 Okay, we're going to make a start. I know a few of you are still in the breakout refreshment room... ...but you can make your way back in now. We've got an important conversation about to take place. Last year at Congress, we started a conversation around social care. And we just asked who's doing what in the cooperative movement... Mae'r problemau i amser, yn cael ei wneud o'r ffaith cermarc. Mae'n holl gwrs o ffaintol, mae'n holl gwrs o cwrs o cael balau. Mae'r coop ym Llyfrgellau, mae'n holl i gwrs o'ch coop yn holl i gael. Mae'n holl i'n holl gwrs o'r cymysgau a'r holl gwrs o'r coop yn holl gwrs o'r coop. Felly we'n doi bod yn fawr i'r rhaid o'r fawr, gyda LCA yn y Cyngor Cwp Epid-ythol, Ond rydych yn fawr i'r ddolethau Cymrydio yng Nghaennau Pwgol Llyfridd yng Nghymru, y dylai'r 120, yng Nghymru i'r Fawr, gyda'r ymddi yn mig a hyn yn cyfre y Cyngor Cwp Epid-ythol y rhaid. A bod ni'n fawr eich dwylo'r cyflwyno i'r bobl hefyd dyna'r 7 cyngor Cymrydol pwgol yng Nghymru neu'r cyfrwno fawr. co-operatives ffoster interdependence rather than dependence in care, given by privilege in voice and inclusion, which is a theme that came out really strongly last year. In their 2017 report they broke down day care, foster care, persons living with disability, physical illness, auxiliary care, elderly care, domestic workers co-operatives and provided a whole host of information and case studies. I showed how legislation in places like Italy enabled the legal recognition of social co-operatives through the adoption of law 381 and it dramatically increased the ability of co-operatives to assist elders and persons living with disabilities. So, what is it actually that we're doing? You know, in terms of the broken markets, like Shireen said, it's on all our minds, there's a lot of broken things at the moment and it's where best to put our efforts, but again looking at the ideas from the international health co-operative organisation, some of their findings across the world around the way that care co-operatives are financed and these are consultants with vast knowledge and experience of working with co-operatives and social economy organisations, and looking at the ideas that we're developing around maybe having a care dividend, a way to put in and get something out in later life, and the idea of equity and supporting maybe young and new people into care, and we'll hear from Emma Shortley, but Emma's equal care co-op, 63% of the people working in the co-operative have never been in care before, so we're absolutely convinced that there are solutions, but what we're trying to do here today is understand precisely what the problem is, because once we're clear on what the problem is, then we can start looking at applying co-operative solutions to that, so I've got a really amazing panel to discuss what the problem is. We've got Lord Victor Adebowale, who's chair of the NHS Confederation, we've got Emma Back, equal care co-op, we've got Paul Gerard from co-op group and I'm hoping about to appear on screen, I've got Michelle Rashman, there she is, wonderful, and Michelle is a dimestillery care services user, and of course we've got our very excellent chair today for this panel, how to fix a broken market and that will be led by our esteemed mayor, Labour and co-operative at Greater Manchester Andy Vernon, thank you. Thank you very much Rose, thank you very much indeed Rose, good afternoon everybody, I think it is just about afternoon, great to see you all here, I suppose I should do the formal bit first, fulfil my official duties in welcoming you all to sunny Greater Manchester, have a great congress here, enjoy the facilities, enjoy the city, in the sun, but maybe, maybe don't do the full Jack Grealish if you're thinking about tomorrow and everything, we do, Jack has single handedly restored our reputation as the home of 24 hour party people, so well done Jack, but we will move on to a much more serious topic and as Rose said it's about social care, the state of social care in England, what we do to fix it. You might remember when I was health secretary, 14 years ago now, I tried to bring through a major reform of social care, I proposed a national care service, I was clear at the time that if we didn't fix what was then a broken system, it would in the end make the NHS dysfunctional as well, and I think in the decade or so since then we've only seen that start to play out and the situation. I've always believed that a big part of the solution to social care in England is in this room, it's in the cooperative movement, and today's discussion is to see if we can really unpack that and find a way of bringing forward cooperative solutions to fix a broken market, and here in Greater Manchester we're very interested to see if we can develop those ideas and bring them forward into our more devolved integrated care system here. So we've got a great discussion ahead, we've got experts who are about to enlighten us, but I'm going to start with Michelle, great to see you Michelle on the screen and everyone can see you in the room. First and foremost I think it's important to get the perspective of somebody who uses care services, could you tell us what's wrong, could you describe what has been the problem with social care as far as you see it? I think it's one of those things, there's a lot of things like this now, where you don't know it's broken until you need to use it, and we're all going to need to use it one way or another at some point. I think we all like to live under that, we all like to think we're going to be that sort of feisty non-agenarian who lives independently and then dies peacefully in the sleep, but that's not the reality for most of us. Unless you've got the Barclay brothers paying for you at the Ritz, like Thatcher, it's going to fall on friends, family, neighbours and the care sector to look after us and look after our loved ones as we all age longer. I looked after my mum