VoCEdDaveyFullEp 14.5.24.mp4

[00:00:00] Hello, I’m Suhail Mirza, and welcome to Voices of Care. My guest today, when he was appointed as the Liberal Democrat leader, stated that he would be the voice of carers and so aptly, Sir Ed Davey, very much welcome to Voices of Care.

[00:00:13] Voices of Care. The healthcare podcast.

[00:00:19] It’s a privilege to have you here. Now, you’ve been on record as saying that the carers and being a voice of carers is fundamental to you. That’s obviously a political and professional imperative, but your connection to social care and caring is profoundly personal to you, isn’t it?

[00:00:34] Yeah. And I think a lot of politicians take stuff from their private life and think about it and how it works in public life. And that’s definitely the case for me. So my father died when I was four and my mum was widowed with three boys under the age of ten. And she was amazing, brought us up. But then she became ill with cancer. And then eventually it became terminal. And for three years my brother and I nursed her at home until she died. So I was a young carer. And, you know, I think I was doing stuff you wouldn’t be allowed to do now, administering morphine and electric shocks, you name it. So as a young teenager, I was a young carer, then living with my brothers, lived with my grandparents, and particularly my nana, my grandmother, was very close to her. She looked after me. And then when she became frail, I sort of looked after her, mainly through care homes and sheltered accommodation and so on, but also a bit of personal care as well. And then my son, John, who’s now 16, it became very clear in his first year that he had some neurological problems. It’s still undiagnosed, but essentially it means he can’t walk or talk, although he’s making a bit of progress, but he’s going to need 24/7 care all of his life. So my wife and I, with support, provide care for him now. So caring has been part of my life, and remained very much a daily thing for me.

[00:02:12] And you bring that passion very clearly for anyone who observes, to the debate around the NHS and social care, just as a perspective as a politician, but also as a parent and looking at the state and the commentary around the NHS and social care. The British Social Attitudes Survey, this year recorded the lowest level of satisfaction amongst the public for the NHS and social care since records began in 1983. Uncharted territory we’re now on, massive waiting lists, etc. As you observe the landscape, what’s your view? I think you’ve said that it’s the worst you’ve ever seen it.

[00:02:47] Yeah, it’s deeply troubling. And people, when they can’t get a GP appointment, can’t find an NHS dentist, waiting a long time for an ambulance, you know, look at the cancer waiting times and all the rest of it that lie behind the findings you describe are deeply troubling to people, and they’re worried about their nearest and dearest. Employers are worried about their employees. You know, people are feeling this at a very profound level. And, there’s no easy fix, but there needs to be some long-term reforms, because if you look at the demography, if you look at what people are seeing in the figures for long-term health trends and long-term population trends, it’s not going to get easier to fix this thing. So we’ve got to think both about the problem in front of us. But we’ve got to think long term. And the political system hasn’t been very good at that in recent years, to say the least.

[00:03:39] No. And talking about this, let’s zero in on social care. Firstly, before we look at the NHS, often the poor relative of the NHS in perception, sometimes the problem you’ve identified and you’ve talked about this in terms of people not being able to access care, half a million people waiting for assessments, this is not a new problem. Social care and its reform and how we fund it has been around. I’m reminded of, I don’t want to age you, but you’ve been in politics for nearly 30 years. But under the coalition government, the Care Act, the works of Dilnot, I mean, this was very well trailed out. I mean, it’s been around for ten years as a policy priority.

[00:04:19] Yeah. Well, before the coalition, I was working with colleagues in my party, the Lib Dems, people like Paul Burstow and Norman Lamb and others, and we had identified a number of issues that the NHS wasn’t delivering on. Mental health was one of them, and care was the other in many forms, both social care and family care. And when we went into the coalition, we determined that we would bring those insights and those views to bear. And I have to pay real credit to Paul Burstow, Norman Lamb. I think they really worked hard. They listened to the sector. They were very much the driving force behind the 2014 Care Act. Obviously, it was looking at Dilnot Commission, which will remember paying for social care, but it went beyond that, Assessment for Carers, for example, and we felt that we’d managed to move our coalition partners to a position that they didn’t really want to go. There had to be some compromises on the way, wasn’t exactly what we wanted, but we got to a point and we thought there’s been a degree of consensus behind this. And one of the many things I was disappointed after the 2015 election. It just sort of was reneged on, particularly the paying for social care, and the funding of local governments meant that things like Assessment for Carers just sort of almost not happened. And what it means is we have a legal framework, you know, there’s a lot of work being done, but it’s not being implemented. Would we have to bring things up to date? Almost certainly. Was it perfect? No, it wasn’t, but there is a framework there for hopefully the next government to look to and take forward rapidly, but we need implementation. We can’t just have more words.

