EP:30 A NEW BEGINNING FOR CARE:WILL THE NATIONAL CARE SERVICE SUCCEED?

INTRO: [00:00:00] Stories, labels, Misconceptions, NHS remains a blessing. Created in 1948, we want it to remain great. A podcast where we share our stories, explore solutions in all their glories. They say it's broken, but it's not done, with your host Val Barrett and Dr. Jeremy anderson.

Val: Welcome to Stories, Labels and Misconceptions with Val Barrett. 

Dr Jeremy: I'm Dr. Jeremy Anderson. 

Val: And this week we are going to be talking about the new National Care Service. And the question is, can we really fix social care?

[00:01:00] 

Dr Jeremy: This is very exciting Val.

We've been talking about for a long time on this podcast is the need to fix social care. 

Val: Exactly, because I'm Miss Mona. I moan about the lack of social care and the fact previous governments haven't got a handle on it and then I read about this commission. 

Dr Jeremy: Yeah, I missed the announcement.

So apparently Western made the announcement that there's going to be this National Care Service. I actually don't know enough about the current system. It's opaque to me because I have no experience with it. When people need care at home, they get a care package.

Val: They're going to pay for that.

Dr Jeremy: And coming from Canada, I thought a care package meant somebody baked goodies and left it on their doorstep. That's what a care package is in Canada. 

Val: I would not pick up anything off the floor that had edibles in it. 

Dr Jeremy: People use the term, a package of care or a care package. The system in this country is [00:02:00] local, like council by council, they offer a certain amount of support for people with certain kinds of needs. 

Val: When you own property, parents usually want to pass it on to their children. That's the usual thing. If they need care, i. e. if they're unfortunate enough to get dementia or they have a stroke and they need to go into a home, when that house is sold off, money is taken away from that property to pay for their care. As far as I know. 

Dr Jeremy: Okay. 

Val: That still happens. For those that don't have a property, there is some care available. 

Dr Jeremy: Yeah. 

Val: There's care and there's care. I remember looking for my dad we went to a few places You had five star, they [00:03:00] had a restaurant, cinema bar, so nice. And then a 1969 care home. Old fashioned, basic not pleasant to look at. I don't know. Yeah. It just wasn't. 

Dr Jeremy: And so what's the difference between five star care and the old fashioned care home?

Val: I imagine with, it's They're doing it between the NHS and private healthcare. 

Dr Jeremy: Okay, if people can pay they get good care. 

Val: I wouldn't say you're getting whatever's provided by 

Dr Jeremy: the local council, it's mediocre. 

Val: I'm not going to say the actual hands on care is going to be better or worse. Because we shouldn't Look at that as if just because it's in a very cheap, basic care home versus a care home that a lot of people can pay for, like a thousand pound plus a week. Sure. That the care is going to be any better because people are people wherever they work. But you're more likely to go out on better trips. Your surroundings [00:04:00] are nicer. Your rooms are nice. It's just nice. 

Dr Jeremy: Yeah. 

Val: What's the word?

Dr Jeremy: Aesthetically? 

Val: Yeah. 

Dr Jeremy: Yeah. 

Val: It's modern. Do you know what I mean? 

Dr Jeremy: Sure. But no matter how modern it is, if the care is substandard and, you have disabled people, sitting in dirty diapers for hours on end.

They don't use the word diapers. 

Val: When are you going to integrate into British society, how long have you been 

Dr Jeremy: here? 

Val: What? How long have you 

Dr Jeremy: been here? Oh I'm sorry. I should have said. Nappies? 

Val: Come on. 

Dr Jeremy: Okay. So a nappy just completely full, marinating in your own urine. That's what we're talking about, right? 

Val: Don't give me that image. 

Dr Jeremy: Don't. 

Val: He's not the one I want to be. Take for instance the food. 

Dr Jeremy: Yeah. 

Val: If you look at some private schools, the menu is like restaurant food. 

Dr Jeremy: Yeah. 

Val: And then you look at a state [00:05:00] school, the menu is just basic. Yeah. Even the food's different. Everything's different. We're always going to have a two tier system. Those that can afford vast amounts and those who can't. Not to say the care itself should be two tier. We want equality across the board, let's get into this. We know the Labour government commissioned Dame Louise Casey to lead a review on creating a national care service, a system that's supposed to do for social care, what the NHS does for health. Now, this sounds brilliant. 