and my dad, my dad died 18 months ago, my mum's now 94, and that's something I started to do because we lived a long way from each other, I did a 600 mile round trip to take my dad to the dentist and I thought we've got to sort this out. So we ended up having to sell our house that we loved to move it, to move all in together in a big house so we could look after my mum and dad. And that's now, we're now just about to go into the eighth year of that, and during that time we've sort of cobbled together a system where, you know, there's me, there's my husband, but he's in his 70s. So you've also got a situation where old people are looking after old people, and then my dad had strokes, so that kicked in for a little while a sort of reablement service that was a bit ramshackle. Then my dad died, and then that meant that even though he was very, very old, you know, he was kind of also helping as my eyes and ears for my mum, so it meant that I went from living upstairs to having to move in with my mum, and all of this has been done, you know, in a sort of ad hoc chaotic way. There's very little information out there that's that's sort of obvious to people. So for instance, I didn't know until my charopatist told me that my mum was entitled to a council tax exemption because she has dementia. And I told somebody else this who I thought they would need to know and they said, oh, I know this because somebody told me in the queue at home bargains. And I think that kind of sums up how we find out things. It's just so chaotic and relies on a lot of well meaning, you know, it relies on a lot of people pulling themselves out of line, and I think nobody understands how it impacts your life until it happens to you. And I think that's true of lots of things at the moment, you know, I think that, but yeah, I think we need to all keep in mind that this is going to affect us all one way or another, whether it's us that need care or whether it's our loved ones or our neighbours or our friends. At some point, we all have to access extra care. And if it's not there, it's really, really frightening. Well, Michelle, thank you. You've said it so succinctly and powerfully and thank you for sharing some of your personal experience with everybody here at the Congress. I know what you're saying. I'm just entering that world myself at the moment and just having my kind of first experience of it from a family point of view. And I think you've put your finger on the problem as to why social care never gets its rightful place at the top of the agenda. It's because most people can't see it and don't experience it and it's only too late, isn't it? When they do experience it, they probably wish they'd kind of focus more on it before, but that I think is part of the issue and it's something we've got to change. I mean, I'm going to turn, thank you, Michelle. I'll come back to you a little later. I'm going to turn to Victor now, perhaps more from an NHS point of view, Victor. You know, something, I think the word Michelle used was ramshackle. You know, when you're talking about, if you like, preventing people going into crisis so that they're in hospital, it needs to be better than ramshackle, doesn't it? But also, if you think about just the kind of the basic sort of operating standards of social care where staff are paid a minimum wage, they don't get the travel time between the 15-minute care visits that they do, you know, looking after someone else's parent should be the highest calling you can answer in life, isn't it? Instead, as a society, we're almost saying it's the lowest, which is entirely wrong as far as I'm concerned. How can a system organised like or not organised, you know, so disorganised as that and so malnourished as that in terms of the way it's funded? How can that ever do the job that you needed to do for the NHS? So, as well as being on the board of the co-op group, a proud board member, I'm also the chair of NHS Confederation, which is, we represent where the large representative body of health and social care leaders in the UK, and I've just come from the conference in Manchester where you were at, Andy. And actually, your idea when you were the health minister of a proper national care service is one I personally support of then and support now. But to cut to the chase, one in three of our beds in this country are occupied by people who don't need to be there. And one of the reasons that they are there is because we don't have care packages in the community for those people. So it's a clear and present danger. And when people talk about the health system being in crisis, i.e. blocks at the front door of hospitals and blocks at the exit, it's because of social care. So if you were to talk to anyone in the Confed, they would say, if the government was going to give the system more money, they should prioritise social care. So that's the first thing. The second thing is, even if there were to give it more money, it's an atomised system with very little structure and there are various markets. So people say that you can't make any money out of social care well a couple of years ago. Bridgepoint bought Care UK for £432 million Bridgepoint's venture capital group. They don't give money away. They've bought it because they can make money out of it on the one hand. On the other hand, we do have a problem of very low wages. I mean, I've been to places literally and sat on one side of the road and watched people leave care homes and go and get jobs at Amazon because they get paid more. I've literally seen the flow. They get paid more, a lack of career training, infrastructure, poor management, poor leadership. Crisis is too light a word actually for the social care system because crisis implies that you've reached a point where we could go one way or the other. It's far worse than that. It is literally broken. So what do we do about it? There are three things. One I'm here because one of the