VoCVicRaynerFullEp5.6.24.mp4

Speaker1: [00:00:00] Hello, I’m Suhail Mirza, and welcome to this episode in Voices of Care.

Speaker3: [00:00:05] Voices of Care. The healthcare podcast.

Speaker1: [00:00:10] My guest today is Professor Vic Rayner, CEO of the National Care Forum. Vic, it’s a delight to have you. And welcome to Voices of Care.

Speaker2: [00:00:17] Thank you very much for inviting me.

Speaker1: [00:00:19] No, it’s an absolute pleasure. We’ve got a lot to cover today. But I wanted to spend a few minutes, if I may, to ask you to expand upon the work of the National Care Forum. It’s been around a long time advocating for the not-for-profit sector. There’s a sidebar. I should actually congratulate you on your award on the best places to work under the Sunday Times this year.

Speaker2: [00:00:39] Yes. Thank you. So, the National Care Forum, we’re a membership body for not-for-profit care providers, as you say. What that means is within our membership, we have a really wide variety of organisations covering all sorts of different types of social care. So, we have housing associations as part of that membership. LATCOs, local authority trading companies.

Speaker1: [00:01:00] Social enterprises.

Speaker2: [00:01:01] Charities, social enterprises, all sorts of things. And they’re providing care of many different types. So, day services, home care, residential care, nursing care, supported living, supported housing, etc. and for all ranges of people. So, what’s great about that is that, when we want to talk about care, we’ve got members who are delivering care in every sort of part of the country, as well as every different type of service. So, they’re a fantastic bunch of organisations, whether it’s about their not-for-profit status or whether it’s because of the way we try and work and support them. They’re really, really keen to share ideas to share resources and support each other. And often we find that they’re very innovative and approach challenges within the sector with a really positive focus.

Speaker1: [00:01:52] And it’s quite a significant part of that overall landscape. My numbers may be slightly out, but over £2.3 billion if you take all your members.

Speaker2: [00:02:01] Yes.

Speaker1: [00:02:02] And over 100,000 people.

Speaker2: [00:02:04] That’s right.

Speaker1: [00:02:05] So that’s a significant part.

Speaker2: [00:02:06] Absolutely a significant part. And what’s interesting and I know we’re going to talk a little bit more about not-for-profit, but actually, in the UK we have a smaller proportion of not-for-profit provision than other parts of the world. And clearly, I’m keen to see if we can increase that and improve that proportion.

Speaker1: [00:02:25] Absolutely. And as well as being obviously a membership organisation advocating for reform and your members’ interests, of course, you conduct research on a wide variety of policy issues, and there’s so much we could cover. But I was particularly interested in terms of the I think a study that you’re taking part in with the University of Leeds promoting diversity and addressing underrepresentation.

Speaker2: [00:02:47] Yes. So, we do get involved in lots of different research projects, and we’re really keen to support our members to do that as well. So, MEND I think, is the research that you’re talking about with Leeds, that’s very much focusing on how we bring more men into the social care sector. As you might know, only about 19% of the overall representation is men. So keen to get that increased and find out why. There’s lots of research we’ve been involved in over recent years. We’ve been looking at work on a national minimum data set for social care focusing on all sorts of issues around vaccination, Covid. Clearly there were lots of areas for research. And I think that’s one of the things that I hope that we can contribute to the sector is that we are really, really enthusiastic about working in partnership, and that’s with bodies like universities, but that’s also with our colleagues across the social care sector. So, we take a very active role in things like the Care Provider Alliance, Digital Care Hub. And I also chair the Global Ageing Network. So, you know, we feel that we have a real responsibility to support the sector as a whole, as well as specifically our members.

Speaker1: [00:03:54] And the sector as a whole, dare I say, needs that support. We have an election imminent upon us. One remembers the manifesto commitment from 2019, People at the Heart of Care white paper 2021. We’re not going to tarry too long here, but social care, whatever study you pick, Public Accounts Committee, we can start there. I mean, there are tremendous challenges briefly that the sector absolutely is facing.

