We carry a future: the potential of immigration for social care in Scotland.

On Tuesday past I met some of the UK Government ministers along with three Scottish Government ministers to explore the issues of immigration as they relate to the recruitment challenges facing the social care sector in Scotland. It was a useful sharing of perspectives though I fear it will not lead to the urgent outcomes desired by many of us in the social care sector in Scotland.

Whenever I mention the topic of immigration, I am acutely aware of the polarities and positions that folk seem to adopt with almost knee jerk automatic reaction. In this short blog I want to underline why I think we need to de-politicise the issue of immigration even if that be a hope beyond heeding.

Scotland has always been a country which needs and requires an international workforce, and this has often been the case in social care. There is a demographic truth that is undeniable which states on the one hand that we have an ageing workforce population and on the other that we have an ageing overall population. We know that that by 2039 there will be an 85% increase in those aged 75+.  Latest estimates show that:

‘by mid-2043, it is projected that 22.9% of the population will be of pensionable age, compared to 19.0% in mid-2018. As the proportion of Scotland’s pensionable age population grows, the proportions of both Scotland’s working age and child population are projected to fall.’

This is at the same time accompanied by a really positive reality which is that there are more of us living for longer and into what demographers call the ‘oldest old’ age categories. National Records Scotland projects that the number of people aged 90 and over in Scotland will double between 2019 and 2043 from 41,927 to 83,335.

As I said this is positive news especially if we can continue to work to address health inequalities so that more and more people are living healthier into older age. But at the same time all this good news has an impact on our working age population. It is this that makes a flexible and responsive immigration system even more urgent and necessary for Scotland as a whole but for social care in particular.

Put simply there are fewer people of working age in Scotland, and this is only going to increase especially with a relatively closed immigration system. Now whilst that has a direct impact on our fiscal ability as an economy and society it also has an impact on our ability to fill jobs from an indigenous population base. It gets even more challenging when we recognise that an ageing workforce is consistently less productive than a younger workforce. A recent report has stated that:

‘…although “long-term sick” as a reason for inactivity accounts for 6.6% of the inactive population of 16-24 year olds, this rises to 38.4% of inactive 50-64 year olds.’

Without rehearsing the arguments over Brexit and the reality that Scotland voted substantially to remain in the European Union, the impact of Brexit and in specific the introduction of new immigration procedures has had a profoundly damaging effect on social care in Scotland. There are several reasons for this.

One of the main reasons is that in the conversations I have had with employers and social care providers, especially in rural and remote areas, we know that many folks from Europe went back home when the pandemic hit to be with their families. This was wholly understandable as the virus swept across Europe. Many of those individuals are unable to return both because of the cost of and obstacles within the new immigration system. In some parts of the country up to half of those who had worked in the care home sector and who were from Europe have left.

Secondly the whole narrative around immigration not least around Brexit has been at times toxic and unwelcoming of the immigrant. Despite the efforts of some, not least the Stay in Scotland campaign, many folks have considered that they were not welcome and who would want to stay in a place where you are not valued?

Thirdly and perhaps most immediately we know that many of the amazing women and men who were at the frontline of our pandemic fight in social care have been exhausted by the effort and looking around at the relative lack of societal valuing of their work (and those of their colleagues in social care) have decided to move into other sectors such as hospitality and retail. Indeed, the inability of those two sectors to attract an international workforce has meant that there are many more opportunities in those areas of work for social care staff. As social care providers have always known the skills someone develops in social care – skills of integrity, empathy, communication, are very attractive indeed to other sectors who often pay more and reward better.

Lastly the introduction of the points-based system and visa requirements, together with the failure to recognise the distinctive needs of social care with a salary threshold which does not equate to the reality of reward in the sector, has meant that traditional routes for attracting international staff have largely been cut off to Scottish social care. This is in no small part because unlike in the rest of the United Kingdom most social care provision in Scotland is delivered by small and medium sized enterprises who do not have the scale, capacity or experience to manage the labyrinthine ways of the immigration process.

So, the above is the mechanics and the reality of a fractured immigration system which is resulting in real damage to our ability to care as a nation. Yes, we all recognise the importance of recruiting from within our own communities and we are seeking to do that and much more. Yes, we all recognise the criticality of improving pay and conditions, and we are on that journey but let us not forget that the vast majority of social care in Scotland (and in the UK) is paid for by the State so until the Treasury really opens the purse strings and recognises the social and economic contribution and criticality of social care we will always as nations be dancing on the edge of potential.

But against all this background it is not just numbers on a demographic spreadsheet that we have lost and are losing. We have lost people, real folks who have brought over the years, their skills and talents, their innovation and creativity, their humanity and adventure to our villages, streets and cities. They have been our neighbours and friends, they have sat alongside us, worked amongst us and have been one with us in all places and spaces.

A migrant and international workforce elevates our community to a new level. We are a better place and people because we have a door open to the world, a light of welcome to encourage strangers to find a place at our hearth.

People like me will doubtless keep working at opening that door to the world, because we know that for us to care for those who need it that we cannot do it alone with the demographic realities we are facing. I will keep arguing for the urgent necessity not of butchers and truck drivers getting visas, but for folks to get visas to come and work in nursing and social care, for folks to be prioritised and for social care to be added to the Shortage Occupation List. In all the focus on toys not being on the shelves at Christmas where has been the equal focus on people not being cared for? We need urgently a regionalised, flexible, responsive immigration system which meets the needs of all sectors and all parts of the country.

The sense of a broad, inclusive and confident community is at the heart of what I think permeates the rhythm of our way of being as a people in Scotland. Not emotional idealism wrapped around a flag but a hard reality rooted in open acceptance. The welcoming of divergence and difference are the marks of maturity – the comfortableness with otherness is the soul of community. The immigrant is not to be feared but to be nurtured.

This past week was the 100th anniversary of the birth of one of Scotland’s greatest poets, George Mackay Brown. I had the honour to meet GMB when I lived and worked in Orkney some 30 years ago and this last week I’ve been reflecting on and revisiting his poetry – hearing in the words and rhythm his distinctive voice of soul-filled space and Orcadian wisdom; a place which welcomed me as a stranger and has done for so many over the generations.