solutions that we should explore more is the co-op solution. The reason why we should explore the co-op solution is that actually local, close, connected, bespoke is the answer. These are principles. I think that it is possible to make a profit. There's nothing wrong with that, but it's at whose expense and where does that money go? If it's kept in the community, it's more likely to be valuable. I have run large-scale social care services that have been designed by communities, delivered by those communities, and they work and have been evaluated by the LSE for every £1 spend. You save £6 minimum, leading to £28, so it would save the taxpayer money. So it is possible. The principles are obvious. I cannot understand, and you're a politician, so you can tell me. I don't understand politics any more. I thought I did, but I don't. You couldn't make it up, could you? No, you really couldn't. But I cannot understand why successive governments have failed to get to grip with it, because actually I see it as relatively low-hanging fruit, most people, when they get to, I would say, around about 35-40, either know somebody or are directly experiencing a social care challenge themselves, or know somebody who is, or they're starting to think, you know what, my mum and dad are getting on a bit, or my sister are getting on a bit. So it actually would be a very popular measure, and we've been let down. So I do think it's right for co-ops, disrupted market, very dodgy practice where the consumer doesn't know what they're getting. There's poor quality, which is where co-ops started, adulterated milk, poisonous food, it's the equivalent. I'll just say this about the co-op group. I'll just say this because I think you're great, you know that. I've said this about the co-op group. The co-op group does funerals at the one end, so it will bury you. And at the other end, it will feed you. And in between it will do you a bit of insurance. The bit that's missing is the social care bit, isn't it? A bit of care before the co-op buries you, and some decent food while you're growing up. It seems to be an obvious one, so I do think it's worth exploring. It doesn't mean that we're going to do it, but I think the co-op model is one that we need to explore. We can't carry on like this. It's going to do dotage as well as death. People like me, you're 60s, you know, I'm knocking on. Because one of the things about social care that we don't explore, it's not about the elderly, the thing that really gets to people is the uncertainty. As we've just heard there, it's not knowing, it's not being able to plan your life. It's not having the system come to you. This is one area where you need certainty, quality, and then the peace of mind that comes from that. At the moment, what's just been described there by Michelle is what's called negative value transfer, whereby the person has to go around the houses trying to get bits, and that costs the person, but more to the point, it costs the system, keeping all those bits going. There's no value. What we need is positive value transfer where you go to one place and you get what you need, like the sort of thing that you're doing. I want to hear about that. That's brilliant service. That is really clear. That figure, one in three of the best. My political life, having put forward the national care service, of people telling me, we can't afford to invest in social care, but we can afford an inefficiency on that scale in the NHS. Really? I'm afraid of the reflection of what you were saying about broken politics, actually. I don't know whether the co-op movement really... Well, you are in politics. But seriously, this is a major failure of our political structures, isn't it, to pick up this issue. In that situation, again, the co-op movement can move in from the bottom up, can't it, and start to show the political world proper solutions and Emma, no pressure. We think you've got what you've got. So, tell us about it. Well, I'm going to come right out there and say that co-ops aren't actually the solution to social care, but they are the right starting point. Equal care started because there is a problem with power in social care. It sits with the people who are not at the heart of what the entire system is built around and for, and that is the people getting support, but it's also, it takes two to tango, the people who are giving it as well. Fundamentally, at the heart of social care, there is a relationship that has been ignored, that has been exploited, that has been venture capitalised, and the people who have been left are the people who are in that relationship and the people who are very close to it, as Michelle was saying, so family, friends, the ones who are there to pick up the pieces. So, it started with power. It's like, right, we have to set out to rebalance the power dynamic in social care in favour of recognising that power is a funny thing, it's spread through systems, it sits in different places, it builds up, it moves around, but in favour of the people who are getting support, that is ground, that is the ground of what we're doing. Easy to say. So, some objectives associated with that, it's about relationships, so we have to put that relationship above all else, that means noticing it in the system, that means picking it up, that means designing for it. We want to share power and we want to move away from this idea of care, something that is really scarce and really kind of like you have to hoard it, like it's sort of dragons gold. It's not scarce. We are all human beings, we all care for one another. I thought I was going to get to this point a little bit later on, but we all care for one another and we all care for the people that we love. So, it is not a scarce resource, it is abundant, we have a lot of it. The problem is that none of that is recognised by our current economy, by our current health and social care system. There is no way of