Speaker2: [00:04:21] Of course. And I think that we can be very Pollyanna and think about those as brilliant opportunities. And there are, of course, opportunities in that. But it doesn’t take away from the fact that many organisations are finding that the sort of financial pressures, whether that’s around funding or cost of living crisis, have put enormous pressure on their organisations or whether that’s about the fact that they are having to change and develop the way that they work because of the changing needs of the people that they’re supporting. So, there are many challenges facing social care. I think one of the biggest ones is that there appears to be a lack of understanding about the centrality of social care in each and every decision that policymakers have to think about. And you’re right. We’ve got an election coming up. We’re hoping that we will see a really strong set of commitments from manifesto documents and, and other areas. But we also need those who are making those statements and making those decisions right now to be really clear about the importance of social care.

Speaker1: [00:05:33] No, absolutely. And I think moving from the challenges which are well-worn and absolutely justified, let’s talk about some solutions. And you say the election is imminent. And I think in terms of social care, it has been given some prominence. I think Liberal Democrats, Sir Ed Davey, perhaps fired the starting gun with a commitment to free personal care, etc. I wanted to talk about the National Care Forum and your own advocacy, which I think has been very powerful over the last year, about the must haves, a list of must haves that the next government of whatever hue must take into account in terms of social care. If I may, I’d like to start with the first one, because here we’re solution orientated and that’s think social care first. Can you expand? For me, that seems to be the frame within which we should approach this challenge.

Speaker2: [00:06:21] So all of our must haves came out of great engagement with our members and wanting to try and understand from them what are the things that would make a difference. And you’re right. Absolutely. Let’s focus on solutions. Let’s focus on being really clear to the next government what it needs to do. That will mean that we’re not in the same situation as we are, or we faced over the recent years. So, the idea about thinking social care first was to really try and shift the way in which governments approach problems and challenges. Now, social care, as we know, you know, people who are engaged in the sector understand just how key a role it plays in millions and millions of people’s lives. Whether you approach it from the perspective of unpaid carers, of which we know there are 8 to 10 million people actively involved in caring, never mind those who have it as an additional role to other parts of their lives. The ability for them to engage in economic activity, join the workforce, to have to look after themselves and therefore not need additional health care. That’s all predicated on them being able to access social care, really good social care for the people that they love and look after.

Speaker2: [00:07:34] There is a really, really important group of people who are wanting to employ and engage their own care workers who are wanting to engage in economic activity themselves and be a great part of communities and live the lives that they want to live. And again, their access, their ability to do that is really closely integrated with the ability to engage people. And what that means is you’ve got to look at things not just at the social care policy in isolation. You’ve got to look at things like benefits, you’ve got to look at things like travel policies. You’ve got to look at things like employment legislation. And how does that enable people to do these things? And for too long, social care has been a real afterthought in all of those decisions. And we still see it even when we’re supposed to be under the auspices of a piece of legislation which talks which gave birth to integrated care systems, integrated health and care systems. We’re still only talking about the NHS 90 to 99% of the time. And we have to think about that social care first.

Speaker1: [00:08:49] So the Health and Care Act you’re talking about of course, two years anniversary. And as you say, I guess you’re saying social care should be a golden thread that runs through all of these policy commitments.

Speaker2: [00:09:01] Social care is a golden thread, but it’s also a really important strategic partner. And that’s the bit that I think we are missing in so many of these discussions. So, for example, if you thought about some of the initiatives that this government has had in place. So, we’ve moved from a position where we had local economic partnerships to now, we have local skills and improvement partnerships. Now in most places around the country, the social care workforce would make up somewhere between 5 to 15% of the total working population.

Speaker1: [00:09:36] Hugely significant.

Speaker2: [00:09:37] But I have found very few examples of those local skills and improvement plans that have had any focus on how do you develop that social care workforce? How do you ensure that training works well for them? If you look at the apprenticeship programme, many large social care providers put significant levy funding into that apprenticeship programme. Yet they really struggle to access it, access the money from that because they’re unable to fund the backfill that they need for when people are on apprenticeship programs for the time that’s away, plus the amount of funding that’s available for social care apprenticeships once you get past level two, is significantly lower than most other sectors. So, at each and every turn, it feels like social care is an afterthought. And that has to change if we’re to achieve the kind of ambitions that we have as a country and to recognize the significant demographic changes that are coming.

