 Good afternoon everyone and thank you for joining us for this online event from the conversation. Following the publication yesterday of the UK government's long awaited white paper outlining how it intends to reform adult social care in England, we're going to be talking about the challenges and the opportunities the sector faces. I am Dale Burning Sauer, commissioning editor on the politics and society desk at the conversation. In a recent speech, the Secretary for Health and Social Care said that David described figuring out how to improve the social care system in England as one of the most challenging questions of our time. He also said that the pandemic had been a turning point in answering that challenge, and he and care minister Gillian Teigen are adamant that this government will. The plan they've now laid out is in fact to keep people funded. It aims to give people choice, control and support to live independent lives. Some experts and politicians argue that that's nothing new. That's been the aim for decades. The pandemic has of course wrecked havoc on the entire system on the border care workforce and on countless people's lives. David has highlighted the three main points as reforms are focusing on how the sector is funded, how it is staffed and how it is integrated with health care. But for many people who use and who research the sector, the biggest question is that as a society we've yet to ask ourselves what we actually want social care to be. To answer these questions and more we're joined today by a panel of experts from across the UK. We welcome Jess Morgan, Professor of Collective Intelligence, Public Policy and Social Innovation at University College London and Project Lead for the International Public Policy Observatory. Hello, Jess. Next we're joined by John Gladby, who is Professor of Health and Social Care at the University of Birmingham. John is a qualified social worker who sits on the border with NHS Trust and of a local authority children's service and his director of impact, the newly established Centre for Implementing Evidence in Social Care. Welcome John. We're also joined by Isaac Samuel, who is a freelance co-production advisor and community campaigner. Isaac has an invaluable experience as someone who has directly used the social care system and is also passionate about social care as a profession. He is a member of the National Advisory Forum for the Regulatory Body's social work engine. Welcome Isaac. Lastly, we welcome Liz Jones, who is a quality director of the National Care Forum. Liz has over 20 years experience across the civil service, local government and charity sector. She is a fantastic advocate for the people who work tirelessly to promote and to provide social care. Welcome Liz. We've got an hour today and we'll open up the floor around 10 minutes before the end for any questions. So if you have any questions for our panel, please put them in the comments stream and we'll try to get to them at the end. So this is a question to begin with for everybody. The white paper has been a long time coming. It was first promised in 2017. Now that it's here, if you could each go around and say one good thing and one bad thing about what the government plans to do. So I kick off. Yes. The good thing is that it's there and its words are actually really quite good. But I think what is missing and I'm sure we'll go into this in more detail is really an economic plan in particular that addresses things like workforce. So there's a gap between the aspiration and the means of achieving that aspiration. Liz. Partly what he said. So yeah, there's some great things in it. Focus on housing, focus on tech, focus on innovation, focus on people. The real thing that is missing is immediate action and support now to deal with the very significant workforce pressures that are really undermining health and care systems in lots of local communities. So great. There's a real emphasis on choice and control and people and the I statements and making it real. As a person that draws on social care, I probably don't know much about kind of money and stuff, but I just wonder how you get to those real experiences of good lives if there isn't enough money or resource. And it seems that we're offering the real opportunity to get things right, but lack of money and resource to do it and people need help now. They can't wait for policy change, which often takes 10 to 15 years. Thank you. Yes, I mean, I think the focus on housing is really welcome. For too long, we've had a separation between the kind of bricks and mortar where people live and the communities where people live, and then the care and support that people draw on. And so emphasizing housing felt a positive feature. But I think that the downsides of the lack of any kind of practical detail really about how we try and move towards those long term aspirations. A lot of the practical detail is either underwhelming or it's things that have already been announced or things that have been tried before and didn't deliver those aspirations. So the long term goal is great, but how we get there still seems open to question. Thank you. So I guess, even when the government makes big announcements about social care reform, there seems to be a lack of clarity over exactly what we're talking about. John, what does the term adult social care actually cover? Yeah, I mean, that's a really good question. It's a term that's often used for practical care and support for a range of different groups of people. Sometimes our frail older people, sometimes people of working age with physical impairments, with mental health problems, with learning difficulties. And then the unpaid carers that provide support as well to people. And it's often referring to supports that help with some of the practical tasks of daily living that can be difficult if you've got care and support needs. I think one of the difficulties we've got though is that a lot of the policy debate and certainly a lot of the media debate seems to focus on quite small or quite specific parts of the social care system without thinking about social care in its entirety. So just as an example, we spend about half the budget on people of working age. And yet the vast majority of the debate has been about older people. And within that it's been about care homes, often the bits that touch upon the NHS rather than focusing on social care in its own right. And you see that replicated in all kinds of ways so that the white paper led to a launch of a new website, which was great. Actually, the vast majority of the photos on that website were about older people. They weren't about people with learning disabilities or people with physical impairments