Dr Jeremy: It sounds like exactly what you've been calling for, what the two of us have been calling for on this podcast. It's like they've been listening to us. 

Val: But as usual, the devil is in the detail. [00:06:00] How it's going to be paid for, because there's going to be a big cost.

Who will it help? Can we afford to wait until 2026 for phase one and 2028 for phase two? We can afford to wait because there's nothing here at the moment. We've waited so long for different governments when they've come in.

First thing they announce is we're going to sort out social care. Then they realise it ain't that easy. At least Labour has fired the starting gun. And Dame Louise Casey. She's on that case. We'll wait until phase one comes in, the end report, next year.

So today we are unpacking what this proposal really means. And whether it's finally the fix, social care has been [00:07:00] promised for decades 

Dr Jeremy: so they haven't figured out all the details yet, but they have a framework of different phases they're going to introduce?

Val: As far as I know, there's two. Okay. And like I said, Phase 1 is next year. Phase 2 is 2028. Let me see what's going to happen in Phase 3. Do. So they want it to be a 10 year plan. So the 10 year plan must be delivered in 2026. However, the Department of Health and Social Care remit makes clear That the first phase of , the phase of the Casey Commission's work in 2026 must set out a plan for reforming adult care over 10 years.

With phase two, they're making longer term recommendations. The worry I have [00:08:00] for this is when we have elections. Unless You, the government, are guaranteed to stay in power for the next 10 years. That's unlikely to happen.

So would that mean when a new government comes in because we've been told that reform likes the American system, would this be all scrapped? And this is why I say, The precious NHS has to be taken out of politicians hands. Every time there's a plan, and this is the downfall of any government with a 10 year plan, it never goes to 10 years.

I think the most you can do is a three year plan. Which isn't much, but at least then it's guaranteed to be done while you're in government. Instead [00:09:00] of promising this, knowing you might not be around to foresee it and the next government can just, scrap it.

Dr Jeremy: Yeah. 

Val: I want government to be smaller. I want things like this to be independent of any government. It's way too important. To keep swapping and changing things, starting things, stopping another government, say we don't approve of that, so I don't know.

Dr Jeremy: Right. Some people say the NHS or national care service is government. So when you want government smaller, you're not saying you don't want these things. 

Val: I just don't want them to be the political Health is so different in some cases you are messing with people's lives.

[00:10:00] People not getting diagnosed earlier with cancer, not getting their hip replacement, let's get back to the plan. The department has asked the Casey commission to consider older people's care and provision for working age disabled adults separately, recognizing these services meet different needs.

I'm glad they've done that because they are different needs. Not everyone can fit into one box. It's not clear whether this heralds a plan that would initiate a more formal split between the two types of service, currently delivered under a single system operated by local authorities.

Dr Jeremy: Right. 

Val: The plan for the commission's 2026 to 28. Work is briefer and vaguer. 

Dr Jeremy: It [00:11:00] seems like the details are pretty vague, what do you see as the problems with the current system in terms of the way we provide social care now? What's wrong? What are we missing? What are we lacking? 

Val: It's just not fair. 

Dr Jeremy: It's not fair.

Val: what's the word it's sparse. 

Dr Jeremy: Sparse. Yeah. 

Val: It's very rarely there. Very rarely kicks in. We want a system where elderly people are not In the NHS, on a bed, when they're well enough to go home, but can't because there's no social care.

Dr Jeremy: There's no social care. I heard about a patient this week just discharged from hospital after multiple surgeries they need care. Several people per day but that's going to drop off within a week or two because the system says after that amount of time, you're cut off.

If you want more, you have to pay for it. How does somebody who's not working who's disabled and had surgeries, pay for it? They only get a carer coming in three times a week. 

Val: That is what the commission is going to look at.[00:12:00] 

Dr Jeremy: Yeah. 

Val: I hope. Something's not dissimilar to the NHS we pay money. towards the NHS, whether you use it now or not, one day you might. 

Dr Jeremy: Yes. 

Val: It's about creating something similar a separate pot, not the same pot, a separate one, because it's going to have to be there.

The service is different. In some cases, the service is about keeping people well. and out of NHS. 