Speaker1: [00:10:32] Absolutely. And you’ve talked about workforce. Let’s move on to that, that’s one of your key must haves and improvement to pay terms and conditions. I’ll come back to that because that’s inexorably linked to the funding question. But you’ve talked about training and access. I mean, there has been some improvement and work. I mean, great work being done by Skills for Care, because obviously the Long-Term Workforce plan for the NHS was deafening in its silence around social care. But just to touch upon some of the initiatives, uh, the career pathway, Level Two adult social care certificate, there is now funding that’s been dedicated that I appreciate, it’s a small number, but are those some positive signs that you’re seeing?

Speaker2: [00:11:14] Well of course it’s important. Those things are really important. So, some of those will be the building blocks of what we need for the future. So, Skills for Care has done a fantastic job in trying to bring the sector together around developing a workforce strategy. And I’m delighted to be part of some of those steering groups and discussions looking at that. And that will be really important where we are now for a new government to have a look at and to think about. And you’re right that the absence of a workforce strategy for social care has hampered the development of the sector very significantly in recent years. The care workforce pathway and the funding that you refer to, those are important initiatives. But of course, the Public Accounts Committee looked at the work of the government around those issues, around workforce, and they were fairly well, the National Audit Office were fairly scathing about the pace of change.

Speaker1: [00:12:13] I think their phrase was there was no convincing plan to address the chronic shortages, the words that come to back to my mind.

Speaker2: [00:12:19] Very good, very good memory. So, I think they were pretty damning of the progress around that. And I think that and of course, you mentioned Putting People at the Heart of Care. So, when that was initially announced, there was 500 million plus, which was ascribed to workforce. That went down to 250 million pretty quickly. And we haven’t yet seen any significant investment in relation to that. So, it feels a little bit like these are words about workforce, but they’re not putting the emphasis and pressure on them that I would think a sector facing 152,000 vacancies would secure. And I think we have a challenge in this sector. So, I constantly try to talk about social care as a public service.

Speaker1: [00:13:03] Yes.

Speaker2: [00:13:03] And I think that is really important to remember. Even where people are paying for their own care, they do have a statutory entitlement to it through the Care Act. It is a public service that’s being offered. It’s just that the way we’ve structured the finance and funding means some people pay for it and some people don’t. It doesn’t mean they don’t meet a statutory threshold and they don’t require care and as a part of a public service. And if we want those public services to function for the time when people need them in the way that people need them, then we need to make sure we invest properly in the staff that do that.

Speaker1: [00:13:37] And that investment is going to become a categorical imperative, because the numbers I’ve seen and you’ve seen, the next ten years, we need, I think, at least 440,000 new people joining social care workforce. And they’re going to all need to be trained.

Speaker2: [00:13:52] Yes, they will need to be trained. And I think we also need to think really hard about how realistic that number is, because I think somebody was talking about it the other day, and that is about 60,000 new people coming in to the workforce each and every year. New.

Speaker1: [00:14:13] Not recycle.

Speaker2: [00:14:14] You know, not in counting net.

Speaker1: [00:14:16] Yes.

Speaker2: [00:14:18] And only 60,000 people leave school every year. So, is that each and every school leaver is going to come into the social care sector? Feels unlikely. So how do we think differently about workforce? Are some of those issues around the way in which we deliver care? I know there’s a very significant push around delivering care at home, and that’s really important. But if we want to do more of that generally, that is a more workforce heavy way of delivering care. So actually, are those statistics based even on the way in which we want care to be delivered in the future? So, I think there’s lots to work on there. Care workforce pathway is important because it should set out a framework. We’re only part of the way through that at the moment, so it’ll be up to the new government to see if they continue it. The pay terms and conditions are absolutely critical because we cannot be in a position where I used to be part of the care workers charity. You’ll know that well, it’s a very important organisation, but we know that there are significant numbers of care workers living in poverty.

