Care Crisis: Could Volunteer Teenagers Fix The System? (Paul Sagar)

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1:16Hello, and welcome to Radical. Often on this show, we hear from people who have a radical idea or who have chosen to live a radical life. This is slightly different. Our guest today is someone whose life has been altered in the most radical way imaginable, not because they chose it, but because of something that happened to them. Paul Sagar is an academic, a political theorist at King's College London. He studies the interplay of politics with issues such as liberty, equality and fairness. In 2023, while rock climbing in Scotland, he suffered a catastrophic accident that nearly killed him. He survived, but in an instant, a significant portion of Paul's liberty was taken away from him.

2:03It left him tetraplegic, more or less paralysed from the neck down. He's now reliant on full-time care. And he has an idea about how to address one of the most pressing and knotty political issues of our age, the crisis in adult social care. As fate would have it, we recorded our conversation a couple of days before the Prime Minister announced a radical overhaul of the care system in England. Paul Sagar's idea is less wide-ranging, but perhaps in its own way, no less radical.

2:41Paul Sagar, welcome to Radical. Thanks very much for having me on. Thanks for coming in. could you just in brief before we learn more about you outline what is your radical idea so my radical idea is that at the moment in britain we have a series of problems but they come down to that we don't have enough people working in the care sector and we don't have enough high quality people working in the care sector in part because it's not well respected and it's not well paid adult care adult care and this is something which is going to require many different aspects of a solution but one potential way to address several of these issues i think is to encourage university age students people who potentially haven't or indeed would have an offer to go to university to take a year maybe two years as part of a nationally organized scheme to volunteer in the care sector working with adults for example in nursing homes in care in their own homes organized by local authorities and the idea here would be that we would ask them to put on pause going to university for maybe a year maybe two and in exchange we will give them a discount on their final fees for example 50 off of their final tuition fees if they spend a year working in the care sector first a sort of voluntary national service basically that's kind of the idea um what we are aware of from looking at multiple studies and much much historical experience is that people don't really like doing national service unless there's a war on All right.

4:14Then you can motivate them through patriotism and shared endeavor and the threat of the enemy to volunteer. But when you don't have that scenario, it's much more difficult to get people to just volunteer out of the goodness of their heart. Some people will, but not that many will. So what we need is a different approach where we encourage people to do something which is like a voluntary national service, but isn't organized around, for example, the military, but is organized around other pressing social needs and isn't based either on straight conscription, where it's like, do this or else, because all you're going to get then is very miserable people who don't do a good job because they don't want to do it.

4:47And we incentivize them, but we don't want to make it, I think, strictly just, well, we're going to just pay you to do this, because then it becomes a job and people should be able to choose what jobs they get. That's a wider question, but I think that's quite important. But we should also recognize that if we ask somebody to do a difficult, demanding job like care work, which is a very difficult and demanding job, there should be some kind of incentive and some kind of compensation for them at their end. So not only would they be appreciated as being part of a voluntary workforce that is helping the country, but they're also going to get something out of it for themselves.

5:20So it's the best of both worlds in that regard. Well, there's no doubt that there is a problem in social care, and it's a very live topic in politics, even this week. But the basic problem is there are not enough carers. If you look at the numbers, and these numbers come from Skills for Care, which is basically a charity that does the workforce planning for the care sector. There's about 110 ,000 job vacancies in the adult social care sector now. But in 14 years time, so by 2040, there's going to be over half a million by 2040. So in 14 years, we're going to see a fivefold explosion of empty adult social care workplaces.

6:06obviously at the moment a lot of those places are being filled by workers from abroad which is a politically fraught subject so perhaps your idea could begin to address some of those problems before we get into the detail I want to hear about you you're here in the studio you're in the wheelchair what was your life like before your accident what did you how did you see the future for yourself? So before my accident, I was 36 years old, having a successful academic career, maximising my interpretation of work from home in the post-pandemic world where a 5G internet connection meant that I could answer my emails and do my reviewing work and whatever didn't require me to be on campus meant I could do it out the back of the van that I was living in, in Scotland in the summer of 2023 because I'd put my flat on London on Airbnb.

