Episode 6 - Steve Peddie

In this episode, Mark and Nerys sit down with Steve Peddie, Care and Health Improvement Advisor at the Local Government Association (LGA). With over 40 years of experience in adult social care - from frontline social worker to Director of Adult Social Care, Steve brings rare depth and honesty to some of the sector's biggest questions.

From his accidental entry into care work to his vision for a technology enabled future, Steve shares what's changed, what hasn't, and what still needs to.

Transcript

SPEAKER_02 0:05

Hi, I'm Mark, and in my day job I work in the technology-enabled care sector. And this is Home Trues, where we try and curate interesting conversations with people in and around the care sector and bring them directly to you.

SPEAKER_01 0:16

I'm Neris. I work alongside Mark in the sector, and we're really um really pleased to have uh Steve with us here today, who brings a wealth of experience in adult social care and has brought a lot of care um to these roles over the years. So thank you for joining us, Steve.

SPEAKER_02 0:31

You're welcome. Steve, tell us a little bit about what you do and why you do it.

SPEAKER_00 0:36

Okay, so um I'm a care and health improvement advisor, which is um, you know, like a senior advisory role um in the sector of adult social care. Um I've got a couple of roles. Uh I started the job around about five years ago, with my principal role being uh responsible for digital technology in adult social care for in the local government world. Um, and since then it's expanded a bit. Um, but uh I think for the purposes of today we'll we'll we'll sort of keep it at that. Um so we're in a partnership between the Local Government Association and ADAS. So one's the uh membership organization for local government, and the other one is the membership organization for directors of adult social care. So where I came from was um previously a director of adult social care. Um and I'm a social worker by background. So, you know, I I've been through the ranks in uh adult social care over the last sort of 40 years, uh, and then kind of uh broke out of that natural career progression to come out and be an advisor.

SPEAKER_02 1:51

How did you end up in social work in the first place? Was it something that drew you were drew to from an early age? What was the original story? I think it's it always fascinates me how different different people are drawn to that kind of vocation. What was your story?

SPEAKER_00 2:04

Um I guess I came from a family that were in uh kind of you know uh caring professions, um, although I uh I didn't expect to just end up staying in in care. Um uh so I didn't really have a career plan. You know, I did a degree in social sciences, um, I did um, you know, work uh after that in kind of care work. I was a residential care worker, um, and uh I was then working with uh young people um with disabilities and uh I kind of grew into that, I suppose. I didn't have a natural career desire to to go into care work, but I ended up liking it, enjoying it, feeling that that was where my heart was.

SPEAKER_01 3:00

And what what kept you in it then? You know, so you stumbled into it. So what were the the kind of the moments in that early career that that that kept you?

SPEAKER_00 3:09

Um I I think for most people in in care work, it's um initially very immediate. You know, you can see that you're actually doing some good, uh, that your relationship matters to somebody else, that um you're you're trying to combine uh something about yourself and your your natural empathy for for people and uh with your professional, developing professional expertise. Uh so I I guess for me um it was that seeing kind of instant results from from being there and and working with people.

SPEAKER_01 3:48

And and and seeing them, I guess, right? So you know, seeing their um seeing their their their strengths, um, but also seeing their their needs and being able to you know step in and and help.

SPEAKER_00 4:01

Yeah, no, absolutely. I think it's the combination of you and the individual that's making something happen for that individual. Um and you know, um one of the things that I I always wanted to happen for individuals is uh regardless of whether it was a a child, young person, or an adult, was that that they could get the support to you know what people might call self-actualized, you know, to to achieve the the best that they could have in their their own lives, despite the fact that, you know, for most people that we support, there's a level of adversity, whether that's coming from the outside or you know, it might be um a disability. You know, the the whole idea that uh social care is really about achieving equity for people who've got, you know, who are just like me and you, but they they just have something else that might be a little bit of extra adversity in their lives.

SPEAKER_01 5:04

And and and and that that what matters most, I love that phrase, right? Um be great if you could share some examples really, because that that must be very different for different people, um, you know, what what they what they want.