Speaker1: [00:15:26] Absolutely.

Speaker2: [00:15:26] And we’re asking those people to come and support the most vulnerable people in communities. And so that has to absolutely change. And it’ll be interesting to see where we are in terms of the commitments that parties are prepared to make around making that fundamental change.

Speaker1: [00:15:45] And how they bring them into fruition. Just very briefly, I want to pan the camera out a little bit. I mean, you mentioned earlier your role as chair of the Global Ageing Network. Now, this whole issue around ageing demographic, the need for social care provision, it’s very much a global issue and not just a Western world issue. I think the stats I saw India are seeing senior people, their population over 60, I think from 138 million over the next couple of decades to 240. And I know you took part in an important conference. So, this is a really global issue.

Speaker2: [00:16:19] Yes, absolutely. And what’s really frustrating to me is that often when the government talks about that, we talk about it as addressing the UK workforce market, and that will solve everything. Now, you’re absolutely right. The pressure globally on attracting people to work within health and care is phenomenal. So, the patterns that we have adopted in recent years, firstly as part of being part of the European Union and now with the focus around international workers, is to try and encourage people to come and work within the UK. The level of encouragement changes. It’s quite political, I think but you know.

Speaker1: [00:17:03] Actually if I may say so, that was very deftly put, if I may say so.

Speaker2: [00:17:06] But I think what we you know, what those working within care understand is that the contribution of those international workers is phenomenal. And many organisations, it’s been a lifeline and of course, a lifeline for the people who are receiving care and support. So, we have been, you know, as a country, we have relied on international workers for health and care solutions. I don’t think that that’s sustainable going forward. Never mind some of the challenges about the ethics of getting people to come from other parts of the world where they have a growing need for a health and care system and for those workers to be there. So, we will have to think differently about that. But there are, you know, we also could think really positively about being part of a global care community. And actually, I know personally I learn enormous amounts from working with colleagues from all over the world. You’re right. Not just the Western world talking with colleagues in all parts of South America and Africa and India about what they’re doing, how they’re tackling those changes. We’re going to talk a little bit about technology. I know, but I think if we look at India particularly, I have no doubt that they there will be a great leapfrogging of technology in India to support that care market because it’s going to grow at such a massive rate and that we should be looking at that and learning from that as quickly as we possibly can.

Speaker1: [00:18:35] No, absolutely.

Speaker2: [00:18:35] And contributing to that, of course, as well, because we have got opportunities to share the knowledge and experience that we’ve gained.

Speaker1: [00:18:42] Great work that’s being done here. I wanted to pick up on a phrase you mentioned earlier, public service. Much of social care, even if it’s provided by for profit, is funded by the public purse. Now, one of your must haves and a very passionate one is to people, not profit. Your members are governed by many different statutory requirements charities Commission, etc. and I think you’ve been on record talking about language of profits and profit extraction. Maybe not have a place in public service. And you’re calling on the government very, very clearly to enable the growth of the not-for-profit sector. Can you just explain how important that is in the context of growing inequalities? We’ve had the Marmot review a decade or so ago. This is quite a big societal issue, not just a sector one.

Speaker2: [00:19:29] Yes, I think it is a really big societal issue. You’re right. And I mentioned at the beginning that, you know, the UK is one of the countries, particularly within Europe, who has which has much higher, prevalence of for-profit care provision than in other parts of Europe and indeed other parts of the world. I think it’s really important because when we talk about social care and public services, I think that this is public funding and public money. And actually, I think there is a real imperative to do as much as possible to ensure that that funding and public money remains within the communities that have either provided it through local taxation, such as council tax or through government taxation and revenue through that. So, I do think that there’s an imperative around that. I think also what you are assured of, I guess, in that context, is that all the funding that’s available has gone back in, been reinvested into the quality of care, the workforce, the fabric of a building if it’s a residential care setting.

