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can I welcome everybody to this session? We have about 60 minutes together with the focus on social care. It's really good to have social care on the platform. And I'm delighted to be able to, in my capacity as chair of the social care leaders group, to bring social care into the room in a much more integrated way, working with our partners. And can I also welcome those livestream to it as well that they are very welcome? And any questions queries they have. Please feel free to get involved. First off can I say that the leaders in social care group is quite a unique group because what it does is bring social care leaders across the voluntary sector, the private sector and the public sector. And in many ways it has been a seven year journey to develop that leadership capacity within social care facilitated by the Northern Ireland Social Care Council and people said to me, You know, how can we manage to build agreement in terms of the principals and values that we would want to work at as leaders in social care with with three very distinct different cultures and it is a credit to the social care leaders group of 30 so organizations that we manage to do that, and it is holding us in good stead in terms of our cultures and values and the way we want to work as an integrated part of what I would call an ecosystem. That's the new word I'm going away with from this session. What is the social care workforce? 36,000 staff. The diversity, the scale, the skill and the capacity of those 36,000 individuals is remarkable. And we've seen that in coated they operate in older people learning disability, mental health, physical disability. They really reach into and touch community and families and individuals. The social care leaders grip as employers. Copper creates across all settings, whether that's care. Homes, day centers supported housing with people, homelessness and addictions. So if anyone wants to work in an integrated system way in a social care setting with social care leaders, I would commend the social care leaders grip to you before I introduce the speakers. I was very struck with what I read in the research report that you're going to hear from from Camille and I'll quote this because it's very important. Care workers are first on the front line, delivering care and precarious circumstances, but last to see meaningful acknowledgement for their perseverance. Ensuring progress is in the wider public interest. So we're gonna have a conversation and a discussion about what that looks like and what we need to lean on to be able to bring social care much more mainstream into this integrated care journey. Before I do that and introduce, Can I welcome Ran Williams, who will say a few words as our sponsor. Hi, everyone. Thanks very much. My name is Brian Williams. I'm one of the directors and co founders of Connected Health, so we employ about 1700 Home cares across, and I we do $35,000 of care per week. We do about 5.5 million physical care visits per year, and we have also lead the way in terms of developing and looking at what technology can help augment and improve what courage do on a day to day basis that most value to our clients. So it's our pleasure to be involved in this particular panel. What we're interested in is how we revolutionize the role of home care within social care and what it can do within the broader health and social care system. So very simple things like Let's see our home cars as an entry level profession into the bladder health and social care system. So how do those cars develop and growth so within our own connected academy and things like that were interested in 17 different types of accredited training programs that make those cars advanced their skills, their development of growth that makes them really sticky within the system. We also looked at 5.5 million physical care visits per year, but yet we collect zero data or information. So how do we know somebody's getting better getting sicker other than positive data from markers and communication and things like that? So what I'm interested in in terms of home care was 18,000 registered home curves. And then I what a workforce. They're generally paid around 11, 15, 11, 11, 50 per hour, right, ridiculously low wages in terms of what they do. But that place within the system is where the big winds are in terms of acute discharge. In terms of engagement, the primary care But we've got to re engineer the model to make sure that social care and particular home care has a much more central part a much greater currency within the broader system. And that's why we're delighted to support this particular session. Okay, so I want to just say a few words about the three speakers. We're going to give them 10 minutes. I'll keep an eye to that, and then we want to allow 20 minutes for discussion in any questions. And I'd like to leave with one or two things that we're gonna say we're going to do in terms of the way forward. So I want to make sure we deliver on that. I want to welcome Camille Long. Long is it? Got it right here will give key headlines from her research on social care reform across the UK and some proposed solutions. Some international perspectives, an important key messages on what we need to do around social care. And I read that report with avid interest Sean Holland, who will know who was formally the chief social worker for social care Northern Ireland, and he talked a bit about the opportunities to build a sustainable social care system and finally, Matthew Taylor. I've known a long time. I've never met him, but I've known him a long time in terms of his strong policy and strategy leadership over many years, and it's it's a pleasure to be on stage with him. He will outline NHS confederation views on building a sustainable social care system in the UK and the political and systematic wide changes that it needs so over to the three speakers. And then I'll be back in terms of the questions. Hi, everyone. So, um, can you, uh, mentioned, uh, and I'm a researcher at the Field Trust. So we're health and social care think tank, and we worked to generate evidence based research in policy for health and social care and social care has really been a growing area of interest for us in the last few years, in the face of several failed attempts in England, at least two reforming the sector, and this has prompted us to look at other countries to see if there's anything that we can learn and bring it to our own context. So I lied our work on social care across the four countries of the UK and we have quite an interesting natural experiment. I think about how social care reform could be implemented just by looking at our immediate UK neighbors and seeing what's been prioritized by each of the four countries. So I've been asked to give an overview of social care reform across the UK and to reflect on what learning either in the UK or internationally can help us to create a step change in reform. No. So I guess when we're thinking about the solutions, it's helpful to first of all, start with the problems. So what are the reforms intended to address? And so this slide summarizes, um, some of the problems that we found when we were looking at the English social care provider market, which is written up in a in a paper called Fractured and Forgotten. And we published that last year. And although these problems speak, I think to the English context, I'd say that there's probably quite a lot of similarities from across the UK, So the decreasing pot of funding, which we heard about in this morning session as well, has obviously been a big problem. And with implications for almost all of the challenge is listed on this slide. So, for instance, around shaping the market and balancing stability with innovation, creating a