[00:06:05] No. And the words one is reminded of going back two Prime Ministers of the commitment in the manifesto to fix social care. So let’s see what the next Government brings. But staying on social care. You mentioned the role of family carers yourself as a young carer. It’s often a group that’s neglected in mainstream commentary. All the evidence shows that unpaid carers play a vital role without whom the system would collapse. But they also need support in terms of respite care. And I think this is quite an important element of your vision for social care.

[00:06:35] Yeah, I mean, we’ve clearly got to look after care professionals much better. And let’s talk about that in a bit. But I think care professionals would be the first to say, let’s also look after the families and the loved ones and the neighbours and the friends who do the vast bulk of caring inevitably. I’m not talking about child care. I’m talking about looking after disabled people, looking after elderly relatives, looking after spouses, you know, the whole gamut. And, it’s really quite a tough thing to do. And, you know, one thing I hope we can do much better on is make people understand that care is a tough job, should be valued much more, and people who are doing it, even if you’re doing it for your wife or for your son or whatever, your mother, if you are doing something that’s really quite important and people need to both recognise that and support you. I’m not talking about massive amounts of money either, by the way. You know, respite care isn’t that expensive really, in the scheme of things, when you’re keeping the family carers going, some training to help them do stuff. I mean, I wish I’d had training as a young carer, you know, I was administering morphine without being trained. Can you believe it?

[00:07:55] Astounding.

[00:07:55] It is astounding. We had this bell jar of morphine in my kitchen, and I’d empty it as a 12, 13-year-old. So we need training. And I also think we need a better financial deal for carers. I mean, there’s a big debate over Carers Allowance, for example, needs complete reform, an absolute disaster. And there are other aspects to how you would sort out the finances. I’d also, by the way, make it a lot easier for people who are able to work alongside caring to do that, because it keeps them healthy mentally and it brings more money in because people who are doing full-time caring for loved ones, guess what also happens? They’re quite poor,

[00:08:39] Because they have to stop working.

[00:08:40] Yeah, you may have your loved one who you’re looking after may have been working, but had some illness which prevents them from working. If you then have to stop work, you might have gone from a double-income family to a no-income family just because of unluckiness of health. Now, you know, is it right that we treat people like that in that way and is it sensible in terms of the long term because you could help people get back to work.

[00:09:05] And looking at the larger trends. You’ve talked about the demography. We’ve got an ageing population, co-morbidities. This is going to continue to get more complex. And the demands for carers, both the family carers and professional carers, and you have of course called for a cross-party consensus across health and social care. Can you expand a bit about that, particularly around the support, free personal care and also how we’re going to properly pay professional carers?

[00:09:31] Well, I mean, as a Liberal Democrat, I’ve got loads of ideas about how I want to reform both support for family carers, social care, and the NHS. Of course I do. But, I’ve been around long enough to know that if you make it just a political football, you will not get anything going. And we’ve just seen that and my experience in government of having tried to get consensus, then being disappointed by the result, we’ve just got to get this and that means we have to get everyone around the table. So I’ve called for all the main political parties to put in their manifesto a commitment to work cross-party, to finally get an agreement on this, both what it would look like and how it would be funded in the next Parliament. And just imagine if we did that in the next Parliament. We got a cross-party consensus of how we’re going to do this thing. I think it would be a transformatory Parliament.

[00:10:28] Well, we’ve got a bit of evidence, I guess, to support that, because had the Care Act and all the reforms you talked about been implemented. I think the numbers are about…

[00:10:38] A million or so people would be getting care now who don’t.

[00:10:41] And that would have been transformative.

