Val: [00:00:00] Welcome back to Stories, Labels and Misconceptions with Val Barrett. 

Dr Jeremy: I'm Dr. Jeremy Anderson. 

Val: And today we're talking care, not just who gets it, but how it's done around the world. We talked about the National Care Service last week. That's been proposed in the UK, but is it the answer?

What can we learn from countries that have tried? Let's see.

Dr Jeremy: Good question, right? What's been proposed so far, I was looking into it. As you said, they got Dame Louise Casey to head a commission to figure it out. Their recommendations are due in 2028. They've allocated some funding towards that until then. 

Val: Phase one. 

Dr Jeremy: Nothing's going to happen quick, right? 

Val: It's 2026. 

Dr Jeremy: 2026 is 

Val: phase one. I don't know what phase one is. 

Dr Jeremy: I think it's this planning and consulting phase. Nothing's happening [00:01:00] yet. They have to figure out what model they want and come up with the money 

Val: An idea how it will be publicly funded. And I have an inkling it is going to replica the NHS. There's going to be an extra fund. That only goes to the NCS, the National Care Service, so there might be, extra tax, extra national insurance. If we want social care for the future and a social care that is a bit more equal. Then we have to think about funding it the same way as the NHS

Dr Jeremy: right. 

Val: Hopefully not as complicated as the NHS, but we know when things start, they get bigger. So it's about them not just planning for 10 years, it's about them [00:02:00] planning for the future. for beyond that. 

Dr Jeremy: Yeah. 

Val: Because people are living longer. And I think 

Dr Jeremy: It's new for England, but there's no such thing as a new idea.

So trying to figure out how to do this, , they're going to be looking at where it's been implemented already. And so as we said last week, Scotland and Wales have started to implement their systems. Countries around the world that are, or that have tried this already.

And they're dealing with some of the same issues that the UK is. So it's interesting to take a look at how those systems are structured, how they're funded, how they work, because it may give us a preview of what might be happening in the UK. Yeah. Or, yeah, 

Val: Let's look at Japan.

Dr Jeremy: Okay, so Japan, very much like the UK, but maybe even further along in terms of demographics. Something like 30 percent of Japanese people are over 65, so they have a huge number of [00:03:00] people to look after and a smaller workforce, I don't think we're like that in the UK, but we're moving in that direction. Our program is going to face some of the same problems Japan is having. 

Val: Yeah. 

Dr Jeremy: And another issue I think is similar between the UK and Japan, as we talked last week, a lot of the care jobs are being done by people who immigrate but we also have this anti immigration attitude in this country.

We want Reduce immigration. Japan is notorious, famous or notorious, you might say, , for not being keen on immigration. How do they do this when it's fairly difficult to immigrate to Japan, but they've got this massive population that needs care? How do they do it? 

Val: Okay, I'm just trying to find out how much it cost.

Dr Jeremy: The research I was doing was showing that Japan was, they fund it through a, a long 

Val: term care insurance. 

Dr Jeremy: It's an insurance [00:04:00] program everyone over 40. has to pay into you get care based on need, but everybody pays into it. And it, it emphasizes autonomy and local care. 

So they, there's never enough money for these systems, they have a system for paying for it. The challenge with this system, I think, is, workforce issues. They have an agreement to bring in workers from places like Philippines or Indonesia or Vietnam, but, it's still difficult to get a job in Japan, people have to be able to speak Japanese, right? Exactly. If you're going to be working with elderly Japanese people.

Val: But it says here, if somebody is aged between 40 and 

No one: 65, 

Val: the premium would be 11. 58 percent of their salary to pay into this, insurance scheme. 

Dr Jeremy: Yeah. 

Val: Yeah. , And they've been doing there since [00:05:00] 2000. 

Dr Jeremy: Yeah. 

Val: They have an ageing population. 

Dr Jeremy: Right. 

Val: Japan and China. 

Dr Jeremy: Yeah.

One of the ways they're coping with, their demographic problem is, using technological solutions. There's no such thing as a solution, only a trade off technology can solve problems, but creates problems, right?