sector that is responsive to people's wants and people's needs and enables them to lead the lives that they want to. And we've spoken already about work force and you might have seen skills for Care Report on the English work force, which came out last week and really highlights the extent of the challenges that England is now facing. Um, with a decrease in the number of field posts and an increase in the number of vacancies. And I think high demand in the sector and recruitment challenges have really put pressure on. The social care workforce is worse than their working conditions is worse than their wellbeing. And there are limited skills, development opportunities, poor progression, poor career progression, opportunities and pay that has limited competitiveness against other sectors and in particular against colleagues in the health sector. And it's important, of course, to note that the consequences of these challenges and the impact that those on the people who draw and care as well as unpaid carers who suffer the consequences of the system, it's not responsive to their wants and needs. And so each of the UK countries has recognized these shared challenges in their plans for reform. Uh, and so it's quite interesting because the solutions are starting to look a little different. So what are these reform starting to look like? So this is very illustrative slide, and there are very many other tidbits that are underway across the four countries. Um, lots of responded responsive funding to around the workforce and unpaid carers coded. But today I really wanted to focus on the aspects of of reform that are more long term. And so each of the different countries has has got two more advanced or not stages over the last two years. But I really wanted to highlight with this slide that it is on the radar for each of the parts of the UK. So I'm going to pick out a few elements of reform around the offer around the market and around the workforce to highlight what different parts of the UK are doing. Potential questions that we might want to consider around reform and then conclude with some experiences outside of the UK as well to think about how we can bring this together and create step change. So firstly, if that works and one of the biggest aspects of reformed and I think it's possibly the one that we talked about the most is changing what people are entitled to from the state. And so all of the four countries have put forward proposals. But I think England possibly stands out as having most recently legislated so firstly, to introduce a cap on personal care costs, which will be set at 86,000 lbs, which means that no one will have to pay more than 86,000 lbs towards the personal care in their lifetime, which is still quite a lot of money. And in addition, the means test, which is currently set at 23,000 lbs, 250 will be extended 200,000 lbs. And so what this means is that in principle, more people should be entitled to state funded support. Although I should say when I prepared this presentation a week ago, I hadn't realized we might have a new chancellor and we're hearing once again about more delays to implementation and I think that really highlights the challenges of taking big steps in social care. Another point I wanted to point out on this slide is the context of Wales, which has taken things quite a step further. So they've committed to having, um, an implementation plan for social care system that would be free at the point of need. An implementation plan should be, uh, put forward by the end of 2023. So there really is some variation across the UK and how far governments are willing to extend publicly funded support and, of course, acknowledging that the system is already at different starting points as well. But how the offer is funded, especially in the long term, will really be key to ensuring the sustainability of reforms. So, secondly, across the UK, policymakers have also been grappling with questions of accountability. Who should be responsible for making changes, social care and what what level? That's that, whether that's national or regional or local. So I try to represent, hear how the various reform plans reconfigure accountability for social care and specifically around commissioning, and this really isn't a perfect science. So apologies Um, and I think what it's really clear across the reform plans is that we do need to have a clear idea of who is responsible for what. So in England and Wales, accountability is still very clearly with local authorities. But in Wales there is also a desire to pull knowledge a national level, and you'll be much more across the structure of social care in Northern Ireland with the integrated structure of health and social care, so local government doesn't feature in quite the same way. But if you're really interested to see how developments around, the regional integrated care structure can change somewhat, accountability arrangements and Scotland, I think, has really taken things in a much more radical direction by taking accountability away from local government, having legislated for this this year and placing it with the national care service, which will be accountable to Scottish ministers. And so the idea is that the national care service would ensure consistency and set the vision for the system with the local delivery role as well. And so what? This raises questions about whether having more of a national or regional input and design, delivery and structure of social care can improve accountability of creating change, and if so, how much of that does need to sit at a national regional level and at the field trust We recently health and roundtables that brought together people from across the UK to discuss what learning could be taken from these potential accountability shifts. And I think there is a consensus that we do need national leadership for the big ticket things, but also local autonomy and local leadership to drive improvements that in the care system that are the closest to the people. And the most important thing, of course, whether that's a national or local level, is that social care has given an equal place around the table, and it's really high on the agenda. So thirdly, I think, well, I was going to use the word ecosystem as well, but you have beat me to it. So creating an ecosystem of diverse providers that can ensure stability and fairly priced care is central to having a social care system that is responsive to people's wants and needs. So each of the countries are considering mechanisms to create stability in the market. So, for instance, through the setting methodologies and some, such as in Scotland, have been in place for several years and have had a lot of challenges. Others, such as in England, are being implemented as we speak around the cost of care. And I think what's interesting in Wales is that the commitment to a national office and a national framework draws on that kind of intention to pull knowledge and good practice at a national level. But having enough flexibility to reflect the specificities of Wales is 22 local authorities and so using market mechanisms to drive provision in the social care sector can be filled with lots of opportunities, but they can also be some trade offs. So there's a question about whether changing the supply of providers might affect the stability of social care system and also affect potentially the quality of care for people to. And I think there is also potentially a trade off about creating more consistency and stability versus some of the things we heard about this morning around innovation and how we can have a culture of taking risk. And so finally I think we've heard already a lot about the workforce and over the course of the last two days I think we've heard how important the workforce is both in healthcare