[00:10:42] It would have been huge. And, you know, I think a huge benefit to our economy. I mean, obviously we see it in terms of what is the right thing to do, looking after people properly, giving them respect and dignity. That’s a value in and of itself, however, I think people see this just as a cost to the economy. I think that’s just the wrong way to say it. I think if you get care right, particularly those long-term trends into the future, you boost your economy. I mean, look, at the moment, the state of the health service is a drag on the economy. People who could be in work or would want to work longer hours can’t be because they can’t get the treatment they need.

[00:11:23] And I think if you said that contribution, I think the change of narrative has been called by other people, and Skills for Care has been on record as saying in their report last year that the social care sector, in terms of economic value add, contributes over £55 billion to the economy, and that narrative doesn’t get the mainstream press. I think you’re absolutely right. Now, we’ve talked about social care. If we can flip it to the other side of the NHS, we’ve been very privileged on Voices of Care to have many of the most prominent chief executives and trusts within the NHS. There’s a number of things that you’ve pledged in terms of conversations you’ve had around primary care, mental health budgets. Many, many CEOs across the NHS landscape watch Voices of Care. What would you say to them in terms of what you’ll be campaigning for post the next election?

[00:12:09] Well, I hope it’s not going to seem too simplified, but here it is, from my perspective. I think we’ve really got to have a radical transformation of primary care. More GPs, more paramedics, more NHS dentists, give community pharmacy a bigger role so people can access health care close to them, get that advice they need for self-care and all those trends. So people are kept out of hospital because no one wants to go to hospital, do they? And, you know, there’s lots of surveys suggesting that people are going to A&E because they can’t get an appointment with their GP, and that’s crazy, terribly inefficient. Now that means recruiting more GP’s.

[00:12:53] And actually the number of GP’s, despite commitments that were made, have actually fallen in terms of fully qualified.

[00:12:58] And you know, retaining them is number one, retaining them for longer, maybe bringing back people who’ve left the profession, trying to get more medical graduates to go into general practice and obviously train more students to go into medicine in the first place. So there’s a whole range of things that we’ve been looking at with health experts to see how you would drive that. And, you know, you could look at similar sorts of things for NHS dentistry, for community pharmacy and so on. So I have unashamedly in the party, we’ve gone for a primary healthcare-led approach. I’d say it’s much talked about again, not delivered. And that’s not to say we’re anti-secondary or tertiary sectors. It’s just we want to take the pressure off them. And you know it seems to me if the hospitals didn’t have so many people rocking up they could actually get some relief, take the pressure off. The flip side of that, by the way, is care. So two things. First of all, people not going to hospital as much because they’re getting the care via their family, via professional care worker through the primary care. So they’re not they’re not having to go to hospital. And there’s not that, you know, revolving door, but also people being discharged really quickly. So, one thing I’ve done in my own constituency, and I saw this actually through a byelection down in Devon and met some people doing this in Devon where the health care system had worked in Devon better with the social care system, where it was providing tailored support for family carers, where they would help the transition of their loved one out of hospital and help the family in the first sort of 2 or 3 months after their discharge.

[00:14:47] And they worked it through with the four hospitals across Devon. So I took that back to Kingston Hospital, my own local hospital, to say, look, can you empower carers of patients better so they can start the preparation for the discharge as soon as they’re admitted to hospital? So you can think about how you can help them. And that’s now being implemented and looks like it could be really successful. So your original question was what’s the vision for health care? Well, it’s primary health care. Stop people going to hospital. It’s carers to keep people out of hospital, get them discharged more quickly. And both those things I think would relieve a load of pressure. So that in a nutshell is our priorities. And there’s many other things. If Daisy Cooper, our health spokesperson, was here, she’d talk about lots of other things. But for me, that’s what’s driving me in what I want us to do.

[00:15:41] And I guess part of that there is some hope for fledgling hope. You’ve talked about this, a great example of taking it from Devon to your local constituency. We have an integrated health and care system under a statutory basis now. And that should have the voices of all the third sector, social care, NHS. So perhaps there might be this community approach where actually access to training for family carers could be part of a bigger solution in terms of the people that we need to deliver these services.

[00:16:08] There’s the potential to do that, but I’m going to be honest, I’m a little bit cynical whether it’s actually happening.

[00:16:13] Fair enough.

