Speaker1: [00:00:00] How do we get people to care? All the rest of it is noise. It is so hard and distressing. The pay that people really need and deserve hasn't been funded. It's such a great career opportunity. Be bold. Be hopeful. Be imaginative. Be creative. Because there's no money. What would the risk be of disrupting those established relationships and moving somebody from their home? I think the potential for digital is huge. But actually the funding hasn't kept pace with that.

Speaker2: [00:00:35] Voices of Care, the healthcare podcast.

Speaker3: [00:00:39] Valerie, great to see you and welcome to Voices of Care.

Speaker1: [00:00:43] It's lovely to be here. Thank you for having me.

Speaker3: [00:00:46] No, no. It's great. It's been a while since I've seen you. And I think you're coming up to your fifth anniversary, not far off since you took the helm at Choice.

Speaker1: [00:00:54] Yes, just over four years. Unbelievably, it's gone by very quickly.

Speaker3: [00:01:00] Yeah. Yeah, I think you chose your timing when during the pandemic, I think was when you took over.

Speaker1: [00:01:06] I did, yes, I joined in the pandemic, parts of it were brilliant. It was great to be able to come in and support people in that time. But also it was really difficult. I couldn't go in and meet colleagues and things like that. But yeah, happily we're out of that time.

Speaker3: [00:01:25] Absolutely. And actually, the market. We can quickly look at the care home market. LaingBuisson, of course, you'll know, have produced earlier this year at the end of February, their market report looking at care homes. And it highlighted quite a significant increase, £26 billion, the market value of the market from £17 billion in 2021, 40%. And the foreword to the report talked about occupancy rates coming back, investor activity. What are you seeing in terms of the market generally? It's grown and it remains of interest to investors.

Speaker1: [00:02:01] Yeah, I think that if you look at the King's Fund, I've actually just also done some analysis. The 360 report, which I think exactly tells us what's going on. So, what we're seeing is that because of the constrained budgets within local government and local authorities, actually fewer people are being supported, partly because of the increase in costs, which are driven by the hugely deserved increases in minimum wage. So actually looking at headline turnover figures is possibly not the best indicator because.

Speaker3: [00:02:47] It's a fee inflation driven effectively.

Speaker1: [00:02:50] Yes. Actually, yeah. I think the question is are the people who need support being able to get that support. And I think the King's Fund analysis says that's been quite difficult. And I guess looking ahead, I think that's going to continue to be quite difficult.

Speaker3: [00:03:06] No, absolutely. I think they've shown a decrease in the number of people getting long-term care over the last decade or so. But at the same time, I think there's been activity in the sector. It's still the demographic support, long-term investment choice. I wanted to come on to that, specialist area learning disabilities, people with autism that you support. If you can tell us a little bit about that. But over the last few years, you've been driven also by acquisitions. So clearly, great faith in the market.

Speaker1: [00:03:38] Yeah. So Choice has a long history of...

Speaker3: [00:03:42] Over 30 years now.

Speaker1: [00:03:43] Yeah, we did a 30 year anniversary a couple of years ago. And actually, I was saying to you earlier, before we started, there's a reasonable number of colleagues who've been there through that time, which is extraordinary. There's a kind of lovely core, depth of experience. So the organisation has always been about supporting people who need to draw on care just to be able to, you know, go about their lives and thrive. And many of those people have got learning disabilities, autism, increasingly mental health needs as well. And we do have, I think it's now about 110 different homes. And, you know, from sort of cottages in rural Wales to bigger sort of flats in the centre of Nottinghamshire and stuff like that. So lots of different places obviously where people choose to live. And we have lots of colleagues supporting them to do what they want to do. And you mentioned acquisition. So we have I think one of the things about the way that care is delivered that people misunderstand is that actually most providers are small, medium enterprises. In fact, actually the biggest providers only account for, I think, 5 to 7%.

Speaker3: [00:05:08] A much smaller percentage, a fragmented market.