and also in social care. And so this slide draws from a wider analysis and this paper is available on the website if you're if you're interested and it puts together kind of the different levers that can be used to improve the terms and conditions for the workforce. So they're all interlinked, of course. Um and so they include putting care stuff on the register, as is the case in Northern Ireland having stronger regulation, investing in education, training and development, having activities to boost the status and recognition of the workforce, improving working terms and conditions, and also crucially addressing issues around pain progression. And so we have lots of opportunities here to share with learning of what's working and what potential unintended consequences there might be when we're implementing particular policies. So one of the key questions, of course, is paid for the workforce, and I know I said that I was talking about long term reform, but I think given the cost of living crisis and the concerns that stuff are currently facing, I think we both need to talk about PE in an immediate solution now, but also in the long term as well. So it's one of those key questions that we need to address. England is possibly Eligard behind the rest of the UK in terms of the activities that is undertaken around pay increases. The only country that's not given coated bonuses and it's also a bit of Eligard in terms of registration and wider kind of development around the workforce. I think the most notable development is Scotland, with its decision to introduce the sector minimum wage way above the statutory minimum a rate of 10 lbs 50 an hour, which I think has now been recommended elsewhere in the UK as well. But there are some unresolved questions. So if you're increasing the rate of entry level staff, what does this do to the rate for senior care workers? And are you squeezing the pay differential between entry level or more senior staff? As a result, they've also been key developments in Wales, Scotland and Northern Ireland to establish care work forums to facilitating sectoral bargaining in good faith between the government and wider stakeholders. To be really interesting to see if those forums can have an impact on on improving terms and conditions, for the workforce. Well, we don't know so much about. And I think there is a scope for evaluation and a greater evidence base. Here is the impact that higher pay rates can have the impact of bonuses on retention and the effectiveness of these different leave. It is to make sure that pay reaches pockets rather than profits, and as well as thinking about progression and how this all fits into clear career path ways and to conclude if I can get that, yeah, so then I will trust. We've done a lot of work looking at the international care systems. So Germany and Japan who have been successful in reform, we're currently looking at France as well, and we can maybe turn to that in a discussion. And so we've looked at a lot of believers of what's happening in England, an individual level, so some of the individual levers to address the issues of playing social care. We've considered some of the challenges they may face, but is it possible to reform a social care system? Well, I think looking at Germany and Japan, our experience was just suggest that it is possible, but the key is that neither Germany and Japan tinker around the edges. They've really took on on the whole program of undertaking wholesale reform, whereas England's reform to date, for instance, has been painting the front door, but not necessarily fixing the roof. And so what was the key to that successful reform political leadership at a time of instability? And I think those of us that we're at the dinner yesterday would have appreciated the minister's own commitment and leadership within within Northern Ireland. There's also, I think, something about making a strong public case for change and willingness to iterate and adapt as the situation evolves. So I think we've seen that there's lots of great things happening in the UK to improve the social care system. There's also been lots of public involvement through coproduction, for example, in Northern Ireland and Scotland, and that's great. But we're also seeing how difficult it really is to embed that change, especially in the face of competing pressures and priorities and stable governments. And so it remains to be seen whether any country can really harness that leadership and really create the impetus for wholesale perform and building on all the brilliant work that's already happening in localized pockets. So I think there's a lot of opportunity and it's really important that we remember who were doing this for. So that's the people that we, you know, the people that serve the systems, the staff, the workforce, but also the people that drawn care and unpaid carers. Thank you. Hi, everyone. Um, it's almost a cliche. Um, when making remarks now to emphasize a point by repetition repetition in threes Tony Blair obviously did it most famously in 2001 with his speech on education. Um, it's, uh, set a pattern. Uh, somewhat more problematically. The current think Prime Minister did it recently talking about growth growth growth. Um, today I'm talking about how to meet the challenge in social care, and I offer you another triple triple repeat and being a social worker, uh, what I'm saying is needed is understanding, understanding and more understanding. Now, I know that might sound a bit fluffy, but bear with me. Firstly, I think we need greater understanding of what social care is for what's its purpose. Without this, any proposals for Reforma likely to flounder and currently misunderstandings about the purpose of social care about and listening to the media and indeed many leaders with in the healthcare system. It's very easy to form the impression that the purpose of social care is to improve hospital flow. Now, from this perspective, the purpose of care is to fix delayed discharge. Certainly my experience, um, in trying to make the case for social care funding is that that's the argument that's most likely to be successful in getting additional resources. Um, it's a fundamental mistake. The purpose of social care is to enable people to live as independent as possible safely in in a way that, as far as possible, uh, reflect their ambitions for their quality of life. Now, certainly, to achieve that, people need to be supported to leave hospital as soon as they are medically fit for discharge. But if we think that all Social cares about we're making a huge strategic error, it leads to the neglect of the thousands of people who have unmet assessed needs but are not actually in hospital. And that not only results in a significant compromise in their quality of life. It also leads to many, many avoidable hospital admissions, which internally to increased needs requiring to be met at the point of hospital discharge. If we have you social care through any medical lens at all, I would suggest it should be a public health or salute a cardiogenic lens rather than that of acute health care. Further evidence of the need for greater understanding of social care is the widespread belief amongst policymakers that reforming funding and payment um, mechanisms for social care is reforming social care. Specifically, I'm talking about the role of private wealth in pain for individual care. Now don't get me wrong. It's a really, really important issue already been referred to. And it's one that needs to be addressed with clarity and fairness. But in itself, it doesn't do anything to address the quality of care provided. It also has no relevance whatsoever to the very large number of people who are self funders at all. Um, but too often so called reform proposals for social care and I would suggest