His insights on community infuse his poetry and describe well the hospitality and rootedness of a place not on the edge of civilisation but at the heart of nature. It was a place that taught me that what appears to be on an isolated edge can possess a creativity which centres itself in the heart of life. It taught me that community isn’t an idyllic calmness all the time, but a reality that has to be worked at alongside others prepared to roll their sleeves up to do the work. That’s why we are less without all those who want to come and work alongside us.

I leave you with one of my favourite GMB poems – a favourite because I lived overlooking Hoy for such a long time – Orkney with its iridescence and astonishing light draws you beyond a horizon of sight – it gives you a way of seeing the world unlike any other place I know. We need urgently in our addressing the workforce crisis in social care to have a way of seeing further than we have – to carry our future into our present.

Further than Hoy

Further than Hoy
the mermaids whisper
through ivory shells
a-babble with vowels

Further than history
the legends thicken
the buried broken
vases and columns

Further than fame
are fleas and visions,
the hermit’s cave
under the mountain

Further than song
the hushed awakening
of country children
the harp unstroked

Further than death
your feet will come
to the forest, black forest
where Love walks, alone.

Quoted at https://allpoetry.com/Song:–Further-than-Hoy

Donald Macaskill





Older age and the human right to food: an opportunity for Scotland.

Today is World Food Day which is an international day celebrated every year worldwide on 16 October to commemorate the date of the founding of the United Nations Food and Agriculture Organization in 1945. The day is celebrated widely by many other organisations concerned with hunger and food security, including the World Food Programme who received the Nobel Prize in Peace for 2020 for their efforts to ‘combat hunger, contribute to peace in conflict areas, and for playing a leading role in stopping the use of hunger in the form of a weapon for war and conflict.’

But what does World Food Day mean for Scotland? For me part of the answer to that wide question is the fact that we have also two days left of  UK Malnutrition Awareness Week.  Scotland has many great campaigning organisations dedicated to progressing issues of equality and justice in relation to food. None more so than Eat Well Age Well who this past week have been leading a social and wider media campaign to raise the profile of issues of malnutrition and food poverty as they affect older people in our society.

On Monday I read of the excellent new project being run by Scottish Borders Council, NHS Borders and Food Train’s Eat Well Age Well project, alongside care organisations and and housing bodies. It is designed to increase conversations about nutrition and weight loss in order to identify need amongst the area’s older population with the aim of securing earlier intervention for those aged 65 and over who live in their own homes and are at risk of becoming malnourished.

Eat Well Age Well argue that whilst 1 in 10 older people in Scotland today are at risk of, or living with malnutrition, they believe that this may be an underestimate, with between 20% and 30% of older people living in Scotland suffering or at risk of malnourishment. Those of us who work in social care will also be very aware – especially in the community – of the impact that the Covid-19 pandemic has had on increasing food-illness and malnutrition amongst the isolated and lonely old. I continually am being told stories from the frontline of older folks who are making hard decisions to limit their diet and food consumption in order to heat and fuel their homes.

Quoted in The National, Laura Cairns, Food Train’s Eat Well Age Well project manager, said:

“We have long said that malnutrition among older people is under-recognised and under-reported… Increased screening action and early identification of malnutrition in the Scottish Borders will help address that and create an example that we hope can be rolled out across Scotland.”

Great news for the Borders but sadly illustrative of the shocking increase in malnutrition amongst our older age population. The challenge is expressed plainly by UK Malnutrition Awareness Week who stated:

‘As the winter approaches, we must take action to raise awareness of preventable malnutrition. We also need to alert communities that many older people may find themselves more vulnerable than ever before.

Many older people have become less physically mobile, have experienced loss, bereavement sadness and loneliness. Many lack confidence, are reluctant to go out and have worries about their mental health and general well-being.

Health and social care services, voluntary sector and community food providers are stretched and struggling to keep up. There are already concerns over the difficulties that older people may experience in buying, preparing, cooking, and eating food. Many may not be getting the help to eat and drink when they need it.’

The World Food Day theme for this year, 2021, is “Safe food now for a healthy tomorrow”. Never were words more apposite as we in Scotland prepare for the arrival of thousands at the UN Climate Change Conference COP26 in Glasgow. The relationship between environmental sustainability and responsibility alongside ethical and safe food production should be intimate and inextricable.  The way we grow and produce our food, the food which we choose and the way we consume it affect our health and that of our planet.

For some time now a host of organisations under the excellent, able and creative leadership of Nourish Scotland have been in coalition, campaigning to improve our nation’s response to food.  Nourish Scotland have made five asks, including the creation of a Good Food Nation Bill, the incorporation of the human right to food directly into Scottish law, the establishment of an Independent Food Commission and the development of cross-cutting National and local Food Plans critical to embedding the right to food in a holistic, whole-system manner.

Just over a week ago the Scottish Government published its Draft Good Food Nation Bill. To say that I and others were disappointed is to put it mildly. This is a real missed opportunity, not just because the eyes of the environmental world are on our actions in the weeks ahead, but because there is the potential for a more robust and ambitious piece of legislation which could make real and meaningful difference to the citizens of Scotland not least those who are older and those today suffering from food poverty and malnutrition. What we have, I fear in this draft Bill, is a moving of the plates around the table, rather than bringing us a rights-based innovative new meal! I hope all concerned about issues of poverty and food, malnutrition and diet, social care and health, will take the opportunity to respond to the Bill and communicate their concerns and aspirations.

Food and the right to food is an inalienable human rights issue and so should be central to the development of a new Scottish Human Rights Act. It should not be peripheral to a new Good Food Nation Act in any form and there should be clear and explicit obligations upon both national and local governments, and upon organisations delivering public services, to ensure that the right to food is upheld. This means not simply giving a nod – a ‘regard’ to the right to food but to ensure that public bodies are required to ‘act in accordance’ to the human right to food.

