Speaker1: [00:00:00] Hello, I'm Suhail Mirza and welcome to this very special episode in season three of Voices of Care. I'm joined by not one but three luminaries from social care. Professor Vic Rayner, Chief Executive of National Care Forum, Professor Martin Green, the Chief Executive of Care England, and Doctor Jane Townsend, the CEO of Home Care Association. Welcome back to Voices of Care. All three of you.

Speakers 2-4: [00:00:21] Thank you.

Speaker1: [00:00:22] Social care, healthcare seems to be such a prominent issue at the moment. The election. I'm old enough to remember a film that came out in the 1980s called Groundhog Day, where the protagonist would revisit the same scenario over and over and again. And we've got so much to cover here today. But I hate to remind everybody, but I think the last Royal Commission was about 25 years ago. With your collective wisdom, why hasn't social care been fixed after so many white papers, green papers, and I think now another Royal Commission due? Martin.

Speaker2: [00:01:01] Well, I think partly it's because there is always a focus on the NHS, and what politicians don't understand is the way in which the NHS is an interdependent system with social care. I also think the public have much more focus on the NHS, because they believe when they have a problem, the NHS will cure them. The issues around social care are much more about long term conditions, and people sometimes don't want to have to think about what might happen to them if they need support in the long term. But I think social care has got a brilliant story to tell about how we transform lives and also how we transform local economies. And we've got to just make sure and we're all doing it in our various ways, that we keep that high on the agenda, and particularly now that we have a new government.

Speaker1: [00:01:50] Jane.

Speaker3: [00:01:51] I think it's challenging to get reform because many people go and visit their GP, and so they have contact with health services, but they're not always aware of social care until they need it. I think we are moving into a situation, though, where that's changing because many people have got relatives, they've got neighbours, they're having to give up their jobs to provide unpaid care for loved ones. And when they're trying to battle through the system, they realise how hard it is. And we had some high-profile cases, like Kate Garraway, with the tragic situation with Derek and the huge costs that she incurred. So I think it is coming up the agenda, but in the great scheme of things, I suppose any one time it doesn't affect as many people as the NHS does.

Speaker1: [00:02:40] And perhaps it doesn't get the same coverage. Vic, going back to the election campaign, if we can just briefly, it did get quite a lot of purchase from the Liberal Democrats, more than perhaps others, but it did get a reasonable amount of coverage, and we've got quite a few proposals that are coming up in broad terms at least.

Speaker4: [00:03:00] Well, I think so and I think what was really interesting in the election campaign was, as you, particularly the Liberal Democrat focus on that. And I think what I thought was really stark was that they set out a sort of set of people that they thought were important. And at the top of that list was carers and I think to have unpaid carers and paid carers sort of acknowledged as central to the future of Britain under their party, I think was an extraordinary move and I hope one that we'll be able to continue to capitalise on because I think one of the reasons why we haven't ended up having the right and proper focus on social care is that successive governments have essentially managed to explain it away as an unskilled and unprofessional workforce. And it is a workforce that's almost entirely delivered by women. And I think, you know, we still have a very gendered society in many ways, particularly around pay and progression, etc. So actually, some of the reforms that the new government is talking about, I think are going to be really important in changing that dynamic. And some of the things that were mentioned in other parties' campaigns, particularly the Liberal Democrats. So we've got within there a focus on pay. A focus on contractual issues. And the Liberal Democrats were talking about a royal college for care workers. And we've got the workforce strategy that was brought out last week by led by Skills for Care sort of sector-wide body. We've got Skills England launched today you know, so there are lots of opportunities I think to kind of remind people of what an incredibly skilled workforce we have. We have the privilege of going all the time to visit different services and meeting the most extraordinary people who are working at such a high level of skill with people with such levels of complexity. The notion that this isn't a vitally skilled and professional workforce is a bit of a travesty. And hopefully we can get rid of that.

Speaker3: [00:05:02] I was going to say one of the things that encourages me is there appears to be a recognition in the Labour government that social care, together with health, is important for economic growth. And Wes Streeting has been very clear that he wants to get away from the begging bowl mentality and to see health and social care as part of the foundational economy to help the rest of the economy succeed. So I think, you know, actually, our workforce is huge. Owners always saying, you know, that there there are more men working in care than there are in the British Army, which, considering there are only 19% males in our workforce, is quite a statistic. But we contribute about 60 billion in total to the economy, which is more than agriculture, water, transport, utilities. You know, it should be seen as an industrial sector in its own right.