So if you have AI or remote monitoring or robots, basically doing the job of a person what kind of problems does that cause? People become isolated. Right? 

Val: True. 

Dr Jeremy: If there isn't someone to monitor see talk to them and care for them, you could get older people who are, maybe getting their basic needs in terms of food and, you're getting lifted from, bed to a toilet 

No one: by 

Dr Jeremy: a, by a robot.

If they're not getting any social contact, now you've got people isolated lonely and miserable. So that's [00:06:00] not good. 

Val: What's surprising he says it's funded through taxes and mandatory insurance premiums for everyone age 40 plus.

Speaker 5: Yes. 

Val: What about those? We talked last week about adults with a disability or mental health. 

Dr Jeremy: Yeah. 

Val: What about those below that age? 

Dr Jeremy: It's the 40 plus who are paying In terms of care for people below that age, I don't know if this falls into that system or if there's a separate system.

Val: Cause that's quite a late age to start paying. You would think from you start to work and you start paying taxes that you be starting to pay into the system. 

Dr Jeremy: You'd think so. Yeah. 

Val: So I found that strange. They provide home based and residential care for older adults. They see care as a right, [00:07:00] not a handout, and part of social citizenship.

Dr Jeremy: Yeah, that is something not unique about Japan, But Japan is more collectivistic 

Val: Yeah 

Dr Jeremy: If you're elderly and need care, that's not viewed as, a failure or you didn't make it, you didn't, you did something wrong, that's just, the need for care, it's considered a social obligation that as a good community member, you would do your part to help provide care.

Val: It's managed nationally. or delivered locally, balancing consistency and flexibility. 

Dr Jeremy: Yeah, I think that's a, that's an interesting, thing to think about when we compare the different systems, because, I guess there is a question of, what's the best way to run the system? Centrally at a national level or more locally?

You could imagine a centrally managed system would be more, more equal because [00:08:00] it would be easy to just say everybody gets the same thing, but a local, a locally managed service would actually address the needs of the local 

Val: community. 

Dr Jeremy: Maybe not every system would need to be the same because the needs are not the same.

Val: Yeah. 

Dr Jeremy: Right. 

Val: But the lesson to be learned there, it says Japan integrates health and social care, focusing on aging with dignity and prevention rather than crisis care. 

Dr Jeremy: I think that's hugely important. 

Val: Where here, I don't know how it is there. in, in the winter.

But here, when the flu seasons arrive, even though we know it's coming, still not prepared, still don't have enough beds. We're still not thinking, what can we do differently in the winter months? Cause we know that is the month where we're more likely to get [00:09:00] ill. The older you are, the more vulnerable you are, you're more likely to get sick.

So you would think something like, when they start to give out the flu jabs, they might start to open up the, what were they called? When they did the COVID, wards, the nightingales. 

Dr Jeremy: Mhm. 

Val: They might just use those in the winter months. Sure. Do you see what I mean? Yeah. 

Dr Jeremy: In terms of prevention, encouraging people to eat healthy food, exercise, changing diet, reducing smoking, are preventive measures to keep people healthier, longer.

Val: Those will prevent certain things, but we're talking about the flu season. 

Dr Jeremy: hmmm 

Val: It's more like it always happens, whether people are healthy or not, people are more likely to catch flu when you're vulnerable. So there's a time when they should think, okay, [00:10:00] this is a time when we need more bed space, but right now we haven't got social care as we would like it. So we can't discharge patients yet. What can we do in the meantime we have the nightingales Some people say they didn't use it in COVID,

it was there. It was kitted out. You can't have the elderly on trolleys. You shouldn't be using a corridor as a ward. Everyone deserves to keep their dignity. It's each year we don't learn from the previous year I'm sure they map out the likelihood of XYZ happening in winters. I'm sure they have an average, that might need beds.

Dr Jeremy: Yeah. So that's the Japanese system. Maybe we should think about, some of the other [00:11:00] systems I know, what came up for me doing the research was, Denmark the Netherlands and Sweden. I don't know if you found other places. With a similar system. Let's have 

Val: a look. Ooh, your hometown of Canada. 