SPEAKER_00 5:16

Yeah, I mean, and I think that that um is you know, it differs according to where you are in your life. You know, I think I've seen loads of examples uh where people uh, for example, have had the benefit of um new technology, assistive technology in their lives, for example, which is one of the things that motivates me in terms of my digital role. Um, the fact that uh sometimes professionals assume that what people want is more hands-on care um because um that's that's the solution that everybody knows is going to tick all the boxes for people, it's gonna, you know, it's gonna make sure that they've they've got somebody around for them, you know, it you know, they're they won't be as isolated, uh, they will be able to be helped with their basic functions in life. And yet if you if you ask people, especially people who actually had the experience of having technology supporting them in their lives, they'll they'll say what a wonderful thing it is that they don't have to be totally dependent on um on on another person, that there will be periods of the day where they can use that technology to support them.

SPEAKER_01 6:36

Yeah. I was I was thinking um about this the other day actually. So I wear reading glasses, um, and and it's a probably a great example of early assistive technology, isn't it? So I'm thrilled that now I have reading glasses, I can read myself and I don't have to ask somebody to read it. But it's as basic as that, isn't it? You know?

SPEAKER_00 6:54

And and I think when you know, people often say, you know, are you worried about AI? Um as you know, in as a, you know, what what's that to you? What's its place in adult social care? Is it an existential threat? Whatever. Well, you know, it of course it could be. There are there are arguments for that. But when you see the enormous um uh deployment of things like AI, and you you just mentioned uh glasses, but you know, obviously now we can have technology that helps people uh with sight impairment to read virtually. Um that's life-changing for them absolutely life-changing, game-changing for them as an individual, because nobody really wants to be dependent on somebody else, either as a translator, you know, you know, to be on their shoulder supporting them if they can be completely independent and supported by technology.

SPEAKER_02 7:53

On that point over the years, obviously you've been in this in and around the sector for a while. How have you seen it change in terms of outcomes for people? Obviously, technology has definitely changed. We've talked a bit about that, but how would you describe the evolution and now the current kind of state, if you will, of social care in this country?

SPEAKER_00 8:10

Well, I would say that we're we're we're much more conscious of a strengths-based approach now. Um, I'm not sure. I mean, we didn't used to talk about it like that. I think we we used to think of social care as being kind of plugging a gap that people had in terms of, you know, they they couldn't do this, so somebody would do that for them. So I think, you know, the evolution of social care as being that social care is there to help people to have their gloriously ordinary life now, um, which is which is progress. Um, it means that we've got to be really thoughtful about what what it is that people actually want uh from you in terms of somebody who can offer social care support and listen to them about what they do want and what they don't want. My life, my risk is is the way you live your lives, isn't it? You know, if you want to do a bungee jump, you will do a bungee jump. Your family might say, I'm not sure that's a a great idea, you know. Steve, you're getting on a bit, you know. Um, but I will make my own choice because I've got the liberty to do that. And I think um what we've had to kind of train ourselves to do in social work is to make sure that we're not um, you know, claiming to do the thinking for people. People have got to make informed decisions and we've got to listen to them. And also, of course, in terms of the Mental Health Act, we've also got to um try and get inside the head of what the person used to be like when they, you know, when they had their capacity. Um, and so um that's a real that's a duty on us. But I I really like that discipline, actually, uh as I'm sure most people with a practice background do, that um this is uh this is the way that we get people involved in having agency uh in a social care setting which which could have the ability to overtake somebody's life.

SPEAKER_01 10:21

And how lovely to uh, you know, in some uh residential settings, the perimeter is moved to the outside, right? So you can actually have fresh air, you know. I mean, that's a that's a um a human right, isn't it? You know? Yeah.