7:00and B. Wait, wait, wait, wait. You were an academic at King's College London, but you were living out of a van in Scotland because work from home. Because I could. I always made sure that I answered all my emails. My publication record was strong. In fact, when I had my accident, I was in a coma. And what I only learned many weeks later after I woke up from the coma was I had been promoted. I think I might be the only person at my work who's ever been promoted whilst unconscious. But the point is I was meeting all my requirements, but I realized that in modern technology meant that I could combine my two passions one is political philosophy uh the other is what was rock climbing and I could maximize the amount of rock climbing I did if I maximized my interpretation of work from home I mean that's a pretty radical lifestyle in itself I guess it was I mean it and I I was happily taking advantage of how radical that was but as many things um it didn't feel that radical after I started doing it for a while it just felt like normal to me okay so um tell me about the accident yeah what happened so it was the 5th of j 5th of june 2023 i was climbing um in glencoe uh with a friend of mine uh we were doing traditional rock climbing so we were climbing with ropes helmets uh placing protective gear on the mountain as we ascended as a team the two of us and in the very final uh pitch of i think 15 15 different subsections on the final sub subsection about six meters from the top of a 300 meter route um the rocks shattered that I was climbing.

8:22We now think, we're not exactly sure what happened, but we think that because the conditions were very dry, I was accidentally climbing through a dried up waterfall because we didn't realise that normally it would have been running with water. They'd been unusually dry conditions. I went, oh, that looks like nice rock. I'll climb that. It normally would have been underwater because it was dry and not underwater. The rocks were very weak and they shattered. Now, normally one rock breaking isn't a problem because I had the protective gear. Unfortunately, what then happened as the next four pieces of protective gear which should have caught me all failed and blew out of the rock.

8:54I saw a mini avalanche of rock. How this didn't wipe out my partner holding the rope below me, we will never know. But somehow he didn't get hit by any falling rock. He was able to arrest my fall so that I didn't fall all the way back to the ledge where he was standing. But I hit a protruding ledge on the way down. How far did you fall? Apparently 20 meters. I'm always a little dubious of that number because it's a long way and I'm not dead. having said that i destroyed my left arm destroyed all the bones somehow the the medical team later put it back together with a lot of aluminium and metal and somehow i still have my left arm um but i also landed on my head turned my helmet into confetti as my climbing partner puts it um but most seriously of all um dislocated two of the vertebrae the c6 c7 for any doctors out there vertebrae in my neck uh which caused my spinal cord to be crushed between the vertebrae and has led to paralysis from the collarbones down.

9:49So I have rudimentary movement of some of my fingers, good wrist control, which is unusual for my level of injury. But apart from that, from the collarbones down roughly, no feeling, no motor control, and a lot of complications that have resulted from that. But I should say that the chap I was climbing with, my friend Noah, he is a surgeon, and he was a surgeon at the Royal Elizabeth Hospital in Glasgow. So he not only managed to get me out by insisting that Mountain Rescue use the helicopter and don't try and walk down, but they had to winch me. He then called the hospital whilst I was in the helicopter and told them what to expect.

10:21So as soon as I got off the helicopter, I went straight into surgery. Do you think without that guidance? I'd be dead. There's just no way I could have survived with anybody who wasn't a medical doctor. And if I hadn't been 10 minutes flight from Glasgow, there's just no way I would have survived. It's very improbable that I'm here today. Presumably by this point, you're out i'm out so i remember till about two minutes before the accident i remember shouting down to noah this doesn't look right this this looks a bit too difficult for like the this is should be an easy climb uh but i can do it like it's well within my ability and that's the last thing i remember is shouting to him and uh and from then thankfully i don't remember he unfortunately he had to witness it and he remembers it so in a bizarre way it psychologically was harder for him well certainly harder for him on the day uh because he had to he was you know he's a surgeon but he wasn't expecting to have to be a surgeon on the mountain that day.

