This past week has felt like a bit of a transition week. For those of us who are parents of school-age children most of us will have experienced either this week or the previous one our children returning to school after what has been a surprisingly good and even traditional ‘sunny’ summer.

That first day back at school is a real rite of passage for folks – looking at the new starts all bright-faced and uncertain, and older children re-kindling friendships and contact even if mobile phones have never been out of their hands for weeks! This return to school is more than calendar – it is ritual. It marks continuity and renewal. It also reminds us of the fragility of our systems – education, care, community – that hold us together.

But in the non-school world too we are also seeing change all around us, as conkers seem to be appearing even earlier and leaves are beginning to change colour. There is a growing chill in the morning air, not yet the bite of winter, but a reminder that change marches on. The days remain long, but the evening shadows start to stretch. And as seems to be becoming pattern migratory birds are returning even earlier than normal. The seasons are turning. I have always found these in‑between times to be moments of truth-telling, and opportunities for realism.

Watching children file into school reminds us of both hope and urgency. Schools are where potential is forged; where community is invested in, where futures begin. Yet alongside this forward movement, we must remember that for many families, stability is fragile. While classrooms brim with promise, care providers – homes, charities, volunteer networks – stand on strained foundations and if we allow those foundations to crumble the edifice of health and wellbeing in our society collapses.

This season is I have always felt a time for realistic optimism, a hope for the future grounded in a realistic assessment of the present and that seasonal aptitude has never been more needed than it is now for the world of social care. And realism begins with honesty.

Over 200 charities – many providing key social care services – have come together to issue a stark warning: the care sector is not sustainable as it stands. In an Open Letter to the First Minister published last week they plead for immediate action- sufficient funding and systemic reform- to avert a collapse that would harm our most vulnerable. Their plea echoes continual statements from myself and colleagues as for months now we have warned of real and immediate risk to social care provision, and most importantly the fact that people are dying as we speak and watch, waiting for life-affirming and renewing social care support. A couple of days ago in an interview in Herald Scotland I lamented the apparent ‘paralysis of response’ from the Scottish Government. No one seems to be listening. We are deafened by the inactivity of decision-makers and the malaise of political disinterest.

The charities’ joint letter is clear: nearly half of voluntary care organisations feel financially insecure; two-thirds rely on reserves to keep going, with 91% at risk within four years if trends persist; and a full 81% of voluntary bodies report escalating financial threats to essential services. These numbers are not abstract – they are communities, relationships, and dignity dripping away. The members of Scottish Care echo the same sense of alarm and concern in the surveys we have produced over the last few months. There is an existential threat to survival within the vast majority of social care providers in Scotland.

As we turn our gaze therefore toward autumn and winter, Scotland’s social care system stands at a threshold- facing profound economic pressures and legislative shifts.

From April 2025, UK-wide Employer National Insurance Contributions (eNICs) rose significantly adding around £2.8 billion in sector-wide costs, and imposing tight margins on social care providers, particularly smaller independent and voluntary organisations operating on low fees.

But this isn’t just about finance- it’s about dignity. Providers forced to scale back, cut staff hours, or close services leave vulnerable people isolated and families without support. Realism demands we name this hardship.

Added to this – just last month, the UK government closed the adult social care visa route unless roles meet degree-level criteria- meaning many migrant care workers will no longer be eligible. New recruits must now meet higher requirements, effectively ending overseas recruitment for care work from July 2025. I had a manager in tears this past week because she was having to tell a brilliant staff member that they could not continue her visa.

These changes threaten to exacerbate existing staffing gaps. Social care leaders warn of rising attrition, especially as better-paid NHS roles lure workers away from care homes and homecare services in pursuit of stability and advancement.

The realities facing our communities and our care services are stark. The rise in costs- whether from increased employer contributions, energy bills, or the price of food- tightens the margins of already fragile services. Workforce challenges remain severe, exacerbated by changes in immigration policy that close doors for many who might have chosen Scotland as a place to live and care. Families continue to struggle with the dual responsibilities of work and caring, unpaid carers shouldering burdens often unseen.

These are not passing inconveniences. They are deep and structural. To deny them would be to engage in wishful thinking. And care, if it is to mean anything, cannot be built on illusions.

Realism demands we hold these truths without flinching. Without pretending that goodwill alone can patch the gaps. Realism demands that we have long since passed the stage where Elastoplast measures will patch up the brokenness and ensure the patient survives. Realism demands that we require brave political leadership to make decisions and choices which will result in real change and not simply spew out yet more empty rhetoric. We need hope-full realism.

So where does that leave us? In tension. Realism tells us services face cost pressures, workforce crises, and uncertain policy. Hope reminds us of emerging gains: new rights, rising pay, reform legislation, and long‑term structures that aim to embed rights and consistency.

Hopeful realism is not denial, nor is it escapism. It is choosing to act.

Hopeful realism is the art of carrying truth in one hand and courage in the other. It refuses the luxury of despair just as it rejects the comfort of denial.

Hopeful realism tells us that the narrow road is often the truest one. It asks of us not perfection, but persistence; not certainty, but commitment.

Hopeful realism is not an abstract sentiment; it is a discipline. It is the daily choosing to believe that change is possible- and the practical work of bringing it into being.

Hopeful realism is not a compromise- it is a balance.

It says: Yes, we face severe staff shortages. But we also have the capacity to train, support and properly value a new generation of carers not least if we improve terms and conditions.

It says: Yes, increased costs will strain providers. But investment and fair funding can steady the ship and that the ship is essential for all of us.

It says: Yes, immigration changes will close pathways. But with imagination and policy will, we can open new ones.

Hopeful realism is a lens that sees the cracks in the walls yet still tends the flame within.

The coming months will not be easy. Winter rarely is. But this is not a time for resignation. It is a time for choosing. Choosing to act, to support, to stand alongside. Choosing to hold our political leaders accountable to their promises. Choosing to believe that care, in its truest form, remains one of the most powerful expressions of our humanity.

The return of schools teaches us that renewal is possible. And if we can invest collectively in education- an investment in our children- surely, we can do the same in social care- an investment in our neighbours, families, elders. The spirit of educators and parents who gather at school gates each morning can be replicated by communities, policymakers, and local leaders in meeting care needs with resolve.

Yesterday I was at the Scottish Parliament and was pleased to contribute to a debate entitled ‘ Do we value social care?’ which was part of the Parliament’s annual Festival of Politics. It was a great debate and discussion, and the overall consensus of panellists and audience was no – we value the people and the outcomes of changed lives and independence, but we do not value the workforce or organisations, or even the essence of social care. That has to change if hope is not to become an illusion.

We stand at a critical juncture: buffeted by policy shifts and fiscal strain, yet buoyed by reform, rights and renewed commitment. Hopeful realism calls us neither to despair nor to distraction—but to engaged courage, to act where we can, nurture where we must, and walk together into the change that must come.

The garden is full, the hedges high- and I sense both the fullness and fragility of this moment. The sun feels generous, yet we know autumn approaches. So let this in-between time be our reminder: hope requires practice and action, and practice is hope made real and realised.

Donald Macaskill

Photo by D R on Unsplash

Top of Form

A story is not a luxury.

It is not an embellishment added once other needs have been met. A story is central. It is how we come to know who we are. It is how we declare our presence to others. It is how we resist being erased in systems that too often reduce us to numbers, diagnoses, or costs.

Over the last few months, I’ve had several discussions around data and technology, and the tensions that sometimes exist with the use of personal data and the desire for personal privacy and individual control. As a result, I have found myself thinking again about the question of who owns our stories. In an age where our lives are increasingly digitised, where our memories, choices, and even our preferences are stored in invisible clouds, the question of personal data has become more than technical. It has become moral and ethical.

Following on from those meetings and conversations I have been thinking especially about the stories of older people in our social care and support system. When I speak with older people across Scotland, I hear a recurring theme: a sense of losing control. Not simply over health and care decisions, but over information. Who knows what about me? Who decides what is shared, and with whom? Who holds the keys to my life?

But it goes even deeper than that – it is not just the data that others have of us. It is the sense that people like professionals presume they know the whole story of who I am. So, all this has made me think of stories in the fullest human sense and not the ones written about older people, but the ones they hold within- their own stories. Because far too often, those personal narratives are sidelined. Not intentionally. But gradually. Imperceptibly. Lost in a sea of forms, eligibility criteria, assessments and appraisals. We gather data but lose the person.