Speaker1: [00:05:09] Yeah, it's hugely fragmented. And actually those small/medium providers are the lifeblood of the support, you know, local services employing colleagues locally to support people. And that's really where we've done some very carefully selected acquisitions, where there's really high quality providers who have got our kind of shared values about putting the needs of people we support first, and also in areas where we in our discussions with commissioners, know that they have a need for further support. So we've sort of, you know, carefully joined providers into the group where we think we can then sort of use their relationships and depth of expertise to do more for people in those local areas.

Speaker3: [00:06:08] Because the services that you have are a range of services and there's residential settings. You talked about day settings and some people needing 24/7 care.

Speaker1: [00:06:16] Yeah. I think increasingly the sort of distinctions, I mean, I think as providers we tend to sort of talk about, you know, these sort of regulatory frameworks as to whether people are supported in a residential registered service or supported living. But actually, for the people that draw on our support, it's their home. It's the place they go to, you know, maybe for support during the day. The same as you and I, people choose to, you know, to sort of live and go to different places. So we have colleagues working in lots of different places in England and in Wales as well.

Speaker3: [00:06:57] Absolutely. Now, you talked about the wider setting earlier in terms of obviously, back in March, we've had lots of debate and discussion in the sector. We have a social care commission. You talked about the King's Fund report. The National Audit Office came out with a report back in February, highlighting really the financial sustainability of local government was very much brought to light. So lots happening in the sector. And the Social Care Commission does promise to answer some of the critics' voices that have been raised very loudly over the last few months.

Speaker1: [00:07:33] Yeah. I think, it's really clear that funding, if you look at the King's Fund, all these reports that you that you point to, it's really clear that there are increasing mismatches over a long period of time. You know, they sort of go back eight years and you can see, we talked about the much-needed increase in care workers pay. But actually the funding hasn't kept pace with that. And also people are living longer, which is fabulous. But actually less people are able to actually, you know, get the support that they want. And I think the commission's challenge, I don't think, is to identify what the issues are or what the solutions are. Actually, you know, I think we're on, I don't know, commission number whatever. It's just, you know, the fundamental issue is that there is no way of the government accessing, working out how to fill that gap in funding. That's the conundrum. And actually, because the work that we do is less of a political priority than some of the further inquiries and commissions and things are a way of pushing out that funding question for a bit longer. So I think the nub of the challenge for all of us in as kind of leaders in the sector is actually to sort of think about how do we get people to care and understand about how phenomenal the work is, the opportunity it gives to people, how much value that contributes. And I think if we can elevate and have people understand that, then we might have a chance at unlocking the funding. All the rest of it is noise because there's no money. So we've got to, I think, try to get people to understand and care in order to get some different funding solutions.

Speaker3: [00:09:54] So really, in essence, the government knows the problems, doesn't have the money, not prioritised it. And effectively, that's a communication issue now. So you've highlighted a messaging issue. And it's interesting, you've mentioned the work of Social Care Future, Lancaster University, highlighting that actually the advocacy and the way in which these questions are framed has quite a powerful effect in terms of grabbing policymakers' and all stakeholders' attention.

Speaker1: [00:10:25] Yeah, I think this is my kind of reflection on having thought long and hard about, gosh, you know, how are we going to try and, you know, sort of advocate.

Speaker3: [00:10:34] It becomes a broken record, doesn't it?

Speaker1: [00:10:35] Yeah, I think that is the nub of the issue. And it's completely understandable, isn't it, that it is so hard and distressing for people who draw on support, for colleagues, it's really unsettling. For providers who are, you know, I think people don't maybe understand... And if you think about the fact that, as I've said, the vast majority of providers who are employing colleagues in the sector are small and medium enterprises, essentially what happens is, you know, that in April the minimum wage is going to move to wherever that is set each year. And then that obviously, you know, sort of underpins how providers want to set pay. But what I don't think people realise is that then what you have to do is hope that you can then go to all of your local funding authorities and hope that they will cover that, but you don't know in advance. It's not a kind of logical economic circumstance that you might otherwise embark on. And I don't think people understand that. And of course, if you sort of go back to the King's Fund numbers of pay has gone up 17%, over 8% of funding for working age adults has gone up 13%. Then actually over time the cost of the pay that people really need and deserve hasn't been funded. And actually if you look forward that's you know, that's what the issue is. So what that does, it means if you hear people talk about care often, it's, you know, social care is in crisis. We're on a precipice. We're going to have to, you know...

