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BBC sounds, music, radio, podcasts. Hello, now I've been a journalist at the BBC for about 23 years now. I know, time has flown. And there's a story that just keeps coming up again and again and again. And it is what to do about adult social care in England, whether how to pay for it, whether there should be a cap on how much individuals have to pay, how much the taxpayers should pay, how much we should be paying the people that work in the system.
and many have tried to reform it, and few have succeeded. But where Streeting the Health Secretary today announced that he's going to have another go by setting up an independent commission. The twist is, it will not report back for quite some time. We will discuss what it all means on this episode of Newscast. Newscast. Newscast from the BBC. I like landscape. I don't think I'm being rude. Japping, unemployed people who are overweight. That is not the agenda. It's the fun police working overtime. A star is born, Elon.
So hurt that America with this hat. Frankly, I think we need a British Trump. Take me down to Downing Street. Let's go have a tour. Blimey. Hello, it's Adam in the newscast studio. And we're going to focus today's episode entirely on this big announcement from the Health Secretary, where's treating about the instigation of a new independent commission looking at adult social care.
in England, something that many, many administrations have looked at. Many, many administrations have introduced reforms, but few have actually implemented them. We've come quite close to changes being made, but they've never quite happened. And West Reading is now going to have another go, this time with an independent commission headed by Baroness Louise Casey, who has done many previous investigations into things like the Metropolitan Police,
or child sexual abuse. So she's no stranger to trying to grasp the nettle, a terrible cliched phrase that we will probably hear lots of times in this episode. And here to help us pick through all the details of this announcement is BBC Deputy Political Editor at Westminster, Vicki Young. Hi Vicki. Hi Adam. Happy New Year. Happy New Year to you too. And also joining us is Mike Padjum, who's chair of the Independent Care Group, which is the Association for All the Care Providers in York and North Yorkshire. Hello Mike.
Hello to you. Well, before we dive into the news, Mike, just want to give us a sense of the scale of what you do, how many people you're involved in looking after, or how much money you spend, or just give us something that gives us an idea. We're a small provider, really, in the picture. We look after 137 people, and I've been in the sector 35 years. We employ 240 staff in North Yorkshire. And in 35 years, you will have seen maybe about 25 or 30 different social care reforms, probably.
Many, many promises, and I'm sad to say it, not many have come to fruition, but I'm forever hopeful. One day it'll work. Okay, a bit of optimism for the new year. Vicki, do you want to just set out what we're treating the Health Secretary has actually announced today in terms of this commission?
Yeah, that's right. So he has talked about a commission that's going to look into the issues that there are, and it's going to be Baroness Louise Casey, who's going to be in charge of it. Now she is very much seen as a fixer in Whitehall, someone who tells it straight, gets things done.
But the timetable of all of this, it is what is causing a lot of consternation. There's going to be two parts to it. The first part, as I say, is looking at the scale of the problems, the medium term, what needs to be done. That's going to report in 2026. The second part, which looks at longer term changes and crucially the funding, who's going to pay for all of this, that is going to report some time up.
potentially up until 2028. So there's been an awful lot of reaction to that saying that this is kicking into the long grass yet again. We've had all sorts of commissions and reports that have gone on for years, for decades. You know, why do we need to do all this again? And I suppose the reason 2028 is significant is that on the current parliamentary timetable, the next general election would be in 2029. So there wouldn't be a lot of time for the late stage Labour government to actually implement anything.
Yeah, and this is what's causing an awful lot of questions and where Streeting was asked about this because Labour of course has a massive parliamentary majority. If it wanted to, it could just come up with the proposals and vote it through. What he's talking about is getting
consensus, political consensus, but also, you know, across the country as well, like this applies to England, making sure that people are on board with all of this. So he wants a political consensus. And I think actually, for me, one of the most striking things he said in his interviews today was when he talked about wanting this might be the triumph of hope over experience, but he said he was excited about the possibility of change. And that's because, you know, these things have
run into problems before, and the idea of getting a political consensus, particularly, you know, maybe a few months or a year before a general election, you know, that really is making it pretty hard. And we will explore all of those things in detail in this episode, but let's hear a little bit from where Streating, when he was doing media interviews on Friday morning.