In one care home I visited this spring, a woman in her 90s looked me straight in the eye and said,

“It feels like everyone else gets to write my story. But I rarely get the pen.”

What an image – and it’s one that has stayed with me.

Who holds the pen?

Who decides what is written, what is remembered, what is shared- and with whom?

There is great dignity in holding your own story. To know that your memories, choices, and identity are not just scattered across the systems of State, the operating platforms of a software or care provider but gathered, safeguarded, and stewarded by you.

This, at its heart, is what lies behind the growing movement around Personal Data Stores. Platforms like MyDex, Solid Pods, Hub-of-All-Things (HAT), and so many others are not simply technical solutions. They are moral statements: declarations that the right to hold and control your own data is an extension of the right to hold and express your identity.

What MyDex has pioneered is not merely a secure place for personal data. It is a model for digital dignity- a way for people, including those receiving care, to collect, manage and consent to how their data is used. And more importantly, to participate meaningfully in decisions about their own life.

In the world of social care, where so much of our energy goes into managing information about people, we must I feel increasingly ask a different question: How do we enable people to manage their own information?

Not just because it’s efficient or innovative, but because it is just.

In recent months, I have seen inspiring work in Scotland and across the UK where communities, innovators, and care organisations are exploring models that place the individual at the centre and in the lead. These systems do not treat data as a commodity, but as a sacred trust. They build on the belief that to be human is to have ownership of your past, your present, and your future choices.

And this is where care and technology meet. A human rights-based approach to care insists that we are more than patients or residents, more than service users. We are people whose identity is bound up in the stories we tell, and the stories told about us. The secure cloud, then, is not just about firewalls and encryption keys. It is about respect, dignity, and agency.

And that is a challenge, not least because the technology and social care systems and the way in which they have grown up together and apart does not make the ability to retain control and agency easy. The language of digital care systems has been dominated for too long by compliance – GDPR boxes ticked, privacy notices drafted, systems encrypted. But compliance is not the same as ethics, and consent is not the same as participation.

A human rights-based approach to social care- digital, AI or otherwise- must begin with the understanding that older people are not a single demographic category. They are individuals, each with a story, each with values, each deserving of voice.

Yet policy documents still refer to “the elderly” as a bloc. Health interventions are rolled out to “the over 75s.” Service planning talks of “high-risk groups.” And such treatment of individual older people as a homogeneous group was palpably evident during the recent submissions to the UK Covid Inquiry where it because abundantly clear just how little focus was given to the individual as opposed to the ‘group.’ All such approaches mean that the nuance of identity, of history, of individual choice and decision, and of personal journey is flattened out.

There is a slow erosion of personal autonomy when we reduce people to policy targets. Even when we are aware of these risks and we talk of co-design and co-production, too often decisions are made far from the rooms where older people live their lives. We must do better. Not simply because it is good practice, but because it is just.

Autonomy is not just about choice. It is about voice. It is about having your story held in respect, not just your needs measured in minutes and tasks. When we take a human rights-based approach to care, we are not only ensuring that people are safe or well-fed or medically supported – though all of these are vital. We are affirming something deeper: that people have the right to shape the telling of their lives, to be authors still, even when age or illness might seek to steal the script.

When we fail to do so it is no wonder that people feel unseen.

Ethical software development in care must shift away from systems designed for people and toward systems designed with people. This is what Personal Data Store developers and others are exploring: the digital infrastructure that places the person not the provider – at the centre. Systems and approaches that understand that my data is mine, not the State’s. the social care provider or the software business.

But we must go further.

We must ask, not least as new Ai-driven software systems are being developed, whose knowledge counts in system design? Are older people being consulted, or simply processed? Does our software reflect the principles of dignity, autonomy, and rights?

Too often, digital care solutions are designed around efficiency, interoperability, and cost-saving- rarely around emotion, memory, or personhood. We need ethical innovation that is rooted in relationship, not just functionality. And that may mean that a thorough rights-based analysis and evaluation of what we are already using in care delivery, and what we may want to use in the future requires, some designers to go back to the drawing board and some packages to be made obsolete because they do not sufficiently protect the rights and ownership of the citizen.

The challenge ahead of us in social care is not merely technical. It is ethical, cultural, and narrative.

We must reclaim the importance of the personal story and individual autonomy- not as a nice-to-have – but as the starting point for every decision, every plan, every policy. We must hand back the pen so that people can write their own futures, not have them dictated by systems.

This is not sentimentality. It is justice.

It is time to design care – from analogue to digital, from bedside to browser- based on the belief that every person holds a story that deserves to be told on their terms. That includes building digital platforms that do not mine, manipulate, or monetise human lives, but honour, protect, and empower them.

Because the future of care is not just data driven. It is human-shaped. And it begins by asking:

“What’s your story?”

Then giving people, the time, space, and tools to answer.

And for those who say the systems are too far down the road to change tack, that people are comfortable with their data being accessed by others – then we need to be very cognisant of the fact that there is a sharp generational change happening around public attitudes to data in society, as well as in social care. If we want to prepare for that changed ethical perspective, then we need to start now.

Specifically, a growing volume of research projects and reports are showing us that younger adults, being more digitally immersed, are seeking personalisation, and actively asserting their data rights and thus appear more likely to adopt tools like personal data packs. So, the social care recipient of the near future will increasingly want systems and models over which they have greater control, agency and the ability to write their own story and decide who sees it.

In the end technology will always be a tool. It is our values- the values of respect, autonomy, and dignity- that will continue to matter the most. The future of care is not just digital or data-driven. It is human. And it starts with giving back the pen to the real authors.

I leave you with a poem from the American 20^th century poet Maxwell Bodenheim which casts the inner world of the aging self as a place of memory and continuity, not decay. The “painted square” symbolises identity – the space where one’s thoughts, relationships, and stories live. It speaks deeply to the value of preserving and honouring personal narrative, especially as one grows older. It affirms that autonomy and identity endure, vividly and vulnerably, in the spaces where others might see only age.

Old Age

In me is a little painted square

Bordered by old shops.

I walk in these narrow places,

And hear the creaking of flesh that is still alive.

And outside, people pass,

Strong men with firm strides,

Women whose hair smells of scented leaves,

Children who forget to laugh too loudly.

 

Inside my square I am comfortable.

The old men sit smoking before the shops,

Their faces like neglected icons,

And they nod to me as I pass.

They are my thoughts, my reminiscences,

And each evening I return to them

With food from the present.

We talk of things long gone,

Of people who changed with the seasons,

Of women whose lips we kissed in forgotten cities.

 

Some evening I shall not return.

But the square will remain,

The old men still smoking,

Waiting for my cart of thoughts.

And someone else, in some other square,

Will pass and see them,

And wonder.

 

Old Age by Maxwell Bodenheim – Poems | Academy of American Poets

 

Donald Macaskill

 

Photo by jesse orrico on Unsplash

I’ve always been fascinated by reading and by books – yet they need not necessarily be one and the same. For at a very early age of life the idea of libraries intrigued me so much so that before I even went to school I had taken over part of the hall cupboard in my family tenement and together with my twin brother we had started to arrange and catalogue a few books in the house – we had created the Macaskill Library – less interested in what the books contained but more interested in them as physical objects of story and attraction.

As I got older, I began to develop an interest in the words inside the books, and part of that was confirmed when along with my classmates I was taken along the road to become one of the first members of the junior section of the newly opened Hillhead Library on Byers Road in Glasgow. I had never been in a building quite like it – modern, designed and technological and yet at the same time an oasis for somebody who wanted to learn and to gain knowledge.

Over the years my initial fascination with libraries has deepened and I’ve had the pleasure of visiting some of the most amazing libraries in the world, from the Vatican to the New York Public Library on 5^th Avenue, to the Bodleian in Oxford and of course the beautiful National Library of Scotland in Edinburgh.

I find myself thinking about libraries and their meaning today because it is Book Lovers Day. And as I reflect I cannot but think of one of the libraries which has left a significant mark upon me and that is the Public Library in Kirkwall, Orkney where I spent many a day over 30 years ago exploring the shelves, sitting quietly reading and chatting to some of the regulars.