or people with mental health problems necessarily. So you see that written into the kind of discourse around adult social care. And it then becomes quite hard to have a conversation about social care in the round and in its own right. Isaac, I wondered if you could tell me how you define social care. What is the best way to think about it? Sure. So I love the social care future statement, which is don't we want to live in a place that we call home with people and things that we love in communities where we look out for one another doing things that matter to us. And that is really important. So if we think about the wider determinants of a good health and wellbeing, housing, purpose and meaning, connection to other people. And for people like me, that often means that we need the support of PAs and carers to be able to do that on a daily basis. So it's about a really good life. It's about equal opportunity to do things that most people take for granted. So being in employment, having a loving relationship, being able to go down the pub with your friend, being able to get up and get dressed and all of those kind of things that make such a difference in disabled people's lives. But most people take that for granted. And social care enables me to have a really good life. And I know it does for so many other people and it plays a really important role in terms of enabling people to live good lives. I think we've got a long way to go to make that a statement of reality for all people. If you're someone with a learning disability or mental health challenge or you're an older person, you're less likely to be able to do certain things such as employment, education, all those things that you might need support with. It's a really important part of a society that values everybody. There's one of Boris Johnson's manifesto pledges was to fix the crisis in social care. But is it a sector in crisis? Is it right to talk about it as something to fix? I think there are a few ways of looking at this. And as Isaac said, social care is helping millions of people to live good lives every day and to make the choices that they want to make and to enjoy the experiences that they want to have. So when politicians talk about fixing the social care crisis, they usually mean something very specific. And I think when Boris Johnson talked about it, he was thinking specifically about older people and the cost for some older people if they have to move into a care home, into a care setting. From our perspective, actually, the social care sector is something that brings all sorts of benefits to society, brings benefits to the economy. It has a huge economic value. It's a huge employer and actually investing in social care so that it can deliver really well. It is more than just thinking about the impact on some people in relation to their financial circumstances. When there's a fixing the crisis narrative, it makes lots of things much harder. It makes it harder to inspire people to come and work in the sector. It makes people feel anxious about potentially trying to use services in the sector and get the help and support that they need. So actually seeing social care as an intrinsic part of our infrastructure and our communities, I think is a better way to think about it. And then look at some of the problems. There are some challenges. I mean, don't get me wrong. I'm not painting an entirely rosy picture here. We need more people to come and work in social care. We need them to feel valued. We need them to be better paid. We need them to be appreciated and we need them to feel that there's a prospect, a career prospect for them. And for lots of organisations that employ people, that's exactly what they're trying to do every day. But we do need some help. But I think overall, you know, there are people out there working every day really hard to help people live their best lives. And that's the thing that gets lost with a deficit narrative that talks about always fixing a crisis. Jeff, I would like to turn to you about the role of the state. So, Sajid Javed, is adamant that contrary to previous governments, this government will rise to the challenge. And if we look at this week's White Paper and what's the 10-year plan that it lays out, the question I have is, is this government going about it in the right way now? Has it become a policy priority? Well, I guess in theory, we could all look after our own care. And, you know, 100 years ago, that's what we would have done. But of course, most people died long before they got old. But we all face the risk, the likelihood we will need care. And we need a pooled approach, a common approach to providing that care. In a way, what's odd about this White Paper, which has been a long time coming, is in the 2000s, there was a lot of momentum around policy on long-term care. The Dill Knot Review, lots of planning. The Labour Party in 2010 was promising a national care service. It would have been elected. You know, this might have been happening. Then there was essentially a 10-years of not much progress at all and austerity and trimming back of eligibility for local authority care. Now I'm really glad the government is taking it seriously. I hope this is the beginning of more like a 10 or 20-year process of cross-party commitment to really making a change. But I think it's quite inherently difficult. I'll spell out very briefly a few of the ways I think this is challenging probably for any government. One is that, in a way, some of our traditions have seen care just as parking people or containment. But as Isaac said, this is much more about rights and control and power. And the words are there in the White Paper, but actually making them feel real is quite a challenge. The housing aspects are welcome. We've in the past compared to other countries had much more of a sort of binary approach between staying in your home and going into residential care. Whereas what we need is actually lots of ways you can move in steps to greater support, a much wider range of housing. And at least that is being talked about, which has been a long time coming. Any approach has to both be about well-paid, qualified professionals. And here we have a massive problem of pay, motivation, turnover recruitment, which, as we've said, isn't addressed in this paper, but also volunteers, friends and family. A whole community needs to be part of the support system for people, not just pay professionals. And then finally there's the mix of the human and the tech. Most care is about face-to-face love, compassion and care. But there are also lots of things which now can be done with data and assistive technologies, some of which are mentioned again in the white paper, though