In evidence—I think it was to the health committee—the Welsh Local Government Association and the Association of Directors of Social Services Cymru said that

'Key determinants of health are largely outside the control of health services and so the quality of, and spending on, social care has one of the strongest impacts on the demand for health care.'

That might be stating the obvious, perhaps, but it's a statement that should impact more strongly on our thoughts on the recruitment and well-being of the social care workforce in the short to medium term, because it's not just about the NHS workforce. If the social care workforce collapses, it takes down the ability of the NHS workforce to cope with the extra demands on them. And while I accept, of course, that big cultural and structural changes don't happen overnight, and acknowledge that work has now begun on raising the status of the social and personal care workforce through further regulation and training, we are still losing care workers into the health system because of better terms and conditions there, as well as losing them to other jobs as care is too often seen as a stop-gap, temporary, entry-level sort of job.

What we don't know is how many we are losing through ill health, because we don't know how many people are employed in this sector. Six thousand or so are registered, as we know, but Welsh Government estimates that there are about 19,000 domiciliary workers out there who are now eligible to register. But an independent report on the economic value of adult social care suggests that the estimate is nearer 83,000 care workers and more likely that there are 127,000 jobs indirectly linked to adult social care. And if you don't know who these workers are and can't reach them, how do we ensure the well-being of this hidden army? We know about the GPs, and now we know about the ambulance staff as well, but how many care workers experience mental ill health due to unrealistic time demands, variable terms and conditions, low levels of pay—maybe that residual feeling that you're second-best compared to the NHS? How many are leaving for those reasons, when we might be able to retain them?

And if we're asking for cultural change, if we're asking people to come forward and invest in a career in social care, then Welsh Government needs to constantly make the case with the public that social care is not something less than the medical or nursing care that we know of and to show that. So, while Ministers may expect Health Education and Improvement Wales and Social Care Wales to work 'as one', to quote them, there is a real question for me about the value of the education streams of these organisations being separate from each other, retaining the risk of one overshadowing the other. New entrants should be coming into the beginnings of this integrated service with none of the old trappings of healthcare being more highly valued than social care, and certainly in the generalist areas of primary care, new entrants shouldn't be even aware of any difference, even if they do go on to be more specialised as their careers progress.

For all the good work that's taking place in clusters and other multidisciplinary hubs, it still tends to be medical or nursing members who lead teams rather than those with social services backgrounds, although obviously there are some of those. Without role models, new entrants will inherit this existing sense of inequality between the two necessary parts of care, and as we've lost 5,000 jobs in social services departments in the last seven years, who is it that's encouraging those who have taken the social services route to push for leadership in those integrated services?

Now, 'care' is the word we're using here, and primary care cannot continue to be seen as purely medical, nursing or even about allied healthcare professionals. Social and personal care must be valued equally within that definition. Yesterday, we were lucky enough to be visited by Griffithstown Primary School, who came to the cross-party group on dementia to talk about the brilliant intergenerational work that they're doing. Some of the girls—none of the boys, interestingly—said that they'd like to become dementia nurses. No-one mentioned becoming a consultant or a researcher or a care worker or someone running a care home or domiciliary service or someone who helped to keep people well at home when they have dementia. And I am not blaming those children at all, but they've heard of nurses; they haven't heard of social care. And without clarity on what the future looks like, I think it's pretty difficult to prepare new entrants and persuade existing workers to change what they're doing, which is a pretty stressful experience in itself, and how can HEIW and SCW be sure that what they are training for will be appropriate for future models of care? And, of course, it will be models—plural—because this will be different in different parts of Wales.

Just finally, I want to finish on the subject of third sector providers. I came across a situation yesterday where there was a scheme that pays a small number of third sector personnel with acknowledged expertise to support individuals to have the confidence to make appropriate decisions about their care needs instead of dialling 999. To cut a long story short, they're losing their funding, we're losing the expertise of those members of the care workforce as well as all the benefits, and I want some assurance, if you can respond to this today, about how our care workers from the third sector, and other sectors if you like, will be retained and how we will look after them if we don't even know they exist.