Dr Jeremy: Yeah. 

Val: Receiving them from primary care so they can recuperate and get better, but also to keep them at home. And then you've got carers that may need a break. You've got the elderly that don't need hospital care. but can't live on their own. 

Dr Jeremy: Right. 

Val: But don't [00:13:00] need a home. See what I mean? That middle bit where you can't be alone, don't have to be in a care home, but still need somebody coming in.

Dr Jeremy: Right. 

Val: It'll be interesting when we meet next week. To see what's going on in other countries, we could have a system where you've got some older people. , They're living on their own in a big house. What about having cheaper rent? If a young person can move in, there's a country that does that.

Somewhere does it. I read about that. And they move in, get cheaper rent in exchange for helping care for that person. Perhaps we need to look at options like that, have cross generation support. 

Dr Jeremy: Yeah. 

Val: So say like you've got. Care workers. [00:14:00] Let's look at the care workers that haven't been thrown out the country yet. 

Dr Jeremy: I was thinking about, the problems, the reason we don't have enough social care. Oh, we're going to get onto 

Val: that. We're going to get 

Dr Jeremy: Yeah. We have not enough money and not enough people.

Offering cheaper rent, to younger people is trying to get more people doing the work. That's one way to do it. We don't have any details yet, but, putting more money into the system is going to be important too.

Val: Services have to come under the NCS, the National Care Service. Care homes, home care, disability support all those, and all those won't have the same model. They don't need the same system, but they all need the same thing. Staff. 

Dr Jeremy: They all need staff.

Val: Staff or it isn't going to work. 

Dr Jeremy: You 

Val: It's modelled in [00:15:00] theory on the NHS, universal, publicly funded consistent across regions. But we know that's going to be a huge challenge given how uneven the current system is. So we know that one. Currently, social care is run by local authorities and we know up and down the country, the care is different.

So we have a postcode inequality. We hear in certain areas, you're likely to get care and then certain other areas, and I have the figures here, don't get care. So we will always have that from it's. led by the local authority. That's how it's going to be. So it's postcode lock, a national care service would [00:16:00] aim to standardise care access, pay and training.

So like how we talked before that doctors and nurses that on a register Anyone that works with the vulnerable should be on the register. There's a register in Scotland. They need to change the way they look at this workforce. It's a workforce that is skilled.

Dr Jeremy: Yeah. 

Val: They've got to stop thinking it's unskilled and pay them better. You hear horror of how some are treated there's no national register because we know when it comes to the NHS, we know in some cases doctors might be struck off, nurses might be struck off.

The same should go for social care staff. There shouldn't be any difference. At [00:17:00] all. So the other point is Dame Louise Casey, will publish initial findings by 2026 and full rollout plans by 2028. Around 1. 6 million people in England, age 65 and over, have unmet care needs.

So that's almost one in eight older people. Now that's just people aged over 65. Don't forget the other group is disability support for adults. Let's look at age 18 and over. You've got that or even younger, because you've got a group that don't live in a home, so we've got to look at those provisions as well.

Dr Jeremy: You people working in social care support workers is there currently [00:18:00] no standard or training required or certification? 

Val: I imagine there is, we talked about this before. I couldn't find it. 

Dr Jeremy: Obviously people need their DBS like their criminal record checks.

Val: You would hope so. 

Dr Jeremy: Yeah, but in terms of trying to attract people to an occupation, you want to give it status, better pay, better 

Val: I remember when we talked about this before, Scotland has that, but England doesn't. When we had an episode about social care we noticed Scotland seems to have a better plan.

There's a recognised qualification and a register. Wales might have something as well. 

Dr Jeremy: England is lagging behind. 

Val: Yes, unfortunately. Okay, 

Dr Jeremy: so does that mean care workers in Wales or Scotland are paid better? Are they? 

Val: Don't know about the pay. 

Dr Jeremy: Yeah. 

Val: But when it comes to [00:19:00] standard, we hope there is a decent standard throughout, regardless of pay.

Dr Jeremy: Because if you're doing an occupation anyone can do with no training, they just say, okay, go and, I don't know, wipe this person's butt or something like that. That's not a high status occupation. Those people get paid very little money.

Val: Yeah.