It's not shortage of good ideas on social care that we have. It's a shortage of good politics and that is why we're determined to work together across the party divide. I've spoken to my conservative and liberal democrat counterparts in recent days who are on board. I'm writing to the leaders and spokespeople from all of the Westminster parties today and also my counterparts in the devolved government because we really want to work together to grip this issue.
And Vicki, the first thing that happens though is that Wes treating is going to get together with his opposite numbers and the other political parties to sort of prepare the ground before the Commission even starts.
Yeah, that's right. So next month there will be these talks. And as he said there, he's spoken to his opposite numbers and to the leader of the Liberal Democrats, a Davy, to Ed Argo, who is the shadow health minister, and talks to them about it. And, you know, we've heard them talking today, I've talked to them as well, the parties, the other parties. And, you know, they want to be optimistic about this.
They are worried about the timetable. They said to me, look, we shouldn't be doomed to fail. We've got to transcend that electoral cycle.
But they are worried that 2028 is sort of tempting fate by running potentially into another general election. They're open-minded, but of course it's all about the detail. What they're not doing is saying now, yes, we are going to come along with whatever this comes up with. I mean, that's just not going to happen. There is no guarantee that any of the opposition parties will go, yep, great, we're going to put that in our manifesto. It doesn't always happen like that.
and can they have an agreement, particularly over the funding of all of this? And Mike, I want to drill into some of the real problems that you're facing that could potentially be fixed by this commission, or at least we'll have to be investigated by this commission, but just to get your reaction to today's announcement, first of all, and the various bits of it. First of all, Dame Louise Casey, who is a newscaster, so if you're listening, Dame Louise, you're welcome to come on anytime, so you can spell out your initial thoughts. What do you think, Mike, about hiring her to do this?
Well, I don't know much about her in the past, but what I've read since was announced is that she seems a very able person and I think that she does things quickly and speaks a mind. So I think that's a good thing. My fear is of the length of time that's set out to achieve
the end report which as you've said is 2028 so in my view that's far too long I would like them to speed things up and why they they can't start work until April puzzles me as well because we've been waiting right at least I've been waiting nearly three decades for some reforms coming and to wait another few years doesn't seem well I was flabbergasted when I knew how long it was going to take to be honest
Don't you take any heart from the fact there's going to be an interim rapport, which could be quite a kind of powerful moment next year in 2026.
Well, I suppose in a way, and I always try and be glass half or the problem is I've seen so many recommendations report. So what we should do and it's that the crux is really making sure it happens because even if the report comes mid next year is then how long is it going to take to put things into place because we're having challenges today tomorrow and next week that needs solving and to wait at least another year to see what might happen against far too long. The issue I see is that we already know what needs to be done.
We have had, and I've just noted these down in the 20 years, we have had five health secretaries, 18 ministers, eight green papers, four white papers, two inquiries and numerous reports all saying, what needs to be done? Why do we have to reinvent the wheel? There are many experts who could tell the minister straight away, get on with it. And with such a large majority, I would like them to press forward and do something and be bold. They're my words, not Edward A. Garz. I think he said that a few hours ago on the radio is
We want this come to be bold. Come on, let's do it. And I should say that the do a little shout out to the Kings Fund, who are the Health Think Tank, they've got a page on their website where you can look at all the different reviews and commissions and studies and cross-party negotiations that have been going on around this issue since the 1940s when the NHS was first set up and it is
quite an eye-opening reminder of how many times politicians have tried to grasp the nestle before to use that terrible cliche. Vicki, we should say, Mike is right there. There's a toolbox of things that politicians have had ready to go for quite some time, and I'm thinking it's mainly based on the inquiry that was done by Sir Andrew Dilnot.
Um, under George Osborne and David Cameron in 2011. And the two main things were a cap on the lifetime cost of care so that you were never going to be whacked by massive, massive, massive costs. You could know the maximum you were ever going to have to pay yourself. And also changing the means tests to increase that so that more people got help with the cost of their care from the state. Those are kind of like the two main kind of building blocks, aren't they?
