the infrastructure right in social care. And we see some of the skills that we've pulled out in the workforce strategy as particularly important, include technology skills. We know that. We know that's going to be really important. And that means upskilling the existing workforce and having technology roles in social care so that we have that particular focus. And then we've recommended mandatory training on dementia for the whole workforce, just given the changes that we expect in our population. So it's content as well as the framework itself.

Speaker3: [00:21:19] And on the tech side, just very briefly, before I ask David for his comments on that, is that I think it's digital confidence campaign is a key initiative that you're undergoing right now. 

Speaker1: [00:21:29] Absolutely, yes. So the two things that we try and focus on are the kind of skills and confidence in the workforce and leadership, because quite often what we hear from the sector is, I know I need to do something, but I don't know how to do it. I'm afraid to. It's a lot of money. How do I invest? So there's a confidence in leadership and there's a confidence in in the workforce. So trying to look at both of those angles.

Speaker3: [00:21:52] David, I know you've got a particular interest on the tech side. Please, would love to hear your comments on what Oonagh has just said, but I just want to go back to level two, because the level two care certificate is quite a seminal promotion and a sea change. I think the numbers are something like 41% of the workforce having a level two or equivalent, and we want to change the dial on that. So level two remains, notwithstanding the funding, fundamental part of the vision of transforming and professionalising the sector.

Speaker2: [00:22:17] Absolutely it does. And what we need to do is to see that the people have hope for the future. They can see that their aspirations can be met and they have the confidence, competence in order to, you know, make that contribution. And so that's critical for a whole range of factors. So it's an absolutely fundamental plank of what we're trying to achieve.

Speaker1: [00:22:41] And in the workforce strategy, we recommend that everybody who starts in social care should be working towards a level two. And then within three years they should be at a level three competency. Now that doesn't necessarily mean a level three qualification but a level three competency. And when you look at the definition of a level three, it includes things like working autonomously. Well, a lot of our workforce will be will have to be working autonomously. So there is a policy intention from the workforce strategy to raise the competency, the expected competency level of the of the workforce, and to reward that with pay so that we can have people come into social care without necessarily the skills and qualifications, but we build them up. But there's a reward at the end of it to kind of thank people and to recognise their growing competency. And those two things feel incredibly important. 

Speaker3: [00:23:34] Absolutely and on the tech side, David, just comment from you because tech-enabled care is here. It's one of the key skills that you've identified and something I think that you're particularly passionate about. 

Speaker2: [00:23:44] Yes, I share a community interest company that has a quality service framework, tech quality for the quality of care of technology-enabled care and its application across the UK. But broader than that, as a former director of adult social care and an ICS chair, and indeed as an expert panellist on the Health and Social Care Select Committee, we did a fair bit of work on this, and there's no doubt in my mind that we haven't taken full advantage of what the third decade of the 21st century can offer us in terms of integrating technology enabled care with medical devices, shared records, aggregation of data to help predict the greatest risk and focus our needs. So in order to be able to do that, we need a workforce that is enabled and empowered in order to take advantage of those opportunities as well as the infrastructure in order to make it happen. And this was quite a significant part of one of the workstreams that we ran as far as the workforce strategy. So as Oonagh has said, we need to make sure that we've got this digitally enabled workforce that actually have an understanding of those opportunities as well, of course, as the things around artificial intelligence that we've got coming forward. But it's got to be done safely and effectively. It doesn't replace people. This is still very going to be a people-centric business, but it acts as a support to that and also helps people to retain as much choice and control independence over their lives as possible if applied correctly.

Speaker3: [00:25:16] It's interesting you've both talked around the importance of tech-enabled care and upskilling in terms of digital skills. There's been lots of conversation around the role of AI, some frightening and some visionary and empowering. What are you seeing on the ground? How important will that be for social care and what promise does it hold?

Speaker1: [00:25:33] So I think there's two levels to this answer. The first is at the system level. So Skills for Care has a data set that covers about half of the workforce of about 650,000 people. And we use data science in order to be able to predict things like, what are the characteristics of people who are most likely to leave the workforce within a year? That is incredibly helpful for us to be able to then advise and support employers so that they can put in place the things that are needed in their own workforce planning. So we can tell, for example, that if somebody lives more than 20km away from their workplace, they're much more likely to leave. If they live within two kilometres, much less likely to leave. So things like that are really helpful.

Speaker3: [00:26:16] And very valuable. 

Speaker1: [00:26:17] Very valuable. And so if we're able to join together all of that data, things like the kind of client level data, health data, and then the data from the workforce, there's a lot of analysis that we can do out of that. And then at the individual level, we're hearing about some really innovative practice in Greenwich, for example, the local authority is using AI to look at care needs and to look at the prediction of care needs. 