Dr Jeremy: They get paid minimum wage. . But the idea is, if in order to do that job you have to have certain, you have to have completed certain courses, certifications, qualifications, background checks so you demand a higher wage.

As you demand a higher wage that occupation. is viewed as higher status it becomes more attractive do you want to do something for minimum wage? Or invest in something that's going to get you paid quite a bit more?

Val: That would attract people to 

Dr Jeremy: the profession, right?

Val: Of course we want that to happen. But it's one of the lowest paid sectors in the [00:20:00] country. And the turnover of staff is almost 30%. That's high. 

Dr Jeremy: Yeah. Very high. And I wonder what kinds of people do that job? 

Val: Low 

Dr Jeremy: paid, no qualifications.

Val: Remember, until they decide to get rid of their social care work visas, I'm telling you now, they're going to have to get them back. Social care is only going to get bigger. If we seriously want to be a nation where we're talking about health, talking about wellbeing, we're talking about keeping people out of the NHS, which is a good thing.

That's a good thing. Then these people need to be taking care of In social care, we talk about mental health, that should be down here. Shouldn't it? [00:21:00] Mental health. 

Dr Jeremy: Yeah, that's a good point. 

Val: That shouldn't be dealt with , in the NHS, not in A& E. I've seen it happen. No, not 

Dr Jeremy: in A& E. They 

Val: So really the NHS, should be part of this big social care plan.

Just like you have a bag of all sorts in the NHS, but the NHS is streamlined. You've got hematology, neurology, cardiac, so you've got all those departments. And people that work in them, specialise in those areas.

Dr Jeremy: Yeah. 

Val: What is the National Care Service going to look like? Because you're going to have people that are experienced and qualified in dementia care, stroke care. 

Dr Jeremy: Yeah. 

Val: You're going to have mental health services. They're going to have to be better. There's going to have to be more.

Dr Jeremy: There's going to [00:22:00] have to be continuing education or professional development where people enter at a certain level, get experienced, specialize, do training. And command a higher wage, right?

Because because they have that experience and that that training. And I think the kind of professionalizing the sector. is what's needed. Now, all that means we end up paying more for it, if we step back and take like a bird's eye view of the society, we've got certain things that people say they want or they don't want, That it doesn't really jive, right?

If you don't want to pay high taxes, 

Speaker 5: right? 

Dr Jeremy: If you don't want to provide these services we have a demographic problem. We don't have younger people to take care of older people, we have a huge demand. If you don't want kids and don't want high taxes, that leaves bringing people into the country. But if you don't want immigration, we have to find a way to provide care in a way we can afford. Either the people here have [00:23:00] to do it or we have to bring more people in.

Val: We know the service is already stretched, and I don't believe you can reform a service as big as this, that is going to grow and grow without talking about raising the standard.

It's got to raise there's no ifs or buts, because if you want it to be an offshoot. I don't know the word. If you want it to replica the NHS, then you have to look at everything that you have in the community, some things don't need to go to primary care. Only because there's no secondary care. 

Dr Jeremy: Yeah. 

Val: We're gonna need more community doctors, community nurses, I remember when my son Andre was young, [00:24:00] we used to have the community nurse come around to take his blood through his vortex port and flush it. That was done at home, we didn't need a trip. to the hospital not every nurse knows how to use a vortex port. You need that expertise. 

So might be catheters, can you think of anything else that's more a nurse might need to do instead of just Someone that isn't a nurse that can be done in social care. So you Bloods can be taken at home. 

Dr Jeremy: I don't want to speak for nurses, but I can imagine lots of things done in hospital. But if you had someone with the requisite expertise and they could do that in the community, it might well be more efficient to to do that, in someone's home where it's not a big hassle for them. They don't miss [00:25:00] appointments, they don't expose themselves to infection or injury or something like that.

Val: I think there's going to be a time whether today or tomorrow, that people on dialysis might have it at home. 

Dr Jeremy: Dialysis is something people can do at home. Oh, is it? Yeah. No, not the hemodialysis is something that they've branched out into smaller clinics, but but there's a kind of dialysis that people do called peritoneal dialysis, where they have fluid going into their abdomen.