I actually think those don't go far enough. But all of that makes this quite a difficult challenge. And one of our problems is that compared to the NHS and the health bit of the department, care is very much the poor cousin, much less sort of capacity, much less sort of institutional memory about how you fix things. So I think the government is going to really struggle to act on all these fronts simultaneously. But let's hope at least there is the commitment to the ambition now, which there wasn't much over the last 10 years at least. If we hone in on specific elements of this then, so Liz, if we talk specifically about the workforce, which you have highlighted rightly that the white paper doesn't really look at, even before the pandemic there were over 124,000 vacancies in the UK. And right now providers are talking about a perfect storm of Brexit, recruitment obstacles and dilemmas about the vaccine and the workforce being burnt out because of COVID. And now there's the new on the chronic variant. So how big a problem is the care workforce facing? Well, I mean it's had a very challenging time and I pay tribute to all those people out there every day trying to provide a great service in what has been an incredibly difficult set of 18 months really. So I think that the pressures that we are seeing now were really probably quite predictable and there are some things that would really help. There are some things that there are some policy choices that the government could make. They've made a few of them in the white paper for longer term reform and I'll come back to that in a minute because there are some things that we have all been calling for that are in the white paper which will help us kind of down the line will help us with some of those longer term structural problems. But the immediate pressures that the sector is facing they really are a combination of the impact of Brexit that really has had an impact, the impact of COVID the impact of an incredibly tight labour market so we are really up against it in terms of competition with other sectors. And I know we're going to talk about this a bit later but there's a perception problem also you know social care doesn't always have a great brand. So some of the things that it would have been brilliant to see in the white paper or in fact in the winter plan actually that was published a few weeks ago would have been some very tangible measures to help the workforce. The things that we have suggested is a loyalty retention bonus for care workers all of the other countries in the UK have done that and actually it's a mark of respect and appreciation from government and from society for those workers throughout the last 18 months. We do need to find ways structurally of improving people's pay. The vast majority of care at least 60 to 70% of care that's bought in this country is paid for by the state. So if the state isn't really paying a fair price for that care that enables the workforce to be properly remunerated then it makes it very difficult for employers to do anything other than pay the national living wage and of course employers want to be able to pay people better because A they're doing a very difficult job and they should be and B it means they will stay in the jobs that they do and continuity of care is so important for the experience of people who are using care and support services. Having a consistent team around you who understand you and know what your care and support needs are understand your circumstances and your ambitions and your aspirations is really key and it's very difficult to do that if you've got a team of people that's constantly changing around you and then this isn't a very palatable option for a government that wants to control its borders but actually we've seen the government realise that there are some occupations where actually we do need some help from workers beyond these shores and so it would make sense to have some flexibility around being able to recruit care workers from other countries because the domestic labour market is really really not working so there are things that could happen now really which I think is a real missed opportunity and it's not just the social care sector that's calling for this even the NHS has said we understand we need to do something actively to help the workforce crisis. Thinking about the longer term some of the measures in the white paper will help, it's just they're not going to help quickly enough so there's a range of ambitions around training and development a knowledge and skills framework helping to make the care certificate which is a really important qualification to make that more portable and more of a trusted recognised qualification so people can take it with them and people can start to build their portfolio of evidence and qualification and see an avenue to different types of jobs and to different career prospects within the care sector so there's some good stuff in there it's important that the government embarks on this but it needs to do both things together it needs to help the immediate challenges of workforce pressures and it needs to start to invest properly in supporting the sector and find a way to solve the pay problem it's not really acceptable for the suggestion that this is all entirely a set of private employers problem it's more complicated than that and of course our members are not for profit members so they're coming from a different kind of culture anyway I think I wondered if you could reframe what a workforce shortage actually means what it looks like for the people who really need support so the first thing I'd probably like to start off with is that people with care and support needs to live in hope that the white paper will make a difference because we need something different to happen we need to do something different to get different outcomes and I think for people like me the work for shortage means that we don't get that care we don't get the consistency so I'll talk about my friend Juten who is quite happy for me to share this you know there's carers that are coming day in and day out and they're different all the time they don't necessarily know his needs they're often missed a quite visit because the workforce to fulfil that and that's really sad that means that he's stuck in his bed not being able to do the things that we all take for granted and that's like having a life I'm lucky that I self direct my own support and I employ PAs and if I said to most people that they come and join become a PA, join social care they'll probably look at it in a really not a great profession but my PAs they have really good training to get to work with a fabulous person like me it's not a