We are just two days out from the annual Scottish Care, Care at Home and Housing Support Conference which will be held in Glasgow on Friday 18th May. If you haven’t already got your tickets there is still time to join us at what looks to be an intriguing and enjoyable day.

This year’s conference is entitled ‘Practical promise: making the vision of home care real.’

The word promise is an interesting one. In strict definitional terms a ‘promise’ is a ‘transaction between two persons where the first person undertakes in the future to render some service or gift to the second person’

What’s that got to do with care in someone’s home? – I would suggest everything.

At a very basic level the concept of promise is at the heart of the human exchange which good care and support offers. Every time an act of care takes place there is a service offered and a gift exchanged. Not a gift in the literal sense but the gift of support and person-led care which enables an individual to live their life to the full. At its heart that is what good home care is – it is an enabling process which offers an individual the prospect and ability to live as independently as possible for as long as possible.

All too often in some of the debates I take part in about the future of care and support in our community there is a presumption that care at home and housing support are about maintenance – keeping people safe and healthy. Of course, that is part of the story, but it is by no means the whole.

People who require to be supported in their own home require that support not just to keep healthy but to enable them to lead as fulfilling and as rewarding lives as possible. Life does not just stop with a diagnosis it moves to a different level. Affective, human-centred care at home and housing support is about providing the support to enable people to still dream their dreams, achieve their goals, and create their future. Homecare should never be seen as maintenance – it is always about the promise of a life still to be lived; good homecare is not about a set of tasks to be performed but enabling people through support to achieve their full potential, regardless of age.

The relationship of care is infused with promise at its very centre. It says that I as I support you and care for you, I will be here to make sure that you have a life which is as full and meaningful as possible; that you are not limited by your need of care or support, that you have contribution to make and abilities to share.

But there is also another sense to the word promise which will no doubt be reflected upon during our conference on Friday – and that is the degree to which a promise has a future orientation and perspective. Within the word promise there is a sense of hope, of expectation, of things yet to be achieved… a sense that things will be better and that new direction will be found.

The care at home and housing support sector is at a critical juncture in Scotland at the present time. We are living and working in extremely challenging financial environments, and with great uncertainty and fear for the sustainability of the care at home and housing support sector. But there needs to be promise.

With political conviction and appropriate financial investment, the future direction can indeed be one of promise. Rather than disintegration and paralysis. There simply has to be a future vision of homecare where grounded in the realities of day to day care-giving, we can create a social care system in Scotland which values the human rights of the individual, treats all with dignity and respect regardless of their chronological age, and which seeks to ensure that the individual person is in control not only of their care but of the direction in which they want their living and dying to move. There has to be a vision which gets us beyond the reckoning of support by segments of time for allotted tasks, which seeks to purchase that care at the cheapest price and pays lip service to the principles of choice, control and involvement of the supported person.

We all know what the ‘promise of care’ in the future needs to look like. It is a rooted, grounded practical vision of a Scottish society which cares and manifests that care not just in word but in action. The time is surely here for fulfilling that promise and building that vision into practical reality rather than uttering yet more pious platitudes.

That is the promise – a system which would make all of us who do the work of care and support rightly proud – a social responsibility for a nation. Join us as we continue creating that practical vision rooted in the promise of dignified support and care.

Dr Donald Macaskill

@DrDMacaskill

“Writing is easy. All you do is stare at a blank sheet of paper until drops of blood form on your forehead”  – Gene Fowler

That is how I felt as I stared at the blank screen of my iPad!! A “blog” what is that!! I am too old to learn about these new-fangled methods of communicating!!  I like to talk to people – how spooky is that in this digital world? I have been in the Care Sector for over 30 years and I have experienced, both professionally and personally, the highs and lows that we all face every day.

This Blog could be a “low” but I hope you will find it at least a “medium” . I am the Local Integration Lead for Perth and Kinross; not sure my mother would appreciate me being called a “LiL” as is the affectionate term for us all.  As in every Partnership area we are striving to meet the challenge of supporting the Independent Sector in a period of change and continual pressure on resources. Despite these everyday issues there are still examples of good practice and successful initiatives that we can share.

P&K were successful in being selected to take part in the National Pressure Ulcer Project whose aim was to reduce pressure Ulcers in care homes by 50%. A pilot group of five care homes participated in the programme to test and evaluate documentation and processes that had been put in place initially. Valuable lessons were learnt in P&K and elsewhere during this pilot project. A celebration event in P&K was held in January where the care homes that had participated were asked to present their learning and experiences and share them with the wider care home group.

With the associated learning, such as the newly introduced pocket guide, the Pressure Ulcer Project is now being rolled out in care homes throughout P&K. The pocket guide, which came as a direct result of an idea from a care home in P&K has now been adopted nationally.