And it flushes things out. It's not, they're not dialysing the blood, they're dialysing through this abdominal fluid but that's something someone does on their own at home. And so it's more efficient and frankly easier for the person because they have to do that five times a week. So what they can do is they just, hook up a bag and it goes by gravity. 

Val: And, 

Dr Jeremy: And they just sit there for. 30 minutes or an hour until it drains in and then, [00:26:00] they leave it in for a few hours and they drain it out. 

Val: Yeah. 

Dr Jeremy: Patients can do that themselves. More stuff like that where people can take care of themselves in the community or have someone come in and, Take care of them. 

Val: Yeah. 

Dr Jeremy: Without needing to go to hospital. 

Val: Yeah. 

Dr Jeremy: Definitely a good thing. 

Val: But when we talk about the workforce, in social care, there's 152, 000 vacancies.

Dr Jeremy: They can't find people to do those jobs. 

Val: Some people don't want to do it. It's not just can't, won't. But people that came into the country to do jobs like that, they no longer want them. So what are we supposed to do? 

Dr Jeremy: Make those jobs more attractive, right?

Val: I don't think it's just that. Cleaning someone intimately you can't dress that up we know it's not just about that. 

Dr Jeremy: Yeah. 

Val: If you're going to work in care. Or be a nurse, it's something you want to do.[00:27:00] 

Dr Jeremy: Yeah. 

Val: Regardless of the pay, it's something you really want to do. 

Dr Jeremy: Sure. 

Val: Some people do it even when the pay's low,

Dr Jeremy: yeah. Retaining people right? People, don't like their job, but can't give it up because the pay is good. Right? 

Val: Yeah. 

Dr Jeremy: That wouldn't be the worst problem if you had this care sector so well paid that vacancies were filled because people, really wanted to keep those jobs that would be really good.

Val: At what cost? 

Dr Jeremy: It would cost. 

Val: Now let's say the pay attracts anybody that wants a job. But does that mean you keep that person, even though they hate it, show they hate it and they're not doing the job well. Does that mean you keep them on because there isn't anyone else? 

Dr Jeremy: No, obviously [00:28:00] if someone isn't doing the job, then it's not the right job for them, of course. So 

Val: it's not just the pay. 

Dr Jeremy: It's 

Val: conditions, the hours as well. 

Dr Jeremy: Yeah, I wonder if someone was, given a really good wage for that job, would that make you like the job more?

No. You don't think it would change your perception 

Val: nope. 

Dr Jeremy: No. 

Val: No. I, 

Dr Jeremy: I, I think, money 

Val: isn't everything. It is, when you want your bills paid. 

Dr Jeremy: No, of course, money isn't everything. I just I recall this one guy in a clinic I worked in back in Canada. Who made a lot of money with a tanker truck. He would suck up whatever fluid people needed. So he would empty septic tanks, and But it wasn't just that. And he was like, no, it's not just poop. Everyone just thinks it's poop. It's not. He would get rid of anything, [00:29:00] right?

. But it's a job nobody else wanted to do. But he just it was, it's a fairly simple job, . And he had the equipment and could charge whatever he wanted he loved his job, but that's different. 

Val: He could charge whatever he wanted, and it wasn't really. A hands on job? 

Dr Jeremy: It was hands on because you got to put the tube in the tank. 

Val: Tube. Other than that, he didn't have to clean anyone. Just him his truck and a tube. 

Dr Jeremy: Yeah. 

Val: That's different. 

Dr Jeremy: Yeah.

Val: We're talking about people that have to work and communicate with vulnerable people. Yeah. Those people that may have dementia, where one minute they're okay. Next minute they may lash out. Dealing with people that have had strokes, that can't verbally communicate. You've got to have a variety of skills. You can't have someone there just for the money. 

Dr Jeremy: Yeah. 

Val: Because they don't [00:30:00] understand or hasn't got the patience to, patience. They take it out on that patient. No. These people are vulnerable enough, someone that wants to do it.

Yes. The pay should be better, but no one should take the job alone based on the pay. I don't believe for one moment that a nurse does nursing because the hours are great. And. The pay is the best ever. The conditions are brilliant.

I don't believe that for one moment. People getting to nursing because it's what they wanted to do. It's a vocation. It's not because if it was down to the pay and the conditions and everything else, we would hardly have anybody. They're on their feet for a lot of hours. 