that it's been particularly the case in England have focused primarily on funding, with proposals around training, quality standards, regulation choice and control being relegated to the role of add ons. The second area where greater understanding is required, particularly among commissions. Commission commissioners is the understanding of the actual business of providing social care. When people first was first published in Northern Ireland in 1990 those with statutory responsibilities for social care had significant experience in directly providing social care. In the intervening years, there has been up until the past couple of years a steady retreat from direct provisions to commissioning role, uh, and commissioning from third party providers. I recall, um, an event not dissimilar to this discussion I have with the former Northern Trust chief executive who said that the only role health and Social Care Trust in Northern Ireland and relations social care was to be a commissioner of that care. Um, she didn't see it as being part of their core business whatsoever. That incident, it was never government policy here. We always said there should be a mixed economy, but this retreat from direct provision, I think, has at least three significant consequences. Firstly, it's led to significant tensions between providers and commissioners with the form of believing the latter have totally unrealistic expectations regarding the true cost of care and the latter having a very limited understanding about how much profit is being made and how much profit. It's reasonable, reasonable to expect to be made on the contract that they've entered into. And this leads to a very transactional relationship between commissioner and provider, focusing on time and task for cash rather than commissioning for outcomes. Secondly, commissioners have developed a very modeled understanding of their responsibilities for the quality of the care provided by others. This was certainly the finding of the team who reviewed care failings at done Murray manner in Northern Ireland. Relatives described repeatedly taking their concerns to the provider organization to the regulator and the commissioning trust, and no one seemed to be able to determine where responsibility for what lay. I think that's changed as a result of the ordinary manner, but it still remains a significant feature of the system. Thirdly, trusts remain the provider of last resort. In the course of the pandemic, they had to step in and directly support independent providers with tens of thousands of staff hours, advice, support and thousands upon thousands of pieces of equipment. They did so they worked in collaboration with the provider sector and it worked. But, um, it is something that we only just pulled off. And although that need was most acute during the pandemic, the reality is it's not solely a feature of Cove ID. On a number of occasions, as a result of either business failure or significant collapse in the standard of quality, trusts have had to step in. Now, if that's going to be the case, I think it requires them to have, I believe, a direct knowledge, experience and understanding of directly providing those services. One of the things trust struggled with was finding staff who had the previous experience, knowledge and willingness to go in work in social care when we needed them to to support the independent sector. Um, that reservoir of talent has diminished over years, and I think that puts you in a really precarious situation when you face the fragility of something like Covina or market failure or collapses in quantity standard the final area where I think wider understanding is required. I'm sorry, this sounds very social working, but this is really, really probably the most important thing is understanding what it's like to work as a care worker and understanding what it's like to be dependent on that care. There's been a greater focus on social care in the national discourse over the past year than at any time. I can remember, however, outside of the open access of radio phone ins and what have you, um, the loudest voices have been, and I don't mean this pejoratively from think tanks, from provider representatives, from commissioners and from policy makers. This discussion is incomplete without the collective articulation of the voices of care workers, people receiving care and their families and loved ones. There've You should be at the very heart of the debate when it comes to things like training career pathways, standards regulations are much, much more, or we risk more misunderstanding. And an example is the issue of providing better training. I've read the report. It's an excellent report, and I really, really think it contributes an awful lot to the discussion in the debate. But frequently, training is called on as a way of improving recruitment retention. Um, now that's certainly a benefit that you know, can be evidence. If you train people well, they're more likely to stay in their jobs. Um, but it's not the reason. Only by listening to staff and those who depend on them. Do you get to the reason which is to provide the best possible care meeting the needs of the people using services, the voices of recipients of social care, their friends, relatives, their their family, Um, and the staff. And we have to recognize this is probably the least unionized sector in any area of health and social care. But those staff, we need to seriously support their organization and the amplification of their voice if we're going to succeed in getting the social care that services that we want to need, Um, in our discussion, I'm sure we're going to hear a lot about technical measures needed to deliver social care for the future. Those are valid and necessary, but for them to have any chance of success. And I think you alluded to this in terms of where success has been found, you need to look at culture. Um, uh, and I really think that for the culture change, we need to have greater understanding, and we need to make sure that the right voices are in the discussion. I hate this expression, and I've never used it before in the talk whatsoever because I've just heard it so many times. But I'm going to go for a cultural strategy for breakfast. I mean, it's so well, I started with a cliche. I'm finishing with a cliche. But for any strategy to succeed, no matter how carefully we've thought through career pathways, no matter how much we've considered the benefits or otherwise of regulating the workforce, whether we introduce mechanisms for market regulation, which is something I think personally is definitely needed. Whatever we do, they're all going to fail. If we don't create a culture shift. Which means people understand what social care actually is because they don't understand it, they're not going to value it. Excellent, thank you. Well, I'll, I'll zip through a lot of material as quickly as I possibly can. So, uh, the first thing to say is, uh that the contract the organization I run is not a social care organization, but but it tells you something about the importance of social care to the health system that we formed a healthcare alliance bringing together health organizations who wanted to speak about the importance of social care and social care investment. Um, we have consistently now been arguing for several months at the number one priority for intervention from government is not actually investment in health but investment in social care in particular, salaries of social care assistance. And, of course, we are the proud membership organization for integrated care systems, which should offer an opportunity with the opportunity that already exists, of course, in Northern Ireland for much better collaborative working between health and care. The second thing to say is that, um, the state of