[00:16:14] I’d like it to happen. There is the framework. But when I talk in my local constituency, not going to name any individuals, but for example, community pharmacists fill outside that model, they’ve not been brought into it. When I think of the voice of family carers, I don’t really hear it in that model and not having a go at some of the health commissioners, but whether that’s changed the mentality and the culture, I don’t know, because if you really are going to reach out to families and family carers, if you really are going to reach out outside the NHS family to people like community pharmacists and so on. You did need a change of mindset.

[00:17:04] And that will take time.

[00:17:05] And I think, you know, sorry to come back. I am going to talk about community pharmacists because I actually think they are a very underlooked part of the primary health care system. At one point, 4 million people go over the threshold of a community pharmacist every day. And they can provide lots of health engagements in a way which GPs and hospitals would find more difficult and way more expensive. And there are things that are not getting done. Let me give you one really weird example in my team. If they hear this, they’re just going to laugh at me. And it’s earwax removal.

[00:17:44] Okay. We’ve never had that topic on Voices of Care.

[00:17:47] I bet you haven’t. I think there’s probably a much posher way, micro suction, or something. But anyway, if you think about particularly elderly people who’ve got hearing problems, two major issues. I’m not a doctor, by the way. So if someone’s listening to this and says I’ve got it all wrong. But one is hearing aids.

[00:18:05] Yep.

[00:18:06] And what’s the problem with hearing aids? Not a problem at all, except people don’t know how to maintain them, change the battery and so on. If you’re elderly and your site’s poor or whatever. I bet you end up putting your hearing aid in a drawer. I bet there are millions of hearing aids in drawers.

[00:18:22] My own uncle has the same problem. So you’re speaking to the converted.

[00:18:25] So why don’t we have community pharmacists who can help you with the hearing aids? Second, why can’t we allow community pharmacists who looked at your ears and says, well, you really need to have your earwax removed. And, you know, people are now being charged a fortune for it. I’ve talked to community pharmacists. They’ll say, well, we’ll do it for £20 or £30. You could even make that free. So elderly person who’s getting isolated because their hearing is going down, not going out as much, can’t hear the radio. They’re getting depressed. Getting lonely. Early onset of dementia. Why don’t we think of prevention for diddly squat? Could save you huge amounts of money over the long term.

[00:19:11] I think this will be a fruitful area of discussion post-election in terms of the community pharmacies.

[00:19:16] I’m sorry to go deep down into a particular issue, but it seems to me…

[00:19:19] I think it’s illustrative.

[00:19:21] Common sense, the sort of stuff we can do.

[00:19:23] And you touched upon inclusion and a broader picture and just want to touch on that briefly. Obviously, compassion is a really important value for the Liberal Democrats. The evidence unfortunately shows from the King’s Fund, people with learning disabilities have far less access and take longer to access health services. We’ve got minorities who have poorer outcomes. So I think this is also an important part of how we’re going to turn the dial in making the system fairer for everybody.

[00:19:51] I couldn’t agree more. As I’ve talked in the beginning, I have a son who’s got an undiagnosed neurological problem. He’ll need 24/7 care. He has a father who’s an MP. He has a mother who’s a counsellor and a lawyer. And we struggle to get you know, and we also we’re financially well off, right, compared to most people. We’re very fortunate, very lucky, very supportive family. And I look at my constituents, people who the parents have got learning difficulties themselves, or mental health problems or English as a second language. And I think, how do they cope? And when they come to my surgery, if they get in touch with me, they’re my priority because they need someone to be their advocate. And we need a system that doesn’t rely on the random chance that they go to their MPs, their MP can be their advocate. We need the system to automatically recognise these people need strong advocacy and the system doesn’t do that at the moment. It’s quite a hostile system. And to speak with respect to children and young people, I’m excluding adults with learning disabilities for a second here, but children and young people with learning disabilities and their families. One of the challenges for local authorities is their budgets.

