The following is adapted from a speech given in Fort William on the 24th October at an event organised by Angus MacDonald MP whose primary focus was to explore his proposal to create four new 60 bed care homes in the Highlands. After reflecting on the nature of social care, its current challenging state in relation to sustainability and workforce pressures, I went on to suggest some actions which might make a difference.

So what can be done ?

Like many others we will continue to lobby for a new approach to immigration which is sensitive to demographic truth rather than political rhetoric – Scotland needs, wants and values our international colleagues, no more so than in social care – and with the pain of Brexit still felt so acutely we need the UK Government to restore a skilled workers route, or at the very least to allow Scotland to develop such a model.

It also goes without saying that we need a Budget both in Holyrood and in Westminster that properly values social care not as a nice to have but as a fundamental partner to NHS funding and provision.

But there are other things we can do which I think can help.

I want to suggest several actions:

1. A Highland Weighting Scheme.
2. Flexible models of care, including co-housing, intergenerational living, and community-led support.
3. A reformed understanding of what care home provision in remote communities needs to look like
4. Flexible regulatory and registration arrangements for workers and organisations.
5. Investment in co-ordinated digital infrastructure to support remote care delivery especially in homecare.

1.

One practical solution is the introduction of a Highland weighting– a regional pay supplement for social care workers in remote and rural areas.

Social care providers in the Highlands struggle to recruit and retain staff due to:

• Workforce availability
• Terms and conditions cf to other sectors
• Seasonal employment patterns
• Higher travel costs.

A Highland Weighting scheme would also recognise:

• The higher cost of living in rural Scotland.
• The complexity of delivering care across large distances.
• The lack of affordable social housing.

Such a scheme could be structured similarly to London’s, but tailored to rural realities:

There are some key components

• Base supplement for all care workers in designated Highland zones
• Tiered rates based on remoteness (e.g. mainland vs islands)
• Travel allowances for mobile care staff
• Housing support or relocation grants.

The London weighting scheme has shown that:

• Targeted pay supplements can improve recruitment and retention.
• Inconsistencies across sectors can cause inequality
• Transparent, annually updated models(like the Minimum Income Standard) help maintain fairness.

Applying these lessons to the Highlands would require:

• Clear criteria for eligibility
• Cross-sector coordination
• Annual review mechanisms

Other countries do this:

• Australia offers a range of financial incentives for health and social care workers in remote communities, particularly through the Remote Area Nurse Incentive Package and similar schemes for aged care and disability support.

Key Features:

• Retention bonuses and relocation grants.
• Higher base salaries in remote zones.
• Accommodation subsidies and travel allowances.
• Often tied to return-of-service obligations.

Canada – in the Northwest Territories, care workers receive a tax-free northern allowance to offset living costs and attract staff to remote communities. A similar model in the Highlands could include tiered supplements and housing support.

South Africa introduced a rural/remote allowance for social workers and other social services professionals (SSPs) working in designated remote areas. The scheme was developed using a GIS-based remoteness index to scientifically identify eligible locations.

Key Features:

• Allowance covers costs related to transport, housing, schooling, and lack of amenities.
• Aims to equalise pay between urban and rural sectors.
• Targets vacancy hotspots where recruitment is most difficult.
• Approved by the Social Development MINMEC and supported by national funding.

There are further models in Japan and nearer home in Portugal and northern Spain.

2. Community led-models of homecare.

We must also look to community-led care. We must embrace new models of homecare tailored to rural realities.

For instance, in Rannoch and Dunkeld, local trusts are developing a care-at-home service governed by the community itself. It combines paid staff and volunteers, local governance, and flexible scheduling to meet individual needs.

Again, there are clear international lessons:

Canada has adopted an Integrated Rural Home Care model

The Canadian Home Care Association (CHCA) promotes integrated care models tailored to rural needs, emphasising safety, dignity, and quality of life. Innovations include mobile care units, community-based nursing, and partnerships with Indigenous communities for culturally appropriate care.