A new initiative in P&K is to support the Care Sector in the recruitment of Care at Home staff. We have always known that the recruitment and retention of staff is one of the Care Sectors’ major challenges. How do we demonstrate that the Sector can provide worthwhile training and a fulfilling career?  We have recognised for many years that there is a high turnover of staff generally. Our challenge is to start replacing their knowledge and experience now. The joint initiative between the Local Authority and Care at Home Providers sets out to utilise the Modern Apprenticeship scheme in a way that benefits both the individuals and the sector. The Council will effectively be the managing agent and the staff will be seconded to the Care at Home service for a period of 18 months. During this time, they will undertake the SVQ Level 2 qualification and gain valuable practical experience, At the end of the 18 month programme the Apprentices will be offered a permanent position with the Care at Home Service. I am delighted to report that five Providers have signed up to the scheme.

Every now and again despite the challenges we all face attending endless meetings and discussions, and we have all been there!!  My faith in the sector was restored recently, in terms of reinforcing why I feel so passionately about delivering excellent care. I sat in Perth Concert hall not listening to Andre Rieu, although that would be good as well, but at a conference organised by the Life Changes Trust listening to four enthralling individual stories of the demands and commitment faced by unpaid family carers. They all had different life histories, but the common thread was their wish to ensure their loved ones had the best support through the most difficult period of their lives. They talked about the basic day to day challenges they had to overcome and despite this they maintained a focus and commitment to continue supporting their loved ones.

It isn’t always about policies and procedures at the end of the day, it is about dealing with people in a caring and dignified manner. This was outlined brilliantly by Donald Macaskill in his opening address.

We must always ask the question: “Are we delivering the care and services that people actually want!” 

 Mother Teresa said:

“The most terrible poverty is loneliness, and the feeling of being unloved.” 

Perhaps we should remember that unpaid carers can feel alone and unloved and how we interact with them as individuals and organisations can have a huge impact on their wellbeing.

Bernie Campbell

Bereavement support is not an option

Professionally I have been involved in the work of bereavement for most of my adult life, both teaching and writing about the experience, not least for those who struggle to express their thoughts and feelings. In some senses I am at ease talking about death and dying, about the pain of loss and the emptiness which the absence of love leaves. You could say it has been my particular field of professional and academic interest.

At a personal level like so many I have had times when I have lost those close to me. I have been forced to do the hard work of grief on too many occasions and for too many moments. In those times I have struggled to find a path through and a sense of balance when the waves of absence overwhelm.

Bereavement is the sense of feeling robbed and bereft. For no matter how expected or anticipated a death or loss is, its ache is still sore, its pain still raw, its touch a cold beyond description.

This sense of lost-ness is beautifully conveyed in the original word for ‘bereavement’ from the Old English- ‘bereafian’ which denotes a sense of deprivation, of being robbed by someone, of being seized or grabbed out of living and life.

One of the reasons I wanted to write about bereavement is that at Scottish Care we have decided to make it a focus for some of our work this year. We have held useful and creative discussions with organisations like Cruse Scotland and colleagues in health and social care.

But in wider discussions on bereavement I am sadly detecting a resistance or a certain degree of apathy. It’s almost as if it’s okay to talk about palliative care and end of life, to develop a framework and priorities for those, but somehow bereavement is considered to be the concern and the preserve of the individual.

There seems to be an attitude that bereavement is a grief work which is not deserving of resourcing or strategic priority. I think this is both sad, mistaken and damaging.

We have loads of evidence to show that as a society in Scotland we have lost the cultural and societal ability to deal with dying and have misplaced our skills at working through loss in bereavement.

It is for that and many other reasons that we have solid research which shows that many doctors are struggling to cope with death and dying and are needing support to grieve and to do the work of bereavement.

For social care the Scottish Care report ‘The Trees that Bend in the wind’ last year spoke movingly of the way in which care staff whether in care homes or in the community in homecare services felt poorly equipped to deal with the continual losses they have to experience.

Bereavement support should be a central and critical priority for all who commission care and for all those who make strategic policy and practice decisions. To do other is to fail to support clinicians and carers at their point of real vulnerability and pain.

No matter how skilled and experienced you are we all need to be supported and upheld through our grieving, we all need to find a solace that comforts us in our weakness and binds us up when we feel broken.

When we have a sense of futility and despair, both personally and professionally, we need there to be space to open up and pour out our feelings; we need there to be people who have time and capacity simply to be present and there for us.

Good bereavement support is no optional extra, it is rather fundamental to a society basing its character on dignity and human rights. Good bereavement support renews and restores, it can give a sense of purpose and direction, for many it’s what has literally saved their lives.

I fear that if as a society in Scotland we fail to enable and resource those who do the work of care to grieve properly and to enrich them through good bereavement support then we are sowing the seeds of a harvest of regret and despair.

Dr Donald Macaskill

@DrDMacaskill