One of the folks I met there was called John who was well into his eighties when I met him and yet virtually every day he came to the library. It was in truth partly because of the social aspect of seeing familiar faces and friends; it also meant that he managed to get a bit of warmth in the day, but it was more than that and when I got to know him a little bit I asked him why he came every day. Immediately his response was because “I want to read something new every day until I cannot read anymore. I used to think that reading was for the bairns, but I now know that reading is for all ages.”

What a truth there is in that statement and yet I cannot but reflect on the fact that the ability ot exercise such an aspiration these days is affected by the closure of so many public spaces for reading – our libraries – which sadly are amongst the first public services to be reduced or cut in times of austerity – there are a fewer and fewer places for all people, of all ages to simply sit and read and to enjoy the experience.

Libraries in Scotland have long been engines of community, learning, and social mobility. Yet as I said above, we are losing them at a terrible rate with recent reports showing closures – 42 since 2014 – and cuts to staffing and funding across rural and urban areas, raising alarm among authors and older age advocates.

This is I think is more than disappointing because in many senses we’ve lost an understanding of just how significant reading is for individual and community health and well-being.

I don’t think it was by accident that Scots were famous for the requirement that every child should be able to read and write and that reading had been central to our cultural and national character. Parish schools, universities and public lending libraries like one of Scotland’s first- the Kirkwall Library, established in 1683 – ensured that books became a public resource for growth and learning.

This tradition continues: cultural engagement research in Scotland shows that people aged 75+ are more likely to read than younger groups – underlining that reading remains a valued practice well into older age.

Insights from Scotland’s contemporary wellbeing research emphasise reading’s role in mental and emotional health. A Scottish Book Trust/University of Edinburgh project found that reading fiction in older adulthood evokes hope, nostalgia, humour and identity – helping build meaning and emotional connection. Reading for pleasure also promotes empathy, resilience, and psychological health across the lifespan.

Intergenerational schemes like Scotland Reads unite school pupils and older adult volunteers in reading and story‑sharing. These projects strengthen confidence, literacy, empathy and social networks in both generations – with older volunteers especially reporting increased self‑esteem, new friendships, and purpose through engagement.

Reading is not merely a pastime – in later life it becomes a profound lifeline. Our response to the challenges of ageing and cognitive decline are rightly sophisticated and technological these days but also have to acknowledge and recognise that the simple art of reading has huge benefits to individuals of any age.

Indeed a 14-year Taiwanese study found that older adults who read weekly had about half the risk of cognitive decline compared to infrequent readers – across all education levels. Reading strengthens memory and a US study has shown that engaged leisure reading can improve older adults’ memory skills, laying a foundation for longer-term mental resilience.

The truth of John’s statement to me in Kirkwall is that we keep ourselves healthy by remaining curious and by stretching our imaginations and few things enable us to do that better than by reading books – and as one study in the Times showed a couple of months ago – that while general curiosity declines with age, specific curiosity – such as learning through reading – actually increases after midlife, with benefits for brain health and well-being. You really can teach an old dog new tricks!

We have of course to recognise that there are very genuine barriers which prevent older people from keeping reading alive in their lives or even starting to read for the first time. One of those is the loss of public spaces for people to come together and what that means for the loss of social learning and exchange, but there are also practical issues which older readers face – but none of them cannot be addressed or dealt with.

Age-related eye changes – macular degeneration, contrast sensitivity and fatigue – make fine print and small font difficult so why are we printing less Large-Print books? While digital devices could help, many older adults feel anxious or lack confidence in using them; insufficient support leaves them preferring print – even if e-books might help access. We could improve lighting and produce more audiobooks and age sensitive podcasts which could all help overcome visual barriers and fatigue, making reading more accessible.

Even more critical and often ignored is the real prospect of developing geragogic learning and digital training. Older‑adult focused design education (geragogy) invites learners to set their own curriculum, with practical relevance and peer learning. Tailored support from digital educators helps older folks overcome technophobia with patience and practice.

On this August 9 – Book Lovers Day – let us affirm that reading in older age is far from a fading echo of youth. It’s a living presence: sparking curiosity, protecting memory, anchoring community, and offering lifespans richer in heart and mind.

Let us consider care facilities developing partnerships with public authorities or charities or businesses to have a small mini library open not to residents alone but to the wider community, including children and young people, not least in remote and rural parts of the country.

The challenges are real – vision, lack of location with the loss of libraries, technology, logistics – but the rewards, when older people are supported, are profound.

Reading isn’t a luxury – it is a potent companion for those years when wisdom and imagination can still flourish. As the poet W. B.Yeats, said in “When You Are Old”:

When you are old and grey and full of sleep,
And nodding by the fire, take down this book,
And slowly read, and dream of the soft look
Your eyes had once, and of their shadows deep;

How many loved your moments of glad grace,
And loved your beauty with love false or true,
But one man loved the pilgrim soul in you,
And loved the sorrows of your changing face;

And bending down beside the glowing bars,
Murmur, a little sadly, how Love fled
And paced upon the mountains overhead
And hid his face amid a crowd of stars.

So let us to take down the book in the later years – to read slowly, to remember, to dream – and in doing so, to live again the fullness of a life shaped by love and letters.

Donald Macaskill

Not for the first time and I suspect not the last – I found myself standing in an airport bookshop a few weeks ago – looking at the array of books to entice the traveller to summer reading. I was struck as I always have been by just how many books there are out there on leadership and management – indeed it is a theme I have spoken and written about a fair deal in the past. This year, however, one word seemed to be commonplace both on the covers and inside some of these books and that is ‘courage’ or ‘courageous’. Everywhere I looked there seemed to be work on courageous leadership. It started me off on a spell of reflection and consideration as to what if anything such concepts might mean for or speak to social care in Scotland at this time.

One online definition from Google – much changed by Ai this past week- told me that:

‘Courageous leadership is a concept in leadership thought that emphasises the moral and ethical bravery required to lead with integrity, especially in the face of risk, uncertainty, or opposition. The main aspects include, moral courage, authenticity, resilience, an empowerment of others and long-term vision over short-term gain:’

Not much to disagree with there and indeed concepts of courage in leadership are age old even if books on the theme only started to appear with volume in the 1990s onwards.

But what does the recent resurgence of the idea of ‘courageous leadership’ have to say to social care and Scotland today?

We are certainly living in days of fragility and uncertainty. Every other day I get an email from someone either working in or providing services which raises concerns about the state of the sector and a sense of despair that no-one seems to be doing anything about it, except talking.

Indeed this past week I got an email from colleagues at Alzheimer Scotland which highlighted that their own ‘Stop the Cuts’ online campaign and petition had reached 10,000 signatories – a campaign which I would commend to you and which is seeking to draw attention to the withdrawal of critical support and care from thousands of individuals across the country – all of it happening out of sight and out of mind – as a result of savage cuts to budgets.

And yet in these days of intense uncertainty, when so much feels fragile, it is easy to lose ourselves in the immediacy of crisis and miss the deeper task that lies before us. That task, in Scotland today, is I believe first and foremost to ensure that older people are not only cared for, but valued, cherished, and enabled to flourish. Achieving this will demand not just competence, not just vision, but courageous leadership – in our politics, in our social care, and in the communities where older people live their lives.

Brené Brown, in one of the better recent books on courage in leadership, Dare to Lead, reminds us that:

“The courage to be vulnerable is not about winning or losing, it’s about the courage to show up when you can’t predict or control the outcome.”

That, I would argue, is precisely the challenge facing leaders in Scotland today. We cannot predict the future of social care funding, of demographic change, of the pressures on health and wellbeing. But we can – and must – show up with honesty, humility, and bravery. The problem all too often is a denial of truth, a willingness to take the easy route and arrogance of false assurance.

Too often, our discourse around older people drifts into deficit: cost, dependency, burden. This is not only morally wrong, but also socially and economically short‑sighted.

Courageous leadership, then, is the willingness to confront the uncomfortable truths: that our current systems are not adequate; that too many older Scots live with loneliness, poverty, or untreated ill‑health; and that tinkering at the edges will not suffice.

How you move from the inadequacy of the here and now to a future orientation is what matters and simply more of the same will not do the job. Something political leadership needs to be hearing as we move towards an election next year. Because courageous leadership in social care requires political bravery rather than tramline party conformity. It means telling hard truths about taxation and public spending. It means resisting the seduction of short-term fixes in favour of long-term transformation. Olaf Groth, writing in The Great Remobilization, warns that leaders in our time cannot simply manage disruption – they must anticipate and re design for it. Scotland’s ageing population is not a looming crisis to be feared, but a predictable reality to be planned for with creativity, compassion, and courage.