Speaker1: [00:26:47] It goes back to digital skills and confidence. So if people are confident to use AI, to know its benefits and its downsides, then they will be able to play around, to practice, to get a sense of what's safe, what's not safe. And people are very worried about AI. They're worried about its potential. They're worried about GDPR. They're worried about the kind of personal nature of data. So I think we have more work to do at a system level to either give people confidence and to talk about some of the dangers and to get that balance right, so that we're able to innovate in a way that protects people's rights. And I think that's the balance that we that we need. So we're really we're not even at the foothills. We can see the foothills ahead of us, but we're not even quite there yet.

Speaker3: [00:27:38] Part of that will be to take people on that journey. It's not just a simple imposition. It's about actually people co-producing some of this strategy. 

Speaker2: [00:27:47] Absolutely. And it's been a fundamental part of our strategy as well as the work of in social care to make sure that things, all things are co-produced, including technological innovation. And it goes back to that point that I was making earlier about making sure there is a quality service oversight of all of this to give both practitioners and the public the reassurance that this is being handled safely, effectively and in their interests. I think the dimensions that I have described around the use better use of data in order to understand people's needs now so that intervention and help can be provided tomorrow that actually supports people from the next worst events in their life. Potential hospital admission or to residential nursing home when it might be unnecessary if the right support is provided, as well as that interface between health and social care. As I think about innovation like virtual wards and other types of initiatives around particular cohorts of people in the community, where if you have that kind of technological innovation which helps people's needs to be met more succinctly and precisely, then that will help people to maintain their independence and their control, which of course is what we want as much as possible.

Speaker3: [00:29:07] No, absolutely. Just one final point on the training recommendation. With all of these changes, with new skills that we're going to be required to look at, it's going to require I don't like to use the word revolution, but quite a transformation in the way training and training providers work in digital immersive. I guess we're I mean, I know Skills for Care are actually currently looking at the market and what training is provided.

Speaker1: [00:29:32] So if I just take apprenticeships as an example. So we have seen a 75% reduction in the number of apprenticeships in social care since 2016. And we know the drivers of some of that. So a learning provider will be paid about £4,000 for a apprenticeship in social care and about £11,000 for an apprenticeship in hairdressing. So the market struggles to make apprenticeships work and we have a very high dropout rate in apprenticeships. People will get the diploma and then drop out before they do their endpoint assessment and the maths and English. So how we design apprenticeships is not necessarily working in social care. And then the backfill that's needed in apprenticeships. Sometimes providers struggle with that because of the nature of commissioning. So if we are seeing apprenticeships, which I think we are as a really fundamental part of the future of our new talent and how we attract and retain people. We've got to make sure that they work for social care. And so I think when we're thinking through policy, we need to be thinking about vocational training, which sometimes we miss in that policy landscape. And social care is so vocational. You need experience on the job. And we've got to be designing training in that way.

Speaker1: [00:30:56] And then the training market is absolutely going through a real transformation. You know, if ABBA can do it, then what can we do in social care? We have an endorsed provider process in Skills for Care because social care providers were saying to us, we are completely overwhelmed. We are getting approached by hundreds of different learning providers. We don't know who's good. We don't know what they're offering. We don't know how to make a judgement. It's completely overwhelming. And so our endorsed provider process then gives the sector a bit of confidence that the learning providers that we endorse are bona fide. And so I think things like that, in terms of the quality assurance of the learning market is a really important role that Skills for Care play with DHSC. And then what we have to get better at I think is looking at the workforce strategy looks out over 15 years. How do we start to train the workforce not just for the skills that they need today and needed yesterday, but for the skills that we're going to need tomorrow? And how do we prepare the learning market to have the supply there when the demand comes through, and we've got to balance that supply and demand.

Speaker3: [00:32:09] One final point on this, and I wanted just to wrap up by looking at a bit of a crystal ball in the future, just on that point. And it's a topic which occasionally gets missed when looking at the social care landscape. We were very fortunate on the Voices of Care to have Professor Deborah Sturdy here and nursing, it's ubiquitous in social care. People don't realise that, but that's another aspect, I guess, of the sector, which offers opportunities for anyone who wants to undertake a health and social care career.

Speaker2: [00:32:36] Absolutely. And a fundamental part of the social care workforce. And that's, you know, little understood actually. And, actually profiling the work of nurses and their importance to the sector is critical. I think the other thing about the workforce strategy is that we have focused about, I think Jane Brightman calls it the mighty workforce. 

Speaker1: [00:33:01] Small but mighty.

Speaker2: [00:33:02] Thank you. Thank you. Which is a fantastic turn of phrase. Around social workers, occupational therapists, nurses, registered managers, all of whom make a profound difference to social care and a bit of an engine room actually. That's not to say that others don't have an emphatically important role. But actually having that focus on that group, including nurses, is critical to the future. So that's, that's an important investment for us.