SPEAKER_00 10:36

Yeah, and I think that's that's why in inspections, which you know, people will be aware that we've had now more than a year of baselining inspections from CQC, they've they've zoned in on that um um rightly. And even though every local authority's got some dolls waiting lists, some of them quite extensive, um they they still rightly made the point that um everybody must attend to that because it because personal liberty is um massively important for people, it's a human right.

SPEAKER_01 11:16

So I would like to feel the sun on my face uh when I'm all done.

SPEAKER_00 11:20

Yeah, too. Yeah, exactly.

SPEAKER_02 11:22

Steve, what are the what are the constraints on the on the sector today? I mean, I don't want to go into political cull de sac, and there's a lot often a conversation around funding and is there enough funding in the system to do it, but but from a kind of that practice background to the roles you're in now, what how would you describe the kind of stresses on the system uh across the country?

SPEAKER_00 11:43

Well, whether there's enough money in the system um is uh is an interesting question. Um, I'm not sure I know the answer to that one because um, you know, where you see examples of where systems across health and social care have decided to pool budgets or be um uh or or to take a you know a less usual approach to how things are funded across health and social care. There aren't many remaining examples of where that is still intact um to in order to demonstrate that if only the money could go with with the person um and we could be less of, you know, Louise Casey said, for example, you know, one of the critiques was that the NHS meant national hospital service because that's where all if effectively she she might have been implying that that's where too much of the money is, so that we we've got to turn this around to more of a home-based service across health and social care. So, but you might say, well, one of the stresses in the system is is that there's too much funding over there and not enough over here. But um, I think, you know, I I don't think I could hand on heart say that there's enough money in the health service to transfer over to social care services, but um, you know, that that's not for me to say. But it's certainly a stressor in the system that there always isn't enough funding. I suppose you you might say that there are things that could be embraced within models of care that would potentially take some of the heat out of the system. Um, and hence, you know, my my enthusiasm for for adopting some uh technology-based solutions is partly driven out of making sure that um the things that need to be done by humans are are done by humans, and you know, some of the hard work that humans can't do, or some of the you know, increased quality of stuff that is beyond humans. Let's just take you know the analysis of data in real time around somebody who's got some sort of passive technology going on in their uh home. Uh, that a human is not going to be able to do that. Even if you had five humans doing that, it's not going to be able to absorb all of that data and turn it into actionable insight, but you can have that. Uh technology can do that, or even just some of the more, you know, obvious uh labour-saving stuff that that can go on. The sort of transcription of notes and stuff like that. The sort of stuff that um is more commonly known about. It it is commonly known about, but it's not comprehensively deployed. That that's the frustrating thing. So I think some of the things that are um kind of inhibitors of that, some of it is the funding, some of it is the the leadership, some of it is the the will, the will to break out of the same old, same old.

SPEAKER_01 15:12

And there's maybe a bit of um a shove needed sometimes to you know to to force some of these changes. So we were um you know, talking about you know, regulations or mandates or you know, things like that, where that has you know really driven that change. Um, you know, the analogue to digital switch has has has forced this big switch to digital, which is a blessing, right? You know, it's made it, it's made it happen.

SPEAKER_00 15:35

I mean, you know, in in local government very little can be mandated as as we know. It's um, you know, as as somebody who works at the local government association, um I think we uh we pride ourselves by most of the improvement work that we do being uh on a voluntary basis and you know being because it's the right thing to do. So much of our work is sector-led, is peer-led. Um that's great. Sometimes I do wonder. Um, I don't speak for the LGA here when I say this, but I do wonder whether some top-down ism might be uh might be good. We've you know, we can look at examples, for example, in in Spain, um we we know about that. Um, you know, the state decided that people had had got a right to technology-enabled care. Um it now becomes the default position to have an assessment for um whether technology-enabled care can support you. And so instead of having a sort of a layered-on technology on top of your care, you've got a okay, this is what technology can can do. We're gonna make that assessment um with the use of people who are actually um social care specialists, not you know, uh with technologists. Um, and that that's our starting point. Then what else do you need on top of that in terms of care? In doing that, that's that kind of might be an example of top-downism, um, because the state has decided decided that it's a A, it's a right, and B, it's funded. I mean, 90% of it is funded by the state. Um that's your starting point. That is a strategic deployment of technology. We have got at least as much technology in people's homes in the UK, but it's maybe not used in a strategic way. And it's layered with um with other care. Uh, so you know, there's I I think there's a case for intervention in there. Um that that's that might not be the official line. This is my personal point of view.