11:15So, yeah, I'm very thankful that I don't remember anything from that point onwards until five weeks later I woke up in the hospital and my mum was there. I was like, what are you doing here? Where am I? I said, oh, you had an accident in the mountains. I thought, well, I know that. I was just there. That's how it felt to me. Five weeks were missing. I was unconscious for five weeks, about five weeks. Well, it's give and take. I had woken up and been a bit crazy for a week before I was talking. And apparently that conversation wasn't the first time I spoke to her and asked, where am I? What's going on?

11:46But it took a few times for it to stick. It was the first time that I remember it sinking in. I remember being, well, I know. I was just there. Obviously, I was in the mountains. So it was a very bizarre experience. Can you take me back to that moment when it did sink in? How did you take in not only what had happened to you, but what your and what did you think your kind of life prospects were at that point yeah so it's not it there's not one moment where it sinks in i can very distinctly remember around the time i had this conversation with my mom running my hands down my chest i mean why can't i feel my chest trying to touch my legs like where are my legs and then trying to get up and being like and then it started to to something is really wrong here but at that point i was still coming down off a lot of medication a lot of drugs that i'd been on for weeks i'm unconscious this distorts the mind in all kinds of ways just being unconscious for that long and so i was kind of aware that something really wasn't right and initially you're thinking well you know it's going to get better or i you know and i've said but i've always been lucky there's no way this can be as bad as it seems and and i'm one one moment where it really hit me is i was chatting to one of the doctors in in the hospital in Glasgow and it's a spinal unit and I said something along the lines of you know when am I going to walk again and um and and the thing about spinal patient treatment is they're very honest with you from the start they never lie to you they don't give you false hope and they say look we don't we won't know for sure but I'm going to be honest what she said to me I'm going to be honest with you the chances are you're not going to walk again um and then someone just saying it outright really made me go okay but but i still think i'll get my hands back i was like but surely my hands like and coming to terms with the full extent of the injury the severity and the and the the irreversibility of it in all honesty it probably took me six to twelve months to accept the medical side of it and then another year after that best part of two years to psychologically come to terms with it and be able to move on and actually say okay this is my life now what am i going to make of it rather than i can't do this this is too much i just or even just some days some days i refuse i just will not do this i'm i've lost too much was the thing i said to myself a lot in the first two years there's no one moment there's many phases of of coming to terms with both the physical and the psychological situation which was harder the psychological for me and and so a cliche that everyone who's been it's not even a cliche it's just true and everyone who's been through a spinal uh unit and had spinal injury will will tell will tell you because you learn it is every spinal injury is different and partly that's a physiological truth the way that the spinal cord is damaged is different in every individual and the spinal cord is so complex that the damage even if you look on scans they look identical in two people and they could manifest radically differently in what they are can and can't do so you learn for yourself um so but for me personally psychologically coming to terms with not just my physical inabilities um can't get up i need help with going to the toilet i need to be shout help with showering i need to be dressed by somebody else can't cook for myself not just the physical limitations but the the lack of of independence that that entailed and going from somebody who lived in a well they did always live in a van but for months at a time we'd live in a van to go climbing as much as possible whenever he felt like it so long as he got all this other work done in the evenings to then be told you're now going to need somebody else on hand 24 hours to make sure that you don't die and to feed you and help you go to the toilet um was crushing psychologically for the first for the first two