Yeah, and I think, look, how it's paid for, who pays for it, is the really difficult, naughty part of this. And so by putting that later, I suppose, I don't know, maybe they're, you know, I think their thinking is, well, look, once we've come up with this idea of what needs doing, and if it's a big conversation, a national conversation, everyone's talking about it, and everyone's
deciding we've got to get something sorted. Maybe that helps that second bit, but this is where it's fallen down in the past. And actually, even before that, if you look at Andy Burnham, who was the last Labour Health Secretary, they were in talks. There were cross-party talks behind closed doors between the Liberal Democrats, Labour and the Conservatives. They thought they had an agreement about we're not going to use this in our election campaigns.
And a couple of days later, the Tories had come out with posters saying this is Labour's death tax and his idea was a levy of £20,000, which would be deducted from estates on death. So, you know, there's been a lot of different issues to reason may as well. In 2017, that was dubbed the dementia tax. And again, that almost cost her the election. So, you know, I think there's a problem here about the funding around it all and how you do it. And it's about who pays. It's about that balance.
Is it the state paying? Is it general taxation that everyone contributes to it in the same way as the NHS? That's what Andy Burnham thinks should happen. He says it's unfair. This is a feeling for many people that it's unfair that if you have a disease like cancer or your treatment is free and the NHS, if you have Alzheimer's, that's not the case. You could rack up bills of
tens if not hundreds of thousands of pounds. So should the individuals be paying if they are unfortunate enough to get one of those illnesses? Should families be paying? Should it be paid after someone has passed away? There's all these issues and no one has really resolved that. And I think, you know, Andy Burnham has said earlier today, and I think he's right here, it's about political choice.
In the end, someone has to make a decision that is going to upset somebody. And the problem is that politicians don't like upsetting people. They don't like upsetting voters and saying, do you know, you're not going to get this social care for free? It's not like the NHS. It's not going to be free. You might have to pay for it. And, you know, someone's got to have, I guess, the political guts to do that.
And I just really remember during the Boris Johnson era when I was a political correspondent working at the desk opposite UV key there. So basically David Cameron and Osborne had laid the groundwork to put this cap in to the lifetime costs and to increase the means test so that more people got help with their care costs.
They passed the legislation, but they never actually implemented it. And so it never happened in the real world. Then Boris Johnson revived it when he was prime minister, having said on the steps of Downing Street on his first day as PM that he had a fully worked out plan to solve the crisis in social care. And it was going to be a cap and an increased means test funded by a new health and social care levy, which we see soon act that then Chancellor had insisted on. But then Liz Trust came in, scrapped with Quasi Quarteng, the tax,
And then Rachel Reeves came in as chancellor and said, well, hang on, the cap and the means test wasn't funded. So the new labor government scrapped that as well. So it was back to square one as far as that was concerned. And also remember at the time, the big kind of the big complaint from the conservative backbenches was that if you cap the lifetime cost of care, then that means you actually are the state is effectively helping richer people more. Because the idea of a cap is it means that you get to keep more of your assets
at the end of your life. And so if you've got a house that's worth £1 million, the cap means that you benefit a lot more than somebody whose house is worth, I don't know, £92,000. Mike, what's your view about what's the best way to pay for social care in the future and the balance between the taxpayer and the individual person? Or do you maybe, you don't care, you just want to make sure the money flows at all?
I want to see it happen, but I'm more with Andy Burnham as I think that the state should pick up the majority of the costs and be free at the point in need such as the NHS, because I think if 1948 when the NHS came into being, if people lived much longer past retirement, it would have been dealt with at that time. I think a small contribution from the individual would help, but I just want the problem solved. My view is
that the public is prepared to pay a little bit more for good quality social care perhaps by taxation because I think that people don't realise that when they need social care it's means tested and it is a frightening course when you have to look at it but I do think the public will maybe make this more of an issue for the next election because it's not sold because I think more and more
the problems are coming, the sectors on its knees. And I just might say to Rachel Reed, really, is that in fact, social care can be an economic contributor to the economy. For every one pound invested, it brings one pound 75 back. It's not a drain. And therefore, she should make sure that some of the funding is moved from the NHS into social care to help. And I think that could happen. It's not all about new money. It's about redirecting it. And the politicians and West Street, in particular, talks about hospitals and community.