Speaker1: [00:05:59] Absolutely. Well, I'm hoping that this discussion will contribute to that. We're very much focused on solutions and what with your collective wisdom the government perhaps should do. But just before we go there, I'd like just to touch upon a couple of the reports that have come out recently. Martin, Vic's mentioned, Skills for Care's workforce report and its structure report that came out and just touching upon workforce. It's great to see more filled roles, reduction in the vacancy rate, but there's still 130,000 vacancies and a significant reliance on international workers.

Speaker2: [00:06:34] And I think one of the things that came out for me from the Skills for Care report about the fact that vacancies had gone down, was the fact that the majority of those people had come from overseas, and we still saw that 70,000 people had left social care. The other thing that was very interesting were the numbers of people they were projecting we need in the future. So we're talking about 480,000 more people. Now it's quite clear we are not going to get those from the UK workforce. So one of the things that we're going to have to do is think clearly about how we reform the model for social care, because we have got to work smarter, not harder, and we've got to deliver really good lives for people, but we've got to do it without heavy reliance on all these extra staff, because they're just not going to be there.

Speaker2: [00:07:21] They're not going to be there from either the overseas or indeed the homegrown workforce. So this is a pivotal moment where we should be saying to ourselves, we first of all need to secure our current workforce. And I think all the things that both Vic and Jane have said about that are really important. And we've got a government that's committed to doing some of those things. But then in the next phase, what we've got to do is say, how are we going to meet the challenges of the future? And, you know, Vic's point was so well made. We've got to show people in social care exactly for what they are, which is highly trained professionals. And we've got to get the training, the development, the status and the reward in line with the fact that this is a very important role.

Speaker1: [00:08:05] And one of the other points that came out for me again recently, that, as if we needed a reminder that there are challenges. Jane, if I can come to you to speak on home care, particularly, ADAS produced a report which in a sense was quite stark in terms of the numbers of people waiting for support and also a significant number. I think it might have been 39, 40% of directors reporting providers ceasing to trade or not accepting packages. Something along that. It's quite a stark reality out there.

Speaker3: [00:08:34] And I think much of that is related to the council's financial state. So they haven't got enough people to assess. So there's 418,000 people waiting for assessment. And all of the time they're in the community potentially deteriorating, could be ending up in acute hospitals, which are very expensive and not good for anyone to be there. I think in home care, the way that home care is currently commissioned and purchased by councils and the NHS doesn't allow us to make the most efficient and effective use of the workforce that we've got. Some of them, unfortunately, because they're so cash-strapped, are driving fee rates right down to below the level where we can cover even direct staff costs at the minimum wage and statutory employment on costs. And if we're not careful, that creates an environment where the risk of labour abuse, modern slavery increases, but also using framework contracts where they just allow sort of random bidding. Whoever's the fastest, whoever bids at the lowest price means it's very hard to organize your rotors in an efficient way. So the workforce that we do have, it isn't being utilised in as well as it could be, and lots of care workers have got lots of gaps in their rotors, which is among the reasons why they leave. So we need to completely rethink how commissioning is being done. And some councils are doing that, which is encouraging. So we'll wait and see. But we could do with more research on what good looks like. I have concerns and have them from the beginning that, you know, Care Quality Commission has been asked to go and assess councils and their commissioning abilities, but then they don't know what they're looking for. And when they do find it, they're ignoring it. So some of the councils that have had good ratings aren't recognised by providers as good commissioners. So there's something wrong there.

Speaker1: [00:10:32] I'd like to come back to that, if I may, because I think we all know and we've trodden this path down. Thanks for reaffirming it in terms of these challenges. Looking ahead about what the government should do, the government has talked about a new Royal Commission, potentially a National Care Service. But before we go into some of the details and I would like to cover commissioning and funding and workforce, Vic, it may begin with language and how we frame this conversation. I think it's about a year or so ago, September 23rd, five must-haves for a new government. I think you were very powerfully advocating. You began to think social care first. What does that mean? And how important is that now as the government comes to grapple with this issue?