In my own sector that not only means duties upon those who commission care and support for those in the community, but it also means an adequate allocation of resource and finance to enable real nutritional and health-beneficial sustainable and environmental food is allocated to those cared for and supported in care home and hospital alike. For too long many of us have felt that what we spend on the food and nutrition of those who are supported by the State is woefully inadequate especially for an older population. A human right to food would also serve to prevent folks failing to be properly nourished in their own homes, having to make cruel decisions between being warm and being hungry, and to ensure that as we age food is there in sufficient plentifulness to enable us to thrive and flourish until the end of our days rather than to wither in the body through hunger and thirst. The essence of a hospitable nation is the extent to which it afford fulness to those who sit around its table, whether neighbour or stranger, none should go hungry.

We have it within our ability and grasp to change the way we relate to food, for all ages not just the old, to call out the silence of hunger from the shadows into a light of shared commitment to both the planet and humanity which will banish hunger from fearful lives and communities. I leave you with the words of the English 20th Century poet Robert Laurence Binyon:


I come among the peoples like a shadow.

I sit down by each man’s side.

None sees me, but they look on one another,

And know that I am there.

My silence is like the silence of the tide

That buries the playground of children;

Like the deepening of frost in the slow night,

When birds are dead in the morning.

Armies trample, invade, destroy,

With guns roaring from earth and air.

I am more terrible than armies,

I am more feared than the cannon.

Kings and chancellors give commands;

I give no command to any;

But I am listened to more than kings

And more than passionate orators.

I unswear words, and undo deeds.

Naked things know me.

I am first and last to be felt of the living.

I am Hunger


Donald Macaskill



Valuing social care: mental wellbeing and status. A blog for Mental Health Day

Tomorrow is Mental Health Day which provides us all with an opportunity to reflect on issues of mental health and ill health.

On Monday last I read of the launch of a report by the Mental Health Foundation (MHF) on the stress of mental health impacting on our workforce. MHF has called for the establishment of a Future of Work Commission which it claimed could help ensure post-pandemic labour practices support mental wellbeing.

One of the few positives of the pandemic has been an increased awareness  and appreciation of issues of mental health within the workplace.  However, MHF argued that more needed to be done and their senior policy lead Toni Giugliano told the BBC that:

“Poverty, job insecurity and under-employment are among the root causes of poor mental health.”

A very long time ago I was involved in research on the extent to which one’s occupational role status impacted on your sense of mental well-being and the relationship between your role being under pressure and any  burnout or stress you experienced. In general terms the research showed that the extent to which you are valued by others in the work you do, the societal value of your role in the community, played a very significant part in whether you experienced burnout or stress. If you do a job which others respect, value and affirm then it was a huge contributor to feeling healthy and well about yourself. The positive benefit of a valued role was especially the case in situations where the job you did was under pressure and when things were tough or hard. The opposite was also the case – namely that is if your role was not valued by society or others then that heightened your sense of stress and mental health challenge.

Such an awareness together with the increased knowledge of mental well-being in the workplace has made me reflect on how we regard the role of the professional carer. During the pandemic were you to consider the value we placed on social care workers you at  best would have evidenced a fluctuating appreciation.

Way back in March and April 2020 along with many others I was appalled at the way in which frontline social care staff were turned away from the priority shopping queues at some of our large supermarkets – because they were not employed by the NHS but were ‘just a carer.’ Then things began to improve as the Thursday clapping on our doorsteps began to include care staff not least as the sad statistics of loss in our care homes gained more media attention. But then we went  into the summer and autumn and the clapping fell into silence.

Politicians then began to talk up the role of care and at least during the Scottish election there was an enhanced awareness of the need to reward and better remunerate frontline care staff.

But more recently things seem to have taken a backward step as we saw frontline homecare staff struggling to get priority treatment as they tried to get hold of petrol in order to drive their cars to do their job. Combine that with the unwillingness to ease immigration rules to allow care staff to be recruited and you get a very different perspective on how we do or do not value frontline care work and carers.

Why does all this matter? A huge amount if as we have stated above that there is a close correlation between the way society values the job you do and your own self-esteem and mental health. It is one thing to burst your gut, to put your health on the line day in and day out as our care staff have done for so long and way before COVID-19 if you feel others value you and hold you  in esteem – it is quite another thing if you are held with little regard, given minimum thought and respect and paid inadequately for the work you do. This is often seen in the perverse debate which considers the job of care as ‘low-skilled’ instead of the professional, multi-skilled role it is. Too many people think of a home carer as someone who does the shopping and cleaning for another forgetting that it also carries with it skilful moving and handling, medication management, personal care, end of life and palliative care, mental health support and so much more.

As we consider mental health awareness as a whole society and community I think we urgently need to re-evaluate how we view frontline care. Those who give of the best of their humanity to care for and support another human being, those whose task it is to enable others to achieve their best and fullest potential, should not be viewed with such dismissive disinterest and disdain as they often are. Frontline care is a mirror of our humaneness at its best; those who care – whether in paid care or not – are the best of us.

If we are to address the very real workforce challenges facing social care in Scotland at this time – then we would do well to start with giving proper respect and status to those who care. If we do, then the self-esteem and integrity of the carer will be advanced and we just might avoid the appalling burnout and work related mental distress we are witnessing in increasing amounts. That’s something worth striving for not only on Mental Health Awareness Day but every day.


Access gives control: digital empowerment for older people – a blog for the UN Older Persons Day

A few years ago, when I was attending a conference on technology one of the speakers made the comment that access to the internet and WIFI should be considered as just as important as the right to water, heat, and electricity. He argued that digital access should be viewed as a public utility. I was reminded of that observation today because this is the annual United Nations International Day of Older Persons. The 2021 theme is “Digital Equity for All Ages” and it focusses on the need for access and meaningful participation in the digital world by older persons.