Speaker2: [00:20:39] And what I see within our members is that actually what that not-for-profit provision does is reflect a level of engagement and longevity in communities. So many of our members have been charities or organisations who have been in communities for decades, if not hundreds of years. We’ve got members who are sort of 400 or 500 years old, and they have made a commitment to that community, whether it’s a geographic community or a set of people that they’re serving with a particular health condition or whatever it might be. And I think that that, you know, that contribution to communities also holds them, that the community can hold them to account as well. And there’s something very powerful, I think, about organisations that are run by boards of trustees or boards of directors in that context, in a charitable context, who are from that local community, with expertise and knowledge in the provision of social care, and that that is what their focus is. That’s what their commitment is, and that’s what they’re there to do.

Speaker1: [00:21:47] And you’re calling for the next government to enable that sector to be prominent.

Speaker2: [00:21:50] Yes, and what’s interesting to me is that actually both Conservatives and Labour have focused on the situation of profit. Now, the conservatives have talked about profit in the context of children’s services, and there were some very interesting research done by the Local Government Association, last October, where they talked about recognising that in children’s services, £200 million had been extracted in the context of profit from children’s services, and that they have been much more active in the children’s services field to think about whether there’s some way of recognising or capping profit. The Labour government actually, rather than me, has used the term extractive provision for profit making organisations. And I think that they’ve got some work to do to, to work out what does that mean. Are they talking about private equity in that context? Are they talking about all profit-making models? Are there things that they can do to support that? And the really interesting thing is in Wales, there has been work that’s been going on for the last 2 or 3 years. Looking again at children’s services, where they, the Welsh Government, have said they won’t spend public funding on profit making services in profit making children’s services. And the legislation to enact that came in just this spring so, England is lucky.

Speaker1: [00:23:14] There’s a debate to be had.

Speaker2: [00:23:14] There’s a debate to be had, but we can also watch and see how that works in practice. But yeah, I think I think we would find ourselves in a situation where there was greater, I think, engagement and support for social care as well if there was an understanding of the important role the not for profit played within it.

Speaker1: [00:23:39] Absolutely. You said we were going to talk about technology. I’d like to end there if I may. We’ve talked about the global challenges, the challenges here nationally, workforce delivery. We have to think about different models now. It’s a podcast in itself. But I just wanted to touch upon your view initially around what is happening with technology. Some of the important work that’s being done, the King’s Fund have done quite a lot of research around this, and they used there’s a phrase that there’s very wide potential. What are you seeing on the ground? Because it does have the potential and is already making an impact.

Speaker2: [00:24:12] Oh yeah. I mean, I think the technology is hugely exciting for social care. And I came into this role about eight years ago amazingly. Time flies when you’re having fun, as they say. And I was really surprised to see that there was a relatively low level of take up of technology. So, I mean, I certainly have pushed the National Care Forum and our members to think about the importance of technology in the future provision of care. And I think there’s a number of great opportunities for that. Certainly, there are things around workforce and workforce delivery that could be supported by digital. And we’re seeing lots of that in exciting opportunities around e-learning and around connection and communication. COVID accelerated quite a deal of that significantly. There are some real opportunities, I think, in the context of supporting people to live much more independently as part of that, with remote monitoring and sensors and things as ways of identifying potential risks, but also really empowering things about people being able to manage their own environment and utilise, you know, models such as voice based Alexa and Google Meet and all these kind of things that that can enable people to have stronger connections with people and get medication, props, blah, blah, blah. There’s lots of things like that. So, I think, and a lot of that technology is actually been developed with another purpose in mind. But how fantastic to think about using it in the context of people who want to live independently? I think we should be really ambitious for social care about technology.

Speaker2: [00:26:04] Now, if you look at the health service, I was listening to somebody talk about new technology in the health service and refer to that in the context of needing a generation change before you could use that. And I was like, well, you can’t wait for a whole generation. And actually, when I dug a little bit deeper, I understood that was because of the vast numbers of legacy systems in operation in health. Now, my mum used to work in the health service many, many years ago. She was just 91 yesterday. So, she, you know, she worked there, and she was using technology, you know, 40 years ago in the health service. So there and people who are on a record then, they still need to be able to access that record. So, they’ve got this kind of long, long tail of change for anything that they want to introduce. We don’t have any of that. We can really, really accelerate the way in which we use technology without having to worry about all of that. I mean, I never thought it’d be great, great opportunity to say we haven’t got the infrastructure so we could. But it is an opportunity. And I think we’re thinking about AI. So, we’re part of a great collaboration fuelled by Digital Care Hub and Oxford University to look at AI.