Dr Jeremy: Canada, has a system. So Canada's a little bit different, I think, than, than some of these other sort of smaller geographical countries. Healthcare in Canada is managed at the, provincial level.

Val: Yeah. 

Dr Jeremy: There's some federal funding. Canada is divided into a number of provinces and territories. The federal government handles some things, but other things are managed at the provincial level. More regional?

Val: Would that be similar to our local authorities? 

Dr Jeremy: Yeah, similar to that. I think local authorities in England are more like, municipal. They're associated with cities the UK, is sort of England, Scotland, and Wales, in Canada, it's one larger country, but there's large sections , of the [00:12:00] country divided into provinces, and then below that is cities or municipalities.

So it would be like a separate system for England, Wales, and Scotland. or Northern Ireland, would be like provincial systems.

Val: Don't forget devolved governments. 

Dr Jeremy: Yes. 

Val: Practically do what they want. They make different decisions. Very similar. Because they are devolved. 

Dr Jeremy: Provinces in Canada have their own legislatures. 

Val: Yeah. 

Dr Jeremy: Where they pass bills and manage things. Education and healthcare are the domain of the provinces in Canada. Different, care services in Canada would be regulated at the provincial level.

Val: So you have different variations across Canada? Yes, 

Dr Jeremy: you wouldn't have the same system depending on where in Canada you live, yeah. 

Val: So would that create a lot of inequality based on funding or is every province allocated a set amount per capita,

Dr Jeremy: That's interesting. [00:13:00] Different areas of the country are more economically prosperous. Yes. And so some areas are going to have more money. But in, in Canada, what we have is a system of what we call equalization payments. So recognizing that, we don't really want there to be really stark differences between.

The haves and the have nots in terms of provinces. And so what happens is that provinces with a lot of money. end up paying more money in than they get back, and that money goes to the have nots. So it, the idea is that kind of equals out the level of service across different provinces. And of course, when provinces are making a lot of money, like Alberta, for example, with the oil patch makes a lot of money. They pay a lot of money in, and they don't get as much back and they feel hard done by, especially if they don't get a lot of say in how things go and if they don't want to build pipelines and things. Then there's resentment [00:14:00] builds 

Val: Would Canada be like here where you do have an NHS and a private. Healthcare 

Dr Jeremy: yeah, although I think it's more developed in Canada, you can have, private clinics, if you need an MRI scan, 

Val: you 

Dr Jeremy: Go to a private clinic and get a scan

Val: we have that here. 

Dr Jeremy: Okay. 

Val: Yeah. 

Dr Jeremy: That's a good point. I'll have to look into what's available in public versus private and what you're allowed to do that would vary by province. 

Val: Oh no, we've got places because I remember something was going on, I was watching the news, and Rod Stewart offered to pay for people to have a scan, when he went for his, there was no one else there, and people are waiting for years he goes private. So he offered to pay for a few people to go where he went, 

Dr Jeremy: yeah, 

Val: it's sad in a way, but then you would think when it's that bad the NHS might say [00:15:00] to the private sector, can we buy X amount of spaces? Yeah. At a certain time of the year because I remember there was something where people going to France to have surgery. And I think that was paid by the NHS. 

Dr Jeremy: Yeah. Because people 

Val: were waiting so long. 

Dr Jeremy: Yeah. 

Val: You've got empty spaces in the private sector. 

Dr Jeremy: People 

Val: Waiting for years. 

Dr Jeremy: Yeah. And that's healthcare. What did you find out care service in Canada? How is that done? 

Val: Let's see what it says. Honestly, it doesn't say much. 

Dr Jeremy: Presumably it's funded at the provincial level and then probably administered. Municipalities. 

Val: It says here, Canada has a patchwork system. 

Dr Jeremy: Patchwork, 

Val: okay. Canada shows the, so different system. Yeah. 

Dr Jeremy: In different places. 

Val: Shows the risk of fragmentation. Provinces run their [00:16:00] own systems, 

Dr Jeremy: yeah. 

Val: Some integrate care brilliantly. Others don't. Huge inequalities in access to care. 

Dr Jeremy: Is there an urban rural split? 

Val: It doesn't say, no. 