understanding and valuing that labour, which is for home care at least, has been valued at around 60 billion, 62 billion of informal unpaid care in the UK. Those are the grounding principles. The way that we do it, and this took a lot of trial and error, is that the way that we do it is that we start with teams. So, when you join Equal Care, whether you're looking for support or whether you are looking to give support, you're going to build your team or you're going to join teams. And the team is owned and led by the person who gets that support. They choose who's on their team. It can be paid members, it's family, it's friends, it can be community volunteers, it can be people from other organisations. Some of whom are paid employees of the co-op, but the team can also be comprised of family, friends. Private care workers, anyone who is involved in that person's care. Anyone who is part of there to support that individual. The co-op is then coordinating that team. Yes. One of the things that's emerged over this past year is hats. We think of hats as in some organisations that's called dynamic roles or dynamic governance, but a hat is basically a role or responsibility or a part that you play. So, it could be husband, wife, daughter, unpaid carer, it could be rotor holder, it could be the person who updates that person's support profile, it could be the medication administration record keeper. But the point being that all of that work that's usually transferred to someone in the office and who therefore doesn't know that person remains with the people who know that individual best, which means they don't make mistakes. No, it's brilliant, isn't it? The co-op doesn't employ care workers. Yes, we do. You do, because you mentioned private care workers, but you can work with people who've got, let's say, council or private domiciliary care coming in, but you also can supply your own if that is what that person wants. So, we see them as they are all members of the team. You're a care aggregator around an individual. Yes. So, our care and support workers can choose to either be employed or independent and self-employed. So, this is where the gig economy kind of discussion here always seems to miss out the fact that some people would like a choice, everyone would like a choice, over what their employment relationship is to their work. And, frankly, the relationship between employer and employee in social care in particular is so toxic. It's been so, so, so, so, so disrespected that a lot of our care workers join us. Rhoters that people just couldn't know if you were to deliver that rote, you'd be working until 12 o'clock at night. So, it's given to people that have no chance of working. And, as you say, total disregard for those staff often in private domiciliary care. I asked one of our care and support workers who writes everything down in her diary, just who she's going to see and when, and she did it for the previous agency that she worked with. So, I asked her to do all of the number of hours in the person, and you can just see it in the data. Like it's like a big kind of mishmash of different relationships that start, they stop, you know, there's like little points here and there. And just kind of going back to the whole idea of being a human, our capacity for compassion is limited. Our capacity for emotional labour is limited. And if we're designing a system which is continuously getting people to hit those limits, then you get people leaving. So, she left you to bone out and joined us. And if you look at the, like, if you were to plot on a graph, like all of the key relationships in your life, it would be this continuous, like this beautiful kind of flowing stream for a lot of those relationships. And for care, like, it can be the same thing for the people who care for you and with you in your later years. So, looking at that, the relationships now that people have in equal care when they join teams, they are continuous, they are committed, they are connected to the people that they can work the best with. And it's doable because everyone's playing that part when they can. And also for the person receiving the care, they've got the variety of different people coming in it, and that makes life interesting. Average is about three or four people that people receive support from. So, yeah. It is brilliant, I have to say. Well, hang on, so I'm just going to pause it there and say, it sounds brilliant. It sounds brilliant. And this is when I'm going to come back to you, Michelle, if you don't mind, because as I understand it, you've been a member of this co-op and have received some of the support or been part of some of the support. Does it work from your perspective? Yes, it does, actually. So, my mum had council care for, I don't know, quite a while, a few months. And it actually started off relatively OK, but it deteriorated really, really quickly. I don't know if that was just as everything's falling apart, it just seemed to be exponential. And so she ended up in a situation where, I'll just explain what happens is, I have care coming in for one hour a day in the morning, just so that I can basically, so I can take the dog for a walk, to be honest, and just have one hour, hour to 24, where I can not think about anything, just let somebody else deal with my mum. And that one hour is supposed to be 10, 30-ish. And what was happening is that the carers were coming either at 8 o'clock in the morning or half 12 in the afternoon. And the problem with that was, first of all, if they came at 8 o'clock in the morning, my mum was wiped out for the day because she's a late riser. And it also meant that, and if it was later, I'd be hanging around the dog a big cross in his legs. And it was just, it was so disruptive that I ended up just thinking, I might as well do it myself, it would be easier for me to do it myself. And the other issue was that the council installed a keysafe so that