years i'd say roughly two years before i managed to come to terms with it and it wasn't a black or white thing and it wasn't overnight and I had to do a lot of things along the way that got me into a mindset of expanding my boundaries ever so slowly um for me psychologically how did you approach it did it involve a lot of therapy yeah were there friends and relatives that you relied on yeah so so therapy um I'd already been doing therapy for a couple years for the accident and I was able to get in touch with my my existing therapist and I said you know the poor guy first time he realized i had an accident um i i was a video call i had tubes up my nose and i was in a hospital and anyway my mom hadn't warned him that i there was a special reason why i need to speak to him again but he took it in his stride oh my god he didn't she said can you please talk to my son i think he needs your help and your therapist i don't think he knew that what had happened he thought maybe i just had a a depressive episode or something but it was a bit worse than that anyway but i reconnected with him after the accident and uh we started working together and i'm still working with him and luckily the i had mountaineering insurance because i was with the british mountaineering council um uh i didn't even know they were providing me insurance i was spot i was a member because i liked the work they did for climbing access my dad said to me when i was in the hospital you do realize that they they provided insurance don't you no but that's helpful but a stroke of luck what a stroke of luck because it helped pay for a lot of adaptations help pay for the wheelchair that i'm sitting in right now um also help pay for therapy they paid for a good year and a half they covered the insurance covered therapy and i now pay privately because it's worth it friends and family enormously important if i didn't have the unbelievable levels of support that i received from my family i and i've seen what's happened to some people who don't have family support when they have an injury like mine and it's terrifying to think i i feel my heart goes out to these people because i know how close i came to sharing their fate except i have family that have done enormous amounts for me and friends i had friends come to visit me i think there was one day when i was in in in the royal london hospital waiting to get transferred to spinal rehab i was there for three and a half months and there was one day in three and a half months someone didn't come and visit me with a friends or family and that's just so important long term about um psychological recovery but the other thing is that i had i had care i had um people who so for the first year i was in hospital and then in well first eight months in hospital then four months in a nursing home in enfield where care is just part of what's in an institutional arrangement you were in a nursing home presumably with your with your co um your fellow uh patient no no so basically i was considered to have completed rehab spinal rehab after four months which is very controversial in my my physiotherapy my private physiotherapist for spinal injury who i work with now gets angry when she hears this because she thinks i was not ready to be discharged but they needed the beds because there were other people who need so i understand why but uh my house my flat i couldn't go back because it's up a flight of stairs so i couldn't go home so we had to sell my flat and again this is where parents were so incredibly helpful for me they helped or basically did it for me they sold my old flat and got me somewhere that was wheelchair accessible in walthamstow where i live now and um uh but it wasn't ready when i was discharged from spinal rehab i and so i had to go and live in a nursing home so i went to live in a care home in enfield i was in the high dependency part of it so i was with people with brain damage and high level needs and what was that um that was well the first couple of weeks it was a lovely break from hospital because they actually had my own room and i didn't have to hear other people having their bowels emptied at 6 a.m every day which is what i'd been living through for the previous four months like a bonus yeah um but then i crashed pretty hard because having somebody screaming at 8 a.m with brain damage and he can't help it but i just wanted to sleep um being in a situation where there are people with alzheimer's who are coming into my room sometimes to try and talk to me um you know there's nobody else there of my age or who is basically functioning normally.