Another writer I have come across, Kirstin Ferguson, in her recent work Head & Heart: The Art of Modern Leadership, calls on leaders to bring both rational clarity and deep empathy to their roles. This balance is essential in social care. We must be analytical about budgets, workforce planning, and integration with health services – but we must also be profoundly human, listening to older people’s voices, respecting their dignity, and recognising their aspirations.

I often say that leadership in social care is not about heroic acts, but about everyday bravery. The carer who chooses to stay an extra 15 minutes with someone who is lonely. The manager who challenges unfairness even when it risks unpopularity. The politician who argues for investment in prevention, knowing the electoral rewards may be minimal. These are acts of what Brown calls “whole‑hearted leadership.”

But let us be clear: the stakes could not be higher. If we lack courage, we will condemn too many older Scots to lives of diminished wellbeing. If we embrace it, we have the chance to create a Scotland where older people not only live longer, but live better – where health, dignity, and purpose are not privileges, but rights.

We cannot avoid the realities of ageing. We cannot skirt around the inadequacies of current provision. We must go through – with vision, with honesty, with courage. And in doing so, we may yet build a Scotland where ageing is not feared but celebrated, and where courageous leadership makes older people’s wellbeing a cornerstone of our shared future.

 

As the great contemporary Nigerian born poet Niyi Osundare writes in ‘The Leader and the Led.’:

 

The Lion stakes his claim

To the leadership of the pack

 

But the Antelopes remember

The ferocious pounce of his paws

 

The hyena says the crown is made for him

But the Impalas shudder at his lethal appetite

 

The Giraffe craves a place in the front

But his eyes are too far from the ground

 

When the Zebra says it’s his right to lead

The pack points to the duplicity of his stripes

 

The Elephant trudges into the power tussle

But its colleagues dread his trampling feet

 

The warthog is too ugly

The rhino too riotous

 

And the pack thrashes around

Like a snake without a head

 

“Our need calls for a hybrid of habits,”

Proclaims the Forest Sage,

 

“A little bit of a Lion

A little bit of a Lamb

 

Tough like a tiger, compassionate like a doe

Transparent like a river, mysterious like a lake

 

A leader who knows how to follow

Followers mindful of their right to lead”

 

© Niyi Osundare 2

THE LEADER AND THE LED (Niyi Osundare)

 

Donald Macaskill

Scotland is experiencing significant demographic change. By 2045, one in four Scots will be over the age of 65. This shift demands a fundamental rethink of how we plan, deliver, and finance public services. Many bodies not least the Scottish Fiscal Commission alongside the Accounts Commission have argued that such change is urgent and immediate.

Yet despite their increasing numbers and contributions, older people are often marginalised in fiscal policy debates. Or at worst are the object of casual stereotype and victimisation.

National and local government budgets are drafted and analysed with limited attention to how public spending affects the diverse lives of older people – especially those experiencing poverty, disability, rural isolation, or multiple disadvantages. Or if they are considered it’s solely through a health or social care lens and priority.

While organisations such as Age Scotland and Age UK campaign for the rights of older people, there is currently no independent group in Scotland, or the wider UK tasked specifically with analysing the impact of public budgets on older people in the way the Women’s Budget Group (WBG) does for gender.

In this slightly extended thought piece, I am presenting one argument, namely that the establishment of an Older Persons Budget Group (OPBG) would fill a glaring gap – providing independent, evidence-based analysis and promoting age-inclusive policy development across all levels of government.

A Scotland (and UK) where public budgets and spending decisions reflect the rights, needs, and contributions of older people – ensuring equity, dignity, and inclusion for all in later life should surely be the aim of any or all political and civic leadership.

I started this thought from the premise that Scotland’s governments were not spending enough on our older citizens given their demographic weight. But in truth that’s not as simple argument to make as it might appear.

On the one hand the Scottish Government and local authorities commit significant sums to older Scots. Amongst other areas of spend we have Free Personal Care for older adults alone which costs around £900 million per annum. Local authority adult social work and care budgets rose from £4.3 billion in 2023-24, and £1.7 billion was specifically allocated for social care and integration in the 2023-24 budget. This integration involves 31 health and social care partnerships managing almost £9 billion of health and social care resources, according to Health and Social Care Scotland. Recent announcements on Winter Fuel payments to pensioners account for £100–300 million, targeted at over one million older Scots.

These figures sit within a total Scottish Budget of roughly £59.7 billion for 2024-25. On the face of it, then, older people represent large recipients.

But it’s not quite as simple or perhaps as positive. Currently, adults aged 50+ make up about 40% of Scotland’s population, with those 65+ being around 22%. If spending mirrors population share, older age groups would attract 22–40% of budget allocations. But the reality is more complex. Free personal care and concessionary travel skew toward older cohorts. Health and social care combined outstrip many other areas.

However, other demographic groups also benefit: children’s services, education, rural subsidies, universal benefits. On a strict per capita basis, older people receive robust support – but not overwhelmingly so.

So are older Scots being discriminated against in terms of fiscal spend?

Discrimination implies unfair under-provision, the absence of appropriate support, or a lack of inclusion. On pure expenditure, older Scots are not neglected. Yet any regular reader of my blogs will know how frequently I bemoan the reality that age-based barriers persist in healthcare treatment, social inclusion, and service access. That many older people – especially older women – face loneliness, digital exclusion, and precarious housing. That even at policy levels such as the Equality and Fairer Scotland Budget Statements which promise assessment of impacts on protected characteristics – often age and in particular older age are rarely singled out

Thus, while older people benefit from universal schemes, equality of outcome and lived experience may still fall short.

The House of Commons reported that the Public Sector Equality Duty often fails older people, and protections are weak. Ageism in services is still widespread: and it stated that in the NHS older patients report lack of dignity, de-prioritisation, and negative stereotyping.

This isn’t overt financial discrimination but a systemic, subtle form of injustice, rooted not in budgets per se, but in how budgets are shaped and lived.

Spending on older Scots is not negligible – it is significant, even generous. But generosity without insight risks injustice. Older people are not a homogenous mass of pensions and care. They are individuals-  diverse, local, living incomplete lives.

Similar arguments have been in the past made about women and these led to the formation of Women’s Budget Groups across the UK.

The Scottish Women’s Budget Group (SWBG), echoing the UK-wide WBG, has long scrutinised the gendered effects of budget decisions, embedding gender-responsive and care-led analysis into fiscal debate.

Their approach has both been to undertake impact-focused scrutiny: asking how spending/policy affects different genders. They have presented a robust evidence base which has sought to link budget lines with outcomes not least on care, justice and equality. And they have done all those with consistent advocacy both in parliamentary terms and in the media.

I would contend that an Older Persons Budget Group (OPBG) could usefully apply this model.

There could be many benefits such as a re-elevation of social care, health, social isolation, housing – all key ‘aged’ lenses for budgeting. Just as the WBG surfaces gender gaps, an OPBG could uncover how budget lines – like transport, digital access, social care – tangibly affect different older-age cohorts.

It would help to ensure that age becomes an explicit equality consideration in impact assessments. And importantly it would promote targeted support for older subgroups such as unpaid carers, the very old and the digitally excluded.

It would also act to accelerate inclusion into existing duties. Scotland’s advancing Public Sector Equality Duty (PSED) would benefit from formal mechanisms to assess how policies affect older populations – much in the way WBG urged for gender.

An Older Persons Budget Group (OPBG), inspired by the Women’s Budget Group (WBG), could be a transformative body in Scotland – or across the UK – providing independent, evidence-based fiscal analysis to assess how public spending decisions affect older people. Here’s how such a group might operate, structure itself, and create impact, drawing from proven models and the specific needs of ageing populations.

The practical formation and focus of an OPBG would be important.

I would suggest it needs to be an independent, and non-partisan organisation perhaps hosted by a civil society or academic institution (e.g. linked to universities, Age Scotland, or a foundation). With open membership representing the breadth of age and interests from older age advocates, gerontologists, care providers, industrial and employment interests, the creative sector etc, the OPBG would require a mix of funding sources to ensure independence and sustainability.

I’m imagining a scenario I come across all too frequently for such an OPBG.