Dr Jeremy: It seems to me that, if you live in a large urban centre, you've probably got resources and, services set up.

But if you're in some tiny little town somewhere, off the beaten track, there's probably nothing in your area. Yeah, 

Val: Yeah. I Don't mean to be doom and gloom but this strive to have a system that's equal and accessible to all, it's never going to be. And when you strive for that and can't get it, it says it's failed.

Dr Jeremy: And then 

Val: people say it doesn't work. 

Dr Jeremy: It's especially difficult in a large country like Canada. Vast distances. But what about small countries? Denmark is a small country. 

Val: Small, more [00:17:00] manageable. 

Dr Jeremy: Right. You 

Val: Let me have a look at what Denmark says.

Dr Jeremy: They do it alright. 

Val: They have universal elderly care. 

Dr Jeremy: Okay. 

Val: Every citizen is entitled to free care, including home help, meals and nursing. They focus on independence, helping older people live active lives for as long as possible. No means testing.

Dr Jeremy: Sounds great. 

Val: So the lesson is, when care is treated like healthcare, as a right, it becomes preventive and less costly long term. Things are not looked at early enough, quick enough, the cost comes further down the road. Yeah. We know that inequalities in health isn't just about how you may view health in terms of hospital care. It [00:18:00] incorporates housing, how you live. 

Dr Jeremy: Here's why Denmark is one of the happiest places on earth. 

Val: Why I'm moving there. They might not want me to, but I'm coming. Where 

Dr Jeremy: are the challenges with Denmark? 

Val: Look, there probably are some, but I haven't got that. Let me stay in my happy mode with Denmark for five minutes.

Dr Jeremy: So I'm looking for the worst. I'm going to try and focus on the negative here. 

Val: Know what, you made me lose my train of thought. 

Dr Jeremy: Happy 

Val: place, happy place. When we look at the social determinants of health, if those are not tackled, housing, employment, education. If we don't tackle those things. 

Dr Jeremy: Yeah. 

Val: If you go into hospital, say you have a chest infection. You go in, they patch you up and send you home [00:19:00] to a house with damp and mould. You're going to get it again. 

Dr Jeremy: Yeah. 

Val: What we do is face a problem.

Dr Jeremy: Yeah. 

Val: We don't face the symptoms, the cause that makes, there's always cause and effect. I just said about the chest infection. They'll fix the chest infection, but they don't fix the cause of it, which is the damp and the mould in the home. We don't focus on those issues because we see it as a housing issue instead of a health concern.

Dr Jeremy: Right. 

Val: One of the issues we're always going to be stuck with. Look at Glasgow. As soon as they changed knife crime into a health concern, it reduced knife crime. 

Dr Jeremy: Yeah. 

Val: Like to put things [00:20:00] in their boxes, housing, Education, employment, or benefits. They don't call it employment, they call it benefits.

Dr Jeremy: Okay. 

Val: Perhaps they gave it a positive name. 

Dr Jeremy: Yeah. 

Val: And health. 

Dr Jeremy: Yeah. 

Val: You've got all these departments which you would have. 

Dr Jeremy: Yeah. 

Val: Each department needs their pot of money. But all lead to one big place. You don't tackle housing, health. 

Dr Jeremy: Yeah. 

Val: You don't tackle good education. You're likely to make bad decisions and suffer from bad health. You're unemployed. You stress. Because you're not doing anything. You're not reaching your potential. 

Dr Jeremy: Yeah. Next door to Denmark is the Netherlands. They also have a national care [00:21:00] service with their long term care act. And so I think they differ from their neighbour, in that, It's a bit more individualized.

They have, people can opt for personal budgets for care users. So there's a strong emphasis in this system on personal autonomy. So it's not just that you need care. And so the government says, okay, here's what we'll give you. They say, we'll give you a certain amount of money and you can use it the way you want it.

That seems like a good idea, in terms of giving people choice, I suppose that then raises the issue of, like people may not know what they need, it puts a burden on people to figure out what the, what is the care I need and how do I get it?

I've got the money for it, but now. How do I get it? How do I get what I need? So that can be a problem.