19:32The staff were very nice in this nursing home. I mean, this is the kind of thing that, you know, your situation is extraordinary, but the situation you're describing in the care home is something that could happen to any of us and probably will happen to quite a few of us. And I should say that this was a very good care home. And even at the time, although I didn't love it because I was living in a nursing home, I did appreciate the staff were very hardworking. They were well-trained and it was a good nursing home. I have heard some horrendous stories about people in my type of situation. A chap who's in the rehab unit with me, the last I heard is he'd been put in a, what was described to me as a factory for people dying of dementia or a warehouse for people dying of dementia with no family.

20:12And a lady who was actually, she now left the NHS, but she was working as a carer in the spinal agency unit. She was a lovely lady. She was devastated because she'd been to visit this chap and found that he was just left in bed at 4pm in his own feces, hadn't been up for days because the staff just didn't care. Or it's not even they didn't care, they didn't have the time or the training. And so I was sent to a good nursing home, which enabled me to take the next step, metaphorically, to living independently. But I know of people who, for all I know, this chap is still stuck there. And a lot of this comes down to the postcode lottery.

20:51how do you mean explain that well so when i moved home i moved back to wapen forest and it just turns out the wapen forest is a borough which actually cares about doing the best they can for helping people like me um so they i needed to live in 24-hour care when i moved home because because of my condition it's possible for me to have adverse reactions which causes my body to try and kill me basically it's a weird side effect of spinal cord injury called autonomic dysreflexia not all spinal injury patients get it you have to be injured at a high level so basically if you have a neck level or high high back level injury you're at risk from this um and it's something that it can be arrested quite easily and it can be sorted out but i need someone to help me what happened sorry what happens when that so basically the body starts a self-destructive catastrophic feedback loop the standard one for me is if my bladder is blocked right because i unfortunately have to use a catheter now i can't go to the toilet without by myself um so right now it is draining into a bag which is lovely tied to my leg.

21:48Now, if that catheter gets blocked, what will happen is that my body will panic because there's a pain signal going to my brain and the brain's not responding. And the body's response to that is to start raising blood pressure and it keeps going and it keeps going. And if left untreated, what will eventually happen is I will have a stroke and I will die. Now, it's actually quite easily treated either by unblocking the catheter or giving me medication to reduce it until a doctor can work out what's causing it. But if I'm on my own and this starts, I can't fix it by myself because I don't have hand function.

22:18I don't have dexterity. I might not even be able to get to the medication I need. So I need somebody on call all the time. It's very frustrating in some ways because I don't like having to be dependent in that way and not many people do. But on top of someone to dress me, someone to cook for me, someone to do all these other things, there are also medical implications. But when I went back to Waltham Forest and needed somebody living 24 hours, and what was really great is that they got a local agency who they trusted to take over now i have actually moved since then to a more specialist spinal agency but initially this was really helpful because this was a local agency run and i was in regular contact with the managing director and she would do her best to send me people who actually understood what i needed and and and tried to help me but again i know people who have gone back to other boroughs and they've been told, right, these are your options.

23:12You have to go with one of these agencies. Often these are large national level agencies that employ thousands of people and send frankly incompetent carers to their houses, sometimes who lack basic English language skills and often are negligent. And when people complain, they just get another version of somebody who is often very poorly trained, not able to do the job properly, and they are not able to, or they can try to move to another agency, but they're told, well, this is the only other agency you can go with. And this, I mean, you said, Waltham Forest is your borough, right? And you said that they actually care.

23:50But presumably, I mean, the situation is presumably it's not that lots of other people don't care. It's that the resources are not there a lot of the time. I think it's a combination of both. I think that all local authorities are under pressure to make the budget balance. And social care and the provision of care is one of the, I think is overwhelmingly the thing that they spend most money on. But I think it really makes a difference what the culture is like in your local authority. So I am very lucky that my care is paid for by what's called CHC or continuing health care. So it's actually funded through the NHS.

24:25But other people are not so lucky and they are paid through direct with the local authority. and then it's much harder to get more expensive, more 24-hour type care arrangements. So that's, again, and I was warned before I left rehab, Paul, you might not get CHC. And I said, what are you on about? I can't do anything by myself. He said, look, we're going to try and get it for you, but you have to prepare yourself for the possibility that you don't get it.

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25:59I hope you're enjoying my conversation with Paul Sager. Don't forget, you can subscribe to this podcast on BBC Sounds so you always know about future episodes. And make sure you've got push notifications turned on. That way, you'll get an alert whenever we publish a new episode so you'll never miss out. Now, back to Paul Sager.

26:20okay so your life has the everyday reality of your life has radically changed yep uh the way you psychologically deal with your life presumably has radically changed yes um how has this brought you to your idea the idea you're talking about today so the big one was earlier this year um so i have now moved to a specialist agency um where i have we don't even call them carers we call them pas personal assistants which initially i thought was really pretentious but now actually means an awful lot to me because a carer implies somebody who does it because they care out of love and it's like no it's a job and i don't want them to care for me i want them to assist me And this little tweak, this little linguistic tweak actually makes a big difference.