Let’s say the Scottish Government proposes a £2bn increase in health spending but flattens social care funding. An OPBG could show that older people will benefit little from hospital-focused funding if care-at-home support declines and becomes unsustainable. It could highlight rural inequalities – where older people might be cut off from services due to reduced transport spending. It could publish a budget equity audit, noting that older women carers are disproportionately affected. And in turn it could advocate for reallocation: e.g. £100m redirected to community care and tech access for isolated pensioners.

The measure of a mature democracy is not in how loudly it applauds the aged, but in how honestly it budgets for their dignity. If we can gender our budgets, why can’t we age them too? An OPBG would not simply count pennies; it would count people – in their wisdom, their contribution, and their human worth.

So, let’s start the desire for a more equitable budgetary process which considers age as essential. And in words I have often quoted let us remember Joe Biden when he said: “Don’t tell me what you value, show me your budget, and I’ll tell you what you value.”

Donald Macaskill

Photo by Jakub Żerdzicki on Unsplash

Yesterday (July 18) was World Listening Day, which was established on the birthday of Raymond Murray Schafer, a Canadian composer and environmentalist who is seen as the founder of acoustic ecology. Born in 1933, he developed his World Soundscape Project, which laid the fundamental ideas and practices of acoustic ecology in the 1970s.

World Listening Day was established in 2010. To be honest I had not heard of the day or the World Listening Project but it started me off reflecting upon just how critical listening is in all human exchanges and relationships, but especially the case in older person care and support, when both the way in which we listen often changes with age and that the criticality of listening and memory plays such a part in ageing.

I have always been intrigued by listening, both the physical act and the power of the experience. There is a silence that sits between the words we speak. A pause. A breath. A moment of being present. But what has always fascinated me over the years and what I have found myself thinking a lot about is not noise or speech, but about the spaces in between – the almost sacred moments when we truly listen.

Listening is an act we too often underestimate in social care. It is not passive. It is not simply the absence of speaking. Listening is an ethical stance. It is a political declaration. It is a human right. In the cacophony of policy papers and targets, of assessments and checklists, listening often becomes the first casualty of our busyness. Yet it is only by listening that we come close to understanding another.

In social care, listening is the glue that binds us. It is the art of presence. A care worker crouched by a bedside, hearing more in the tremble of a breath than in a thousand words. A manager who pauses long enough to really hear the fear in a family member’s voice. A system that slows down just enough to hear the hopes and hurts of those it serves.

To listen is to love. To listen is to dignify. To listen is to recognise the voice behind the silence, the soul behind the sound.

But listening changes over time, certainly the way I have listened has.

As we grow older, our ways of listening shift. Not just physically, as hearing fades, but emotionally and spiritually. Age does not only soften the body; it often sharpens the spirit. The older we become, the more we learn to hear what is not being said.

In my experience of being with many older people I notice that listening becomes less an action of the ears and that other senses are used much more. Listening happens with the eyes. With touch. With memory. Listening becomes textured with the colours of past pain and joy. It becomes an act of remembrance, of legacy, of presence. But all too often, older voices are filtered out, dismissed, or reduced to whispers in the policy halls.

If a day like World Listening Day means anything it should help us to focus better on the central priority of listening in social care, and also to help us confront the systemic deafness to older age. We must, I think, re-tune our ears to voices shaped by decades of living, by grief and by grace. And that is all the more the case when we consider the role of listening for those living with dementia.

Because when dementia enters the room, listening takes on new hues. The linearity of conversation may dissolve. Time may warp. Words may wander. But the need to be heard remains as fierce and vital as ever.

Listening to someone living with dementia demands that we listen not with our ears, but with our whole selves. We listen through gestures, through repeated phrases, through the cadence of a familiar song or the shape of a gaze. We listen knowing that meaning is not always in the sentence, but in the connection. We listen for the emotion beneath the word. We listen not to fix, but to witness.

If social care is to be truly human, it must become a listening culture. One that places time before task. One that honours silence as much as speech. One that accepts that the people we support are not problems to be solved, but stories to be heard.

We need systems that make space for listening – not just in individual interactions, but structurally. Listening must be embedded in inspections, in commissioning, in care planning, in leadership. For if we do not listen, we do not know. And if we do not know, we cannot care.

But let us be honest in recognising that that aspiration seems a very far distance from the realities of the moment, where we are shamefully increasing the contracting of 15-minute visits which strip people of dignity and compassion and certainly give no space for listening which is surely the most essential component of preventative care and relationship formation.

The whole of the social care system, not just those at the frontline, needs to learn to listen better and to commit to a deeper listening.

In the words of the poet:

‘To Listen”

after the quiet of care

 

I have sat beside the hush of pain

where words refused to come,

and heard in silence

what speech could never carry.

 

To listen

is not to wait your turn,

but to offer your breath

as shelter.

 

It is the soft art

of placing ego

at the foot of another’s need.

Not to fix,

but to witness.

Not to solve,

but to stay.

 

I have listened with my eyes

when memory was a maze,

when time no longer followed rules,

when a name could not be found –

yet love, somehow, was still recognisable

in the reach of a hand.

 

I have listened through repetition,

through the rhythms of dementia –

where truth is not in sequence,

but in sincerity.

And each telling

is its own kind of courage.

 

To listen

is to lay down power.

To hold the weight of another’s moment

without trying to reshape it.

 

It is a kind of prayer –

not always spoken,

but always heard

if we choose to be present.

 

So today,

before we speak,

let us listen –

with our ears,

our eyes,

our time,

our hearts.

 

For in the act of listening

we offer the most human gift of all –

recognition.

 

Donald Macaskill

In Scotland, where summer is let’s be honest somewhat fleeting – a brief burst of light and warmth between long winters and now seemingly over by May – the summer season here as elsewhere can sharpen grief for people. While shorter days are often linked to loneliness, the pressure to “make the most” of Scotland’s precious sunny months can make bereavement feel even more isolating.

Being honest I have probably never thought of summer as a hard season for those who are bereaved until I was stopped in my tracks the other day by someone who said to me that they hate summer – not because of the weather – but because the long days and nights makes their loneliness more intense. And there was me thinking that the cold winter days were the hardest season for grief.

But then I began to think of my own childhood holidays and upbringing. No sooner had the school bell beckoned the end of the term – and sometimes even before – I was packed off with a few clothes onwards to Skye and long days on beach and croft.

For many older Scots, summer once meant Highland holidays, Doon the Water adventures, garden gatherings, or coastal walks with family and loved ones. Now, the same light highlights an absence for many. Norman MacCaig captures this well in ‘Memorial’:

“Everywhere she dies. Everywhere I go she dies.

No sunrise, no city square, no lurking beautiful mountain

but has her death in it.”

Published in 1991 the poem laments the loss of his sister Frances and described how his loss is ever present, in season and out. It is constant.

Summer is often portrayed as a season of joy – long days, family gatherings, and the warmth of the sun. But for many older people, especially those who are bereaved, summer can amplify loneliness rather than ease it. While winter is frequently associated with isolation and depression, the expectation of happiness in summer can make grief feel even more isolating.

Grief does not fade with the seasons. Grief does not melt in the sun. It lingers. For older adults, summer’s sensory richness – the scent of cut grass, the sound of children playing, the warmth of the sun – can trigger vivid memories of loved ones no longer present.

A 2023 report by the Mental Health Foundation Scotland found that 28% of over-75s felt lonelier in summer, citing “seeing others socialise” as a trigger. Age Scotland’s 2022 survey revealed that 42% of bereaved older adults avoided summer events (e.g., community galas) due to grief reminders. And in my own memory corners research from the University of the Highlands and Islands highlighted that older bereaved adults in rural areas face compounded loneliness in summer, as tourism and visitor traffic contrast with their static sorrow.

Further still research from the University of Stirling found that seasonal changes can trigger memories, making anniversaries of loss more acute in summer. The contrast between external vibrancy and internal sorrow can lead to what psychologists’ call “disenfranchised grief” – sorrow that feels unwelcome or unacknowledged in a world that expects happiness.

It seems inescapable then that summer is hard and I suspect our targeting of issues such as loneliness lacks seasonal considerations. Indeed, organisations offering grief support such as Cruse Scotland report higher demand for counselling in June-August.

One of the challenges of bereavement in older age is that it often goes unseen. A 2020 study by the University of Manchester found that older people are significantly less likely to seek formal bereavement support, despite reporting high levels of prolonged grief and emotional distress.