I’ve written in this blog quite a few times about the role of technology and how critical it is for the current and future delivery of social care. However, at times I think the experiences of discrimination and exclusion which many older people come across in their day-to-day living is exactly what they encounter in the digital world. Despite some significant strides in the last few years, I still believe that age discrimination, exclusion and lack of priority is the reality when we consider the new ‘public utility’ of digital as far as older people are concerned.

There is absolutely no doubt that older people experience digital poverty and exclusion more than any other population group both in Scotland and internationally. The data speaks for itself.

Office of National Statistics data from 2018 show that the over 65s make up an increasingly high proportion of internet non-users. In a major study 79% of non-users in 2018 were 65 or over, with 55% over the age of 75. This compared to 25% and 36% respectively back in 2011. So effectively as the rest of society is becoming more connected and digitally empowered older people are becoming less so.  A similar survey by Lloyds Bank, the Consumer Index 2020 Report, showed that 77% of over 70s had very low engagement compared to just 7% who have high digital engagement.

We have talked about digital exclusion and poverty for some time. We know well some of the main characteristics which prevent individuals of all ages from having access to technology, chief amongst them being socioeconomic background, poverty and other discriminatory characteristics. Indeed, there is wide appreciation that there are some key factors which are involved in digital exclusion including access, both physical and financial; skills, confidence and motivation. Recently Inspiring Scotland published an excellent report reflecting on the Covid pandemic and articulating the importance of addressing digital exclusion. They stated:

‘Overall, it is clear that tackling digital exclusion is essential for individuals and communities to thrive and to ensure that everyone in society receives the opportunities needed to succeed in today’s modern world.’

The pandemic has shown just how much we have become dependent on digital access and skill regardless of our age. At our best we have used technology to connect and ensure that social and personal relationships have been maintained. There has been some really positive work, not least the Connecting Scotland programme. But on their own such innovations and initiatives are insufficient and without real strategic co-ordination the factors which act as barriers to older age participation and empowerment in relation to technology and digital will become embedded. The absence of older age in many of our national strategies and frameworks is particularly concerning, for instance the ‘Renewing Scotland’s Full Potential in the Digital World’ consultation report of late 2020 did not explicitly mention older age.

For me much of the debate around older people and digital access has to be seen through a human rights lens. Article 27 in the UN’s Universal Declaration of Human Rights states that “Everyone has the right freely to participate in the cultural life of the community, to enjoy the arts and to share in scientific advancement and its benefits.” Given that so much of modern culture is now online, given so much which enables an individual to access information about services and supports, about community and connection, are now almost exclusively online, then access to the internet for all citizens is a mark of civic obligation and responsibility and therefore becomes a human rights issue.

Technology and digital matter for many reasons but at their heart is an issue of empowerment of the individual’s personal autonomy and the enabling of their full citizenship and participation in community and society. If we continue to discriminate – and discrimination is not just active exclusion but is also a failure to positively prioritise one group or another in order to level the playing field – then we will continue to build the barriers that limit the ability of older persons to gain the freedom and fullness which digital inclusion potentially brings.

For an older person taking control of your life in 2021 Scotland requires a degree of digital literacy and confidence. That does not just happen – it needs to be resourced in the same way that access has to be resourced whether it is by supplying devices or ensuring that there is adequate connectivity in all places and for all people. Being in charge of your digital world promotes personal independence and reduces dependency – that in itself should encourage investment in technology for all ages.

I really do worry that we are treating older individuals as people to use technology on or for – especially in the social care context. The opposite should be the case. Giving access to information, enabling personal self-management whether it be of finance or health, is about enabling an individual to be as fully independent as they want to be and helps to reduce reliance upon others and unnecessary dependency. There are some tremendous resources out there which help older people become digitally confident such as those from Outside the Box.

But there is also a need to challenge technological and digital attitudes, behaviours and design which serve to disempower older individuals. Just this last week in the US Amazon announced a new subscription service called “Alexa Together,” designed for families with ageing family members who are still living independently, but who may need extra support. It builds on the existing product, Alexa Care Hub, by adding on new protections, like an urgent response feature and access to a professional emergency helpline. Starting early next year, Alexa Together will also make it possible for multiple people to provide support for a loved one — which is useful in situations where siblings may split the duties of caring for a parent, for example.

Now I would be the first to acknowledge that there is real potential in such apps and devices – for instance it can allow carers to set up reminders, give access to music etc, and allow hands free calls and communication.

However, I do yearn for a situation where as much design focus, resource and attention were given to enabling independence for older people as to potentially watching and safeguarding and sometimes passive inactivity. Where is the investment and ingenuity in enabling older persons to be more self-reliant and truly independent in this digital age? Where is the work on accessible, one touch devices etc. It is out there but only on the margins.

The UN Day is about Digital Equity for All Ages and that means putting older people at the heart of design, listening to their designer voice and choice, and being less protective and paternalistic and more empowering and enabling. Digital and technological innovation for older age must tackle stereotypes, prejudice and discrimination associated with digitalisation, taking into account the right to personal autonomy.

We have a long way to go to addressing digital exclusion and making inclusion more than just about having a digital babysitter.

Donald Macaskill

Speaking about care: the necessity of advocacy.

Social care has been much in the news in the last few months, and it will continue to be so – not always for the right reasons. For many people social care support is something they don’t often think about – that is until the services and supports are needed whether because of accident, degenerative illness, and disease or simply the realities of ageing.

In Scotland we have a very clear system for accessing social care support – at least theoretically – in practice it can be a bewildering world of confusion and lack of information. This is especially unhelpful because when people are at the point of choosing social care support provision they are often in a place of crisis and fatigue. The fact that things can go wrong, that information and choice is not always clear and that sometimes an individual or family just need someone to speak for them, are sadly all too common.

Over my professional life I have always been a supporter of the role of advocacy whether that be for those who use care supports to be able to self-advocate or for others to use professional advocacy at specific times of crisis and disagreement. For a period of time, I was part of the Board of an advocacy charity and got to know the life-changing work which a good advocate can undertake and the amazing difference that can result for someone when there is a person in their corner to speak for them and to fight their cause.