Dr Jeremy: There are people who, when they think about a career do think about the money, right?

Val: Okay. 

Dr Jeremy: [00:31:00] If nursing or care professions are well paid, those professions become an option for someone interested in a decent wage, right? 

Val: I don't know. 

Dr Jeremy: Think so? 

Val: I don't mean, I'm not the psychologist. I might need one after this.

Dr Jeremy: You don't think people do that or you don't think people should do that? I don't 

Val: think people do. You've known me a while. I'm not a horrible human being, but there's no way on this earth would I be a nurse, no matter what amount of money they offer me is

Dr Jeremy: yeah. I'm not suggesting that just because they increase the salary it would become an option for everyone, 

Val: exactly. It's not

Dr Jeremy: okay. If we circle back to social care, we've got 150,000 vacancies, right? Yeah. 

Val: Hundred 52,000. 

Dr Jeremy: If there was a government program that doubled the salary for those vacancies, do you not think we'd fill them?

Val: There's so much more the government needs to [00:32:00] do to make this sector more attractive. If they don't fill these vacancies, the reliance is going to be more on people like me, unpaid carers, who may have to leave the workforce. To care for loved ones.

We already know, I'm sorry if I'm going on about dementia, we already know that there are some needs that once they get to a certain level, you need somebody qualified that can care for that person. 

Dr Jeremy: Yeah. 

Val: When the family can't, not because they don't want to, because they can't, I've watched a few people with it

it's just different. It breaks their heart to say, I can't cope anymore. 

Dr Jeremy: Yeah. 

Val: Know, 

Dr Jeremy: What would make a job more attractive? in the care sector more [00:33:00] attractive?

Val: It's got to have appeal. It's got to have somewhere you can go within that sector. 

Dr Jeremy: Job progression, right? A sense you're always learning, developing yourself, 

Val: but you can move 

Dr Jeremy: up. 

Val: Like I said, I think the whole of social care The structure needs to completely change. You'll have the social care staff, then you'll have palliative care nursing because you've got that sector as well. Don't forget that's in social care. 

Dr Jeremy: Yeah. 

Val: Then you'll have nurses, staff that specialize in dementia, stroke mental health.

Dr Jeremy: Or developmental disorders, like autism 

Val: community nurses, community doctors. So it becomes like a mini NHS in the community. A system that is fair, [00:34:00] whether you are in SW10 or in. The North of England, it shouldn't matter. You get that same level of care because people are paying the same level of money into the system.

And part of that is you need the right workforce and getting rid of the visas. They, that's going to haunt them. It really, and that tells you how much they think of the social care sector, because whether you are a recipient of it today or tomorrow, a family member might be, you might be, but it's something that all of us, whether we're physically fit now, We're running marathons or whatever.

Every [00:35:00] one of us should care about social care. We're living longer with illnesses that people used to die from 30, 40 years ago. It shouldn't rely on unpaid carers who have to leave the workforce.

Sometimes their relationship breaks down, their marriages do. Sure. Because they're caring for a loved one because there's nowhere to put them and there's, and they don't have the funds. They don't have the money yet. That loved one worked all their life, paid into the system. You had a generation where I think it was Winston Churchill, one of them said they would be cared for from cradle to the grave.

And unfortunately that's not happening, so I [00:36:00] dread to think that if they don't reverse this social care visas, more adults will leave the workforce to care for a relative because it's going to be them to carry the can because the government has not readied this social care. We've been waiting for years, and I still think it is going to take a long time. But let's look at what Scotland are doing.

Val: So we know that Scotland is already trying this. 

Dr Jeremy: Okay. 

Val: They've been building their own national care service since 2022, but it hasn't been smooth sailing. Nothing new is. No. You don't expect it to. So the key points are delays and rising costs have led to [00:37:00] criticism, questions about whether centralising care actually improves outcomes.

We can discuss that. Thirdly, carer groups worry about bureaucracy overshadowing person centred care. So what do you think about centralizing care actually improve whether they believe it does improve outcomes? 

Dr Jeremy: Centralizing anything, sounds like a good idea. If you have a smaller number of people 

Speaker 6: kind of 

Dr Jeremy: at the top controlling things. You should be able to get something done, right? But that comes at the cost of local solutions for local Problems, understanding the needs of the people in a particular local area might have different needs than, somewhere else, right? So having localized, control gives you more flexibility. So I suppose, there [00:38:00] is a bit of a trade off between kind of this, the the equal or standardized care versus the flexibility to give people what they need. 