social care continues to deteriorate as a consequence of, um, inadequate funding, Uh, and particularly issues around work force that will come to a minute today. CQ see Care Quality Commission publishing it's report State of State of Care. That report argues that in many ways the health services simply caught in a logjam. And the single biggest reason for that is that the the, uh, inadequacies in terms of the capacity of social care, particularly in relation to people who are stuck in hospital, unable to leave hospital. Now I'll come to that again in a second. I just want to emphasize over that there's sometimes a tendency of people in the health world to talk about social care only from the perspective of whether social care is doing the job we want to do for the health service. And I want to recognize that social care is important, intrinsically important for many people. And the more than half I think the social care clients aren't aren't elderly people. So we mustn't simply view the issue of social care through the lens of whether or not it gives the health service what the health Service needs, although from the health perspective, that is, of course, important. Um, so I arguably, I would say that social care in England is is falling apart, not with a bang, but with a whimper. And in line with that, I'm not doing a trouble. By the way, I I stopped doing troubles years ago because I heard I used to be a coach for kids football team, and I once had a coach. We were playing a team. They were terrible and we were winning 8.5 time. It was cold, muddy, rainy day and these little kids and they had a coach. He was going to rather overzealous uh, and he shouted out and I could hear him across through the window, across the pitch. He said to the kids, Look, you know, we've got to deal with the three T e S, t three t s and the kids. So what? What is that, Coach? And he said, It's the defense, the midfield in the attack. So I am. I don't do that, but I'm going to use the acronym of Wimp. So, uh, so social care it's not falling apart with the bank, but with a whimper. So I'll use that that that acronym. So wimp workforce first, I don't really need to labor this point. We've already heard from communal from Sean Pay. Uh, we are still waiting in England to know how the 500 million lbs, uh, discharge fund is going to be spent. I understand Most of it will be spent topping up DOMICILIARY, uh, care workers wages, and then some of it will be directed to the parts of the country, which is the biggest issue in terms of, um, people medically fit for discharge, not able to leave. I don't know where that will be, because I don't know a single acute hospital that doesn't have that problem, but, um So there's PE. There's progression. There's status. Uh, there's a recruitment and I think that I mean, I was just going to check into that debate some ideas that we should be thinking about if we were really, really ambitious. Um, so I think we should have a single entry route into health and care. So I think people who want a career in health care should go through the same, uh, foundation entry point and then decide which way they want to go. Also give them the flexibility to move between the two sectors. Gives people who might have aspirations to be in the health system an opportunity to see, actually that they might be able to fulfill their commitment to care through a social care route. Uh, secondly, I think we should examine This is just my personal conference for you, but I think we should examine the idea of kind of national care service. I think I have this in Germany where we incentivize young people to get to do six months caring as part of their journey from, uh, school to college and higher education. I know a number of German friends who did that, and for whom it was incredibly important in shaping them. So I I think that that that's something that we ought to explore in a perfect world. I also think just to reinforce Shawn's point culture is really important. And and whatever we do with the workforce, we want social care to be organized in a more kind of those of you understand what I mean by this more birth or the model of devolving, uh, and empowering social care workers rather than the rather kind of mechanical, uh, optimistic way in which social care workers are required to work at the moment. So that's workforce wimp. I is integration, of course, and I'm not going to labor the point for the reasons that I just use. But you know, certainly in the health service, you know, one of the biggest problems is that almost every hospital has a whole number of patients who don't need to be there, and being in hospital is not a good thing, unless you really need to be there you become I hate this word, but you become deconditioned. So I saw some research that said that that somebody at the same level of acuity if they are at home, they'll walk an average of 200 paces a day if they're in a hospital to walk an average of 12 places. So, um, you know, it's expensive and it's bad for you. Um, So, uh, and I thought that was a very interesting point that Jim Macky made yesterday and about the fact that if you're spending 3 million lbs an award for people who could be in the community, why don't we simply spend that money on social care? Because it's actually cheaper and better, and some hospitals have started to do that. Many systems and trusts actually have have have, have put money into, uh, into social care. So we have got to tackle that issue. We also, of course, when we think about integration, need to think about, you know, enablement and re able Mint and prevention. Uh, you know, there are If we had a social care model that was more able to help people earlier on, then fewer people would end up in a position where they had to draw on health resources, whether it was a physical health or mental health challenges, Um, and ultimately, let's remember what integration is about is it's not about the convenience of health leaders and social care leaders. It's fundamentally about building services around people in people's needs. And we must always remember we talked about integration, which we often talk about the royal bureaucratic terms that ultimately that is the objective is that rather than the person finding the way around the system, the system builds itself around the person than m uh, moral. So you know, in many ways, we This is a conversation that feels too far because of the pressing issues that I've described. But we knew do need to talk about fundamentally, what is our model? What is the model of care that we want to see? And I think you know the one of the characteristics of that. What we want to model that gives as much choice as possible to care recipients into their carers. And, you know, personal budgets are still a really important and progressing shift that has taken place even if they're not at the level, we might want them to be. So that commitment to choice, I think, is really important. I've talked about earlier intervention, so you know we don't have this model, but we need a model that recognizes that if you intervene early, you can actually enable people to adapt. A point that is made by Charlotte outs from National Voice is very often really important. Point is that the relationship between health and care, acuity and quality of life is attenuated. So there are people with quite severe challenges who have quite good quality of life because they've got friends that have got employment. And there are people who got less acute medical needs who have a much worse quality of life. So we want to model that intervenes and supports people, enables people to have a good quality of life, regardless of the challenges that the personal challenges, medical challenges they might face and then building on the brilliant presentation that we had