The definition of advocacy is the act of speaking on behalf of or in support of another person, place, or thing. An advocate is there not to speak for themselves but to represent another person. The word advocate has an obvious legal overtone and that is no accident because it comes from the Latin ‘advocare’ meaningto “add” a “voice.” The advocate adds their voice of support to a person. But the Latin word also carries with it the sense of ‘summoning’ – calling support to your side to make the change that is needed. Advocacy is not just talking – it is also about action; it is not just a vocal contribution but an active engagement that makes the change happen which someone wants and needs in their life, not least to protect their human rights, individuality and dignity.

There are many organisations which provide advocacy services across Scotland and you can find out more detail and support from groups like the Scottish Independent Advocacy Association.

In Scottish law there are also certain instances where an individual has a legal right to access advocacy services not least as part of the provisions of the Mental health (Care and Treatment) Act. It should be stated that the MHCT Act declares that people who are covered by the right to advocacy are those who have a mental health issue including those with a learning disability, autism or dementia. There are other specific instances, for instance for children and young people, and the new Scottish Social Security Act, where there is a right to advocacy in law.

My problem is that the right to advocacy simply is not being evidenced in practice and that as it stands the right to advocacy does not go far enough especially for those who access social care supports.

We are still celebrating World Alzheimer’s Month and many of those living their lives with dementia are individuals who would benefit from the automatic right to advocacy. The vast majority are unaware that they may in technical terms have such a right. They would benefit from being able to challenge practice which limits their choice and control, their abilities to live independently for as long as they can, and to challenge the financial choices and options they are often presented with.

Scotland has brilliant social care provision on paper but the reality falls far short of the dignified, rights-based, person-respecting social care supports we would want to see in place. If you are lucky enough to have someone in your corner fighting your case then you are doing well. But if you are not – and sadly we are still in a situation because of lack of fiscal priority and blatant discrimination where people have to ‘fight’ for their social care rights in the first place – if you are voiceless, have no family or close supports – who does the talking for you? You need and deserve an advocate.

The creation of the envisaged National Care Service gives us the opportunity to sharpen up and tidy our existing social care legislation, not least of which is the Social Care (Self-directed Support) Act. We should use this time as an opportunity to create equality of advocacy for every woman, man and child who find themselves needing to use social care support regardless of mental capacity or physical condition. We should create an automatic right to independent advocacy for anyone who needs it in Scotland’s social care system. Not everyone by any means would use or need such protection, but for those who might and do it would be a significant step forward in enshrining the human right to social care support as part of our national human rights framework in Scotland.

A society should be defined by the extent to which it protects the voiceless and those with no ability to assert, protect and advance their own human rights and those of others. For some that defence comes in the advocacy, passion, and voice of another.

A few years ago when I was more involved in the world of advocacy I came across a fantastic book of poems, ‘Absent Without Leave, Invisible When Here.’ by Jo McFarlane which was developed to support the work of Dumfries and Galloway Advocacy, and for me one of the poems captures the essence and passion of advocacy.

Advocacy NOW!

In the future

when it’s fashionable to listen

Everyone will have a voice –

the disadvantaged, disillusioned

All will have a voice


Not just to say what’s wrong

or could be better,

but to celebrate what’s good right now


In the future

people won’t be threatened by dissent.

We’ll welcome opposition to the status quo


In the future

when all voices speak as one,

we’ll challenge the hegemony.

We’ll seek the truth that speaks its name

regardless of authority or strength in numbers


In the future

we’ll drown out the volume,

separate the essence from the noise


In the present

we’ll keep fighting for a future

in which ALL shall have a voice




Donald Macaskill.

Knowledge leading to action: the urgency of dementia. A blog for World Alzheimer’s Day

September for some time now has been World Alzheimer’s Month and, on this Tuesday, 21st it will be World Alzheimer’s Day. This year, across the world individuals and organisations will be asked to reflect on the theme ‘Know dementia, know Alzheimer’s.’

It is an opportunity to consider the power and nature of knowledge. As part of this organisations and individuals are being encouraged to find out more, to get to ‘know’ more about the signs and symptoms of dementia so people can get the right diagnosis and support as quickly as possible.

Knowledge and dementia are an interesting association. Knowledge is both personal and emotional, intellectual and factual. It is also something which can inspire, create passion, and foster change.

As I sat down to write this blog, I could not help but think as I have for some years now at this time about my own mother who died from dementia some years ago. Before she was diagnosed, I thought I knew about dementia. In some senses I did, and I suspect I thought I probably knew more than others. As a young student on placement, I met many older patients in what was then termed a ‘psycho-geriatric’ ward including a man who had undertaken a career of neurological research but had himself developed dementia. So, I knew a lot about the technical aspects of the disease as I worked in different places and occupied different roles. But in reality my knowledge was a partial shadow of the truth.

Then my mum was diagnosed, and the lessons of love offered a different, hard, and painful knowledge. It was the knowledge of tear and fear shared by my family as we witnessed mum and granny decline inexorably in front of us. Having worked until her early 80s her decline seemed so rapid and yet so inexorably slow. This was a woman whose solution to all of life’s traumas and ills was the making of a cup of tea, a ‘strupak’. Then came that moment when she had forgotten the steps of her healing ritual and stood frightened in an empty moment without remembrance. She had forgotten how to make a cup of tea. The stripping of inner knowledge is one of the obscenities of this disease. Knowing changed, love remained, but relationships pained and fractured. There was a new world of knowledge, one which was not about the past or action, but one which was about discovering with faltering step and searching fingertips the landscape of a new world.

Knowledge and dementia are indeed strange sisters.

But there is another dimension to knowledge. There is not just the knowledge of fact and intellect, and even that of emotion and heart. There is also a knowledge that changes you and puts you on a new and different path, a knowledge where you cannot no longer be the person you were before it’s awareness, can no longer accept old familiar ways.

Knowing what I do about this disease both in my head and heart I cannot accept the casual discussions and debates, the easy political presumptions, media stereotyping and societal ageism that I have heard and witnessed for so long and which have been so manifest in the last few weeks.