carers could just let themselves in, so I wouldn't have to actually be physically waiting. And I've got a baby monitor, so I'd be in another room with a baby monitor. And there was the day when I heard my mum going, who are you, who are you, who are you? And I went down and there was a strange man she'd never seen before standing at the end of her bed. And that was the new carer that she saw once for twice. And that was the other issue, was that there was no continuity of care. So carers might come once and you'd never see them again. And because my mum's got dementia, that was really disruptive. And also, as a family member, you're allowing somebody into your home with a lot of trust. And if you don't even know the name of that person, that's a very unsettling situation to find yourself in. So with equal care, what we have is this team of three or four people. It sort of alters a little bit from time to time. But basically, I know from day to day who's coming, roughly what time they're coming, I know loads about them. They all input into a rocket chat app that I can also access and input as well. So for something I think that the care of the next day is going to need to know, but my mum might be a bit off-colour or hadn't slept well or something. I can include it in the rocket chat. And so they're up to speed all the time. And it's, you know, those things are really obvious. But they don't seem to... It doesn't seem to happen with the council care. And finally, the other thing I would say that was really... It was uncomfortable when my mum had the council care was the feeling that the carers were being exploited. So, you know, they would rush in, you know, rush in, you know, do the minimum really, because they didn't have very long, rush out again. And there was one particular carer that I would, you know, she might come to my mum at nine o'clock in the morning, and then I'd be, you know, sort of nine o'clock at night, I'd be out taking the dog for a walk again. And I'd see Marie rushing, you know, round town going to a... You know, and that's... It's horrible for the carers, but it's also... My mum's fortunate because she has family around her, but for people that only get to see a carer, that's the only person they're going to see all day, if that visit is 20 minutes long, what's the standard of care going to be? And that was my... That was the point with my mum that I thought, I can't have this any more, because there was one particular time when a carer came at 10 past 12 and they'd gone by half 12, and I just thought that she's very, very slow, she's got very poor mobility, she's confused, she gets dizzy. You know, how are they washing, dressing, getting her to the breakfast table in 20 minutes? You know, and it was really disturbing, and that's why I turned to equal care, because I heard a bit about them, and I just liked the idea of a continuity of care and also a system where the carers weren't being exploited. That is a brilliant explanation. And when you contrast what you had to what you've now got, I think it really kind of shows the kind of shift that you've achieved. Emma, so you must be delighted, aren't you, hearing that? What it says to me is, the model that you've got through equal care is in some ways future proof for families and that it can deal with complexity as the complexity increases, whereas Michelle was describing a situation when complexity increased, the situation of just the council-providing model just doesn't work at all. So, do you want to just respond to Michelle? Yeah. Thanks, Michelle. Just speaking to complexity, we supported one man for about two and a half years, and it started off with one person in his team. He had a diagnosis of motor neurone disease. We all got very attached to him. And then it ended up with around 13, 14 people in the team when it moved to kind of completely round the clock care. And they were all, we did the introductions, they were all people that he was able to meet, to get to know, to consent to be in his team and to join his team. And he started off as well, kind of going back to this sort of being, having that ownership, having that control, he started off being the one managing the rotor. So, he was saying, right, do you want to do this when you're available? So, there's nobody at Equal Care who manages, there's no person in the office sitting and managing the rotors. People say whether or not they can do something and are responsible for their own time, which means that people are on time a lot more often. And this kind of seeing this transition from being able to go from something that was a very simple setup to something that eventually like lots and lots of agencies involved, it became multidisciplinary meetings and a lot of contact with the continuing healthcare team and his NHS district nursing team. And I think that's what, if we're going to create systems that really work for people, there has to be that space, you have to design for space in a way, for people to be people in them. And for those situations to change because they always will, they always do. The... Just coming back to Victor's point around kind of hospital beds, we had one situation in December where a woman we support needed to go into hospital with suspected sepsis. She was in there for three days. She really wanted to come home. They weren't going to let her come home without appropriately kind of the usual story was the stepped up care package in place, she was able to do it. The team, I mean it was stressful but the team got together, decided the rotor, what can we do, who can contribute to what and we got her out on a day of discharge. She didn't sit in a bed, she didn't stay there any longer than she had to. And the team went from a support that was around I think it was seven hours a day through to nearly 24 seven care in order to get her out and then we're able to step it back down. And they were in charge of that. It's