job it's part of my family they do and support me to have a really good life but it doesn't feel like we have those really positive messages what it is to be a carer what it is to be a PA and PAs and carers not only do they provide really important support to people like me to have good lives they live in our communities they contribute to our communities they're part of our communities in a sense that we need to really reframe this really negative rhetoric around social care because we need to attract more people there have been many many bad poor policy decisions we've had Brexit we've had Covid, we've had all of those things but before that there were really policy decisions that meant that there were austerity that plays out within people's lives there were budgets that were being cut there were lack of resource in terms of training in investment in the workforce and year on year we've had to fight to keep our budgets for year on year we've had to fight to retain our PAs and our carers but they make such a difference such a contribution but if we can't pay them, if we can't train them how do we keep them and then we have things like Brexit and then we have things like Covid and in Covid PAs and carers went above and beyond they brought people walking three miles not to take public transport so that they could ensure that they were coming to my home to be offering me care in a safe way I mean that's beyond what most jobs would expect how do I recognise that by being kind and all that kind of stuff but I'd like to be able to do more and let's not forget that carers within the care sector have been massively affected by Covid so many carers have died so many carers have lost their lives as a result of that I think we need to support the carers and PAs because they make a difference John I wondered if you you'll research and then you'll work with in fact if you have insight into what has worked elsewhere or how working in social care in adult social care can be a viable and desirable career path you've spoken I know about seeing social care as an investment in social infrastructure so could you speak about that yeah sure well we've got this narrative in a lot of policy under successive governments that seems to imply that spending on social care is a kind of form of dead money it's about providing a basic safety net that delivers the kind of expectations that the public have of the support that a government will provide for its citizens but no more than that and lots of the speakers today have been talking about trying to move away from that legacy towards seeing investment in social care as being a form of social and economic investment that we make in ourselves as a society it's not a narrow debate about inheritance it's a debate about what kind of quality of life do we want to have together as a community and how do we achieve that I also agree with Liz about moving away from this crisis narrative that we have and today's event is fantastic but it still talks about fixing the system actually is the system broken and do we need to fix it you could say there's 100,000 vacancies in social care at the moment or you could say there's 100,000 opportunities to make a massive difference to people's lives and to grow and to benefit as a person yourself in the process why would you not want to sign up for one of those opportunities and I suppose as a private individual I'm really proud to be associated with adult social care it's changed my life actually it's changed how I live my life it's changed how I've brought up my children it's changed how I relate to people around me I've met so many fantastic people I've learned so much I've been brought into contact with people, sometimes in very difficult circumstances and different transitions in their lives but just met so many amazing people and learned so much from them and it would be amazing if the sector could get on the front foot a little bit more and try and do a better job of explaining why social care is so amazing tomorrow morning actually I'm doing an event in Devon where they're running an appreciative inquiry not kind of is care broken and how do we fix it but what's great about care and how do we overcome some of the barriers so that even more care can be like that in future for other people as well and doing it in that kind of way and that's an exercise that Devon as a local authority is running with some of the people who draw on care and support in the county, some of the people who work in services but also the broader public as well to try and have that as a public discussion and for me what was most disappointing about the White Paper was and some of the associated measures was some of the sort of narrow funding debates that there were around it rather than that attempt to have a public debate about what kind of life do we want to have together, how much do we value each other and then a subsequent debate about and what are we prepared to pay and how's to do that for that kind of quality of life but for me this is a debate about the quality of life that we want to have together as a society it's not a problem to be fixed Jeff I wondered what your response is when social care is spoken about as an investment it also represents the cost doesn't it? Recent cross-party committees in both houses of parliament have underlined quite how big a cost it is figure of 8 billion being tabled so can you speak a bit about that idea? Well I mean every country in the world is grappling with changing needs for care as we are population ages, our average age is older than ever before but the average number of years left to live is older than ever before and there will be more people living with a disability of some kind than probably ever before in human history so this is an absolutely global issue how do we organize care on a large scale in ways which feel good now in some ways that is an investment I agree very much with the spirit of what John said but it's also a cost and it's unavoidable cost some of which won't pay back in a classic investment sense and I think we've got to be prepared to pay that cost the price of a good life for all of us I think our challenge in getting a fix on this is how to ensure we've got the right inputs and the right outcomes to put it in very crude sense and Isaac mentioned this earlier there was a move 15-20 years ago to personal budgets giving more control over money to people I was a bit involved in that which was good that was the idea that in you could then choose who your PAs would be it would be backed by navigation tools so you could find who was available what was the service what was a good home what wasn't and so on that was the vision then but because there