Speaker3: [00:12:31] Collapse.

Speaker1: [00:12:32] You know, we want to tell people of the distress that people are under. However, I think what that does is unfortunately mean that that people, you know, there's a lot, isn't there, just now. I don't know about you, but, like, I kind of don't really watch the news at night because I don't want to listen to it right before I go to sleep. And so adding to that cacophony maybe means that the people that we need to be able to listen and engage, actually can't. You know, the Social Care Future is a brilliant sort of people-powered movement that want to sort of influence and imagine a positive future. And they've done research that proves exactly this, which is the more we talk about an imminent crisis and a precipice and things, the less people...

Speaker3: [00:13:19] Are engaged.

Speaker1: [00:13:20] Are engaged, and actually, I think what we need to do to unlock the money is to flip the narrative. Be bold. Be hopeful. Be imaginative. Be creative. And I think then we might have a chance of unlocking some of the solutions that we desperately need.

Speaker3: [00:13:45] It's interesting because the language has been very critical over a period of time. And I think the work that you're developing with other leaders in discussing, I think some of the evidence shows that actually, if you get the messaging wrong, there's also misunderstandings, isn't there, about social care, because I think there's some research done showing that maybe a third of people still think that the NHS provides a significant proportion of social care, and a lot of it's free at the point of use, which is interesting after all these years.

Speaker1: [00:14:18] Yes. That's exactly. You know, we're immersed in our world, right? And we use all these sort of acronyms and terms and things, and we just think that, you know, everybody gets it, right? But the truth is most people don't. I mean, I think you're rightly referring to the Health Foundation have done some polling and, you know, if you look at the current government, part of their proposed solution is to look at a National Care Service. Well, actually, 75% of people have never heard of a national care service.

Speaker3: [00:14:48] Despite the fact that it was in the manifesto.

Speaker1: [00:14:49] Yeah, exactly. I think in 2022, as you say I think it was 30% of people thought the NHS provide the care and 38% of people think it's free at the point of care, so you can really see the challenge that we have to win hearts and minds to our cause.

Speaker3: [00:15:19] The positive messaging, I mean, reference has been made in the literature to President Obama's campaign, which was couched in "yes, we can", much more positive type of language. You talked earlier around bold ideas. I want to see if we can touch upon some of those now. And I think the mission or the vision that you've been talking to other leaders about is compassionate, well-resourced, relationship-centred.

Speaker1: [00:15:45] Yeah. I think one of the things that is absolutely in the heart of care is if someone needs to, if you or I need to draw on some support and able to live our life. What makes that really positive and possible is if we have people round about us, who know us, who understand us, who can understand where our hopes and aspirations are, you know. On big things and small things and also if we have people round about us who believe in us, actually, I think when that sort of nexus of a relationship exists, then that is such a powerful place. We see people who draw on care, live the fulfilling lives they want to live. But we also see how that improves their health outcomes. But it's not just the impact for them. It's also if we look at, we've done some research on this in colleagues in Choice, but it's the same across the piece. There's also a very positive effect for the people who are offering that support.

Speaker1: [00:17:06] You know, they develop confidence and skills and listening. And we also see their well-being improve. So there's this really, really powerful possibility of a relationship. And when, when those networks and it doesn't need to be paid. That could be family relationships. It can be friends. You know, it's a sort of big network. When you get those networks of relationships around all of us, then things work, right? But what social care sometimes does is talks about, you know, hours and prices and services. And this isn't a commodity thing. It's actually much more profound and complex than that. And I think what could be really exciting is if we can get to that. You know, these are really powerful relationships. That's something that can energise people. You know, something that people can be proud of. And I think if we can, you know, get into the stories of what that means for care workers and for people who draw on care, that I think becomes quite interesting.