from Alison and Kate, We ultimately want a social care model that gives, uh, social care workers, social care, workforce, the capacity to mobilize the community as part of what they do. So in a and anyway, what it's kind of interesting to me is that in certain ways in primary care in England, and I'm afraid this is an area where northern Ireland is lagging behind. But we've seen the growth of the primary care team, and we're seeing the best kind of primary care practices. Health coach is Social Prescribers Outreach in a model which, you know that is, the model we need to see across the system is a recognition that actually a really big part of, of, of, of providing care is to draw on the assets of communities to support the third sector, community organizations and others. And the state should be there to facilitate and enable those systems to flourish, rather than what we kind of tend to do now is just kind of push them out of the way and then provide something that's really often not not great. So that's the model, and then the P is public funding and payment, and I'm not going to get into that. Uh, we covered it, Um, you know, in terms of what's happening, and obviously I welcome the increase in the means test threshold. I have to say it again. This is a personal view. I'm less enthusiastic about the cap. I think it's regressive. I think it's kind of bureaucratic nightmare. I think that would be much easier ways to do this, to be frank, but they're politically kind of problematic. I do think that in this debate about public funding, we need to think about the economic value. Uh, the conflict published a major report over the weekend. Uh, and of course, Nikon has published a report exactly on this during this conference, Uh, on the value added that we get from investing in health care. And we need to understand that better, because part of the reason that we have an enormous issue in the UK of people of working age, not in the labor market, which is one of the reasons we have such we have labor shortages is that we have a lot of people who aren't aren't able to work because of their care needs or because of the care needs of those that they're looking after. And also, of course, when you invest in social care, almost all of that money then recycled around the local economy. Uh, so we need to understand better the way in which investment in social care has economic positive economic externalities, rather than simply saying it's kind of pouring money into a into a bottomless pit. The closing common I would make is this. I do think because we were challenged to say something positive. I do think we it is worth putting time into articulating a vision of what social care could be of of, of what it could feel like of how individual community level, Uh, we could understand care of something which is not a threadbare system that we're afraid to engage with. We wish we didn't have to engage with, but we might have to engage with, and we might have to pay for but instead and absolutely essential and joyful part of our social infrastructure. And I think that because in a way, we're so pessimistic about where care is at the moment. We do need to remind people. And maybe, just maybe, some of these difficult issues about payment would be a little bit easier, because in the end, paying for something that's good is less painful for paying than paying for something that feels like it's always going to be in crisis. Thank you. I wouldn't mind would just prefer to us to sit down to only have about 10 minutes for questions, but I just reflecting on what people have said. What really strikes me and I would love to hear is there seems to be a blind spot when it comes to thinking about a vision for social care and the transformation of social care. We seem well able to want to think about fundamental transfer, fundamental transformation for social care or for other parts of the system. But we seem to ignore social care transformation. And maybe it is because we're caught in the web of transactional commissioning, were caught in the web of what does care cost. And we caught in the web of value for money and a mixed provider system, and we don't seem to be able to get past that. And I was really taken with the conversation about having human relationships around social care. And I do think we've got to start a different narrative around social care, and it's contribution economically, socially to society and communities and anything that I have read in terms of consultation or enjoy engagement. People who know me know that I'm very much from a volunteer community sector background. By the way, when I read my CV, I said that is completely another life now because I'm in the public sector world more and more. But I do think we get stuck and we do have a blind spot when we want to think about social care. So how do we change the culture? Because I do think it is about the culture. How do we build understanding? And how do we get past the barriers that seem to get us stuck in not making the change? Because, believe me, everything I've read is families value, social care, individuals value, social care, community values, social care and they want. And there is a massive In your report, it stood out a massive call for change from the public around how we do social care, so culture, What do we do about the culture? What do we do about increasing greater understanding to get what that vision should look like? And then we're helping not just individuals and families, but that cohort of really, really valuable staff of 36,000 individuals. Yeah, thanks. And, um, I don't actually have much problem with vision of social care because there's excellent social care out there. I mean, I commend the Northern and Social Care Council they've been doing an awful lot of work to raise awareness about what social care is. In the course of doing that, they've provided examples of good social care. Um, from the perspective of service users and from the perspective staff. And, you know, with the top and tail, you've got a vision that's not a hard thing. I think the difficulty is that we have found ourselves backed into, and it's not an unusual problem. When you've got rising demand and constrained resources, you get into this vicious cycle of threshold ing, and I think this is where you get into, um, you know, constraints apply. How do you make it go around you? Threshold. You raise the level of need before you provide a service, and then your early intervention prevention goes out of the window, and it also draws you away from communities into something that is very, very transactional. How do we get out of that? I mean that that's a challenge in all public health, how you shift resources into upstream interventions. But it's not an insurmountable one. I think one of the key things is the cultural piece, and I do think one of the things that we have to do to change culture is to change the voices who are in the debate. Um, and it wasn't just me being like a member of the Y. Oh, karate, um, saying that we need to make sure there are stronger voice is for service users and the front line staff. I actually think that we need those voices to be able to create the right culture because their perspective is really quite different. And interestingly, when you engage with service users and frontline staff in the right way, you often find that you need less social care and have a slightly different type, which is not necessarily more expensive than when you follow the kind of commissioning transactional roll that we've got ourselves locked into. I really think the point about communities is important, not just because they're a resource to be drawn on. I'm sorry to to sort of introduce a negative. No, but it's a reality. I think. It's also about safeguarding. Throughout the UK, we have