hasn't been a fix on the workforce issues with so many people on minimum wages so many people so such high turnover it means this kind of dashing in dashing out very unreliable services even with the best will of the world means that a lot of that system isn't quite working so that's why I think there's an investment in infrastructure needed as well as the long-term investment in workforce I think we do have quite a bit to learn from the rest of the world and this is mentioned in the questions at IPO we've been publishing various scans so for example we've just done one on workforce support in other countries around the world and there's all sorts of things that have been done in terms of extra financial support support with the stress of having to be on the front line of the pandemic respite and so on I hope the policy makers are looking at that and there are other countries particularly the Scandinavians have long had a much higher status for care of all kinds including children's care and social care more of an investment in qualifications and in pay and investment and then none of them are ones we can just literally copy we are a different country we have different cultures but I was actually very disappointed in the white paper how little sense there was that we should be a bit humble about what we could learn from other countries doing this slightly better than us and a final comment and again maybe I'll be out of line with Liz and John as it thinks on this one I can see the need to emphasise the positive an appreciative inquiry approach to what we already have in care there's a lot to appreciate but in a political environment if you're not willing to get a bit angry and argue and assert you risk being squeezed out not least by the NHS which is very good at making claims for money and I think it's in some ways been too easy in the past for politicians to ignore this sector because it is a sector based on love and care and compassion and therefore feels very uncomfortable being angry and talking about crisis and disaster but I sort of fear without a little bit of that the risk is of being sidelined again for the next 10 or 20 years Jeff has mentioned infrastructure needs for the sector and Javid has said that he wants to stop people from bouncing around the system and that integration between health and care is the only way to achieve that goal and we've been promised a forthcoming white paper about integration specifically in the interim though John I was wondering if you could explain what integration actually means and also whether the idea of integrating social care with the NHS or with healthcare doesn't risk medicalising care and what the problem with that would be Yes so I mean well the problem we've got is that partnership working or collaboration or integration means so many things to so many different people so everyone can agree that more joined up care and that more integrated care is important but then you very quickly find that nobody actually understands the same thing by that statement so it's really important that we try and deliver outcomes that matter to people and Isaac earlier touched on that amazing definition by social care future and if we're going to try and deliver that then then different parts of our public services and of our communities will have to come together across traditional boundaries in order to contribute to that vision of what a good society and what a good life looks like and anybody that draws on care and support or is a carer and anybody who's worked in health and social care knows that having single services, silo based services just doesn't work in terms of the messiness and the complexity of all our lives. Real life is just more complicated than the structures we create in our welfare organizations the difficulty is when we start to talk about integration it can mean a lot of different things to different people the debate sometimes gets quite structural wouldn't it make sense if we just integrated organizations so there was a single person in a local area responsible for something like a legal structure and whenever we've reorganized our welfare services we've tended to make them worse rather than better in the short term as we go through the complexity of that organizational change and of course we've got models like that in Northern Ireland that have been structurally integrated since the 1970s but to me don't feel anymore joined up in terms of how people live their lives that in a system where health and social care aren't structurally integrated we've then had debates about a national care service and a colleague from Scotland I think in the chat was asking for views on that and again that could mean different things to different people it could mean that we merge all social care into the national health service so that it's running exactly the same way it could be that we have a national organization that runs all care or actually it could mean we have a series of local organizations responsible for deciding what kind of care and support is needed in the local area but that's part of a sort of national framework of expectations and entitlements and so some of the language we use could mean all those different things at once I think what we've learned over the years and I'm a professor of health and social care so I tend to specialize in work around joint working and collaboration we've learned that it works better when we're clear about the outcomes that we're trying to deliver and then we work out the kinds of relationships that we need with which kinds of services and professions in order to try and deliver those outcomes it doesn't work so well if we leap straight into a debate about kind of processes and structures and then we've also learned that it works better when you pay really serious attention to the different identities and value bases that some of the health and social care professions hold dear it's a soft issue around values and cultures and identities rather than a sort of technical discussion about how can you merge different systems together so I'd be in favor of something that can join up care and support around the kind of lives that people want to lead and that implies that that's individual to the person and the person has significant choice and control over what that looks like I wouldn't be in favor of something that said well if we all just merged it into the NHS wouldn't everything be okay because I don't think it would be so so yes to joining up services but actually debates about integration can get quite confused quite quickly and I'll perhaps just leave you with one academic review that I read that looked at all the different terms that have been used over