In care homes or supported housing, expressions of grief may be muffled by a desire not to burden others, or silenced by the myth that older people are somehow “used to death.” Nothing could be further from the truth. Every loss is unique. Every goodbye leaves its own scar.

And in summer, the world’s brightness only sharpens the shadow of absence.

Added to this much of our cultural language around grief is shaped by stages and steps like with neat boxes of denial, anger, acceptance. But grief, particularly in older age, is cyclical, tidal. It comes in waves that make nonsense of calendars.

A warm June day might bring unbearable heartache for someone whose partner died last summer. A July sunrise may spark memories that lead to tears over breakfast. As researchers like Stroebe and Schut argue in their dual process model, healthy grieving involves oscillating between loss-oriented and restoration-oriented experiences.

In other words, older people grieve and live at the same time. They water the garden and weep for who are not there to see it bloom.

So how can we, as communities, care providers, neighbours, respond?

First, by acknowledging. By refusing the polite silence that often follows death, particularly in older age. We need to create cultures in our care settings – and in wider society – where grief is not only allowed but welcomed, named, shared.

Second, by creating opportunities for ritual and remembrance. Summer is a perfect season for memory walks, remembrance gardens, shared poetry readings, and intergenerational storytelling. We need not wait for anniversaries or official memorials to honour those who are gone.

As the poet Mary Oliver wrote in When Death Comes:

“When it’s over, I want to say: all my life

I was a bride married to amazement.”

Older people carry with them lives of amazement, love, and loss. We owe it to them to witness the whole of it, especially in seasons that hide sorrow in sunshine.

In our policy and practice, we talk about trauma-informed care. Let us also be grief-informed, attuned not just to clinical depression but to the slow ache of bereavement. Let us train staff not only in medications but in listening; not only in safeguarding but in soul-holding.

And let us never forget that love, when lost, does not disappear. It becomes memory, it becomes pain, it becomes the quiet pause in a summer afternoon when an older person turns toward a seat that used to be filled.

Grief does not fade because the sky is blue.

But neither does it mean the absence of joy forever. For even those in sorrow, there can be glimpses of laughter, tastes of delight, moments of music.

And sometimes, that is enough.

The Skye poet Eilidh Watt (nee Macaskill) brought up in the village next to where I spent so many summer holidays, once wrote:

“You were the tide in June, full and fierce,

And now I walk the shore alone,

Seaweed in hand, memory on skin,

And no echo of your voice in the gull’s cry.”

Donald Macaskill

Photo by Elly M on Unsplash

If these themes interest you – you might want to join the Scottish National Bereavement Charter Group at a free event in Glasgow on the Future of Bereavement on 28^th August 20025 – more details here https://scottishcare.org/the-future-of-bereavement-support-in-scotland-28-august/

The following is based on a talk which opened the inaugural Scottish Care, Care Tech Assembly held in Glasgow on 19^th June 2025.

I want to share a few personal thoughts about technology within social care and to do so under a human rights umbrella. And I want to do so from the perspective of someone who has been fascinated by tech and its potential to enhance human connection and humanity for an awful long time.

And I suppose I am also making a bit of an assumption as I start these reflections that I am among people who believe that technology, when rightly held, can serve humanity rather than diminish it.

The Past: listening to the echoes

Let me take you back to a room in a care home in Glasgow’s west end, many years ago. I remember as a student sitting with Mary, a former schoolteacher, now living with dementia. She was holding a photo of her late husband. It was tattered at the corners from love and remembering.

There was no iPad. No voice assistant. No tech-enabled reminiscence therapy. Just two humans, sharing a moment.

Technology hadn’t yet found its way into her world – but care had. Deep, relational, person-led care.

That care home was just along the road from the school I went to and the school she had once taught in. We were on the edge of the University campus – the same University where years earlier I had walked with my classmates one afternoon to visit the Computing Dept. I’ve spoken before about that experience – about how our class was invited along one afternoon to see what was, at that time, reputed to be one of the world’s fastest computers.

It was a whirring series of metal cupboards which literally filled a room with a standard screen and keyboard to operate them. This was well before the era of the ‘mouse’, so all instructions were laboriously typed in by complicated code.

What struck me then was the sense of sheer wonder with which the technicians and scientists viewed their work and its creation. It filled me with both a lifelong fascination for, and indeed a fear of, the power and potential of technology to change the world I inhabit for good and ill.

One of the men working on the computer at the time mentioned that when we had reached his age – an elderly 40! – the computer we saw that day would be the size of a cigarette packet. We laughed then. Nearly 50 years later after my flirtations with a BBC computer, an Amstrad, and an enduring love affair from the earliest Apples, loads of floppy discs and CD-ROMs, I am no longer laughing. The truth of a processor 1000s of times faster and more powerful than the machine that filled that Glasgow room is in the laptop I carry every day and the smartphone whose presence is, reluctantly, my essential life tool.

But sitting with Mary just along from that room and maybe not much more than a decade later we were to a large extent in a technology free zone.

And I suppose if you had asked me then in the past, I would not have even contemplated that tech could be so contributive to and could potentially enhance care. It wouldn’t have been in my worldview.

Then over time myself and others would have expressed fears that technology let loose would replace that care – that somehow, warmth and connection would be coded out of our lives.

I reflected that in my own writing in 2017-18 when I wrote Tech Rights where I explored the interplay of human rights and the potential of machine learning, Ai and the internet of things and suggested that there was as much promise as well as danger in the future.

So, what of the present?

The Present: dancing with change

Today, we stand in a time of rapid digital transformation. In Scotland, digital social care records are becoming the norm, not the exception. We’ve seen technology bridge gaps, not widen them – when done well.

Care homes have used iPads to reunite families over FaceTime. Sensors now help monitor health in the background, offering dignity and safety without intrusion. People living in their own homes are using smart tech to remain independent for longer.

But the truth is, this progress wasn’t born from a boardroom or a policy paper. It was born from pragmatic intent and a ground-up desire to do things differently – and yes let’s be honest also to do things with an economy of time and cost. The current and I suspect the future design of tech will be responsive and reactive to circumstance and to need more than planned intent and policy.

And when the history of tech in care is written the influence of the pandemic will be clear and transparent.

Our present was born from a pandemic – from necessity, from desperation, and yes sometimes even from love.

We had to learn quickly that technology must never be the master of care. It must be the servant of humanity- and especially of the most valuable.

What does the future hold?

It holds possibility. But only if we choose it wisely and in some places that future is already happening…we are already witnessing circumstance where an older person’s voice activates not just a light, but a lifeline of connection and assurance. We are and can create a future where digital tools aren’t cold, but compassionate. Where artificial intelligence doesn’t make decisions for people, but with people. A future where every innovation asks not “What can this do?” but “Whom does this serve?”

But it is how we build that future, design that tomorrow, which is all important and which an event like today contributes so much to.

Many of you will know of the work of the Oxford Institute for Ethics in Ai and the Digital Care Lab and how after over a year of creative collaboration and co-production, a framework for the responsible, ethical and rights based use of Ai in social care has been developed. That work is progressing, growing and becoming even more influential and I would commend it to you.

But the art will be, the essential requirement will be, how do we turn such frameworks and models into the automatic and instinctive actions of a system and of stakeholders who in straitened economic times and faced with the demands of immediacy might be tempted to take short cuts, go for the cheapest or easiest option, both of which usually risk the rights, autonomy, control and agency of the citizen?

The Oxford work and others have shown that the critical way in which you embed an ethical and human rights-based approach has to be through the democratising of design and the granting of control and agency to citizens. Too often I fear we pay lip service to this fundamental principle – the sense of individual citizen control over data – even a discussion I had this week on the principle of revocability – showed just how hard it is for systems which get too big, too distant from the user, from the citizen whose story is the data, to be open to approaches where citizens can re-write, change, edit and remove their data.

The excuse often given for the radical individualising of control around Ai, tech in general as well as in care and support, is that it is too difficult to get to the individual level – that’s an excuse I heard so often during the blanket decision making of the pandemic – and it is today tosh and nonsense.

A colleague recently told me about the work of Pol.is and the more I have looked at it the greater its potential for democratising decision and consent seems to me. Some of you might know of the Pol.is work which has been going on and developing in Taiwan.

Pol.is is a digital tool used in Taiwan to facilitate large-scale public deliberation. It was notably employed by the Taiwanese government as part of the vTaiwan and Join platforms to gather public input on complex policy issues.