repeated failings in the quality of care in nursing homes and residential homes where there are breakdowns in safeguarding arrangements. Now I've spent a career writing policies on safeguarding and, you know, sort of current. One of the last things I've been doing my job is bringing forward legislation to put adult safeguarding on on a legislative footing. But the thing that makes things safe, our eyes eyes on care. Now there's a role for regulated relies on care. There is a role for commissioner eyes on care, but the more I the better. And if the social care you provide is embedded in the community, you've got more eyes on the care. And that's where you will find that you create a culture that certainly in that regard significant improvement. Any questions from the floor? Okay, Martin, do you want Do you want to take the question first? Martin is there. Mike's here? Uh huh. I'm not doing this very well. Where is where is where is Heather when you need her? Thanks, Ann. I suppose where I'm coming from is around. About 80% of what happens in health care comes from our communities. It comes from determinants in the community. I find Shawn's analysis very challenging and very good. But are you making the argument, Sean, for more direct care? Because I think you're probably hinting at commissioner failure in all of this in relation to how we actually provide that care and how we commission it. And I'm also conscious of the fact that we're very often in this area, particularly around nursing home care and residential care, in hock to the commissioner's. In other words, if a commissioner goes belly up, we are the provider of last resort. So do you, Shawn, have some ideas about how we could do that better? Yeah. I mean, I think that it's a mistake to believe that statutory is always good. Um, and private is always bad. It's just a fallacy. Um uh, but I do think there's a case for a mix. I mean, one of the biggest crisis we have in services that been provided at the moment has been much more Abby Hospital. That's a statutory service provided by qualified staff in a highly regulated environment, and it's failed in terms of the quality of care. So it's not a binary one is good, one is bad, and equally Ryan's here. I recall several discussions with Ryan through the pandemic when things were hot and heavy and a really collaborative relationship delivered very quickly. Very positive results. So it's not simple. But I do think that the idea that we moved to, um something where care is almost exclusively outsourced to, uh, private providers is a precarious model. Um, uh, it's precarious for a number of reasons. I mean, particularly if we look at some of the big failings we've seen in care providers. Uh, Southern Cross moving onto four seasons. You know, these are not organizations which failed for any reason other than the business model they chose. So I think the mix is really important, and I think in that makes you need to have community. But Martin, your point about commissioners commissioner failure. I mean, let's not paint these things as failure. But I do think that there are more sophisticated approaches to commissioning, and commissioners don't quite understand the levers they have that they can use to influence the outcomes that they're seeking. Um, and I think the discussion between providers and commissioners can lead you to a better place. In regard to that, it's a question from Laura Collins, directed towards Kamil. How can the informal care economy and the family carers who provide it be embedded in service redesign and new ICS structures, better patient and public involvement and support for this Section 75 grouping who are now also an S t o H group. That's a great question, and I think I'm sure everybody will have something to say about that. And I think with unpaid carers there's a real question. First of all, about knowing who is an unpaid carer. We're still waiting for the results of the census. I think, um, and I was just having this conversation for dinner yesterday that there is a cultural aspect to thinking about unpaid care. And if you expect to be caring for your your parents, then you might not recognize your PSA as a carer. So I think there's first of all this identification of carers. Um, I think what we've seen over Coated, unfortunately, is that there's been a really impact on the well being of carers, and the fact that carers was unpaid cares are often delivering care within the home is something that's been really invisible both in the public eye and in policy making. I think protecting unpaid carers from understanding how that impact on well being has been felt. There was data just a couple of days ago about the impact of cost of living example on unpaid care. So giving a space for that voice recognizing what the challenges are. Identifying them better. Um, I think it's really important. Not just just recently published a paper, actually on on how we can support unpaid carers, Um, and some of the kind of impact that have been felt on well being. And I really encourage you to read it if you have a chance. Does anybody want thank you? I myself declaration first. I'm a doctor, So apologies if my comments are ill informed, but I'm happy to be corrected. Um, I'd start by saying it's been disgraceful. A decade of austerity has underfunded social care to such an extent. It's just impossible to understand the impact that's happening. But we see evidence of that right across the system. It's also the softer things in communities as well, where we lack that wider network that used to create better outcomes and better social interaction. So I think that that's a given to these comments that I'm about to make. But I think looking from the outside in I think the culture of social work is very positive in that you put people first and you know the caring ethos is there. But I do think there's a responsibility that you need to take that there is never going to be a situation where you're going to have enough resources to meet demand. I think one of the paradigm shifts that needs to happen in social work is to create fairness in the system, and that means actually taking responsibility from individuals to creating systems that assess need accurately but in an individualized way and match resource to that. And I think that's the biggest challenge that your face and I'm not sure that you're there yet. Yeah, just as, uh, one of the providers within the independent sector. So if you look at the home care and and I 75% of the car is outsourced to the independent sector, 25% is in the house. The care provider about independent sector is half the cost of that. What it cost to provide one single hour of internal Um, it delivers about 50% less 50% less capacity as well, so that's fine. If we accept that model, Okay, But we have also been the provider of last resort to trust during code, for example, for some of the residents of them, or is another example. And I think there there is trust between 25 75% in terms of how we model and deliver. I think it works incredibly well where there's distrust and when there isn't this kind of high level view of how we should deliver Homecare specifically in our particular case, it makes it much more difficult. But there are significant gains to be made between sitting down with both the internal providers and the independent sector in looking at more clever, more intelligent, more data driven, more outcome based care models in terms of how we commission together. And I think if there is trust like that, we can make real progress. But trust is the key thing, Uh, further question from online from Lee Wilson, directed to any of our speaker's how do we keep the focus on the importance of social care as we emerge from the pandemic? Jeevan make your clothes. I can try and take that. I think it's It's a really