Speaker4: [00:11:11] It's crucially important, really, because a lot of as Jane and Martin have both said, you know, this economic contribution of social care is very significant. And actually the way in which we can maximise that is to ensure that, you know, we recognise social care's contribution within communities, but also how other policies that government will be looking at will impact on social care. So for example, we've just had today the launch of Skills England, the briefing for that talks about the importance of focusing on key areas of workforce, which I think included building and health care. Even in the context of the kind of press release, they can't get to the point where they mention this 1.6 million workforce. So thinking about, you know, if you were going to be sitting in that organisation, you should have the social care workforce absolutely at the top of your agenda because, you know, this is an area where we've had apprenticeships, for example, social care used to have one of the highest level of apprenticeships, that has just dropped through the floor in the last 5 or 6 years since the refresh of that.

Speaker4: [00:12:23] We've got lots of employers contributing huge amounts to apprenticeship levies and not being able to access them because the apprenticeships are not fit for purpose. So there's loads of opportunities to reform and reshape things. But alongside the sort of, those might be the obvious low-hanging fruits and things, but there are, you know, house building, housing requirements for social care, both for the delivery of social care and to enable people to continue to live independently. You know, you mentioned being old enough to remember Groundhog Day. I'm old enough to remember. God, I can't remember the name. Homes for Life. You know that whole focus around making sure that people could move into accommodation and it could be suitably adapted as their needs changed in the future. We just threw away all of that, and we've ended up building lots of accommodation that is not suitable and available for people going forward. So housing needs looking at, employment transport systems, we know that most people who deliver social care can use public transport or could be using public transport if it worked for them. Let's try and make that work more effectively and efficiently.

Speaker4: [00:13:33] Think about the schooling, particularly trying to get messages in really, really early into school. I mean, we spend a lot of time in school reading about how to be an astronaut. Perhaps if we spent a bit more time thinking about how to work in social care, we would have fulfilled ambitions rather than thwarted ones from childhood onwards. There's loads and loads of ways which we could get social care properly inserted into the dynamic, and I think industrial strategy has been talked about. We have got a massive opportunity in social care around digital and technology to completely address this issue of the fact that we have not got 480,000 new workers coming down the pipeline. Other parts of the world are seeing the use of robotics and the development of technology as an absolutely massive export industry for them. The UK could be doing that too. It could be investing in how we adapt technology for social care, because the rest of the world is ageing at pace as well, and the UK has the fastest growing, ageing population in Western Europe. We should be using that as a test bed to learn and enable growth, not just internally with the domestic economy, but also internationally as well.

Speaker1: [00:14:42] So plenty of promise there that we can use and perhaps use, change the rhetoric from the cold calculus of cost to contribution in terms of investment. Low hanging fruit is a phrase we just heard, Martin, Care for our Future, Care England published now some time back end of 2023 and first 100 days, etc. if we can look at funding, there were a number of proposals that you heard, touch upon them to get some quick wins. And I'm talking about funding into the sector.

Speaker2: [00:15:09] Yeah. I mean, things like, for example, changing the VAT status of social care would make a big difference and would be a quick win and it would bring extra money into social care and it wouldn't necessarily take money out of the Treasury. So I think there are some things that we could do there. I think there are things that they need to do around commissioning practice. James eloquently talked about that. I think there are things that we can do with the green agenda. So we talk endlessly about the green agenda, but never do people engage with social care. Now, if you look at home care staff, and particularly in rural areas where there isn't a good network of public transport, we could be saying, well, let's provide people with electric cars, let's enable them to use those for their off time as well.

Speaker2: [00:15:52] So it would be incentivising people to work in our sector. So I think there are a range of things that could be done quickly. Of course, the deputy Prime Minister has made some commitments on the workforce and said that, you know, the end of your zero hours contract, a working care wage, and those are good things, and we would support them. But they have to be properly funded via government. And if the deputy Prime Minister has a view that we can take up the slack and put that money in, there is just not enough money in the system to do that. So I think one of the things the government should do is, first of all, look at what those quick wins are. And we've all, in our various reports identified them, perhaps go forward with some of that and also recognize that some of the commitments made by the Deputy Prime Minister for the first hundred days will need funding, and so we need the Chancellor to follow through and give her commitment to put the money into the system. But if we did that, I do believe it would help on things like recruitment, retention. It would start to be the foundation that we could build upon in terms of the workforce. And of course, now we've got the workforce strategy from Skills for Care.