the years partnership working, collaboration seamless services, coordinated care joined up solutions to joined up problems bringing down the Berlin wall between health and social care all these different kind of concepts that all kind of try to get to something similar and they found 175 different terms that people had used and of course being academics their solution was to come up with 176 that would somehow resolve these issues once and for all rather than saying do you think this is the right way of talking about these things shouldn't we be talking about the kind of lives we want to have and then work out how you design behind the scenes in order to to give ourselves the maximum chance of achieving that but then there are very practical granular things that really do need to be sorted out right how do we need social care and health to work together Well yes we absolutely do and I would agree with John there about the focus on cultures and relationships and there's a question in the chat around the idea that the system is a bit stuck so what's always interesting is that usually when social care is getting any kind of airtime or any focus it's normally in relation to its role for the NHS and you may perhaps be forgiven for thinking that the NHS can at times regard social care as its handmaiden and really what's going to be key to this is seeing the social care world as an equal partner to the health care world so they each play a really intrinsic role in helping people to live their best lives you know one of them is helping people to get well to recover, to prevent illness to manage long term conditions and one of them is helping people every day to do the things that really matter to them so when we only ever talk about social care in relation to the NHS we do get that sense of being stuck and we do get that sense of lots of people being in hospital when they don't need to and either not able to go home or to go into a different type of care setting for the support and re-ablement that they might need or for the long term care that they need and it really does matter it really does matter to those people though it's not so much that it matters to the system it really matters to those people and their families and their life costs the bit we hear less about is the fact that if health and social care are not working very well together then people who are living in the community and might be at risk of needing more intensive care and treatment from the health service if they're not getting the support that they need at home that early intervention and preventio opportunity is missed thousands of people at the moment who are not able to get the care and support that they need because of all the things we've just been talking about in terms of the workforce crisis. So the two parts of the system are really important, but they're equally important and they do have a real impact on people's everyday lives and the lives of the families of those people. So if one bit of the system isn't working very well it has impacts on the other bit of the system, some of them are very visible and some of them are less visible. So I agree with John that the idea of defining a national care service is probably not the way to think about it. The way to think about it is to ask those two bits of the system to really respect each other, value each other, understand each other's challenges and work together to solve them and in places where relationships are good, respect is good and there has been a history of collaboration those things work well and in places where it's rather more arrogant or a bit more siloed those things don't work well. There is a huge huge opportunity coming with the government's plans for these things called integrated care systems which are designed to join up health and care at a kind of population level. And in one sense it's all the things that John and Jeff have mentioned about a big reorganization of structural deck chairs and kind of organizational system and if you just think about it as a kind of a very large administrative exercise then you will only ever get the worst out of it. If you think about it as an opportunity to really enable those two parts of the system to come together then there's a real opportunity. Unfortunately the government doesn't seem minded to put some of the safeguards and legislative requirements in place for those systems that would mean that if places don't naturally get on together with their health and care system they are going to be forced to and so there are some things the government could do now in its legislation that it's planning for those systems which would say basically you're all going to have to talk to each other you're all going to have to work together and absolutely social care is as important in those systems as healthcare and fundamentally really at the heart of all of the people who are going to be using health and care services but alongside that are the people who are providing them and however great your NHS is at the moment it doesn't seem to be able to magic up all the people that we need to provide that joined up system so that people are not stuck in hospital and not going into hospital and nowhere near the risk of of hospital are actually you know enabled to live the lives that they want to at home with the support that they need so there's an opportunity and it's all about respect and being seen as equal partners in my view. Jeff I wondered if we could turn to the future of social care so Javida said that the pandemic has marked a turning point and he's laid out this long-term plan and you and your research you've underlined the importance of social imagination and collective intelligence in response to the COVID crisis and I'm wondering how that a way of thinking informs how you think about the care sector future. Okay well just one little thing to add to the previous conversation the British public really doesn't understand care very much the white paper has this some of the data on it a majority think the NHS provides care majority think it's free at the point of use when people face a personal or family care need they often find it a really traumatic experience trying to navigate around the system so I think one thing we need for the future is actually making it more navigable understandable I actually think some of the words in the white paper are the right ones for the future which are about choice and control and respect and dignity I think in terms of the future relationship of the NHS and care the NHS is bound to be focused on health and medical issues I would hope that care is mainly focused on well-being and happiness and thriving and if you take that seriously yeah