Val: Perhaps it needs to be localised.

Dr Jeremy: Maybe, but the system we have now is localised it's the local council that does 

Val: stuff, 

Dr Jeremy: right? 

Val: They're the ones that dictate. how it's done the framework is delivered from the department of health and social care. This is a framework you have to follow.

Each local authority, should know their needs are in their area. So Kensington, Chelsea might have more people with mental health issues. Than Hammersmith and Fuller. No point in over flooding it with something else, i'm expecting a national framework, [00:39:00] funding and support for local authorities. when it comes to funding, staff a model training. So wherever you live, up and down the country, everyone's trained the same. 

Dr Jeremy: There's a national 

Val: standard. There's a register, but each area has its own plan, so to speak.

Do you see what, do you see what I mean? 

Dr Jeremy: Yeah. 

Val: Because that's the only way to improve the outcomes in an area. If you're delivering something that the area needs, does that make sense? 

Dr Jeremy: Yeah. 

Val: Yeah. Learning from Scotland is good because they've gone through it. They started it in 2022.

The Scottish experience shows a tension between national consistency and local [00:40:00] flexibility. If England cop is the same model without fixing workforce pay and funding, we'll just have a new logo not a new system. I'm sorry. 

Speaker 4: Yeah, exactly.

Val: Yeah. But,

oh dear, but it is, I, it's not going to be easy. 

Dr Jeremy: No, 

Val: By far, this is one of the hardest things any of the governments had to do, which is why they haven't if it was easy, they would have done it they always go for the easy thing.

Let's chop away benefits, but not build, a new social care system. At least the firing gun has started. Once you start, it can be built upon, look at other models, look at what has worked well and what hasn't worked so, so well, because we know it's like an NHS trust, each trust.

Dr Jeremy: Yeah. 

Val: We've got the [00:41:00] NHS and soon the NCS. Yay. 

Dr Jeremy: Fantastic. 

Val: Let's have a look at the psychological and social impact. 

Dr Jeremy: Okay. 

Val: So for people who rely on care and those who provide it, this uncertainty takes a real toll. Emotional labour, financial pressure and constant anxiety about whether support will continue. And we know that. 

Dr Jeremy: Yeah, enormous pressure on families when you're trying to care for a loved one, either, like a parent who's got dementia or someone else in the family who's disabled.

The the impact on just time and finances and uncertainty is stressful. I was thinking, I can't remember where I heard this, there was a study a few years ago looking at happiness and income and what they found, as income goes [00:42:00] up happiness tends to go up, which isn't a huge surprise.

Really? They say money can't buy happiness, but apparently it can. 

Val: Let's give it a go. 

Dr Jeremy: Yeah. 

Val: Let's give it a go.

Dr Jeremy: But at least up to a certain point, it's basically where you're not constantly worried about having enough. To pay the bills 

Val: yeah. 

Dr Jeremy: You don't have to be filthy rich. Just rich enough where you're not always thinking about money. If you're in a family where a care need comes out of, maybe you weren't expecting or even if you weren't expecting it and, someone has to leave their job to care for mom or dad or whatever that puts an additional financial burden on the family.

Aside from concern about the family member and care there's a new concern about, okay what about, are we going to make it, are we going to pay the mortgage or pay the rent 

Val: Yeah. And as we are stressing more and more in society about bills, because it's why I can't stand it when people [00:43:00] say, money's not everything.

It is when you've got a letter saying, if you don't pay your rent, you're going to be thrown out. Says the person with money in their nice house. It's only people with money that actually say that forget the time when they didn't have. Yeah. Understand. Yeah. So when it gets to the point where you are working so hard.

And you've got nothing at the end of the month to show. That must be shit. 

Dr Jeremy: Yeah. 

Val: What am I doing? 

Dr Jeremy: Money's not everything, but it is quite a bit. 

Val: Don't say that. I'm gonna be different. Money is everything. Money is everything.

If you think it's not give it to me and I will show you it's everything. All right. 

Dr Jeremy: You'll be happy to be proved wrong. 