Speaker3: [00:18:10] That's a powerful moral argument, operational argument. It's also an economic argument because I think there is evidence, I think you've alluded to it, with effective advocacy. Every pound spent on effective advocacy. You have a financial background, of course, pays back not only to social care but also to the NHS.

Speaker1: [00:18:30] Yeah, but it makes sense, doesn't it? I had actually had a mum contact me last week and her son, where he lives, the commissioners for her son's care have somewhat unbelievably offered a 0% uplift in his fees for this year. And she is desperately worried that the place where, his home for nine years, where he has all these established relationship that that might be at risk. And you can see that we've seen Mencap and other people, and I and I think if you, if you sort of think about that then clearly that local authority and their funding is under such pressure, but actually what is the what would the risk be of disrupting those established relationships and moving somebody from their home actually that potential cost and risk is significant. You know, they might miss signals of health deterioration. The move in itself might cost.

Speaker3: [00:19:48] The cost could be much more significant.

Speaker1: [00:19:49] Exactly. So it's that sort of how do we think more in a more joined up way about where the investment and things. I mean, it's very much the same discussion that's been had at the moment about, you know, welfare and things. You sort of cancel one part of it without thinking about. So I think it's absolutely fundamental to think about, you know, where those relationships are. And actually that's got such promise and potential. You know, if you think about there's discussions just now, isn't there, about AI and technology and how is that going to change jobs and the workplace? Well, if you come to care, not much, because what it can do is take away some of the dull bureaucracy and make it a bit safer.

Speaker3: [00:20:34] The crushing burden of admin is the phrase.

Speaker1: [00:20:35] But you're actually still going to need a person in a relationship, right? So this is work that becomes more and more valued as we sort of look forward, I think. And I think if we can get excited about the real potential, then we can...

Speaker3: [00:20:55] Maybe get people engaged, including all policymakers. You talked about bold ideas. So part of the movement around Social Care Future and your own discussions with leaders talk about five bold ideas, maybe not able to cover all of them. One is fair funding. So I think we all understand what that's about. But the other one that you talk about, of course, is elevation of the workforce. And would be interesting to talk about that, because that goes beyond merely, not merely, but pay and conditions, but it's elevating the work that's actually done.

Speaker1: [00:21:27] Yeah. I mean, I get really excited about this. I was listening to Rebecca on this podcast also being, you know very... So I think it's about 1 in 20 people in the UK are working in care, right? That's huge.

Speaker3: [00:21:41] That's massive.

Speaker1: [00:21:42] But you kind of think, well, where is the voice and the representation for people there? And I think if you maybe sort of compare that to health where colleagues working in the health system have very strong representation. I think there is huge potential to understand and to hear the expertise of people who work in care. So, like, if I just think for example, in Choice, and I think this is the same through lots of different places. We don't do anything without going to colleagues and particularly the sort of managers of services and say, what do you think? What's working, what's not working? How can we do this? They are the absolute, you know, sort of experts. They've typically been working, I think 80% of registered managers in our organisation have been promoted from within.

Speaker1: [00:22:54] Now I think that's actually quite typical. We're really proud of that. But I actually think it's quite typical in care. And if I went to retail or to hospitality or to financial services, that is a sort of opportunity that for expertise and development that you would cry out for. It's phenomenal. It's such a great career route for you know, for colleagues who want to kind of learn on the job. But there's also really lots of formal learning, but you can progress really quickly. It's such a great career opportunity. And as I said earlier, we can also see evidence about how life-changing that is for colleagues and how much experience and expertise there is in the sector. So the question for me is how do we represent that better? How do we tell the stories of all the people who have found their energy and their experience and their confidence and their skills and their leadership skills and their ability to listen to people who, you know, might communicate differently from you. And maybe not verbal, you know, that's just like such a deep experience and expertise.