and every government i've known since i've been around said the same thing but it's never actually happened it's still arguing about who pays for what and the NHS gets the biggest share and it's got the strongest voice unfortunately but mike isn't the problem though that the the NHS and emergency care and people needing operations to to replace a hip that's always going to be
need money straight away at the expense of social care. It's so easy to say, oh, let's divert some money from the NHS to social care. But actually, who'd you take each NHS pound away from? I think that's where the government, again, needs to be bold, because I want to see social care come into the NHS and be one organisation, perhaps the National Care Service, which brings health and social care together, because I still see the arguments between local authorities and the NHS, who pays for what.
And I do think if the public could see more of what's happening in hospitals nowadays with lots of people queuing up on trolleys, older people in hospital, because they can't to get a bed, because there's no capacity in the community. They would vote with their feet as I don't think they see the bigger picture. And we've got a bit of work to do to tell the public how bad the system is at the moment. Well, do do that now? Like give it give a paint a picture of how bad the system is and why we should all care like 10% or 100% more.
But there are over 2 million people in England, not yet any care whatsoever. But nowadays, there is capacity in the independent sector to deliver services for people so they can be discharged in hospital quicker when they're fit to do so. But there is a blockage. People are in hospital for longer than they need be, because in the capacity in the community, because local authorities can't afford the costing, so what it takes for social care, because their budgets are stretched.
And I think that's the fundamental problem. Also with GPs now, I'm not able to work 24-7, is to get a lot of people going to A&E because they can't get a service from the GPs and this community is on its knees. And I think one quick thing the Social Secretary could do is to actually divert some funds. I know it's politically difficult.
But the line showing the budget went in and just local authorities need more funding and therefore we can unlock the system. But it's a political choice and I don't think politicians think there are any votes in social care, but I think that's going to change very soon. But Mike, is it that providing social care is very expensive and local authorities can't afford it? Or is it just that local authorities just don't have enough money for it full stop? I'm trying to work out where the pressure is there.
It's certainly not cheap, but if you're providing a service 24-7 to people, it's going to cost now, particularly because of the actual costs of providing the services, particularly on staff, because it's very heavy on staff. But is it less expensive than care in the NHS? So we are spending more than we need to in the NHS.
because we can provide the care for less expense in the community. But there's a disconnect between health and social care, because local authorities are responsible for social care and the NHS is health. And I think that's why, rather than taking around the edges, we talk about integration, but it's been going on for many, many years, is we need to be brought and bring them together with one body, with one source of funding. And Mike, would you be okay with being absorbed into the massive behemoth that is the NHS?
Yes, well, the principle I would say is it's no different to how GPs work. They're independent contractors. They're a franchise, but they're inside the service. Whereas opposed to us who live in public sector care are outside, I would willingly, from my perspective, come into the NHS, still remain the independent status of GPs have got, but feel that we're valued and more part of the solution, rather than the problem.
Interesting though, because when you talk about GPs being in the NHS, but they've got quite a lot of independence and actually quite a lot of them are run as more like small businesses. And that means that actually sometimes they can provide, not provide the service that people necessarily want. And it's okay, they can sit back and say, no, we don't need to do that.
Well, I think there's a model that could be followed similar to GP's work, but I know a lot of providers will want to provide the service. What we want to do is provide the public the best care we possibly can, and also to deliver for the health service as well. But the sector doesn't have the best reputation out there, and I think it's a challenge. There are many different sizes of businesses in the independent sector, small family businesses and corporates at one end.
some of which might be making what people might see as vast profits. The majority are just about making ends meet. And Vicki, it was interesting when Mike mentioned the idea of a national care service because he's not just plucked that idea of nowhere. That is something that we're treating the health secretary has mentioned today. It's in the labor manifesto. It's been in labor manifestos at the last few general elections. Do we have any idea what they mean when they say that?