The future of social care is centre stage in both Scotland and the other nations of these islands. The lazy debate which has been held has wholly failed to appreciate the nature of social care and the reality that it is more than a series of services and supports but a whole eco-system that enables people to fully live their lives as citizens regardless of condition, age or infirmity.

But perhaps where that public and political debate has fallen most short has been in its exploration of dementia.

The knowledge that needs to be shouted from every street this World Alzheimer’s Day is that dementia is a health condition first and foremost. So why? why? why? are we allowing its treatment to be seen solely through the prism of a social care solution? Paradoxically maybe those of us who have over the years resisted the pathologising of dementia and what happened when I was young which meant people were to be hospitalised, perhaps our emphasis on the need to see dementia as more than just a neurological disease, perhaps we bear some culpability. But the pendulum has swung far too far to the extent that dementia is in the eyes of many seen as a disease which can ‘solely’ be supported by social care interventions and supports. This is naive ignorance. It is a denial of the clinical reality that dementia is a disease first and foremost and one that requires significant clinical and health service intervention alongside social care support and re-enablement.

Where this simplistic dualism is seen most acutely is in how society resources and finances dementia care – or to be more accurate does not finance it.

It is wholly iniquitous that if diagnosed with dementia one has to sell one’s home to receive residential nursing home support. Now credit where it is due, the Scottish Government have committed to extending free personal and nursing care to better reflect the true cost of care and have recognised the gap between the true cost and the reality of underfunded rates in our care homes – though we await the realisation of the commitment. But that does not go far enough. How is it in any sense fair that someone who is in the advanced stages of dementia is not given the option of 24/7 nursing and social care in their own home? Why if someone chooses to or needs to live in congregated living like a care home is it assumed that their accommodation costs would be the same as at home? Come on this is the crude arithmetic of discrimination.

Henry Simmons the CEO of Alzheimer Scotland in a newspaper article this past week rightly argued the policy on enhancing free personal and nursing care still left people with advanced dementia facing huge costs because of the high level of health interventions and care that they need.  I was fully supportive of Alzheimer Scotland ‘Fair Dementia Care’ campaign when it was launched and remain so. As Simmons said to The Herald.

“In Scotland, we’re looking at five years to see the development of the new National Care Service, and three years for the rest of the UK before the full amount of new funding will find its way to social care.

“Notwithstanding the fact that people with dementia do not have time to wait for these improvements, there is also one fundamental and massive inequality that neither of these proposals go far enough to resolving – or even mentioning – and that is the fact that people with advanced dementia… are still going to have to pay substantial amounts for their care costs.

“Take a person living with advanced dementia. Their illness – a direct result of an untreatable brain disease – has progressed to the point where they may require assistance to walk, bathe, toilet and communicate.

“For this person, these are unequivocally health care needs.

“Why do we still feel that it is acceptable that we ask this person to pay for their care?

“We are talking about people who have worked their whole life, contributed through tax and National Insurance to help build the quality of life than many of us seek to enjoy.

“Why is dementia so different to other terminal conditions? It’s unequal, it’s unfair, and it needs to stop.”


People who have lived with dementia and those they love have known for years about the grotesque inequality of the funding of care and support, of clinical intervention and health support for the condition. It is a knowledge that should shame those who make political decisions and exercise fiscal oversight.

Knowledge must always lead to action, or it withers the heart. Knowledge of the inequity of support and care for those living with dementia should challenge us all to create a system which treats all with equality regardless of condition, age or illness. I yearn for the maturity and the dignity of such a day to come. I suspect – sorry mum – that such a day will not be brought about by cups of tea alone but my calling out the inequality at the heart of dementia care for what it truly is – an abuse of the human rights and dignity of tens of thousands of our fellow Scots.

Donald Macaskill

Every Story’s Ending: a vision for a human right of palliative care.

I’ve mentioned before in this blog that the openings of books and stories always seem to remain with me. Whether it’s a simple ‘Once upon a time’, or ‘The clock struck thirteen’, ‘It was the best of times and worst of times’ or the more recent ‘Mr. and Mrs. Dursley of number four, Privet Drive, were proud to say that they were perfectly normal, thank you very much.’ – the opening of a book can stay with you long after you have put the book down- but of course that very much depends on how good the book is in the first place.

What I struggle with is in all honesty remembering any final lines. There is of course, ‘They all lived happily ever after’ but despite attempts to talk up the endings most are forgotten – unless the ending is a poor one – that we do remember.

This past week I was pleased to attend the launch of ‘Every Story’s Ending’ which is in my view probably the singular most important work on palliative and end of life care to come out of Scotland in many years. The report comes from the Scottish Partnership for Palliative Care and is the output of hundreds of conversations, insights and reflections on the essence of palliative care and why it is so important for a society. It has about it the spirit of those conversations in its narrative, honesty and depth. It is a fairly long report but please read it because it will return the effort twelve-fold. The report has loads of practical recommendations which are rooted in sense and experience.

We put so much energy into planning birth and entry into life but so little in thinking or planning around our death and departure. But the way we end our story is as critically important as what comes before not only for ourselves but for those we leave behind.

In considering the report for me inevitably what it says about social care is especially important. That section starts with a wonderful quote from Annie Gunner Logan which describes well the distinctiveness of social care and why it has to be considered as central and intrinsic to all attempts to foster and improve wellbeing and health.

“What we [social care] do is get alongside people when they have very significant challenges in their lives and struggle to participate in society as full citizens, and we support them, wherever possible, to make their own decisions and move their life forward as best they can. Where the world makes it very difficult for people to do that because of their age, impairment or whatever, we do what we can to help by ensuring that they are comfortable, are cared for and can have at least some kind of independence and peace of mind in their individual circumstances.”