medical stuff matters but other things like friendship social interaction fun matter matter probably even more and yet they'll always be disregarded by the health system so I think our challenge is how do we put in place often the very boring bureaucratic administrative financial things which can support that and although I agree that structural change often is a diversion and the managers will spend all their time on it one of the reasons we have a good health services was a structure was created the NHS which you know two three generations later we still have and that's why I'm a bit more positive about a national care service at least providing a framework an umbrella for the national conversation about what kind of care we need and how we'll provide it in in the future so actually if I had to make a choice I would hope that in 20 years time there would be something which looks like a national care service but very much not monolithic not a command and control mega bureaucracy and definitely not integrated the NHS because it's got different tasks but something which really is visible people understand they care about they feel it serves their needs in the way we do have a good relationship with the NHS and we basically understand what it's about before we go to questions from our audience I'd like to ask everyone on the panel obviously the white paper has big aims with a long tenure plan but a little detail as you have as you've highlighted so as the plans actually take you know firm up and become more visible what do you each want to see what would you like to see and what will you be really looking out for Isaac would you like to start so I think we've come a long way in terms of ensuring that the voice of people at general care and support and the families are essential to developing the infrastructure and policies and the care system that we need I think we need to go a lot further than that I think to get it right we need to ensure that we are having those voices whilst not only making sure that you know local systems are able to provide good care and support to people but the white paper is actually a reality to people I believe in co-production which is about ensuring that voice of people at general care support and their families are involved in shaping designing and evaluating what works for them we know what works for us so you have to include us in that conversation and we have to be central to it um John yeah well I agree entirely with Isaac um I guess having read the white paper um I'm not sure any of the answers to the challenges that we face are going to come nationally um I didn't believe that before but I definitely don't believe it having read the white paper um so that means they're going to have to come locally from the the sector itself and people who are connected to the sector so that's going to have to be about about daring to believe that the future can be different it's going to have to be about innovation um it's going to have to be about coming together to talk about and to work on these issues at local level and adult social care is often very fragmented and sometimes the relationships can be quite competitive between some of the different stakeholders so there are very few shared spaces for people to come together from different backgrounds to talk about these things and to work on common um problems and to try and develop common um solutions and a lot of what impact uh that the new centre that that I'll be running will be doing will be around uh convening actually bringing people together different stakeholders with different perspectives to to work on what um what better approaches might look like at local level and trying to generate some of that innovation and some of that uh learning bottom up um so I think that point about innovation is interesting um and the point about competition is interesting actually uh we have a very collaborative group of care providers um who are anxious to learn from each other and and improve what they do so I'm quite excited for the idea of being able to get involved in shaping new models of care and working with people and communities to to bring innovation to the way that we think about um uh shaping the services that our members deliver uh and I'm also interested in how we can um harness some of the uh technology advances that do really give people a bit more independence and more control over their lives I'm also interested in how the data and intelligence debate pans out because there are some real opportunities around the government's data plans but there are also some real concerns about how data might be used governance accountability consent and ownership so I want to make sure we harness the opportunities and we don't um we don't just watch the risks grow uh we've talked about workforce um I really do think there's an opportunity to do something now as well as build the longer term um I guess the longer term transformation uh for the workforce so they feel really truly valued and appreciated in every every sense um of the terms uh and finally housing I think the housing the fact that housing is in the white paper and there is a chapter that talks about um every decision about care being a decision about housing is um it's quite refreshing to hear from this government actually we talked about those things many years ago uh it's good to see that that's back in the equation and thinking about how we work with people to shape their potential housing options uh I think is quite a challenge but I also think it's quite exciting um Jeff we have some audience questions and I'm wondering if you could take the first one um from James the fact that DPs are struggling so badly feels like a further major issue care recipients with health issues seem to be funneled to A&E when a strong relationship with their GP would be much better for all what are your response to that yeah well in a way this relates to I think this broader question of sort of the collective intelligence of the system now part of that is the sort of work which John is doing which I'm really glad about gathering our knowledge of what works what doesn't work lived experience orchestrating it making it widely available and also tackling the data things Liz said but I think there's a local side of this very relevant to GPs and a few years ago I was involved in working in several areas where we tried to get all the people who were as it were involved in the the support for the mainly the vulnerable elderly the GPs the local authority the charities the neighbors to work together to reduce the unnecessary pressures on A&E this was very much driven in a way by health service needs but it led to much better solutions of some