27:10But my PAs, I usually have one person living in for two weeks and they change for someone else for two weeks. In the summer, because of summer holidays, they needed a bit of cover. And I had a PA for a couple of weeks, a young Irish lady, who turns out she was a master student at King's College London. Not in my department. She just finished doing a master's in diet studies. She's now a qualified dietician. in future she will be working in hospitals probably in the nhs but she's actually from ireland and she said to me oh you know i'm doing this for for a year you know until i get a placement in hospital because i i did a couple of years of care work in ireland before i did my master's after i did my undergraduate degree and she's like i just really like it i find it really rewarding and i thought that was really interesting and also i really appreciated when she was working with me that she was young, enthusiastic, switched on, super reliable.

28:02And I just thought, hang on a minute. Like this is, you know, and this is an idea. And I spoke to her and she said, you know, I often try and convince my friends and people are surprised when they hear that I've done this because they think, why would you be a carer? Isn't that a disgusting job? And what they're kind of saying is with low status, isn't it? And she's saying, you know, I really want to change people's minds about that because I find it really rewarding. And I found it really rewarding having hurt and i like my other pas as well they're also great um and and it helps that they're paid more than average by my agency so i was going to say it sounds like one of the problems you identified is that as a society we don't adequately respect i think an accord respect and uh value and remuneration yeah to the people who look after us whether that's people in your situation or you know all of us getting older so but so your idea is to get uh undergraduate students before they've gone to university um to make up some of the shortfall is that is this about filling those places or is this about getting a different sort of person with different motivations into this into these jobs well it's both to be honest um i think as you as you already said um we've got a huge shortfall and we're not going to be able to cover that just through encouraging 18, 19 year olds to do this, but it will help a little bit.

29:29And it's not so much different kinds of people because there are many fantastic people who work in care from all kinds of different backgrounds. It's more to change social perceptions of what care work is. And I think we could be sending a few messages here. One is it's something that we value. It's something that we encourage people to do. It's something that we need them to do. And so we don't expect them to do it for free. And we're not also saying, oh, you know, it's just something that you do if you can't do anything else, right? That actually we think bright people who are smart enough to go to university, we would like them in the sector because we recognize that it's a difficult job, that you have to be able to think on your feet.

30:06You have to make decisions about medication. You have to understand people's private needs. You have to understand their psychological vulnerabilities in some cases, that this is not a quote-unquote low-skilled job that we don't respect. But actually, it's the opposite. So it's partly more about changing the long-term perception of what this kind of work is, whilst also getting more people into the sector. So let's say I'm an 18, 19-year-old, or there's an 18, 19-year-old listening who's got a place at university. Well, we're just at the start of the year, but let's say they've deferred it for a year and your scheme is in place i can now uh i can now volunteer uh to do what for how long how much training do i have to do and and am i going to get paid for it okay so there are multiple different ways this could be set up one one potential way might be and there could be different tracks one could be working in nursing homes so it could be that you do you do a year where you're going to work in a maybe local nursing home doing the kinds of work that's very important in nursing homes, cleaning people, feeding people, making sure that they're well looked after.

31:12That's one option. Spending time with people, talking to people. Another track could be visiting people in their own homes. So people who are either my age, but need somebody maybe in the morning or at certain points in the day, people who are older, people who may be going into nursing homes in a few years, but aren't there yet. People with degenerative diseases who need a bit of help. That could be another track that you move around the community. so there's different versions that that could work i would again my suggestion is not necessarily that we pay them because then it's just like well they could just get a job working in care it would be it would be more that we say look the idea here is that it's a kind of voluntary um arrangement but you're going to get something in return and it could be a reduction of the debt that you owe on your university degree and also a reduction on the interest that you end up accruing on that so it's a deferred yeah so so what's so what's the incentive like why um how much are you gonna um pay me if i if i take up this option um and why would it be better than let's say just getting a job and saving the money yeah so i think one the fact that if it's part of a nationally recognized scheme you could potentially get a qualification out of it that something could be added to your cv you would also be able to tell employers at the end of your university degree you know I did this for a year I have practical lived experience of doing a difficult demanding job which has significant responsibility and I know I spend quite a lot of time with undergraduate students and they are switched on about the kinds of things that will matter when they leave university so many of them are doing extracurricular volunteering already at universities in different sectors sometimes because they think that's the thing they need to do to impress future employers And I sometimes explain to them that actually employers are often impressed by having normal, quote unquote, jobs, not volunteering as an intern in some highfalutin NGO.