fantastic. And one thing I've not asked you, you mentioned you do employ some of your own care workers. Do you mind if I ask what they get paid? We're a real living wage employer so this is another reason why Equal Care only really works at scale so with enough care and support workers. So the annual salary is 21.255 is what that works out to outside of London, that's 10.90 an hour. We were paying above the real living wage but then it did go up quite a lot. And we pay that as a salary. So if you're a community nurse and you get a salary from the NHS there is no reason why you would expect your pay to stop for a moment that you step outside the door of somebody's house. So why should it be the same for social care? So why should it be different for social care? So whether you're travelling or regardless. And then for the independent workers that is a situation where you're travelling to the place, you're not getting paid. So their rates are around £18 an hour now. So they get paid for their travel time? They factor in the travel time in their hourly rate so it depends on where they are and which teams they want to join. Wow, something that works in social care. This is really, I think. You deserve all of that appreciation because what you've achieved here is pretty huge really in the midst of a broken world you've made something work. Don't underestimate that. That is an incredible achievement. Paul, I'm going to look in your direction now and say we have a solution here. I think, as Emma said at the start, perhaps it's not the only solution. How do you see it in terms of this plus other co-operative models? I think the one bit as well just to last point on equal care co-op is attrition rates. Attrition rates across the social care sector up to 40% attrition rates in equal care co-op. We're an average of 3.4 on a quarterly basis. So you've got that continuity and the expertise and capability that comes with the continuity of the people providing care. For me, if you look at co-operative models, three things would jump out of me and Emma's set them out so powerfully. One is democracy in a sense that if you put the person receiving the support at the heart of it, it's fundamentally democratic and co-ops at the best of fundamentally democratic organisations. I think that's a really powerful part of it. I think... This is odd saying this to a former Secretary of State for Health. There is not enough money in the social care system. Full stop. Eve Denney's, as Victor suggested, businesses extracting profit and asset out of it. Well, as Michelle's right, it's the worst type of extractive capitalism, isn't it? You're doing it on the back of vulnerability, aren't you? Absolutely. And people who are struggling to make life work. It couldn't be more broken, could it? Absolutely. The co-operative model is a non-extractive model. Profits surplus come back to members. It's the second point. I guess the third point for me, and this is the thing that's really struck me, and Emma Broad brought it out so well, co-operation is a noun. You have a co-operative. It's also a verb. The point about social care is to integrate. It works when it's integrated. When you get both unpaid as well as statutory provision voluntary, when it's integrated, co-operatives, when we operate well, co-operate, integration is natural. Absolutely. Those three things are powerful. The one thing I would say on these and I've had the privilege to speak to Emma on a few occasions, co-ops provide a solution. I think they absolutely do. I have no doubt on that. There needs to be a framework for co-operatives to fruition. We need to think about capital. We need to think about the commissioning process. We need to think about how we help them scale. But the solution, it just feels it has to be because it's non-extractive, it's democratic, and it's integrated. You see, you've really put your finger on it there, because when Emma was describing the discharge process you were working with the continuing healthcare team and also the process of managing a discharge. I noticed you perk up a little bit at that because discharge is not something universally done well in the NHS. You don't need me to tell you that. But that point that Paul has made there about how this model or all co-operatives models, because of their collaborative approach, can, if you like, integrate with NHS staff as well. That's where this might be hitting something really important. First of all, the reason why it's problematic is because it's a boundary issue. It's at the boundary of what the NHS does and what the social care system should be doing. That's why it's problematic. It's at its most complex in the boundary. I think what Emma's described is a learning system. The thing that you need if you're going to operate teams around an individual is that they need to be capable of learning, because the individual's changed, you learn new things about them, and then applying that learning in new ways of intervening and what have you. On the co-op thing, can I just say, I think there are three buckets of learning that we need to explore, because I'm not going to sit here and say, you know, equal care is a brilliant model, but I'm not going to sit here and say the answer. What I'm going to say is that it's worth exploring, right? It's worth exploring, because I've learned the hard way that it's better to be slightly sceptical about every solution that's presented to you. But I think there are three buckets that are worth exploring from a co-op point of view, and I'm speaking as a co-op board member, if I may. The first is what I call the lack of a personal financial infrastructure. So you can put money in every month to pay for your funeral, but you can't put money in every month to pay for your social care. And why isn't it not possible to do that, and be guaranteed that care when you need it from an organisation like equal care, because you're putting in