very everyday practical looking out for people caring for them having a neighbour you could ask to help out if there's something was going wrong and I still think we haven't got that right and yet if we didn't really mobilise the brain power the collective intelligence of all the people who are the system at a local level we could greatly reduce those unnecessary stresses on the health system and improve people's happiness and well-being as well and they say there's some good models which have been done but they're definitely not everywhere um John Matt asks what about all the unpaid family carers and other informal carers um how how can it become a priority to organise and support and measure the support that this group of carers gives yeah well there's there's um fantastic things happening with charities like Carers UK um providing support to carers and drawing attention to the contribution that carers make and ways of kind of calculating the financial contribution that unpaid carers make which is more than I think the whole publicly funded NHS and social care system put together actually if there weren't unpaid carers then the whole system would would cease instantly and be instantly bankrupted um I think for me the issue comes back to one of adequate funding and of choice and control and so if there's choice that then people can can choose the kind of relationships that they want to have with each other and when I was training as a social worker I met people that with practical care needs that that really wanted a a family member to to do that for them where it possible because of that that was just the nature of the relationship that they had and that that was their choice and the choice of the family member I met other people in very similar situations who the last person they'd want doing that kind of stuff for them was a family member who wanted to keep the family member as a family member and have someone else as a providing care and and support and so if there's no choice and if there's no control and then if there isn't adequate support for anybody then the bulk of that is going to be a negative experience and it's going to fall on people who draw on care and support and it's going to fall on unpaid family carers and and all the evidence from Carers UK and others is about how negative that can be if you're thrust into that situation without without the right support whilst actually if there is choice and control if there is support then then people can choose how they live their lives they can choose the kind of relationships they want to have with each other and there's enough support to enable people to live chosen lifestyles without anybody feeling backed into a corner or anybody feeling exploited by by anybody else so so unpaid carers are crucial but the system doesn't work for anybody if there isn't choice and control and if there isn't adequate support available for everybody um Emma asks is there anywhere in the world that we can learn from to do social care better so I know Jeff you mentioned that this has been left out of the white paper which countries would you point to that um where the model is um instructive for the UK who do you want to answer that um Jeff if you if you'd like to could you well as I say we've been doing some of these scans through hip-hop COVID in society so do please look at our our scans and what's happening around the world the Scandinavians do this well Japan which is almost the oldest country in the world now has in some ways an extraordinary care system though still very reliant on women and the family as well but this is I hope one of the jobs of John's new program is that to make sure we are constantly learning from the most interesting practice around the world and and humble to to to accept and probably we aren't the place doing these things best and we've got you know lots we could learn from others but John's maybe better to ask the question than me yeah just really briefly I I I agree entirely with Jeff and I agree with the spirit of the question at the same time sometimes these kind of debates have led to the search for a magic answer you know there's a country that's cracked it and if we were just a bit more like country X then it would be okay here too and just in my experience to date I've not found a country that or a society that's cracked it everyone's struggling with the same underlying challenges and then there are loads of examples of good practice in different countries including some examples of good practice in systems that you that feel pretty pretty kind of negative and not great examples as well so I think there's something about looking for the good practice irrespective of the overall nature of the system and then just I think that humility that Jeff mentioned is really important but but equally equally not not assuming there's a magic answer out there that we just haven't found yet and if we keep looking hard enough we'll we'll find it you know I think we've learned it's more more complicated than that and then I think the final thing I'd say is I think there's something about balancing the humility to look for good practice elsewhere and to to learn from that we've also been quite proud of some of the things that we we do do well and I took a group of I was with a group of social workers that went out to Chicago and that met up with social workers from Hamburg from Chicago from Casablanca from Paris and from a couple of other cities as well all sharing some of the work that they were doing the theme happened to be around tackling abuse and violence and and neglect and having spent quite a lot of time in in some of the the kind of neighborhoods in Chicago meeting community workers and social workers there there was loads of good practice that we learned from but there was also loads of stuff that we didn't like about about that system and some of the social workers on the plane on the way back and this was from a local authority that had quite negative ratings for its social care said do you know what everyone always tells us we're rubbish no but actually we do adult protection we do mental capacity we do support for carers we do a load of things really really well in comparison to anything that we've just seen even in a city as amazing as Chicago for the last couple of weeks so I think there's something about getting that balance right between humility to learn and and pride in in in what we do and it doesn't work if if that balance between humility and pride gets out of kilter thank you all we've reached the end of our webinar thank you so much to Isaac and to Jeff and to Liz and to John for contributing to our panel and thank you to all of our listeners for tuning in