SPEAKER_01 18:02

But I I I like that you, you know, uh led with A, it's a right, right? So, right back to the the beginning of the conversation about that, you know, what matters most, and and people don't, you know, people want independence, aren't they? We we all do, so why doesn't everybody um else? Of course they do. Um, and there's there's very few things in in life that you can say is is um uh you know can be both better and can be less expensive, right?

SPEAKER_00 18:28

Yeah, that's a win-win, isn't it? And when you ask people, you know, there's there's a a really good study uh that's been done in Shropshire recently where they they deliberately uh went about trying to see if it was okay to replace some care visits with virtual care visits. Um so obviously that has been in tandem with the care providers. So nobody's sort of fed up that that that's happened. There's had to be an arrangement worked out about how providers can be paid to do that. So there had to be a unit of currency for a virtual visit, which uh as I understand it in that case is that a virtual visit is paid like a 15-minute um face-to-face visit. So there has to be some sort of unit of currency. Um, it's uh and the people that have had the advantage of that say that they really like it. It adds to their life. It doesn't, it's not seen as a is something that's being taken away from them, which is really, really important. Uh, and those people who are informal carers who support their cared for person also say it's added something to their level of feeling secure about mum or dad, um, that uh it's given them more information and more insight into what mum or dad's life is like. So, you know, it it's added data informed information, and everybody's happy because it it costs a little bit less. Shropshire is a rural county. Um, people have got to travel an enormous number of miles. I used to be the director in Cornwall. You know, typically carers could travel 100 miles in a day. You know, that that's a lot, not very good for the environment either. Could you replace some of that?

SPEAKER_02 20:29

Yeah, I know that's common in the Nordics, and the kind of kind of camera-based or other technology-based services. Yeah. I guess the thing that's in my mind as you're talking, Steve, is that are we doing enough to support the workforce, like meanwhile back on the front line? How do we, if we haven't got that mandate to scale in the way, uh the way that kind of state intervention of technology, how do we how do we support people on the front lines who use technology in the in the in models of care? And are we doing enough there today?

SPEAKER_00 20:54

Yeah, and I think it's it's probably something that's missed. You know, the evidence would say that we're not training the workforce enough. Um so if you look at the um the the iTech uh 2026 survey that came out relatively recently, I think it was something like 19% of the workforce said that they felt confident in the use of technology. Um and you know, I I might be misquoting that, but it was it was fairly low. Um, and and so I think that sort of it gives us an impression that we need to do more. Um it's difficult to work out whether you go for a generic approach to training the workforce or whether you specifically bring in new bits of technology and then train the workforce. I mean, it certainly in terms of the rollout of um what what became fully digitized, you know, the um the technology in registered providers. Digital social care records. Um, it seems like the sort of in-time training of, you know, we're going to have this, we're going to switch it off on a certain date, we're all going to do the training. Uh, you better get to be a part of this because if you because we're not because we're switching off what what used to be uh the way of doing things, so this is a new way of doing things. So everybody kind of bought into that because it was absolutely required, and then and then that became the new way of doing things. That when I've been into um care settings and I've listened to staff talking about that, there was always a period of time when people were, you know, going through that nervousness about adopting new technology and thinking this is probably the time when I might have to exit because it, you know, I'm not the very techno-savvy, and um and and and that's been almost immediately overcome by the the advantages of that technology.