‘How it works:

• Citizens respond to open-ended questions and vote on other people’s comments.
• Pol.is uses machine learning and data visualisation to group participants based on shared opinions, highlighting areas of consensus and disagreement.
• Unlike traditional polling, it avoids polarization by encouraging constructive dialogue and surfacing common ground.’

It is a tool which already has helped to bring democracy and decision making to very small and local community levels – its adaptation and use in settings such as residential care, community groups has, I think, huge potential, not least in its approach to inclusivity and achieving consensus and agreement.

Just imagine how such an adapted tool to enable individual participation and decision making could be used in a social care context around data control, management and use?

When I wrote my extended thought piece on TechRights I was very clear that the future developments of Ai, machine learning, the Internet of Things and robotics could and should only be enabled through a robust and ethical human rights framework – everything I have seen in the intervening 8 years convinces me even more of the validity of that assessment.

Human rights have to be the baseline not just bolted on; we need person led tech not just person-centred design.

And we continually need to re-design how we implement rights in technical practice. I think it is the task of all of us, no matter where we are in the pathway of design and development, in use and implementation in care environments, to consider our human rights and how they impinge in the use of tech and digital.

Here is my latest musing: a Human Rights Framework based on the acronym H.U.M.A.N.I.T.Y.

H.U.M.A.N.I.T.Y. Framework

H – Human Dignity

• AI must enhance, not replace, relational care.
• Systems should respect inherent human worth, prioritising the individual over efficiency.
• Insist on the truth that care is a human act, not a mechanical function.

U – Understanding

• AI must be developed with contextual awareness of care realities.
• Systems should reflect the lived experience of people receiving and giving care.
• Understand the cultural, emotional, and social nuance, which are vital to ethical care.

M – Moral Responsibility

• Those designing and deploying AI must act with ethical integrity.
• Care providers have a duty to ensure AI is used in ways that align with care ethics and human rights.
• There needs to be a stress on values-led leadership and responsibility in the care sector.

A – Autonomy

• Individuals have the right to make informed choices about how AI affects their care.
• AI systems should promote control and consent, not paternalism.
• Autonomy is essential for citizenship and empowerment in care.

N – Non-Discrimination

• AI must be designed and tested to eliminate bias and promote equity.
• It should support inclusivity, particularly for those often excluded: older adults, disabled people, ethnic minorities.
• There should be a built in commitment to social justice and fairness.

I – Integrity

• Use of AI must be transparent, honest, and accountable.
• Integrity means being able to explain and justify AI decisions, especially when they affect people’s lives.
• Create a sense of moral coherence in digital and care governance.

T – Trust

• Build trust through co-design, openness, and clear communication.
• Trust is sustained through relationships, not just systems.
• Trust is the glue of good care and support – and it must be protected in tech use.

Y – You-Centred

• AI in care and support must be person-led, not system-led.
• It must serve the individual’s rights, values, and story – not just operational efficiency.
• Care and support are affirmed as a deeply personal, relational, and human experience.

Last year, I visited another care home. There, a woman named Ishbel had started using a voice assistant. She said, “I call her Alexa, but I treat her like she’s my lassie. I tell her goodnight, and sometimes, she tells me the weather. But mostly, she makes me feel I’m still part of the world.”

That’s the heart of it.

We’re not building devices. We’re building belonging.

So, as we look ahead, let us walk forward not with fear of what we might lose, but with hope for what we can gain.

Let us shape a future where digital doesn’t dim the light of care, but reflects it—brilliantly, boldly, and beautifully.

Let us- together- hold hands with tomorrow.

 

Donald Macaskill

 

Photo by Robs on Unsplash

The last few weeks and indeed the month of June has seen a hive of activity in the world of policy and politics around health and social care. From the passing of the Care Reform Bill to the publication of the Health and Social Care Service Renewal Framework alongside the Population Health Framework there has been no shortage of meaty content for the policy and political anoraks to feast upon. Sometimes these actions can seem very distant from the delivery of care and support and even more so from the recipients of social care and health services. Just occasionally the words are worth taking note.

In what follows I want to reflect on some of the major events and key publications. Admittedly this is an initial reflection because I think it will take some time for the full range of ideas and plans to come to their fullest fruition.

The aspirations of the Health and Social Care Service Renewal Framework (2025–2035) are to be admired. Its aims are to take a fresh, strategic leap toward a future where Scotland’s health and social care are integrated, prevention-led, and digitally enabled. Few of us would find fault with this – grounded as they are on the almost forgotten work of the Christie Commission. They are anchored by five principles – Prevention, People, Community, Population, and Digital. Again, few would object to such a focussed analysis and the aspiration and tone which desires a decade of transformation.

Meanwhile, the Population Health Framework commits to closing health inequalities, shifting resources to upstream social determinants, and embedding place-based prevention. Together, these documents sketch a bold vision: health and care built not just for people, but around them.

I read both reports against the backdrop of the discussions I and others have been having which were contained in an Open Letter published in The Scotsman. This letter co-signed by leading clinicians and practitioners across health and social care in Scotland, and informed by Enlighten, argues that our system is “unsustainable, overly complicated, difficult to navigate” and goes on to demand long-term, collaborative reform.

I am therefore pleased that taken with the two published reports there seems to be an emerging ground for consensus and indeed collaboration.

The shared and consensual path forward seems to be growing, it is one which envisages:

• Shifting services upstream, reducing reliance on acute care, and investing in community-based surroundings – all hallmarks of smart, modern reform.
• Principled planning -moving from siloed service design to networked, population-focused approaches.
• Digital-first ambition – a necessary catalyst for efficiency, access, and personalisation.
• Cross-sector unity, echoed in the Open letter’s plea for independent, third sector and community partners to be full co-designers of reform.

There is real potential therefore in the work that has been and is being done, but it would be disingenuous of me to not also comment about what strikes me as being missing so far, not sufficiently emphasised and what steps, I believe, could make progress upon the shared aspirations more likely to succeed.

Bold though it is, the Framework underplays the significant contributive role which social care can deliver for Scotland and most importantly from my context for the health and wellbeing of all, not least older Scots. At times both documents are written too narrowly from an NHS centric lens – maybe inevitable given their origins, but I think they can also be improved by using a more communitarian and social care lens.

Take for instance Scotland’s world-leading and seminal legislation and basis of accessing social care, the Self-Directed Support (Scotland) Act (2013, amended 2025) and the new Care Reform (Scotland) Bill (passed June 10, 2025). Both I would suggest offer powerful mechanisms to enhance the Service Renewal Framework and the Population Health Framework – especially for improving care for older Scots in care homes and at home. Allow me to illustrate some examples:

Self‑Directed Support Act (SDS)

Choice and control are central and key principles of the way in which social care is delivered in Scotland. We have not always got it right and have not always adequately empowered those who use supports – but be that as it may – that these two principles are central is of very real importance and should not be brushed over or set aside. There was a long struggle to shape the SDS legislation and to base it on principles of greater personal autonomy, control, and empowerment. SDS enshrines the rights of people who receive care to shape how, when, and by whom it’s delivered – vital for older Scots wanting autonomy in diverse settings. The absence of its centrality in the new reports is more than disappointing.

One of the major goals of the new Framework is to re-align service provision – SDS if properly embedded (and not in the resource deprived and patchwork way of the moment) can genuinely shift services upstream by centring individual needs, supporting the Prevention, People, and Community principles of the Framework. The recently renewed statutory guidance for SDS can be used to extend SDS into care homes, enabling residents to even more than they do now to better direct elements of their own daily lives – activities, meals, visits – empowering both dignity and quality. Others and I have long argued that to limit the ability of older people in residential care to have full control through SDS is a limitation of their rights.

Then when we consider the Care Reform (Scotland) Bill again there are numerous and very real opportunities to bolster the reform goals.  This is most obviously the case in the new rights to respite for unpaid carers. Indeed, one of the glaring omissions of the Strategic Reform Framework is the virtual absence of recognition of the critical role unpaid carers pay in the whole health and social care economy. The new law mandates Councils to assess carers and provide funded breaks which aligns with the emphasis within the Framework upon prevention (by reducing burnout) and People (supporting caregiver health). It directly serves older Scots living at home.