I think what they mean is it's about national standards because as we were hearing there, because local councils provide some of this service or the funding for it, it means it's pretty patchy. So depending on where you are in the country, you might not get the same access. And so it is trying to make sure that there's a more uniform approach. Now, whether it means, as we're saying there, that the social care sector does get subsumed into the NHS,
I don't know, but I think part of this is, of course, how those two are completely linked. And we've heard for so long, haven't we, the issue about people being in hospital who shouldn't be there? And it is having an effect on the NHS. You know, there was someone earlier talking about the fact that actually
If social care isn't improved and sorted out, it's going to drag the NHS down with it. And actually that could be the actual incentive for the politicians to make what might be on popular choices, because, you know, Labour has come into power saying that this is one of their top priorities is sorting out the NHS. And really that can't be done without sorting out social care, which again brings you back to the idea of why this timescale is quite so long.
And we should say that this whole conversation is about England, because in Scotland, for example, there's been free personal care since the early noughties. And that's a useful reminder that A, the system is different in different parts of the country, and B, we're also talking about paying for different things here. This is all about
about personal care so that the help that a person needs to, I don't know, get changed or to get washed or to take their medication or monitor their blood pressure and get help getting around. This isn't about what they call the hotel costs if you're living in a care home and having to pay for your meals and the electricity that you use. We're actually, when we talk about social care funding, it's quite a narrow thing.
And then the other thing that struck me as I was going down memory lane looking at some of the other reviews of this is that actually when you go back to the Dilnot review where they proposed that the cap and the increased means test, so much of that is actually about creating new financial services products. So new insurance policies that people could pay into throughout their working lives to cover them up to the cost of the cap. And you realize actually
We could be talking about some quite massive changes to not just not just care, but actually financial services as well and that you'd have to take out potentially a care insurance policy in your 20s to pay for you when you're in your 70s, which just sort of gives you an idea of how big and kind of far reaching this could all end up being.
And it does, and again, it does depend, obviously, with what Louise Casey comes up with. And she might come up with something which, you know, the Labour government might think, well, we couldn't possibly countenance that. I mean, this is the problem when you, you know, do bring in an independent reviewer, if you like, of the situation. You're almost
passing those difficult decisions potentially on to somebody else. And in the end, as I said before, someone is going to just have to make a decision. And I add something in. It only in the fact is, I think that the mistake we do it, we try to find the perfect solution. My view is we may not be able to get it perfect.
The system we've got is imperfect to the villagers. Let's do something and refine as we go along rather than waiting three years to actually come up with something everyone agrees. I don't think that's possible. I would like to make a start now and refine as we go along because anything is better than the system we've got at the moment.
And I suppose we have had tweaks, for example, like the social care precepts, so local authorities in England being able to add a bit extra onto the cancel tax if they have got to pay for those social care. So it's not fair to say that nothing has happened for 30 years. There have been some incremental changes.
little things, but we still haven't got far enough because I don't think, and again, local authorities have to drive down the cost of care over more than a decade, which resulted in challenges for providers to actually deliver the best wages they can for staff, because one thing we need to solve is what we pay social care staff, they need to be on a part, at least with the NHS, that would be one quick fix for the government to sort to help on the recruitment crisis.
And that's the thing, Adam, it cuts across so many different departments and actually the idea of staffing, that is a big issue as well. So if you look at what's happened there, the changes to foreign workers and them not being able to bring their family in with them, what's the impact of that, the national insurance for employers, those rises, there's all these different decisions being made in different parts of government.
which are having an impact here. And so I suppose that is part of Louise Casey's role, isn't it, to bring that all together? And so actually, you know, if you want to make this work, you're going to have to make some changes about how you approach immigration. You know, I don't know, but I think it's very far reaching. We look forward to perhaps providing a bit of help and information to Baroness over when she comes to look at things, because I think there's a lot of expertise. We're more than happy to help solve the challenges ahead. Thank you very much, Mike. Thank you. And it was good to speak to you both. And Vicki, lovely to catch up with you as well.
eight zero and I know that Laura in particular will like reading all your messages because this is a subject that she is very very invested in journalistically and she and Paddy will be back with the first weekend newscast of the year very very soon bye bye
From one newscaster to another, thank you so much for making it to the end of this episode. You clearly do, in the words of Chris Mason, ooze stamina. Can I also gently encourage you to subscribe to us on BBC Sounds?
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