Annie Gunner Logan Director of the Coalition of Care and Support Providers in Scotland (Health and Support Committee Inquiry into Social Care)

That is a description which shows the potential of social care to enable the individual and wider community to achieve the fulness of life and purpose that they want and desire. Sadly, in the debates I have seen and heard in the media this past week as England and the UK Parliament has considered social care funding there has been a palpable lack of real understanding of what social care is and its potential. It has been very much about the NHS and looking at social care through an NHS clinical and acute sector lens. This has sadly missed the whole point. The debate has been about cost and deficit, need and limitation rather than potential, autonomy, control, and choice. Good social care allows an individual to achieve to their fullest potential and perhaps that is especially the case where social care supports the flourishing of the person at end of life and through effective palliative care and support.

The report highlights many of the challenges facing social care if it is to enable people who want to die at home or in a homely setting to achieve their wishes without unnecessary and unscheduled admission to hospital in the last months and year of life including the need to reform commissioning, increase financial investment and better train and support the workforce. The recommendations are self-evidentially implementable.

But this past week has also seen other work not least a commitment in the Programme for Government to the creation of a new Palliative and End of Life Care Strategy and also further work in the development of a new Human Rights Act for Scotland.

We are with all these changes and initiatives at a point of real potential and opportunity. For those of us who have worked in palliative and end of life care for many years there has been a desire to create systems and models, supports and structures, relationships and freedoms, which enable people to end their life in a way which upholds their choice and dignity, supports them and their families and friends, and ensures that we become the best nation in which to end one’s life such is the quality of palliative and end of life care support.

I have written elsewhere about how this can all be encapsulated if we have the dream and ambition within our social care and human rights legislation to declare clearly that citizens in Scotland should have a ‘human right to palliative and end of life and bereavement support.’ Scotland has the legislative, policy and practical opportunity to become the first nation to enshrine such a right within our society and community. It is an opportunity which should not be lost.

Death and dying is part of everyone’s story but the way we support and care for that ending is something which is unwritten. We face the challenge to make sure that everybody’s ending tells the story of a society that enshrines the rights of choice, dignity, respect and humanity. And if it does that will be a final sentence worthy of remembrance.

The End 

Not every man knows what he shall sing at the end,

Watching the pier as the ship sails away, or what it will seem like

When he’s held by the sea’s roar, motionless, there at the end,

Or what he shall hope for once it is clear that he’ll never go back.


When the time has passed to prune the rose or caress the cat,

When the sunset torching the lawn and the full moon icing it down

No longer appear, not every man knows what he’ll discover instead.

When the weight of the past leans against nothing, and the sky


Is no more than remembered light, and the stories of cirrus

And cumulus come to a close, and all the birds are suspended in flight,

Not every man knows what is waiting for him, or what he shall sing

When the ship he is on slips into darkness, there at the end.


“The End,” © 1990 by Mark Strand from The Continuous Life by Mark Strand.


Donald Macaskill

More than a visitor: a reflection for World Suicide Prevention Day

Next Friday (10th October) is World Suicide Prevention Day. I have written before in this blog about the challenges of mental health for older people in society. Those challenges are even more acute when it comes to considering the prevention of suicide amongst the older population.

This year’s theme is ‘Creating Hope Through Action’ and aims to empower people with the confidence to engage with the complexity of ‘hope’. There are dozens of organisations including well known ones like the Samaritans who campaign on World Suicide Prevention Day under the National Suicide Prevention Alliance (NSPA).

Together, they ask the governments in the UK and Ireland to make suicide prevention a priority and help raise awareness about how we can each support each other better.

On the day itself we are being asked to share the things that we do which helps us feel hopeful when we are going through a difficult time. For example:

  • Reaching out for a coffee with our best friend
  • Taking a walk in the fields and letting the wind blow everything away
  • Go for a run along the seafront

Suicide affects many people in Scotland. In 2020, 805 suicides were registered in Scotland (575 males and 230 females). These numbers comprise deaths coded to ‘intentional self-harm’ and to ‘events of undetermined intent’. See


Throughout my life I have worked with people affected by suicide and mental health challenges and whilst it is always dangerous to make any statement in this area because of the risk of it becoming trite, I think there is one thing more than anything else I have learned and that is that communication and talking are so vitally important. It is one of the reasons why I get so angry that for too many of our older citizens, whether they use social care supports or not, as a society we have steadily reduced the opportunities and chance to chat and talk, to listen and to be available. If social care is about anything it is about the dimension of care which is social and relational rather than simply about task and function.

Now I am the first to admit that conversation and communication is not easy especially if someone is distressed, anxious and upset. There are times when we worry about saying or doing the wrong thing but in most of those instances doing nothing can be just as bad.

Since its creation Public Health Scotland has produced some fantastic short animations to help individuals address the challenges of communicating on hard issues including listening, questioning and responding. You can access these through the NES website

There are a whole host of reasons why someone might be at risk of suicide including family breakdown, insecurity of life including employment, alcohol and substance misuse and so on, but over the years we have often ignored factors relating to age as key influencers.

During the pandemic many older individuals felt a sense of powerless, they endured isolation and exclusion, a sharp loss of contact and routine, and some developed a sense of worthlessness because of the way society was perceived as valuing older age. There were some older adults who felt that they were a burden to family and friends and many experienced bereavement without the usual supports of ritual and family for their grieving.

Increasingly professionals are aware of these heightened risks and some resources have been developed to support us all to be aware of the risks of suicide in older age not least as a result of the pandemic. I would personally commend the NHS Education Scotland work in this space.

Talking and listening, supporting and being present are all so critical perhaps especially at times of memory and community celebration. World Suicide Prevention Day allows us to focus on the importance of this work as professionals and as individuals and I hope we can all take some time on that day to reflect what we do as individuals and organisations and what more we might be able to do.

There are also times and spaces where silence interrupts the talk, and it is easier and better simply to sit and to be with another. It is in those spaces that I find, along with others, that poetry offers a unique insight into the emotions that many of us struggle with.

Some of you might know the poetry of the activist and mental health campaigner P.Bodi  who for me provides short but deep insight into the struggle of living and loving. In her work ‘Inherit the Dawn’ P.Bodi writes poems for hope. They are poems written for anyone who has ever struggled with their mental health, and for those who are in need of compassion, empathy, and gentle reminders to keep going.