Speaker2: [00:17:00] We have a framework on which to hang this, and we could bring all those things together so we could get a really clear foundation for the first hundred days of things that could be done quickly. And then we need to look at the medium term, what we need to do, perhaps in the first two years, and then for the longer term, what you would do in the following 2 to 5 years. So I think, you know, there needs to be a really clear plan with some deliverables, and then people can know how far we are on the journey.

Speaker1: [00:17:28] Now thank you for that. And I'm going to come on to workforce because that's incredibly important. There's plenty of proposals that impact, the whole of the workforce in the UK, but in particular social care. I just briefly, Jane, give you the last word on funding. We've been around this track a lot, but rather than talking what numbers we need, and if you read the Health Foundation, that can be 30 million if it's the matching the National Living Wage, or if you want to match band three NHS, it's a lot more than that. Fair cost of care. Can we talk about that in commissioning? Because unless we really understand this, it's just moving pieces on a puzzle which is not going to get solved.

Speaker3: [00:18:04] Yeah, I think that's a really important job that we've got to do to explain that if you ban zero-hour employment, you need to ban zero-hour commissioning because that's what drives it. And the reason that councils are using that, it's not necessarily because they want to. It's all they can afford to do. So you you have to understand that employment and commissioning and regulation as well and funding are all interdependent. And we can't just fiddle with one bit of the system and not look at the whole. There seems to be a bit of rhetoric that it's all about bad employers. Now, there definitely are some employers that we all think probably shouldn't be doing what they're doing, but there are ways of if the regulators were doing their job properly and if they were producing poor quality care, they wouldn't be able to operate. So I think we'd need to see some changes in how councils go about commissioning and purchasing. But also we need to remember the people that are currently having to pay for their own care, because if the wages go up quite high, that's going to impact on their ability to afford the rates for, you know, home care and care homes, which some of them are already struggling, which is why there are so many people giving up their jobs to look after family members.

Speaker3: [00:19:24] So it is difficult. And I think so far, the Labour government has just talked about how there's no money and you know that Wes Streeting has talked about fixing the NHS, he's deliberately not said anything about social care and he's said that he doesn't want to make promises that they can't fulfil. We all understand that. But there seems to be a bit of a sort of cognitive dissonance in a way, from, you know, from saying that, but then in the next breath saying, right, okay, we're going to require you to have occupational sick pay and pay rates of, no zero hour contracts and all the rest of it. As you know, in home care, 70% of the hours are purchased by the state. In care homes, it's probably around about 40-50%, something like that. And then we've got all of the people who are under 65 people with long-term disabilities, most of that is funded fully by the state or the NHS. So you can't just, you know, tell people to pay more. The money's got to come from somewhere.

Speaker1: [00:20:31] And I think they've got to perhaps have the honesty to admit that that's been one of the items of rhetoric. We're going to tell the truth. We're going to be open about this. So let's see if we can pick that up. Workforce. I wanted to Vic, the strategy produced by Skills for Care, lots of bodies contributing to it. A fantastic piece of work. Turning point, it's been called. It does require and it says very clearly that every stakeholder, and particularly the government has to play its part. I just want to touch upon some of the proposals around training and also the role of immigration, because this is going to be quite important about what levers the government needs to pull to make sure that these numbers are met.

Speaker4: [00:21:15] I mean, I think, you know, I think we've talked a little bit about really how, you know, currently the numbers of international workers are quite significant in terms of the overall proportion as somewhere around 7 or 8% of the overall workforce. So that isn't something that can be transformed overnight. I mean, I think the strategy could only go so far in a sense, because clearly one of the, you know, the key partner in a sense, or one of the key partners is the government there. So I think what we need to be all pushing for really, is to sort of pick up on the areas that are strongest in that strategy, the areas of kind of really core consensus about the need to kind of transform, the need to retain, and the need to kind of train that workforce and be pushing the government to look at that strategy as a sort of underpinning for its future work. What I think we need to be really sure of is, you know, whether the government will put into place, it's not just money, is it? Some of it is absolutely about back to that kind of thing. Social care first in that way. So when we were having the discussions about the strategy development, you know, it was really clear that the only way we could make a sort of fundamental shift was to start focusing on care as a kind of core profession at a very early stage in people's education.