Val: But also with this view of looking at health, we can't keep looking at health [00:22:00] in isolation and wait until you feel pain, you feel discomfort or, because you don't take your car for an M. O. T. because it's not working. You take your car for MOT to keep it working. So we take care of a machine parked outside your home.

Dr Jeremy: Yeah.

Val: More so than we take care of ourselves until it's too late. Oh, I've had this pain for months. Then you see the doctor, but you didn't see the doctor until it got really bad. 

Dr Jeremy: Yeah, that's going to make it really expensive in the UK if people can't find a GP.

Val: Yeah. 

Dr Jeremy: A lot of people don't go for preventive care then come to get something checked or fixed. And you realise oh, this is much more serious than I thought, and now it's a lot more work to address that, right?

Val: But the story has never been about preventative [00:23:00] health, preventative care. 

Dr Jeremy: No. 

Val: Am I saying it right? I'm mixing myself up. 

Dr Jeremy: Preventative care. 

Val: Never been about that, about looking after yourself until you get pain. People think, Oh, you don't visit the doctor just to get a checkup you might go to the dentist and get a checkup, but to go and waste the doctor's time.

I'm not feeling ill. Not feeling tired. We tend to leave it until the feeling happens, because that's how some view health. It's a feeling. You've got to feel something. 

Dr Jeremy: Yeah. The problem is the things that cause ill health, like, there's no symptom of high blood pressure, right?

Exactly. But it's silently. Making you unhealthy. And you won't know until it's too late. 

Val: Until you get a blood test. 

Dr Jeremy: Yeah. You gotta take care [00:24:00] of yourself. It's all diet exercise reducing things that make you unhealthy and doing healthy behaviours.

That, that keep you healthy and then just monitoring and it doesn't cost that much to, go to a yearly checkup and just get checked. 

Val: This should be on the NHS. 

Dr Jeremy: I didn't mean cost to individuals, but cost to the system.

Val: It wouldn't be. It wouldn't cost 

Dr Jeremy: very much at all. Yeah. 

Val: They wait until he gets bad to somebody probably stage four cancer. 

Dr Jeremy: Yeah, that's much more expensive for the system to treat, at stage four and all the other services that need to get pulled in, and compared to if you catch it early. 

Val: We have to change how we talk about health. 

Dr Jeremy: Yeah. 

Val: It's not just about, okay, you diet and you exercise. That's going to help in certain things. 

Dr Jeremy: Yeah. 

Val: But you can be the healthiest person on earth. That's not going to stop you from getting cancer the only way to keep [00:25:00] an eye on that is to have every six months or yearly checkup. A full checkup, of your heart. Liver, lungs, everything, osteoporosis can come at any age, especially when you're older. Going back to the misdooming gloom, you could be as healthy as Jack the Bean and your social housing is unhealthy. 

Dr Jeremy: Yeah. 

Val: Shouldn't be allowed. Allowed that housing providers can get away with people living in a, potential killer. Because it is. Yeah, that's another silent killer. Your home can kill you. 

Dr Jeremy: Yeah, what this discussion is raising is something I was noticing when I was 

No one: researching 

Dr Jeremy: for this episode. There's different systems is it centrally managed or locally managed?

Do you as the user manage the money allocated to you, or does [00:26:00] someone else decide do you use technology or not? What kind of technology do you use? All that's great. 

Speaker 8: But 

Dr Jeremy: all of these systems, have the same challenges how do we pay for it?

Who does the job 

Val: exactly. 

Dr Jeremy: And, I think in order to tackle those problems and make the system successful, 

Speaker 8: Means 

Dr Jeremy: that it really does need to be a sort of whole government approach, right? So if you want to have a national care service it might require you to bring people in to do the job. So that means you can't be siloed in your part of the government and the Immigration Service or the Foreign Policy Service Ministry is doing their own thing.

You need to bring them in. Because you might need a visa program, right? 

Val: But haven't you noticed? When one policy area,

I'm going to say, I want to say this, when one area has a policy on immigration, from the home office, they all want to [00:27:00] cut down on immigration. That's fine. But then they talk about social care. Let's look at 

Dr Jeremy: that. 