Val: Driving in my Ferrari. 

Dr Jeremy: Yeah. Being an unpaid carer is not just about the stress [00:44:00] of caring for the person. It's everything else that comes along with it. Everything's connected. 

Val: Exactly. Dr. J. 

Dr Jeremy: Okay. 

Val: Let's finish 

Speaker 4: okay.

Val: I'm just going to do a misconception.

Dr Jeremy: Yeah. 

Val: One of the biggest misconceptions about social care is people think it's only about the elderly. In reality, half of social care spending supports working age adults with disabilities or mental health needs. 

Dr Jeremy: Half, fully half. Wow. Okay. 

Val: What's your misconception, Dr. J? 

Dr Jeremy: Oh, I don't know. I think you pointed out a good one, right?

That social care is not just, for the elderly. It's for people right now. I think misconception. I was thinking about this this idea that like at the moment we're not attracting enough people into these roles despite the need. And so for a [00:45:00] something that we had immigrants do, right? And I don't know if there's so much of a misconception, but, I wonder if just my own experience with the immigration system. When you come to this country to work, you're required to work in the job you applied for the visa under. You can't change. 

Val: Didn't know that.

Dr Jeremy: As you live and work here 

Val: and 

Dr Jeremy: if your status changes, once you get indefinitely to remain and you're not applying for visas now you have a choice. You don't have to stick with a specific employer. I can imagine there's lots of people who come to this country at least when they had the social care visa who you might think they're doing this because they love working in social care, but maybe they don't. Maybe they don't have a lot of choices. 

Val: Don't know.

Dr Jeremy: For for people from some countries where people routinely go abroad to bring, to send money back [00:46:00] home. Yeah. The local training you might only have a choice of becoming either a nurse or a maid or a custodial worker. 

Val: A maid? 

Dr Jeremy: What's that? A cleaner,

Val: it's a bit old fashioned. It's a bit old 

Dr Jeremy: fashioned. Okay, we can edit that 

Val: me 

Speaker 4: up. 

Dr Jeremy: But what's the modern term for that, like a house cleaner, right? Why the fuck you 

Val: use the word maid?

Dr Jeremy: Oh god. 

Val: Yes, this 

Dr Jeremy: is, this is adventures in cross cultural linguistics.

Val: Do you use that in Canada? 

Dr Jeremy: Oh yeah. You're 

Val: kidding me. 

Dr Jeremy: I was thinking there's a lot of people who do these jobs and they don't have a lot of choice in the matter. It's just, this is what their opportunities

but once people get choices, once they have the means. Maybe they make different choices. And I think we have to factor that in to whatever changes we want to make to the, to our [00:47:00] systems in terms of providing care we have to understand that we want to give people choices, the choice to do this job.

And yeah, what are the changes that we need to make? To make people make those choices.

Val: There's one big misconception I thought you would have said. 'Cause you mentioned it in the beginning. 

Dr Jeremy: Okay. 

Val: Because you are new to the country and the way the system is. 

Dr Jeremy: Yeah. 

Val: A lot of people think even those born here think the NHS covers care needs. 

Dr Jeremy: Oh, it doesn't. 

Val: Social care is means tested. . And is completely separate from the NHS. And some people don't realise that until they need to access it. 

Dr Jeremy: I experienced it this week hearing about a patient who, was under NHS care, when discharged, they were told they weren't going to get sufficient, care at home, despite the fact they [00:48:00] have a pretty lengthy period of convalescence.

Val: So that's the end for this week. If you're like me and you've listened to this and you're caring for a loved one, please know your effort isn't invisible. You are holding up a system that should be holding you. Take a moment for yourself, breathe, rest and remember care starts with compassion.

We know the conversation on social care won't go away and neither should our compassion. So join us next week to talk about social care systems in other countries and see what England can learn. 

Dr Jeremy: Sounds great.

Val. 

Val: Thank you. Nice to see you, Dr. Joe Moomin. It's been a long time. Great to see you too. 

Speaker 4: Hi 

Val: Junkie. 

Dr Jeremy: Will do. 

Absolutely. 

Val: [00:49:00] See, i'm saying it right. That name has to change. Okay. Bye. 

Dr Jeremy: Thanks. Bye bye.