something? So why can't we explore that? That's bucket one, see if that happens. Bucket two is the federated model. So what co-ops are good at, and that's what the co-op group is good at, is actually bringing in lots of small things together to make a hole and put in an infrastructure in place. Which you're doing a bit of that, but it's a very human level. So is it possible that we could create a federated model that actually delivers at scale, commissioned by social care or NHS, but actually the co-op lets come explore that. And the final model is direct provision. So either by investing in, or finding a model that the co-op can deliver to your employer. I think those three models are worthy of exploration, or go somewhere to answer the problem. I'll take your point about scale, and I think it needs to be matched on the commissioning side. Correct. So you may need an authority, or a group of authorities to say, we'll take the equal care principles, but we'll do it across a scale with people who are getting care paid for by the local authority, or self-funded as well. Anyway, I think you're making a really important point there. We're coming to the end, and I think we've got the five-minute warning. So I suppose a big question to you all. I'd like just to hear from you all one more time. I guess the question is, should the co-op movement get behind fixing this broken market? I know there's lots of other broken markets out there, so it's not the only broken market that we have to live with. But the question is, should we do that? Michelle, I'll come to you again for a final thought. Given what everyone's just described, it does feel the co-op ideal is uniquely suited to social care, doesn't it, in terms of the culture and the ethos of cooperatives feels that the fit is perfect. There's a kind of reason why NHS organisations and councils provided care, sometimes it doesn't work, because it isn't personal enough. So maybe the co-op movement is the only movement really that can fix social care. Well, somebody has to step in, because this isn't a bullet that any of us are going to swerve. So there should be much more of an imperative out there. Never mind Philip Schofield, but there should be much more imperative out there to get this fixed. Talking about Boris Johnson. I was actually thinking Philip Schofield must be relieved. That's my favourite. The things that people, especially middle class people, don't realise how this is a welfare issue that's going to affect them. For instance, I know somebody who, her in-laws, both went into residential care. One was in for about 18 months, the other one's still in residential care. It's been going on for three years, and it's cost those people £300,000 and rising by £1,000 a week to keep her mother in a bed, because her mother's got dementia, she's blind and she's deaf, and yet with all of those issues, she hasn't yet qualified for free care because she's been assessed as being able to come home and have carers, so therefore she doesn't need nursing care, which would be free. That's the sort of situation we're in. I don't know if this is true, but I'm hoping it is. In Germany, carers like me, people who get carers allowance get £1,500 a month. My carer allowance is just over £10 a day. My mum's attendance allowance doesn't cover her monthly care package with equal care, so her savings that my dad ferreted away all through his working life are hemorrhaging. I think if the middle classes woke up to the fact that their children who couldn't get on the housing market aren't going to inherit anything anymore because everything's going to be eaten up and dad's care needs, and I think it's like we've slept-walked into this situation as a society, and I think it should be much more at the forefront of people's minds, actually. 100% you could not have put it better, and I hope you can hear the applause. I don't know if I can hear anything. I'm just a disembodded head. A very articulate one, though. I'm sure. Thanks for sharing everything you have, though, today. I just want to say, Andy, that my little old dad was a lifelong Everton supporter. Who was he? God, well, you know how that is. We need care as well. I think we need equal care. He went out to the Zedcast theme tune. When my day comes, so will I. Lovely to meet you virtually, Michelle. I'll just turn to the panel and just say, is there any reason why the co-op movement shouldn't now move its might into this space? Paul, I'll start with you. Co-ops currently provide less than 1% of care in this country and social care. If you're in Italy, it's 40%. There's a reason. I think there's lots of broken markets and I think the movement, co-operatives, and as Victor said, primary or secondary co-operatives can be a really powerful solution. Another thing I would say, honestly, is the Fairbanks produced that document last week with Unison. They did. It's an interesting document. You will know this far better than me. There's not a lot of flesh on that. I wonder if there's any other answers out there that aren't as compelling as the co-operative part of the answer. I don't think anyone's got a better idea of what you're talking about. I think what Emma's getting towards is a whole system solution, isn't it? Absolutely. It's joining all the dots between the players who will be involved anyway. That's really something quite exciting. Emma, from your perspective, is there any reason why the co-op movement shouldn't, you know, in the absence of politics at a national level and anyone else doing anything, I think as Michelle said, someone's got to do it, so why not the co-op? I know of less than five really other co-ops in social care. I signalise the way. So there are some in the room, Michelle. So there are some, yeah. And it's a bit lonely, you know. But, yeah, I mean, as I said at the beginning, co-operation is the right, it's the right mindset, it's the right approach to start with. It's