Speaker3: [00:24:09] As I was listening to you, you said it earlier, we're sort of immersed in the sector. There's a world outside the sector that doesn't know. And I think it's a really powerful point because within health you have organisations that represent, very vocal on behalf of nurses, quite rightly, doctors absolutely. Care workers. That's a different maybe. I mean, there's some great work being done by the Care Workers charity, of course, who, you know, we know very well. So the question then becomes, how do we do that?

Speaker1: [00:24:39] Yeah. And I think that's as you say, the Care Workers charity recently convened, lots of different care workers together. And actually that group said we think we should be registered and recognised, and I would be completely in support of that, I think. Let's go. Let's get you registered and recognised so that all of these facts and figures and statistics that I'm talking about can be used in this discussion, so that, you know, who should Baroness Casey be talking to the people...

Speaker3: [00:25:08] That actually deliver.

Speaker1: [00:25:08] Yes, exactly. And the people who draw on care. You know, there's people like, you know, you and me and lots of others. But actually, how does she make sure it's truly representative of the people who draw on care? And those people who are, you know, who are supporting them, you know, where do you get that? I think it's really important for us to think about how do we elevate these amazing colleagues in care.

Speaker3: [00:25:33] Absolutely. No. And you're clearly very, very passionate about that. Let's go to the other one of the other bold ideas and merge two of them together, which is the community-based, centred support. You alluded to earlier volunteers. It doesn't have to be paid. It can be informal, but the people who draw on care. This idea that actually they have a voice and agency to co-create. What's been your experience on the ground of that? Because that's been advocated for a little while by some, like Social Care Future, but a long way to go.

Speaker1: [00:26:07] Yes. So I'm going to tell you two different stories actually to illustrate this I think. So properly listening to the people who draw on care. I think it was IHI years ago that used to talk about instead of saying to people, what's the matter with you? You know, what's a much better question is to say what matters to you, right? And I think that just epitomises where sometimes some of these things can go wrong. I was talking to a parent months ago, and he was describing, you know, my son has this and he has these needs and he has. And I was saying, well, what does he love? Like, you know what gives him joy in the morning? Like, I get all that stuff.

Speaker3: [00:26:50] We don't hear that question that often. We just don't.

Speaker1: [00:26:53] No, that's the thing. And so just before Christmas, I had a really moving email from the sister of a lady we supported who lived in her home for ten years, and her sister said that she wanted me to hear the eulogy that she had read at her sister's funeral about how happy her sister had been in her home. She'd lived in 15 or 16 different homes and hospitals since she'd been a young girl, until she came to live in her home. And her sister said that one of the many things that just made a difference was that the team there took so much time to try and understand where and how this lady was happiest. And actually her thing was animals. She grew up on a farm when she was very young, and the team figured this out. And so she would regularly visit and volunteer at a farm. You know, she was really into Doctor Who and could watch as much, but I think it was the farm that really...

Speaker3: [00:28:10] Ignited her.

Speaker1: [00:28:10] Yes. And her sister sent me the copy of her eulogy. And that, I think, is like is just the epitome of when we talk about, you know, services and hours and needs and care ratios and things. Actually what was important for that lady was...

Speaker3: [00:28:29] Is the lived experience.

Speaker1: [00:28:31] Is I want to be with animals like that's my place, right. That's where I'm like, that's where I'm happy. And I think it's making sure in all of this stress and pressure that that's the question that we're asking, like, what's your thing? Right. What works. And then this kind of community thing I think is really important. You know, we're talking about moving. It's one of the big shifts, isn't it, in the NHS and moving things into the community and things. But it's like what does it mean? What does that really mean? And one of the things I inherited, a choice which I really love is there's this huge social network in the organisation. And one of the highlights of everybody's year is we have a talent competition of Choice Got Talent. And, the team that run it travel all over and do regional auditions and there's all sorts of skills and abilities, and then we hire a huge venue and have the most amazing day and lots of people can come. And actually, if people don't want to come, we stream it live. We do online voting. I mean, it's just fabulous. Anyway I was, I was visiting a home down near the coast, and I could tell one of the girls was and she sort of came up and she said, I recognise you from Choice's Got Talent. And I was like, I remember you. You were just fabulous. She was quite shy and she kind of opened up and she said, oh. And then she, you know, sort of told me her kind of story. And she talked about how important that was for her. She likes singing but didn't really have a way of like...