Val: And to please a certain group of people, because Labour seem to have knee jerk reactions as and when things unfold, instead of having the guts to say, look, we're doing the right thing.

We need the care visas. for people to come in to run social care is already overstretched. And to take that away, it's going to be even worse. But yeah, they go with the people that's got the loudest megaphone.

Yeah. They go with the megaphone instead of having the balls to say, , you know what, this is best for the country. A policy in one area of government [00:28:00] impacts on the area that needs it the most. 

Dr Jeremy: Exactly. There's these competing priorities, right? So we want a care service.

We also want to reduce immigration. If we were planning on, developing a workforce for our care service by bringing people in that's not going to fit with reducing immigration. So, if immigration is not an issue, or is not an option, then what do we do we have to make working in the National Care Service attractive to people as possible.

Like the domestic workforce needs to be incentivized. To work there. To do this right, we need to make, jobs in the National Care Service at least as well funded and attractive as jobs in the NHS. So if you have people who really want to care for people, 

Val: hmmm 

Dr Jeremy: They need to be, given, dignity training prestige.

Career progression and, something where they feel like they're contributing, but there's also personal [00:29:00] development and career development, as they would get in the National Health Service. The same thing needs to exist in a National Care Service. 

Val: We did touch on that last week.

Let's look at the German model. They've been doing that since 1995. 

Dr Jeremy: Okay. 

Val: It's a statutory long term care insurance and the mandatory insurance is funded by workers and employers and it covers both home and residential care with options for family carers to be paid.

This encourages shared responsibility between the state and individuals. The lesson is sustainability comes from shared funding and a clear entitlement system. What do you think of that? 

Dr Jeremy: From what I can see, the funding is [00:30:00] paid through insurance premiums, so people are paying for this. And then there's co payments as well. I think that's where the sustainability comes in. They're trying to make sure it's properly funded. But also 

Val: Family carers can get paid.

Dr Jeremy: Yeah. 

Val: It really acknowledges care work as real work. As opposed to the UK giving a carer's allowance. They get paid. 

Dr Jeremy: That really is a key difference. They actually pay family members for this.

Val: The reality is it's emotional labour and Germany pays for it, 

Dr Jeremy: hmmm 

Val: That's what they do it's been going since 1995. We're going to have to find out how much they actually get paid. I could be spending six months in Denmark and six months in 

Speaker 9: Germany, depending 

Val: on weather, but yeah.

And I think like we said last week, the biggest [00:31:00] workforce outside of the NHS. carers, unpaid carers, because make no mistake, it's work. It doesn't matter that it's for a loved one or a friend. Family based carers 

Dr Jeremy: do need to get paid or some sort of credit. I suppose that raises the issue of how to pay for it though. 

Val: But they say, at that, member engagement event, they raised the allowance I thought, I ain't felt a thing, love. I ain't noticed it something else has risen and the money's been swallowed up somewhere else, where I don't feel that change.

Dr Jeremy: Do you think people would accept higher taxes to fund care for the elderly? A specific tax to fund the National Care Service?

Val: I think we have to be realistic. Whether they accept it or not. If you ask people, would they prefer not to pay tax? [00:32:00] Duh. Of 

Dr Jeremy: course, yeah. 

Val: It's one of those things that, if you don't need it today, You might need it tomorrow. That's why we've got to look at social care differently. We all might be recipients of it one day. 

Dr Jeremy: Yeah. 

Val: Pay more tax. That might have to happen. 

Dr Jeremy: The reason I was asking is because obviously before the, they were elected, Labour was promising they wouldn't raise taxes. And so they've really hamstrung themselves, in claiming that, they're not going to do this.

Nobody likes to pay tax, but part of the reason is the idea their tax money is going towards something that they're not getting any benefit for it.

But if you had something like a service where. Even if you don't need it now, you're going to get the benefit later. 

Val: But it doesn't matter. Would 

Dr Jeremy: you be more willing to pay for that? 

Val: Look, we pay tax and some people don't have children, but their taxes go towards education.