Speaker4: [00:22:55] We've currently got ourselves in a situation where we don't actually have any post-16 qualification for the next couple of years for social care because the BTEC system has gone and we don't have anything replacing that. I mean, that's an appalling situation to be in, and so we need to try and see about how we can perhaps plug some of those gaps, even on a temporary basis. Because what happens is, if you're looking at something like FE and you take away a qualification for a couple of years, you lose all the teaching staff in relation to that. You lose the infrastructure that sits behind that. You lose the placements that have been arranged and organised. So we can all play our part in stepping up to make sure that those gaps don't become sort of seismic chasms, but the government will have to move at pace in order to recognise the need to do that. And we're currently at a situation where, which is what is so frustrating when we see something like Skills England talking about healthcare needs because actually healthcare does have a system and structure for funding and investing in healthcare staff. We're currently in a situation where there are familiar patterns of workforce development funding has come to an end and there is not a replacement for that. So we're in this ignominious position of having absolutely no central funding for training right here today.

Speaker1: [00:24:14] And there was an initiative from the previous government in terms of the Level Two entry certificate, social care, etc. that's still being reviewed. And I think Skills for Care have recommended that continues to roll out. So reform of apprenticeships etc. could be an incentive to really boost those workforce numbers.

Speaker3: [00:24:32] Yes. And I think what we really need to see are partnerships in particular locations. You know, I can imagine providers working with colleges of further education giving that experience, them having, you know, training centres, some of them already do have, you know, they've got whole rooms sort of set up to teach people how to get people in and out of bed and all of that kind of thing. But it does need some coordination. And I, you know, I think it would be a role that someone like Skills for Care could play. Unfortunately, you know, the previous government has removed quite a lot of their funding. So we have to hope that that gets restored in some form so that they can play that leading role.

Speaker1: [00:25:10] And in terms of partnerships and collaborations, Martin, I just wanted to touch upon briefly the proposal I think you made about giving social care a proper voice in the Integrated Care System landscape and also just touch upon nursing, because that's often overlooked and its ubiquity in social care. I think 34,000 nurses, we were very privileged to have Professor Deborah Sturdy on Voice of Care, who spoke very eloquently about this role. So role of nursing and also social care having a proper partnership voice in Integrated Care Systems. What's your view on that? Is that something that could potentially change the landscape?

Speaker2: [00:25:49] Well, it definitely could. And I think it's quite outrageous that we have got Integrated Care Systems that are supposed to be developing an approach to integration across particular localities, and yet they are systemically set up to be advantageous to the NHS. And the point Jane made about the issues around training. You know, there are enormous amounts of money in NHS training and if it's an integrated system, why isn't that available to the social care sector as well? And one of our challenges is that the NHS dominates every single agenda, and even to the point where we're talking about integration, the integration structure was set up in a way to be advantageous to the NHS. The NHS is always very reluctant as well to transfer money across the system, so all they do is make sure that the NHS budget seems to be their main priority, not outcomes to people. And unless we start shifting the dial and thinking about people and outcomes instead of organisations and processes, we're never going to achieve what we need to achieve, which is an integrated system that enables people to live well.

Speaker2: [00:26:58] And so much of the system is about propping up one organisation rather than saying, how can we use that money for the benefit of our citizens? How can we use it so that people live well? How can we use it so that it's preventative rather than dealing with people when they get in a crisis? And what we've got at the moment is a crisis system. It's not a health and social care system. It's a health and social care at crisis system. And we need to pull that back. And we've got to start using the money much more effectively. And until we do that, until we recognise this interdependency between health and care, we will always see social care as the poor relation and on the back foot. And actually, if you look at the 21st century, it's characterized by long-term conditions. The NHS can't cure dementia, the NHS can't do some of the things that people need it to do with long-term conditions. But social care can make sure people live well. So we've got to make sure the NHS comes into the 21st century rather than languishing in the 20th.

Speaker1: [00:28:00] Absolutely. I wanted to touch on technology last but just before I do that. Vic, obviously the National Care Forum represents the not-for-profit sector. Just to expand upon that discussion, its representation, what have you seen? Obviously you've called for the sector to be promoted in terms of not-for-profit. Where do you see that fitting in what the government should do there because it plays a special role in the social care landscape?