tricky question. And I think unfortunately, what we've seen in the media in in during coated is is all of the negative things that happened during coated. We've heard a lot about burnout of staff burn out of unpaid carers, been, uh, lack of access. Um, two people who drawn care. Um, and I think what we need to do is reframe that vision. There are some great groups out there, such as social care futures, that I have a really interesting vision of trying to make social care positive. So and and kind of making sure that you build that case for investment into social cares are not because it's it's a crisis, but because it's something that we aspire to. Um, and I think that does require some public leadership. It requires better awareness. Sure, you're saying of what the social care system is and what we can achieve with it, Um, and also a really clear pathway of how you get from the vision to how from creating the vision to how you actually get there. Any more final questions to comment, comment, and then question Tracy. Okay. Hello. I just like to recognize and thank Sean Holland for his contribution this morning. Shawn quite often gets it right there, and I know Matthew, You said you don't want to be a pessimist to be a pessimist, but I think there is a real strength in being real and knowing where the problems are in the system in order to fix them. And I certainly know that Sean does have his finger on the pulse in that regard. So thank you for that, Sean. I'm here on behalf of service users with PCC. One of the first things I just like to say is that I think if there was to be a change, it really should be in addressing the balance between the private sector and the public sector. And I think that's something that would fill in all the gaps, as Sean would say, about knowing what the true crossed of care is, and also for ensuring what people know about quality and what's being delivered in terms of the work force is not a quick, clear question on pay. Most of the people I've spoken to love their jobs, And yes, if the pain came with it, that if the pay came with, if the pay came with the job and the rewards in the job. That's quite enough, but reward is the primary factor that keeps them in a job, and I think culture is also very important in that respect. We do have a lot of very good social care workers in the system trying to there. But if they're not in the system, where their skills where they're not getting the reward from their job and they're all over, they're understaffed in a particular sector. In the for example, perhaps sometimes in the in the in the private sector, then there isn't going to be the retention. So I don't think it's just a simple thing of pay, so that that was all the all the points. But again, I'd just like to say thank you very much. Shaun, I know you have been a great campaign er for us, and you have tried very hard to understand the problems. So I hope that's recognized, and I'm sorry we're going to be losing you to another department. It's supposed to be one of the challenges for social care leaders, um, social work leaders. It's really articulating the extent of the cost of care. So we have a very changing demography. We have a very, um really a real focus on wanting people to live in the community. And absolutely, that is correct. But it sometimes feels that the social care harm caused is only picked up at the point when someone has a complaint, something went wrong and something or there is a scandal. We have many people across our society every day who are not able to get out of their houses, who are not able to live the independent lives they have that they want. And we need to have the honest conversation about what is the extent of the need. What is the cost of the care and what is the performance of the sector? Because if we have those conversations, then we have a fair chance of planning and we have a fair chance of enabling our social care staff to do the right thing. So we want to plan for CF services. We've got to make it possible for people to do the right thing. And increasingly, when you hear about the pressures of social care, staff are under trying to hold together. Um, you know runs and facilities. You really do get the sense that we're not making it possible for them, and something and things going wrong become an inevitability. So I think the challenge for leaders are is just as they've had in healthcare. What is the honest conversation of what it costs to deliver social care in Northern Ireland? And then we may have a chance of doing the right thing. And I think that leaves us with A With an ask is around our social care leadership, where those leaders are and how we do start to have those honest conversations, because I'm left feeling with more as you do more questions than answers. And I haven't gone away feeling a comfort, to be quite honest about where do we go from here? So I really would appeal to leaders in the room as individuals or as organizations, and also as family members and carers. Where do we go for the call to action to have those conversations because, to be quite honest, they're going nowhere and we've got to get past transactional relationships. We've got to get past failure because we need to talk about what comes from the failure and how do we learn from the failure? And we cannot separate by sector because I think that is a call nowhere. So I think I wanted to come away more optimistic and I'm not, quite honestly. But I do think what it has done is just increase the need for a call, too. Action on transfer, Some thinking around what good social care looks like in a transformative context, not in a transactional context. And And if you want to think things through, please use MISC social care leader script to help with some of that conversation and enabling as well as others. Yeah, we're giving people from. All I wanted to say is that we do need a transformation of the discourse about care. And I think if you look at transformations that have occurred in society, they are a combination of statutory change of change in civil society and change in normal and attitudes. You know, whether it's you know, smoking or feminism. It's that combination of factors that lead to fundamental change, and what we have to do about care is recognized that we are all carers, that human beings eat and they sleep and they care. And there are other things they do, which I shouldn't mention, because it's lunchtime and we are all carers. And this kind of notion that cares about a small group of United people receiving a kind of residual service. It's really about how we understand care, uh, as a whole and understand that we're all carers and understand it's a fundamental human quality and attribute. Um uh, and I would commend to those who haven't read it Madeline Bunting's book Labor of Love, which is all around this kind of idea of how we start to talk about care as being a central attribute of human of human beings and I want to end with just one positive story from that book is that she cites a guy who was a rougher it's just called him Gary, and he had to retire early because he had a bad back, and his family said that Gary was a miserable git. That's the phrase they use, uh, just sat around moaning. And then one day he went to the local news agents and saw an effort in the window for social care assistant and in his late fifty's became a social care assistant and his family said it utterly transformed him. He became gregarious. He became motivated. He became happy. And I sort of want to him with that positive story about the potential that exists if we were able to turn this discourse around and make it much more positive. One. I'm going to let everybody go for lunch because we have another meeting to go to. Is not right, Patricia. Okay, Thanks very much, everybody. Thank you.