[00:21:14] And what happens is they’re very worried about high cost families turning up. Remember a few years ago, a family turned up with four kids with special needs, and it cost the council completely out of the blue in year, about half a £1million to meet their needs. Now a small local authority can’t really cope with those big costs. So my view is this, if a child, young person with profound learning disabilities, that’s going to be quite costly and needs residential or whatever, that should fall on the national budget. Because the national budget is able, with all its ability to deal with those sorts of unexpected unplannable costs. And that would allow local authorities to focus on the lower cost, higher frequency, high incidence type learning disabilities and give a much better service and not be so we’ve got to protect our budget every single day of the week. And it could change the relationship between the family and the local authority so they can work together more. And it’s those sorts of shifts in how the statutory sector works with the private sector, with the voluntary sector, with the families that could, I think, make the biggest changes.

[00:22:36] Absolutely. One final question, if I may. We’ve talked about the NHS. We’ve talked about social care. Now, as you know, 20% of health outcomes are determined by the treatment you get, whether it’s the NHS or social care, and the rest is the core social determinants. Now I want to really take the lens back. Professor Michael Marmot has done some amazing work at the Institute of Health Equity. And this year, in January, he produced a report showing that 1 million people in 90% of this country died earlier than they should have in the decade prior to the pandemic. Now, I’m slightly, with some trepidation, going to refer to a Conservative politician, Benjamin Disraeli, who wrote a book called Sybil, or known as The Two Nations almost 200 years ago, bemoaning the division and the gap in health inequalities. And Professor Marmot, now nearly 200 years later, says Britain is a poor country and is unhealthy to paraphrase him. Where a few rich people live healthy lives. How are we going to address those fundamental bigger determinants? It’s a huge question, but we have an election coming up and I have you and your wisdom.

[00:23:45] Well, it needs another podcast to answer that question, but let me have a go on 1 or 2 specific areas, which for me are quite big behind it. The first is housing. I don’t know if you remember, in the pandemic, we’re lucky enough to have a garden, and my wife and I and the kids, remember that lovely weather there was in the first few months of it, and we sat out in the garden coping. And I would think of my constituents who were inside very small accommodation, overcrowded. By the way, there’s loads of them now, still in temporary accommodation, massive rise in temporary accommodation, constituents who are living in hotel rooms for the family. Now, if you want to talk about health outcomes, how are we going to house people properly? How are we going to make sure that there’s affordable housing? So this is quite close to home again, because I met my wife on a Liberal Democrat housing policy working group in 2003, which probably means we should both get out a bit more. But it doesn’t mean that she and I talk about housing a lot because she’s a social housing lawyer.

[00:24:52] She’s now a councillor in my constituency, and she’s leading our work on housing. And we’ve got the largest council house building programme we’ve had for over 40 years. And she is passionate about making sure that we’ve got that affordable housing that’s, you know, well insulated for noise and for energy. So people can have really high quality houses. And that makes a massive difference if people aren’t overcrowded, if they don’t have to hear their neighbours all the time, that their energy bills are low and they’re warm. And just imagine if we had that as a core to our housing policy. People’s mental health, people’s physical health, all those conditions from asthma to COPD or the many health conditions which are related to poor housing, can make it transformational. Now, that’s not going to happen overnight. But imagine if we had a programme. I’ll give you an insight to government. When I was Secretary of Energy and Climate Change and we were looking at fuel poverty. And we got this study which showed that for every pound invested in quality homes that were warm and not damp, the health service saved £47.

[00:26:08] That’s a hell of a return.

[00:26:09] So I took it to the Secretary of State for Health. People can guess who it was. And I said how about giving me some money, working cross department so we can deal with damp, cold homes? I didn’t get a terribly good response, but, you see, I said, I think a lot of this isn’t as difficult as people make it out to be. You just go with the evidence, go with the analysis. And we could we could transform. We could, we could say 200 years after Benjamin Disraeli, do you know what we can see one country, one nation without these awful inequalities.

[00:26:48] On that visionary note, thank you very much for your wisdom and your time, Sir Ed Davey.

[00:26:53] You’re welcome. Thank you.

[00:26:54] My pleasure. If you’ve enjoyed this episode of Voices of Care, please like, follow, or subscribe wherever you receive your podcasts. And if you want to learn more about how we’re turning the dial on the debate in health and social care, please visit newcrosshealthcare.com/voicesofcare. In the meantime, I’m Suhail Mirza, thank you very much and look forward to seeing you on the next podcast.

[00:27:14] Voices of Care, the healthcare podcast.