Speaker4: [00:28:23] Yeah, I mean, I think when the original discussions were being held about what a National Care Service might look like, there was certainly a focus in relation to an expansion of the not-for-profit sector or a focus on not-for-profit or organizations that have a kind of public sector ethos in that way. And I think we'll have to wait and see what that framework looks like because it looks like the National Care Service will be shaped around a framework. And I hope that not-for-profit provision will continue to sort of grow within that context. I mean, I think we, you know, there is a lot of contribution that not-for-profit organizations make, which is much broader than just the delivery of care. So lots of our members have been located in communities for hundreds of years sometimes, and give a much broader contribution around some of the advocacy, volunteering and wider support elements that they provide. And in the current context, particularly in relation to the focus on the sort of restrictions on public money, trying to get ourselves into a place where we commission and we invest in organisations that are returning all of their surplus back into communities, I think is going to be an important part of future development and growth of social care.

Speaker2: [00:29:38] What I want to say about that is I think we should stop thinking about organisations and structures, and we should start thinking about people and outcomes. And there are lots of opportunities for the voluntary sector to have a role. But the majority of services are delivered in the private sector, and we need to remind ourselves the private sector is the one that delivers the huge amounts of investment, inward investment into social care. And you cannot just have a system which is all about one particular bit of it. And I think also my view is public sector ethos is not good actually. We've had so many examples of the public sector that have failed us. What we need is public service ethos and it's about outcomes. It's about people and it's not about whether or not you're a charity, a company, or indeed a mutual.

Speaker1: [00:30:26] One penultimate question, if I may. We've had the first Covid report. Baroness Hallett, I feel that it's incumbent upon us to touch upon the impact that it had. But what we can learn from that and how important social care will be when or if there is another pandemic.

Speaker3: [00:30:46] Interestingly, one of the newspapers asked last week if we were to have another pandemic, are we in a better place? And I thought to myself, well, if it's another coronavirus, we're probably be okay, because as long as the guidelines and everything are similar. But if it was something completely new and different, I'm not sure that we have really taken forward the lessons that were learned. There are still many gaps. We still can't get delivery of basic projects like workforce commitments that have been made. We haven't got the scientific committees with social care embedded. As Martin said, it's difficult to talk to the Integrated Care Systems. I think it's a minimum. There should be a social care lead in every integrated care system. That's someone that the providers can talk to because the need is at all levels from you haven't paid my bills through to I've had a great idea about how we can do things differently, but at the moment just talking is difficult. And so I think Baroness Hallett has raised some very important recommendations. And just the way government worked, we saw that with our own eyes, didn't we? It was quite chaotic, and there isn't a sign at the moment that that has improved. So hopefully you know, something will come out of it that will make things a bit better. But they've got to get their skates on because we never know when it might happen.

Speaker1: [00:32:08] Absolutely. Martin, just a quick observation.

Speaker2: [00:32:10] I mean, Lady Hallett's report also clearly showed that the government's total obsession during the first phase of that pandemic was the NHS. It wasn't identifying who was most vulnerable and actually the most vulnerable were in social care, but at the same time as the most vulnerable were in social care, they were doing things like taking away our PPE and giving it to the NHS. And so the whole focus of government planning was on the NHS and it was a good example. And Vic made that really great point at the start of this. It was a good example of how the whole system reverts to these issues about the organisations, and actually it should be about saying, well, where are the most vulnerable and how can we support them? And certainly, Lady Hallett's report raised some really big questions, but I hope that during the course of this inquiry, she focuses on a forensic analysis of what the issues were and some clear recommendations to improve it in the future. Because I do not want this report to just turn into a blame game.

Speaker1: [00:33:08] Absolutely. I'm going to finish up by asking each of you to really share a couple of things you'd like to see in the in the short term, we've got the new ministerial appointments. I wanted to quote a health secretary who said the arrangements for the care of older people cannot continue in their present form for much longer. And that was Frank Dobson in 1997. If we fast forward to Mr. Streeting now, two things from each of you that you think are an absolute imperative for the government to implement and implement at fair speed.