SPEAKER_01 23:06

And and I wonder you know, the the very uh type of wonderful person that is drawn to work in um social care, uh, you know, I don't want to over-generalize, but are probably not the same people that are the you know the tech specialists, right? So I think what's worked really well I've seen in in you know that true co-production is when you've um, you know, when the tech sector and the technology specialists are kind of allowed around the table with the you know the the people that draw on care and support, their families, um, you know, the local authorities, the care provider, you know, you get everybody around the table, all bringing their own perspective to it. And and and we welcome that, right? The the the opportunities that that we have um you know to do that. But um, yeah, I I often think those decisions are put on the shoulders of people, and and I've heard that from you know directors of adult social care and you know commissioners with that practitioner background to sort of say, I'm the last person to be, you know, doing this technology. You know, they don't feel that confidence in it, but but you know, we would welcome that um that round table discussion, that's how we get there, isn't it? Yeah.

SPEAKER_00 24:16

Well, I think some of the people that have end up being most evangelical about technology adoption um are in that situation precisely because they've surprised themselves that they are not um that they weren't gonna be the one, you know, they identify themselves as being the one that might have had to have gone and found another job. Yeah. Because, you know, um, you know, I spoke to an individual who said, well, she she felt she didn't do very well at school, she had dyslexia, she um she always felt that she was kind of criticized for not doing very good note-taking on the care records, and she thought uh this adoption of technology in terms of care records was probably gonna be the death knell for people like her. And then, of course, and it won't surprise you to to know that this was a a massive support for somebody who uh felt that her way of um describing things um with words wasn't wasn't great because she was she was helped with the technology. Exactly. She was able to use symbols to describe things um where things were difficult to to understand. She was a voice note. There was there was she could just do voice notes, yeah, um, and she could and speak this into technology that was already in her hand, yeah, a mobile phone. Um and so instantly it became something that was just like the parts of her life that she practiced a million times.

SPEAKER_01 25:57

Yeah, sprinkle a bit of AI on that, translate it to another language, share it with the family, you know. I mean, yeah. Yeah, exactly.

SPEAKER_02 26:04

That's probably a good segue into your hopes and and kind of thoughts for the future of the sector. If you think about the next few years, Steve, what's what do you hope the sector comes, you know, is able to do both with technology and in general? What what's your what's your thoughts?

SPEAKER_00 26:19

So if you look at some of the things uh that um we're we're we're trying to get to um in order to to all be at that sort of outstanding level of provision. What does outstanding look like? And outstanding in terms of technology looks like that leaders have have taken the opportunity and then have decided to drive that opportunity or drive those opportunities into new ways of doing business, then that new way of doing business includes the use of technology enabled care, includes the use of shared records to make sure that we've got one view of the individual so that we can see them as a whole person. And I'm talking about health and social care together. Um it includes also making some good choices about where we deploy technology and where we keep it human. You know, I mean, I think it's important to say that for some things, some cases technology could do it all if we wanted it to, but it might not be the right thing to do. So I think making discerning choices about that. So if you look at say information, advice and guidance, it's really important for people to be informed um users and consumers of adult social care and support. Um and that can all be provided on a digital platform. However, even though it's good practice to do that, and in fact, you would probably lose marks if you didn't provide it, um, if you only provided it like that, then you would you would be an inadequate uh on on that point, you know. As a descriptor, it clearly says that um that if you're only invested in digital technology as a way of make of helping people to be informed, then you know that that wouldn't be the right thing. Because um in a world of um you know gaps in accessibility, in in equity gaps, you're only compounding the equity gap that people who've got additional needs have, or somebody who's you know described as hard at hard to reach or you know hard to help. So I you know I think that's an important thing. So I mean, I think you know, taking uh AI, for example, again, it's really important to be discerning about where we deploy AI. I thought it was really I thought it was really interesting, for example, um on a recent um trip to Madrid to see that they're still keeping their outbound phone calls to people being done by real people. Whereas I've recently seen an example in the UK of outbound calls being done by a bot. Now, you know, both both of those things can be very useful, but um, if you ask people about what they thought was important to them about preserving, I think I've got a strong hunch that they would say that they would like to preserve outbound calls. They completely agree. They would they would they would look forward to that. Yeah. Um, and I you know, I very much doubt whether anybody would elect to, you know, talking about virtualized care visits. I very much doubt that anybody would want to sacrifice all of those. So I think it's got to be a blend between um technology and hands-on care. Um and yeah, I think that I think that across the whole kind of AI development world, that it, you know, I would like to see the human in the loop. I would, you know, uh, it is possible for decision making to be made by technology. And there's of course, um, it's very true to say that AI can support decision making and support better decision making in both health and social care. But I think it's uh it's about supported decision making rather than making decisions for us because AI, in the end, can't actually do your thinking for you.