Speaker3: [00:30:13] Expressing that.

Speaker1: [00:30:13] Yeah. Where am I going to sing. But she was supported and encouraged and, and it's a really fab environment. It's like everybody can be themselves and they're, you know, some people get up on the stage and then it takes a wee bit of time until they want to get going and everybody is fine to wait and they're just, oh, it's just fab. Anyway, she had said this was just, you know, the sort of beginning for her, but sort of better than that. She then met a couple of other people there who lived nearby, who are now her friends.

Speaker3: [00:30:43] So they were unconnected. They were unconnected prior.

Speaker1: [00:30:45] Not before she did it. But they also have barbecues locally. And, you know, she jumps on the bus now to see her friends, and she has, she's just got a local busking license, and she's going to start busking along with the manager of the service, who unbelievably plays the ukulele. But what you could see is how, you know, it's not. Sometimes we just think about the person who draws on care and then the people that are with them on a day-to-day basis. But it's much, much more, it's more than that. It's like, what does what do you want to do in addition to that? Do you want to be able to sing? Do you want to find a place to sing? Do you want to have friends? How do you build relationships with friends? How do you do that in a way that...

Speaker3: [00:31:33] Giving the space for authenticity.

Speaker1: [00:31:35] Yeah, but I think just finding the ways and means and the desire for all of that is also really important. So yeah, I think that can also be such an important part.

Speaker3: [00:31:47] So we talked about two of those bold ideas, the people who draw on the services, people who provide the services. We've talked about Care Workers Charity as a vehicle for the latter. In terms of making sure Baroness Casey hears from the people who draw on the services. What things have you seen, or do you think could be done to make sure that voice is really clear?

Speaker1: [00:32:05] Yeah, I think I actually think Social Care Future are doing a super job. You know that is a movement convened by people who draw on care. They've been really vocal in working the recent inquiry in the House of Lords. I think you can see the influence.

Speaker3: [00:32:19] We were very privileged to have Anna Severwright here with us.

Speaker1: [00:32:24] She's fabulous. So I think it's just that elevation of, you know, I think we all have a role to amplify the voices of the people who draw on care, rather than pontificate on our own views. I think that is completely secondary.

Speaker3: [00:32:43] It's a really important shift.

Speaker1: [00:32:45] Yeah. And I think if we can collaborate in that sort of mindset and perspective, you know, what's more interesting and what's going to get people engaged and hopefully, you know, help solve the funding conundrum. They're not interested in me, but they're probably really interested in, you know, some of the...

Speaker3: [00:33:04] There are a lot of people interested in you; otherwise, you wouldn't be on the podcast. But I know what you mean.

Speaker1: [00:33:08] The stories of the people, what's working and not working for them. And how do we solve for them?

Speaker3: [00:33:15] Absolutely. Yeah. So moving from the very quintessence of care, which is the people, to an adjunct, which is one of the other bold ideas I wanted to just end with on this part of the podcast is you've advocated the importance of technological innovation, AI, so just briefly touch upon how do we position that as being an enabler to promote the sector?

Speaker1: [00:33:39] Yeah, I think it's part of like a really exciting future, isn't it? You know, care has maybe been slower than other areas to adopt technology, but actually I really see it going at pace now in so many different areas. You know, if you think about somebody who is really sensitive sensory being able to, you know, shout at your lights and have them reduce is, you know, how fabulous is that?

Speaker3: [00:34:12] Science fiction, not long ago to be able to even do that.

Speaker1: [00:34:15] Yeah. But it's really, you know, if you're sensitive to sound and light and things like having control over that in your environment is so much easier. But you know, things that, you know, digital care records, you know, we're kind of trialling things where you go into the kitchen and you have to remember that maybe your food requirements are different than my food requirements. Well, there's like a little code I can just scan and it says.