It's not something you can opt out and say I don't have kids. I ain't paying for that. So whether you are. [00:33:00] A recipient of the NHS, you have a long term condition. . Is irrelevant at the end of the day. Yeah. We pay tax, we expect the government that is elected to distribute, our taxes and the government of the day, Pay from our taxes what they need to. Healthcare, transport, education, better roads, better whatever. Whether you believe or not you're getting better. Is irrelevant. We've got to pay the taxes. 

Dr Jeremy: I don't have children. But I happily pay taxes to support an education system because, honestly, I recognize that our society is better for having, a population that is educated, that has access to education. Yeah. We don't want a population where the majority are not educated, we want a minimum level, right? Even if I'm not accessing this service. I don't want to live in a society where old people are suffering [00:34:00] and dying we don't want to leave people to suffer and die early. I don't want to live in a society like that. So whether I benefit from it myself or not, i'm still happy to pay the tax for that. 

Val: Whether you're happy and you know it, you've got 

Dr Jeremy: Do it, you've 

Val: got to do it. Yeah. 

Dr Jeremy: Yeah. Absolutely. 

Val: Have, you, they'll be knocking your door. Sending you letters, you'll be dragged away. You don't pay your taxes, so the biggest thing. How is social care going to be funded? If we want to keep people out of hospital. And help manage things at home better it's going to cost billions. More than people think it will. 

Dr Jeremy: The stat, I saw was, they were throwing around numbers like four billion pounds.

But given the number of care workers, that amount of money only amounts to about 20p an hour [00:35:00] extra, there's billions they could pour into this. You'd require, you'd require, 20 times that amount, to have a significant impact on wages. 

Val: But you know how much the NHS costs. It's gonna be huge. How much do you think it costs? Let me quiz you. You probably never get it. 

Dr Jeremy: Okay. 

Val: I'll give you three figures.

Dr Jeremy: Okay. 

Val: Do you think costs a hundred billion a financial year? 150 billion or 200 billion? 

Dr Jeremy: 200 billion. 

Val: 204. 9 billion by 2024 25. 

Dr Jeremy: Yeah. 

Val: Yeah.

Dr Jeremy: That's the NHS, right? 

Val: This funding, comes from taxation and national insurance and covers services like GP. Social care hospital care mental health and public [00:36:00] health initiatives. 

Dr Jeremy: Yeah. 

Val: We know mental health is a big slice of the cake. You slice. We talked about that last week in social care. 

Dr Jeremy: Yeah. 

Val: That costs more, than the elderly. Remember we mentioned it. 

Dr Jeremy: My sense with mental health is that. It's always relatively poorly funded. It might, 

Val: it, it might seem that way, but it costs a lot.

Dr Jeremy: Yeah. 

Val: It's area is inequalities. Depends where you live. 

Dr Jeremy: Is that cost in terms of money treating people, or cost, in lost productivity? People are not being treated. That's costing the economy 

Val: I think that's what I'm mentioning.

Dr Jeremy: Yeah. 

Val: It costs to run mental health services. 

Dr Jeremy: Wow. 

Val: Okay. It has increased and it is 18. 99 billion a year for mental health. 

Dr Jeremy: Is 18. 

Val: Yeah. 

Dr Jeremy: Almost 19 billion. Wow. 

Val: So you can imagine, cause it's been [00:37:00] rising. We know that's only going to get bigger. 

Dr Jeremy: Yeah. 

Val: I'm going to compare hold on so we can compare remember that figure. Oh, bloody hell ah, I knew it was cheaper. 11 billion on elderly care compared to 18. 99 for mental health care. Yeah. Mental health is a big slice of the cake. And yet people are saying it's not enough. 

Dr Jeremy: Yeah,

Val: will it ever be enough? We don't have an endless pot. People paying taxes have the right to question. Why is this growing? Why aren't people working? More people work, more people pay taxes. And to think that's cost a lot more. Then elderly. Wow. Yeah. It's huge. [00:38:00] 

Dr Jeremy: Yeah. 

Val: They have to figure out what type of mental health services how do they categorize it? What are they doing to keep people well, mind, heart, and soul, 

Dr Jeremy: yeah. You 

Val: know it's all right having these services, but you don't want people stuck in them if they're able to get better. I don't know much about mental health. 