Speaker4: [00:33:38] Yeah. So I do think that grasping what type of organisations you want to deliver care is a really important aspect of it. Actually, I'm not sure that I would like to leave stand the notion that public sector has been the failure that it's put out to be. We've got lots of focus on lots of things that have moved out of public sector, such as water transport and all sorts of other things that were desperately trying to bring back into the public sector. And many of the things that we bandied as inefficiencies in the past around pay, terms and conditions, etc. in the public sector are actually the things that we want to encourage and bring forward. So I do think that we have to focus on that and try to understand, to try to view. I think what would help us in that context is to view social care as a public service. The only reason that people pay for their care is because we've created a piece of legislation that has created a means test, and it's an arbitrary split around who pays for their care and who doesn't. Everybody's entitled to it under the law as a public service, and it needs to be thought about in the context of the organizations that are appropriate to deliver that and the structures, etc. etc.

Speaker4: [00:34:47] So I think that is important because that ends up with some important delivery. And then the second bit I think they need to move at paces is around the digital agenda. I think there are massive opportunities there, both for the workforce in that context, attracting workforce, encouraging workforce, enabling people to deliver the most they can and to enable people to live as independently as possible. We haven't talked a lot about people who are using care and support services. That's our ambition. It's absolutely front and centre of the things that we need to do. And one of them is going to be about how we enable technology to give people more independence in their lives, more ability to live the lives they want and to encourage greater opportunities for preventative care which will be vital if we're going to all live much longer with long term health and care conditions, we're going to need to get that right. And we need to get it right quickly.

Speaker1: [00:35:42] Thank you. Martin.

Speaker2: [00:35:43] Yeah, I think one of the things I would implore them to do is to end ageism in both health and social care, because older people are not getting a very good deal. And certainly there are some big differences between the way in which younger people's services are commissioned and older people's services are commissioned. And I think a focus on the whole commissioning agenda would be really helpful, and that could be done quite quickly. I also think absolutely true that we need to be looking at technology, and we need to be thinking about the future and how we're going to do things in the future, and they're going to have to be done very differently to the current situation. I would also urge them to go back to some of the legislation that is still on the statute book, like the Care Act, and make it available to people. That was a good piece of legislation. It enabled people theoretically to have some really good outcomes for themselves and their families. And yet the problem has been it hasn't been delivered. So I think I would not only talk about the new stuff that needs to be done, but I'd also do a bit of an analysis on what we can build on that's already in place.

Speaker1: [00:36:49] So no need to reinvent the wheel. Last word to you.

Speaker3: [00:36:52] So we've talked already about things that could be done in the here and now. I'd like a government that also thinks long-term because we've got aging, you know, as, as a major, profound societal change that's been talked about for a long time, but literally nobody has grasped the nettle. I think Chris Whitty, the chief medical officer's annual report last year, was a very, very good piece of work that raised the many issues around health of an ageing population and just putting into practice some of his recommendations would be really good. Thinking about technology solutions in the very longer term, I mean, we don't really hear very much in the Labour manifesto about AI and technology. More generally in other countries Japan, South Korea, China, as Vic said earlier, you know that automating their factories, they're automating their food outlets. Um, you know, the robots are literally taking over, but because they're just worried that there aren't enough working-age people now, ultimately it could end up being quite good for us in care because, you know, people like Amazon are automating their distribution centres. If McDonald's, you know, automates all of the fast food outlets, all of the people that used to have those jobs will be grateful to come and work with us. You know, we're one of the last places where you can have a real person. And that's not to say that we don't need technology. Of course we do. But I think, as we've seen also many risks and issues around rights that we have yet to work through. You know, just one bit of code going wrong this week. Not even a cyber attack has brought, you know, vast swathes of the world to a standstill. So I think that there's I'd like to see more thinking about those societal changes.

Speaker1: [00:38:37] Yes, that's perhaps another podcast, if I can manage to persuade you to come back. Technology in the longer term. But for now, thank you so much Vic, Martin, Jane, for your time and always for your wisdom. It's been a pleasure.

Speakers 2-4: [00:38:51] Thank you.

Speaker1: [00:38:53] 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 learn more about how we're informing the debate on health and social care, please visit newcrosshealthcare.com/voicesofcare. In the meantime, I'm Suhail Mirza. Thank you very much and look forward to seeing you on the next episode.