The new Bill also furthers the aims of the new Frameworks in its emphasis on the continuity of care which secures stable care packages even if individuals move across local authorities -reducing disruption and supporting independence and long-term care planning, which is again in line with Population Framework aims.

But it is perhaps in the wider area of reform that there is an emphasis which can potentially help to properly achieve the aims of both the Frameworks. There is a real opportunity over the next few weeks and months for the whole system to build on the Bill’s emphasis on ethical commissioning, to embed Fair Work standards, sectoral bargaining, and clear progression ladders – all key to staffing stability across both home and residential care. And most obviously the significant digital and data achievements and innovations of aged care in both homecare and residential care have much to teach the wider acute, secondary and primary care communities.

The SDS Act and Care Reform Bill aren’t just legal formalities- they are levers to deliver the visionary ambitions of the Frameworks. When applied strategically, especially in care homes and homecare, they can drive real change, embed prevention, increase autonomy and frame stability and sustainability.

The Frameworks show we’re on track. The open letter tells us we have to be bolder, faster – and more inclusive. But without a social care turnaround and emphasis, I fear, this ambition remains incomplete. That will inevitably mean that we need political courage across the Parliament in making fiscal decisions that truly see the balance of care and support, move from the acute and secondary NHS hospital sector to community health and social care. We have talked about this for a long time and now we must see action rather than aspiration. How that is done and whether additional funding comes from re-alignment of other priorities is clearly a political decision, but the necessity of action should be inescapable. We cannot continue to see social care solely through an NHS lens, care and support in community offers true preventative advances and it is that we need to focus on rather than a singular obsessive focus on delayed discharge. Social care is more than that.

It is surely our mutual collaborative responsibility to now start to transform strategy into practice and go beyond grand vision to tangible improvement in the daily lives of older Scots. I am certain the independent and third social care sector is up for that task.

Donald Macaskill

Photo by Alex Skobe on Unsplash

 

Today (21^st June) is World Music Day – a time when across the globe, communities gather to celebrate the universal language of melody, rhythm, and song. When radio stations take advantage of the day to entice us to listen more and when a plethora of local events celebrate the day.

I have been an avid listener to so much music since my earliest childhood days when like so many of us the music our parents listened to shape our eardrums and taste. For me it was a mixture of Gaelic song filtered by Jim Reeves, Elvis, the Beatles and Johnny Cash. Then with the maturity of age the eclectic mix of Crowded House, Abba, Runrig and my source of all inspiration to this day Bruce Springsteen and the E Street Band. Our music shapes, moulds, inspires and conditions us.

So, as I reflect of World Music Day, I do indeed think of all the gigs and events I have been lucky enough to attend but I also think of the less grand and quieter, more intimate spaces where music has exerted its power over me, from my family front room to student flats and outside buskers.

But over the last few years in particular I have grown to appreciate the tremendous power of music in places and spaces which are even more hidden and quieter than the usual performance venues we might be familiar with, in our care homes, in hospital wards, in the living rooms of those living with frailty, dementia, and decline. It is here, often behind closed doors, that the true miracle of music quietly unfolds.

For older people, music is not merely entertainment. It is connection. It is comfort. It is continuity of self. It is therapy. In these spaces, music is a vessel that carries the individual across the sometimes-frightening gaps carved by time, illness and memory loss.

As a young parent I was acutely aware of the work of music psychologists in terms of early brain formation, and you only have to look at the music catalogues to see the downloads from Bach for Babies to Mozart for Toddlers. It has taken us a bit longer to validate the significant role that music plays for older people care and support.

Modern research has increasingly begun to validate what many carers and families have long intuited: music accesses parts of the brain often untouched by disease. The pioneering work of neuroscientists such as Oliver Sacks, and more recently the international consortiums studying music and dementia, show us that the neural pathways involved in music processing – particularly rhythm and melody –  are uniquely resilient, often remaining intact even as cognitive faculties decline.

In functional MRI studies, regions such as the medial prefrontal cortex –  areas tied to autobiographical memory and emotional regulation –  show sustained activity when individuals listen to personally meaningful music, even in advanced stages of dementia. In one striking study published over a decade ago in 2015, researchers observed that musical memory can remain accessible even when other forms of memory are lost, offering individuals a bridge to their sense of self.

Music appears to activate broad networks of the brain simultaneously: motor areas, language centres, limbic regions responsible for emotion, and –  perhaps most importantly – the default mode network linked to self-awareness. It is no wonder that, in so many cases, individuals who struggle to recognise loved ones can nevertheless sing along, note-perfect, to the songs of their youth.

I have to confess that in not a few places I have argued that it is important that we recognise the sheer value in people being entertained and in taking enjoyment from sound and music. I also believe it is critical that we also recognise the profound benefits which can be gained by people at any age in life participating in and creating music. Life should not just be about passive receipt of the creativity of others but a participation in self-expression and creative musicality. But be that as it is , I sometimes feel we lose sight of the sheer therapeutic value of music and musicality, and do so at our cost.

Beyond the astonishing resilience of musical memory, a growing body of research has documented the tangible benefits of music-based interventions for older people.

Randomised controlled trials have consistently shown that music therapy can reduce symptoms of anxiety and depression in older adults, particularly those living in long-term care settings. The act of listening to, or creating, music stimulates dopamine release, contributing to improved mood and wellbeing.

In dementia care, personalised music playlists have been shown to reduce agitation, restlessness, and the use of antipsychotic medications –  a profoundly important finding in light of concerns over overmedication in care.

Even more so whilst music cannot reverse cognitive decline, engaging with music – whether through singing, drumming, or listening – provides meaningful cognitive stimulation, maintaining attention, language, and even aspects of executive function.

And perhaps most importantly, music offers a shared space for relationship, for communication beyond words. It creates opportunities for care staff, families, and care home residents to connect on a deeply human level.

Of course, not all music is created equal. The most effective musical interventions are not generic playlists of “golden oldies”, but carefully curated selections rooted in the personal histories and preferences of each individual. The song that stirred a heart in 1955 may not be the same as the one cherished in 1975. That is why the amazing work of Playlist for Life deserves every bit of focus and support.

In this sense, music care becomes an act of human rights-based care – one which honours the individuality, autonomy, and lived history of the person. We must resist the temptation to treat older people as a homogeneous category and instead engage in the work of listening to their life stories, through and alongside their musical tastes. I have no doubt a lot of my story is tied into by walking alongside Springsteen whilst others would run a mile from that journey !

If we are serious about reimagining care and support in Scotland and across the UK, then music should not be seen as an “add-on” or a luxury, but as an essential part of care practice. It has been easier to argue that point and case for residential care, it has been well-nigh impossible to convince commissioners and financiers of the value and merit in prescribing music and its therapeutic use in care at home. Yet, if the benefits of music not least as a preventative tool for decline and deterioration – are true of residential care then that truth sings even louder in someone’s own home. It is not fanciful or naïve to argue that we should have music as a core part of relational, time-flexible, person-led homecare. This is  surely the heart of social prescribing?

We need greater investment in training care staff to use music therapeutically; partnerships between care homes and professional musicians; research funding to deepen our scientific understanding; and national policy that recognises the centrality of the arts to wellbeing across the life course.

In the end, music reminds us that identity endures even as so much falls away. The rhythm of a waltz, the swell of a hymn, the first few bars of a favourite song – these can bring a spark of recognition, a light behind the eyes, a squeeze of the hand.

And that is why, on this World Music Day, I find myself filled not only with gratitude for the gift of music, but with a renewed sense of responsibility. To ensure that every older person, regardless of circumstance, has the right to their song. The right to be heard. The right to be remembered.

Because, in the words of the late neurologist Oliver Sacks:

“Music can lift us out of depression or move us to tears – it is a remedy, a tonic, an orange juice for the ear. But for many of my neurological patients, music is even more – it can provide access, even when no medication can, to movement, to speech, to life. For them, music is not a luxury, but a necessity.”

I will give the last word to The Boss, who speaks of the power of music in “No Surrender” (from the Born in the U.S.A. album, 1984):

“We learned more from a three-minute record, baby, than we ever learned in school.”

This line beautifully captures how deeply music can shape identity, inspire action, and teach us about life- often more powerfully than traditional education. It’s one of Springsteen’s most quoted reflections on the transformative force of rock and roll. And for those whose sounds are different – all music changes our worlds if we allow ourselves to hear.

 

Donald Macaskill

Photo by Marius Masalar on Unsplash