33:00Actually, if you can turn up and do it. So that's one option, that it would actually be part of an integrated scheme that would signal something at the end, rather than just having a job. Because on a sort of fairly regular basis, governments will suggest some kind of national volunteering service or something. And it always kind of gets shouted down as if it's some sort of regressive idea. How do you change that? So by making it voluntary, not a national volunteering service where you're sort of forced to do it or shamed into doing it, but doing it and say, okay, well, you're doing it voluntarily, but you're doing it because there will be something in it for you.

33:43And sometimes people get very suspicious of that. Oh, well, you know, if you make it sound like, you know, they're only doing it for themselves, but you can do something for other people whilst it also being in your interest. These things can harmonize. And so I think that it is naive to sort of morally browbeat young people and say, oh, you should just volunteer for the sake of volunteering for the sheer love of your community. That's a bit unrealistic in 2026 in a population of 70 million. Well, it's also unrealistic because young people quite rightly feel like they're getting a rough deal compared to older generations.

34:17Yeah. And well, I think that is that is a major problem. And this this scheme alone will not solve it. But it could be a way to break generational barriers down. But so you would have to train people. You couldn't just send these 18, 19-year-olds straight out of school into the care sector. So what kind of training program do you envisage? Who's paying for the training program? Yeah. Well, I would expect the government to pay for it. That would be straight up. However, I think it's worth the audience being aware, because I imagine most people won't be, because I wasn't until I was in my current situation and went and dug into it, how little training people already get in the care sector.

34:52So it's a little difficult because you have to dig into the details and it's actually not completely clear what statutory requirements are. But basically, someone who works in care is expected to get a care certificate. That usually involves between 30 and 50 hours of training. Often, most care agencies who are hiring care workers are going to do that either, well, normally through a five-day intense course. and then with some periodic online top-up sessions done on a computer at home or maybe over Zoom. So we dug into this a little bit. It's the Care Quality Commission, the CQC, that regulates this, right?

35:32That's right. And they say that the requirements for becoming a carer, and we're talking about England here. Yes. It's all England, so it's different in Wales, Scotland, North Ireland. but the requirement in England is completing a 12-week induction scheme or 40 to 60 hours of training online, which I suppose is about a week and a half study or a week if you work very hard. So the way that 12-week induction usually works will be five weeks of intents actually being shown how to do things and then you're training on the job. So you're basically supposed to be learning while doing the job but really you're doing the job.

36:10and so at the moment many people will be receiving care from somebody who has had five days training is how it seems to work given i've spoken to carers and they've told me yeah that's and that's how and in your experience that doesn't work in my experience it doesn't work that doesn't work well because that means that you can have people turning up to your house as i've had who do not seem to know the basics of handling skills of medication preparation in some cases and again listeners may find this hard to believe but if you ask somebody who's encountered the care sector it is not uncommon to have somebody who you cannot hold a conversation with in english um and i find that i found this unbelievable at first and just just to be clear uh of my two regular pas one is from slovenia and one is from the philippines i'm not bothered about whether or not people having this as a first language.

37:05I can talk to them about anything because they have very good English, so I don't care that it's their second language. But I've had situations where I've had people, I've asked somebody to open the door because the delivery driver is going to arrive, and they've stared at me and started doing the controls on the bed because they do not understand what I'm asking them. I totally get that. You want need to be able to have a conversation with your carer. But also, we have a lot of people in this country, maybe elderly people who for whom English either isn't a first language or don't really speak very much English at all.