Speaker3: [00:33:34] Absolutely. Sorry. Go on.

Speaker1: [00:33:36] Oh, I was just going to say that small but mighty part of the workforce is, as David said, really core to the workforce strategy. If you look at registered managers, there's about 25,000 of them. And your registered managers set the culture in an organisation. If your registered manager leaves, your turnover increases. With a new registered manager, your turnover increases. So focusing on that group, social workers are absolutely core to assessments, to meeting people's needs to that real personalization. Occupational therapists core to rehabilitation and prevention. And our nurses, as we see people with increasing clinical needs, nurses are absolutely are absolutely core to that. So even though they make up about 5-6% of the workforce, so they can often be forgotten. If we focus on that relatively small number of people that we can get our arms around, it will have a massive impact on social care. And we need to be focusing more there. And that's what the workforce strategy tries to do to pull out those kind of core roles. In nursing particularly, we've got about a 30% turnover rate for nurses in social care, compared to under 10% in the NHS. We need to attract more nurses into social care. We need more people to come in as placements, even if they don't stay in social care, what they will do then is move into health and into the NHS, but with a real understanding, not just of social care as a sector, but what social care does at its best, which is personalisation, prevention. It will allow people to see the individuals that we support through the lens of their lives and not the lens of their disease. And that's what we can offer in social care, even on somebody's way through their career. And we don't talk about that enough. 

Speaker3: [00:35:23] No, I'm glad you have. As I said, Deborah Sturdy was very, very passionate about saying that actually, all clinicians as part of their training should spend some time in social care, which I think was really powerful and very rarely said. One final point, the transformation in social care I liken to a marathon rather than a sprint. We've got the ten-year review happening in the NHS with a bit of a crystal ball. What would you like to see from policy and providers if there's 1 or 2 key priorities over the next 12 months? 

Speaker1: [00:35:53] So I think for me we need to see the equivalent of the NHS ten-year plan in social care, and the Secretary of State and the Minister for Social Care have committed to that. And I think that's going to be the core conversation. But the commitment for me, coming from a workforce perspective is that we need an approach that starts to look out over the next 15 years and starts to join together in the way that we've done with the workforce strategy, the different levers to make that change happen. I think the most impactful thing that we could do is to implement the workforce strategy that we have developed with the sector, with all of the different voices, so that we've got all of the levers pulling in the same direction. And what the workforce strategy tries to do is to balance urgency and hope. And I think we need that in social care. We've got to there is an urgency here. Our population is growing, living longer, not living healthier. So there is an urgency here, but there also has to be hope. And social care has to be part of the solution and not just part of the problem. And so that's the kind of ask that I would present, I suppose that we get moving on some of this and that we keep our optimism because this is so important to so many people's lives.

Speaker3: [00:37:08] Absolutely. David, final word with you. Just to broaden that slightly, one of the recommendations in the workforce plan was the idea around the integrated care systems having their own strategies. Who can bring that together with your background? Obviously as a chair of the ICS, how important will the voice of social care be in of itself, but also in an integrated system?

Speaker2: [00:37:29] Sure. And just to say, as a preface to that, I think I completely agree with Oonagh's comments and I think I would emphasize workforce prevention, digital and strengthening of community-based services. And I'd also emphasise the importance of making a start now on those things. So it might take, we might need a ten year plan. We do. But actually making steps, incremental steps now to start to improve things is really part of dealing with that urgency. On the issue of integrated care systems, we suggest that a national workforce plan for the NHS and for social care separately is a good thing because you need that strength of both systems. But at a local level, integrated care systems should have an integrated workforce plan in order to make sure that they've got the right ingredients in those local plans, because at the end of the day, we live in quite a differentiated world and we need it to be responsive, strategically sound, but responsive to local need. So I think ICSs and ISPs and ICBs have a fundamental role in making this happen at a local level.

Speaker3: [00:38:39] And urgency and hope are the words we're going to leave there. Sir David Pearson, Professor Oonagh Smith, thank you so much for your time and your candour. Really welcome it. 

Speaker2: [00:38:49] Thank you.

Speaker1: [00:38:49] Thank you.

Speaker3: [00:38:50] Pleasure. If you've enjoyed this episode of Voices of Care, please like, follow, or subscribe wherever you receive your podcasts. And if you want to find out more about how we're turning the dial on health and social care debate, please visit newcrosshealthcare.com/voicesofcare. In the meantime, I'm Suhail Mirza. Thank you very much for joining us and look forward to seeing you on the next episode.

Speaker4: [00:39:07] Voices of Care, the healthcare podcast.