Dr Jeremy: Yeah. 

Val: Are some able to get better? 

Dr Jeremy: Yeah. 

Val: Better integrate into society and work.

Dr Jeremy: Oh, absolutely. So the previous job that I did before I worked in sickle cell back in Canada, I was working in vocational rehab.

People who, many of whom were, either not working either because they got injured on the job or they were on a, on disability and our job was to help get them back to work. 

No one: And, 

Dr Jeremy: So it's one thing to say someone is capable of working. It's different to say somebody is a competitive applicant for a job. Right? 

Val: Yeah. 

Dr Jeremy: There [00:39:00] has to be a job for people before they can start paying taxes. Even if there is a job, a person with significant mental health problems or physical disabilities, may not be a competitive applicant for a job.

And if we're saying we're not going to support people because of mental health concerns. They can go out and get a job. Okay we need to make sure they're competitive. Otherwise we're leaving people to suffer.

That doesn't work either. 

Val: No, it doesn't. Okay, let's leave it there. 

Speaker 5: Okay.

Val: Anyway. To me, if we are going to create a national care service that keeps people well and out of the hospital. We need to integrate housing into that plan. Yes, it's going to have its own [00:40:00] entity because it's housing, but as we've learned

are there instances where people have died because of the mould in their homes? How are you to go to the hospital, have your chest infection or fixed up or patched up, go home to a home that is silently killing you. That makes no sense. We've got to look at all aspects, all the social determinants of health.

Dr Jeremy: Yeah. 

Val: Order to make people better. 

Dr Jeremy: Yeah. 

Val: It isn't going to work. It won't. 

Speaker 5: Yeah. 

Val: Housing is getting worse. 

Dr Jeremy: Yeah. I will just second that Val. I will just say, the label here is national care service. But to make it work, it's not just about care. It's not just a healthcare budget. It's a whole of [00:41:00] government effort to coordinate across departments 

Val: in order 

Dr Jeremy: to make it work.

So yeah, that's what I would say about that. 

Val: But what we'll do over time, we only just touched on Other systems around the world a tiny bit, but what we'll do as, the model is rolled out. In 2026, the first phase. 

. 

We can look at that. Even if we can get someone on Yeah.

Any of these countries, it would be great. To find out about, the housing. 

Dr Jeremy: Yeah. 

Val: If they have any, issues there, what we're having here, 

Dr Jeremy: Uhhuh, 

Val: And how they look at that. Do they put it under health? Because if Glasgow can put knife crime. Under health, we could surely do that with housing.

So like I said, it's how we view health. 

Dr Jeremy: Yeah. 

Val: Because everything leads to one place. The NHS. 

Dr Jeremy: Yeah. 

Val: We look at the cost at [00:42:00] the end of the journey. Instead of the beginning 

Dr Jeremy: yeah. 

Val: And thinking what could make this person's health. get to that point.

Dr Jeremy: We'll see if Wes wants to engage in some creative reframing 

Val: I doubt it. Do you have anything else? Any last words? Any departing? No, 

Dr Jeremy: no, that's it for this week one thing we didn't talk about so much this issue, but we might revisit it.

Next time is the idea of loneliness because I think Oh yeah, we're 

Val: going to talk about that. Yeah. That's a big one. 

Dr Jeremy: It's a big one, but follows on from this because some of the solutions to the workforce issues with a care service are techno solutions.

Speaker 7: Yeah. 

Dr Jeremy: Even if the technology can do a job, it leaves people lonely. That's a huge problem. We want a solution that works for people, but doesn't leave them abandoned and miserable. 

Val: We'll put that in the diary for next week. 

Dr Jeremy: Let's talk about that next time.

Val: We'll talk about that. So we will say goodbye for now. And yes, [00:43:00] you've been listening to stories, misconceptions. Join us next time as we debate loneliness. Okay. And is it just age related? Yes. I heard him on the audio. If he's got anything to say, he should have a microphone instead of being in the background, control your dog. Thank you, Dr. Jeremy. 

Dr Jeremy: See you. 

Val: Bye. Bye.