because the right levels of tension towards how power is distributed in and amongst organisations. But it is the beginning of the journey, not the end. The bit about co-ops that I think could also be brought in to this conversation is the attention to where the money goes, so like where the value is and how co-ops can start to bring some of that value that's currently sitting outside the externalities of our economy and to start looking at really innovative ways, really human ways of how we can bring that in. And stop leaving people on the outskirts. Come on, co-ops. Honestly, I had us all hanging on every word today. Well done again to you, Victor. So in November 2022, the director of ADAS said, and it was reported in Manchester Evening News, things have never been so bad. This is a human crisis at a massive scale. It's not just a few thousands of people, it's millions, and it's going to affect you regardless of what class you're in. Co-ops have got a duty to get involved in this. Last year I came and I said co-ops need to make themselves relevant, well, easier opportunity. I think you've got to do it. So that's the first thing. The second thing is you need to hurry slowly. You need to explore the solutions rather than rushing. So I'm really grateful for Sireen's leadership on this at the co-op group. Let's explore, let's do that properly, and then when we do it, let's go real fast. So let's learn short, think long. And the third thing I want to say is that I don't think that this is something which requires us to look for a solution. I think we need your leadership, because if we're going to do it first, I think we should do it in Manchester for all kinds of reasons, not least you're the mayor. But I think don't look up. The days of looking for solutions up there, if you look up, all you're going to get is a great neck. Look out the solutions out there in the communities. I think the co-op movement and the co-op group go a long way, quite fast to solving this. Manchester first and then nationally. Let's just get on with it, please. A great neck and something else dropped on me when I found when you look up and try and deal with the... You heard it from the chair of the NHS Confederation. You've got to do it. Did you all hear that? Which is pretty direct, Rose. I think we're just at a bit of a reset moment, aren't we? We've kind of lived through a period of time, you go back to the 80s, where essentials were sold off. And where have we got to? We've got to a point where there's sewage in our streams and our rivers, as people with no water down in the southeast today. We've got energy bills people can't afford. We've got trains that are utterly chaotic. Places with no bus service. Where has it got us this approach? Extractive capitalism has just left us, left people without the basics. So it is a reset moment. We have got devolution in places like this. We have got a strong co-op movement. Let's get these two things together. We're open to the idea, Rose, of being the first, if we can construct a pilot taking equal care values and putting it on a bigger footprint. We're open to that idea. I'll hand back to you at this point. That's brilliant. Thank you. Thank you very much now. We're just going to test that with all of you because, as we all know, co-ops are member-led and it's never top down. It's not about anybody dictating how things should be for anyone. So this is a piece of work. We've been doing, like, starting the conversation last year at Congress. We've been working with co-op group on this. So we'd like to get, actually, at your view before you can go and get your lunch. And so on page four of your programme are coming up on the screens now. You're going to be able to see a QR code. And we just, first of all, not least led by, again, a co-op group on the team. We just want to check have we got the question right? Because those of you who have been to co-op at those UK events, you know we love a design sprint, so we know that's how to look at the solutions. So have we got the problem right? The UK domiciliary care market is broken. We've generally poor provision, which means quality and outcomes. We've got poor working conditions and pay. We've got lack of trust, lack of equity, lack of voice and lack of consumer choice in the UK domiciliary care market. So I just want to give you a chance now, and we'd just like you to vote on have we got the problem correct. Is that the problem that you're seeing, that you're hearing, that you're experiencing? Few, 78% straight off there. And those notes are really important because we will keep working on this. So I imagine knowing the co-operators that I do will have got one word slightly wrong or there'll be a bit of a nuance that we need to pick up. But we will of course take that all on board, but I think that's pretty indicative that we think we've got the problem correct. So okay, moving to the next slide then. It's the same question that Andy asked Emma and the panel here when it comes up. The question is going to be is this something that as a movement, we should put as a priority focus on this broken market? Yes or no? So should the co-operative movement work together to find solutions as a priority? Hallelujah! I think we've got our remit there, Cherine, Victor and everybody to go do some work on further work on this. As we've said, there are other co-ops out there. We've focused on one model not least because you pay well. You've got 63% of people coming from non-care positions into the place. Loads are really good, but there's lots of co-ops and this idea as well, we should say as well. You're one of our co-op platforms who came through our program out here. So the co-op is the app itself. What we did, I don't think we were clear on that. The app is the co-op in a sense so you join that app and that's how it all works. So okay, thank you so much. Thank you so much. Andy, Victor, Emma, Carl and Michelle. Thank you.