Speaker3: [00:34:42] It takes care of it.

Speaker1: [00:34:42] Yeah. You're like, wow. That's just you know, that's making everything easier and safer. So I don't think it replaces, I'm all for the human connection and relationship. But it frees up your time from, you know, writing records and having to read things. And you know, it can just and also I think it can be really empowering for people who draw on care and for colleagues. One of the most popular things we've done is we have Choice Hub, which is almost, I would say like a sort of internal Facebook kind of Instagram thing. And honestly, like if you ever have a bad day, I just sort of sit and have a little oh, it's like, you know, Tom did this and we were off here and so-and-so just got her Level Three. And then everybody like connects with it and they're like, oh, well done. Like that's just fabulous.

Speaker3: [00:35:33] And it takes the focus on.

Speaker1: [00:35:34] Oh, it's so good. And it connects all, you know, as I said, we've got sort of 110 different settings. But actually it's like really energising because, you know, it brings together the, you know, all the people that are drawing support. And because they love seeing people sort of thriving. So some of these tools are that is so simple. It's not complicated technology, really powerful. Like just, you know, so I think the I think the potential for digital is huge to free up energy.

Speaker3: [00:36:07] Well, hopefully, there was a report by the county councils network in February showing that nine out of ten councils are actually using AI to varying different degrees, removing potholes to all the other provisions. So I wanted to talk about councils, if I may, just to bring the conversation to a sort of broader context in this whole advocacy piece because they're going to be very important partners in any conversation, given the fact that they commission so much of the care. ADAS produced a report. I think it was called Time to Act, where I think they're beginning to recognise that the narrative, as you've advocated, does need to change.

Speaker1: [00:36:46] Yeah. I think you can begin to see that. I think one of the I guess the structural challenges is, you know, this is not a sort of centrally commissioned single area of kind of public expenditure. It's complex, right. People who draw on care, huge workforce and very fragmented provider. But of course so many different commissioners as well, and their structures are changing as well.

Speaker3: [00:37:15] It's quite a balancing act because the National Care Service, obviously Scotland were along that road which they have had to scrap. So as you say, it's a very complex moving parts.

Speaker1: [00:37:26] Yeah. But I think the question is can, you know, do we all think maybe flipping the narrative a bit and being more bold and energetic and hopeful? Do we think that might get the attention in order to help solve some of the sort of sustainable funding things? But you can definitely see lots of these lead organisations beginning to pick up this kind of hopeful narrative. So I think the key is, can we get there quickly? And just kind of be bold and hopeful for the future.

Speaker3: [00:38:05] And then one final question, if I may, we're well ahead of any initial findings from Baroness Casey, and it's obviously the final report's 2028, etc, etc. But given your long experience, given what you're calling for as a change of narrative, what would you like to see come out of the commission, perhaps in the short term and broader, fairer funding, of course. But in terms of practical things that can help all stakeholders, including providers?

Speaker1: [00:38:33] Yeah, I would just actually like to see the commission elevate the helping this task of let's us educate, elevate, energise, give recognition to the importance of the energy of the people who draw on care and care workers. I think if the Commission can help us all do that, then actually we get to the and I know that Baroness Casey is really, really well respected for that as well. So I'm very optimistic about it. But for me that's the key to the secret is can we. Yeah. I actually think she probably knows, you know, the answers right now. But the key is how do we persuade of the need for the funding? And I think we do that by being hopeful.

Speaker3: [00:39:35] Well, on that hopeful message, hopefully the commission and all of the stakeholders are listening. Thank you very much for your time, Valerie Michie.

Speaker1: [00:39:43] Thank you very much.

Speaker3: [00:39:44] I really enjoyed it. Thank you. 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 turning the dial on the health and social care debate, please visit newcrosshealthcare.com/voicesofcare. In the meantime, I'm Suhail Mirza. Thank you very much for joining us today, and I look forward to seeing you on the next podcast.

Speaker2: [00:40:05] Voices of Care, the healthcare podcast.