SPEAKER_02 30:45

Yeah, completely. I think the blend is really important. I mean, I'm a big advocate of the augmented experience. I think I think it's very different talking to a smart speaker around today, the experience of controlling your smart home, but with the advent is different to when you're talking to a person about a care, you know, a check, even a check-in. And to your point, the conversation is just part of the thing I look forward to. It's part of my care package, even if it's as informal as a conversation on the phone. So I think I think it's a really important thing. But it leads me to my my kind of I guess my final question, Steve, around the funding kind of concepts of um some of the conversation nationally is around where does copay and private pay sit alongside um state funding. And then you touched briefly on the National Care Service concept. So I would wonder, is the space, I think, are we ready as a for as a society for thinking about actually copay and private pay solutions to some of these, both technology and care provision in this country?

SPEAKER_00 31:36

Yeah, I mean, I I think I'd I'd be in favour of a state-sponsored right to state funded technology um supported care. Um there, you know, the various studies that have been done about how much the state can fund all of care would would tend to still support the the concept of an individual uh means tested contribution towards that care. Um so um I think in that sense, you know, um one of the better things that we can do is to try to keep people more informed about about that much more ahead of time than at the moment, where you know it it tends to be the case that people assume that the state will will fund their care. Um, and you know, I think it is the case that that when people have got to shoulder the burden of their care, they're likely to um uh take advantage of less of it than they they might need. So a national care system might not look like a fully funded um system, but it might be a system that had everybody in the tent, that everybody gets an assessment. You know, going back to Spain, the state does the assessment and then and then it gets farmed out to a municipality. Um what could it look like in the UK? Who who knows what we'll what we'll end up with? And I'm not necessarily advocating the the Spanish system because in that system uh I don't think that the National Health Service and the National Care Service are necessarily one service. So, you know, I think there there are um limitations to to the data sharing, which might, you know, which needs to be um fully embraced as part of our new national care system, sitting with the national health system, I I think. But um, because I think again, going back to that, what good or outstanding looks like, I think CQC are right in saying that that looks like one view of the person. So I'd I'd love to see that as crack that because you know I'm old enough uh in the social care world to remember when we first started to try to do that. It's a very long time ago.

SPEAKER_02 34:07

Well, Steve, thank you so much for sharing your insights, right? It's been an absolute fascinating. I'm sure we could talk for a whole another hour on this, but I think that a real privilege to hear how you've uh grown in the sector from generating paper, and now we're trying to get rid of the paper. Um, but yeah, really enjoyed it. So thank you very much. Thank you.

SPEAKER_01 34:24

Thank you. So fascinating uh conversation and and and a history lesson, really, with um with Steve. What what did you take as the home truth from um?

SPEAKER_02 34:36

I think it's still the potential of of the technology, right? I think that from Steve talking about when he did first computer in the social work office.

SPEAKER_01 34:43

Yep.

SPEAKER_02 34:43

And now obviously we then generated paper, then we took paper away. And now it's about how how do you scale a technology? This is it the Spanish model where we it's state intervention and legislation, yeah, or is it from the ground up under we commission differently in local areas? And I think we still don't know the answer to that. And it's interesting to see what inspection and the CQC regime is bringing in terms of a new lens. So, but I think the potential of technology is still the home truth there for me in the social care sector.

SPEAKER_01 35:07

Yep.