Speaker1: [00:27:17] Doctor Caroline Green.

Speaker2: [00:27:18] Yes. Doctor Caroline Green, looking at and so people want to look at the Oxford Statement around the use of generative AI. And then please do that and see if you want to sign up and be part of it. Anybody is welcome to do that.

Speaker1: [00:27:31] And there’s great potential in AI, in generative AI and large language models, etc. And Doctor Caroline Green’s work is obviously in the ethics of this, and I wanted to touch upon this wonderful, perhaps we don’t even know what the benefits are. But I just wanted to touch upon because I think it came out that we must remember that social care is also quintessentially a human activity, and therefore some guardrails and ethics around that is important.

Speaker2: [00:27:55] Absolutely. And I partly because of the global role and just because I’m really fascinated, particularly by robots and how that might, how that might kind of inform our development societally, societal wide. Actually, I think it’s really fascinating, but also in the context of social care. And Japan is clearly the place that people often go, and Japan and Singapore particularly to think about that. And they are looking at it through a lens of human hands. So, I think that it is absolutely right to think about the potential, but then to recognize where human connection and human contact needs to be made. And I think one of the really fascinating things about the AI work is we have approached this through a very co-production identified lens. So, there was an initial sort of meeting of people who came together, and that Oxford statement came out of that. And then what we’ve done, and Caroline has kind of really sort of spearheaded with colleagues is to think about how do we bring care workers into that set of discussions because not everybody’s excited about the need for less, perhaps AI bringing the need for less workers in there, or also people are worried about, you know, how do I set the boundaries of that? And we also are bringing together people who receive care and support services, because I think there’s a sort of set of assumptions that we sometimes make about how much people want personal care, for example, to be delivered remotely or through robotic technology or whatever it might be. But I think that we are increasingly seeing that the sensitivity of robotics might make some of that possible.

Speaker2: [00:29:55] But also what I think it does is free up care workers to do some of the most amazing work that they do, which is about the human conversation, the connection, the support that they can offer and maybe take away some of the roles that are less popular and less fulfilling in that sense. So, there’s a lot to kind of unpick, but I don’t think we’ve got an awful lot of time to sort of sit back and watch. So, Japan, they, they thought it probably took somewhere between 3 to 5 years to properly understand and embed some of the roles of robotics. What’s fascinating to me there is the driver, the governmental driver. There was absolutely around industry and economic contribution. So, we’ve done some work as a social care sector to try and capture the economic contribution of the sector as a whole. I think the kind of current number is somewhere around 55 billion as a sort of net contribution. But actually, if we thought about it as a sort of technology industrial sector strategy approach, then actually that contribution of social care could be through the roof. I mean, if we were able to look at that global ageing challenge or that global change around that and identify within the UK solutions that could really support people across the world. That would be phenomenal. It would turbocharge the sector and its importance and its role in the way that health tech often does, but it would also create an enormous industry for the future.

Speaker1: [00:31:45] I think that’s a perfect way to prefigure the election that’s upon us. And 3 to 5 years, a length of a parliament.

Speaker2: [00:31:53] And I think some of the things in social care are clearly long-term issues, but some of them cannot wait. And you know, the connection is really clear in my mind.

Speaker1: [00:32:07] Let’s hope the politicians are listening on that optimistic, visionary note. Vic Rayner, thank you very much for your time and your wisdom.

Speaker2: [00:32:14] Thank you.

Speaker1: [00:32:15] 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 are re-envisioning the debate of health and social care, please visit newcrosshealthcare.com/voicesofcare. In the meantime, I’m Suhail Mirza. Thank you and goodbye.

Speaker3: [00:32:34] Voices of Care. The healthcare podcast.