In the United States there are many ‘At Home’ Service Models. For instance the innovative PACE (Program of All-Inclusive Care for the Elderly) combines medical and social services to help seniors stay at home safely with an emphasis on rural and remote living support – from St. John’s United (Montana) and Missouri Slope (North Dakota).

In Australia amongst many rural responses there is the IMOC Program (Innovative Models of Care trialling multidisciplinary care models in remote towns, including in NSW. There is the PRIM-HS Model in Mareeba in Queensland which is a community-led and co-designed model integrating local government, clinicians, and volunteers and aged care providers focussing on sustainable, locally tailored primary and social care for rural populations.

3.

Care homes must also evolve.

Flexible models like co-housing, intergenerational living, and small-scale community homes are being trialled in rural areas across Europe and could be adapted for rural Scotland.

We have also to be prepared to build not what is wanted and needed now but what is going to be acceptable in 10 or 20 or 30 years – and all the signs are in the UK and internationally that when people do need to move into residential care they want small, purpose built residential settings within local communities – and which are embedded, adaptable, and supported by technology.

Research by Alzheimer Scotland last year advocated for what has become known as the ‘small supports’ model – which many in the sector are only too open to deliver but which at the moment is wholly unaffordable because of the low levels of funding through the NCHC.

Indeed, Scottish Care and other stakeholders have done work on costings for a 20-25 bed care home model rather than the current model of 50 plus. But whilst it might be desirable it is wholly unaffordable within the current fiscal envelope. So key to all this change for care homes is a radically revised Cost Model within the National Care Home Contract.

4.

Flexible regulatory and registration arrangements for workers and organisations.

I am aware of the work that Jaci Douglas from the Care and Learning Alliance has been leading on in terms of the Single Care Model in the Highlands. I was pleased to meet Jaci and hear of this innovative work and I shared with her that similar models had been and are being developed and delivered in rural Canada. There several provinces maintain professional registries for early childhood educators, often linked to broader care workforce strategies. These registries support career mobility and professional recognition across child and adult care sectors.

The work of the Highland consortium is exciting, and I hope will go from strength to strength –

‘It is about taking a holistic approach in rural communities, an opportunity for people to live and work in their communities in a way that is flexible, everything needed is met i.e. person has child care which allows [her – more often women] to go to work and to care for parents or other loved ones which otherwise wouldn’t be able to.

Many carer roles are part time in smaller communities, not enough hours, this combined role would allow more full-time opportunities, this can be the difference between working and not is it worth working when not enough hours.’

To succeed it needs regulatory change and flexibility.

Australia at this very moment is actively exploring a national registration scheme for care workers that spans aged care, disability, and early childhood sectors. The so-called ACRN Proposal (2025): advocates for a nationally mandated, harmonised, and legislated registration and education scheme for all care workers. This would allow for cross-sector mobility and ensure consistent standards across community and residential care settings. Note this is not just for rural communities but it is felt by stakeholders that these communities will especially benefit.

Effectively and put simply we need to adjust our registration frameworks to enable a more flexible approach to services across the age spectrum and across sectors; and secondly we need to enable a much more flexible approach to workforce so that we get away from siloed professionalism which is not only failing us but in truth is divorced from the realities most younger workers want to experience and live in.

5.

Investment in co-ordinated digital infrastructure

The Care Technologist Project in Baillieston and other models developed by Scottish Care and now being adopted at scale in England – equip older adults with smart lighting, voice-activated devices, and robotic pets. In rural areas, such tools can reduce isolation and support independent living.

These innovations show that rural home care can be responsive, personalised, and sustainable – that is if we invest in the right infrastructure and leadership.

Conclusion

We are at a turning point.

We can continue to patch a system that is fraying. Or we can build something better- something rooted in fairness, shaped by lived experience, and responsive to local needs.

Social care is not just about services. It is about relationships, dignity, and the right to live well.

I spoke at the beginning about the sense of belonging that people like my Skye grandmother have always spoken to me about. A sense of duchlas. It is about how we care for one another, especially those who are most valuable and in need of our support. I believe we can – if we are sufficiently adventurous honour that belonging through a social care system that is compassionate, innovative, and rooted in community.

Donald Macaskill