“I will do as the flowers do

Inherit the dawn.

Tell me of the morning

And the gentler days beyond.”

It is this necessity of grasping hope which is the at the heart of the work of many poets who have written about a depth of despair that has cut them to the core, perhaps no more eloquently than Mary Oliver who has across her career written and spoken openly about issues of mental health and challenge.

I leave you with her poem, ‘When death comes.’

“When death comes

like the hungry bear in autumn;

when death comes and takes all the bright coins from his purse


to buy me, and snaps the purse shut;

when death comes

like the measle-pox


when death comes

like an iceberg between the shoulder blades,


I want to step through the door full of curiosity, wondering:

what is it going to be like, that cottage of darkness?


And therefore I look upon everything

as a brotherhood and a sisterhood,

and I look upon time as no more than an idea,

and I consider eternity as another possibility,


and I think of each life as a flower, as common

as a field daisy, and as singular,


and each name a comfortable music in the mouth,

tending, as all music does, toward silence,


and each body a lion of courage, and something

precious to the earth.


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

I was a bride married to amazement.

I was the bridegroom, taking the world into my arms.


When it’s over, I don’t want to wonder

if I have made of my life something particular, and real.


I don’t want to find myself sighing and frightened,

or full of argument.


I don’t want to end up simply having visited this world “

Donald Macaskill

The turning of the seasons: the changing nature of coronavirus response.

The 1st of September is officially the start of autumn and yet where I am sitting now it feels as if we are amid a summer of sunshine – and allegedly the sun and warmth are set to continue for at least another week. As the adage goes now the schools are back the good weather starts. The turning of the seasons has always been of interest to me, not least that move from summer to autumn then onwards to winter.

It has been a strange summer. We have gradually seen Covid restrictions ease in most of society with heightened anticipation and dependent on where you are for some people a full thrust into reverse gear back to past actions. For the majority some degree of ‘normality’ has been possible but for many not least in our care sector restrictions have remained and a sense of the normal has still been out of reach.

I have taken some time off over the last few weeks and in most instances have been seeing family which has meant that I have been to almost the southernmost part of England and far north in Scotland. As I have travelled and talked to people, I have noted a real divergence in attitudes and behaviours during this Covid summer. This is in part because of the diverse messaging from governments and politicians and dependent upon the extent to which Covid has impacted on local communities and people. The lack of consistency in public health messaging from politicians and scientists has been singularly unhelpful and at the very least the failure to mandate mask wearing in public places in parts of the UK will doubtless be the object of hindsight regret.

The diversity of response and behaviour was much on my mind as this week I travelled to Edinburgh for the first time in 18 months. Even a partial return to my old work routine was a strange revisiting of behaviour. I was struck by the level of anxiety that consumed me in a journey which I used to make three or four times a week. I was aware of my physical reaction every time someone who did not wear a mask got on the train, every time someone started to cough beside me or when I saw someone behave in a manner which I would probably have ignored two years ago. That’s to say nothing of the crowded busyness of tourist filled Edinburgh.

When I got back to the cocoon of my own space, I reflected on why I had been so anxious and concerned and in truth it was the same for many of the moments over the last 18 months when conditions changed, lockdowns ended, and restrictions were relaxed. For many folk it has been hard to change the routines of self-protection and preservation.

It was in the context of such thoughts this past week that I have read and watched as both scientist and politician have consistently increased the tenor of warning and that discussions on further restrictions have started to appear.

Anxiety is becoming commonplace as people witness the growing number of cases and the rise in the number of people being admitted to hospital. Scotland has just yesterday recorded over 6,800 positive cases and one of the highest test positivity levels. Against all this we are told that though people are becoming infected the impact is not as severe because of vaccination. But this week we have also read that the immunity granted by vaccination is depleting at some pace, down to 67% for those of us who are Astra-Zeneca double dozed after several months. Hospital cases are rising and at times I fear people are immune to that soundbite, forgetting that a case in hospital is not just someone feeling slightly unwell, but someone admitted with serious illness. And then the data on death and mortality which is thankfully very low compared to earlier in the pandemic – but I do have concern that our reaction to the daily number of deaths is displaced from the compassionate stance we had when we were losing more people every day. For each person there is a life, family and connection shattered and lost.

Looking at the data for care homes we see there are in the past week 97 staff who have tested Covid positive compared to 56 the week before. In the week to 22nd August there were 42 new Covid cases amongst residents, 8 more than the previous week. The number of outbreaks in care homes has also risen sharply in the past week to 47 which is the same number as in mid-February. All the data shows that the majority of both the recent resident and staff cases have been double vaccinated.

We seem to be in a place where the seasons are turning and anxiety rising, where the warmth of the summer sits uneasily with the coming chill, where warnings are rising and concern increasing.

And while all this is going on in the last week, I have held countless conversations which have been dominated with a sense of deepening crisis and fear for the sustainability and stability of the social care sector.

We are amid what feels to me like one of the worst workforce crisis the care at home and care home sector has faced for many years. There are more and more care providers who are struggling to recruit staff because there is so much competition from other sectors such as hospitality. The absence of incentivised reward and adequate remuneration which truly values the skilled work of care is not helping at a time of acute job competition. Added to this we have seen a dramatic drop in the ability of social care providers to recruit from outwith the United Kingdom. Now lest someone immediately says we should be using our own population – I would say do the sums! – we are a nation that needs the creativity, innovation, and insight of those who come to this country and become our community. We have an ageing workforce with a population which is older in greater percentage than any other part of the UK. We need to urgently address the exhaustion and tiredness of our care sector staff and to provide support in very practical terms as we move into autumn and winter.

I do not know what the future will bring but I am more than aware that we need to work with the fear and anxiety which is palpable around us in many quarters. A false positivity will not help address the reticence of people when faced with the fear of debilitating illness and the rising numbers of Long Covid. Covid19 is with us for some considerable time to come and glib phrases like ‘we need to live with it’ will not give the re-assurance needed to those who are fearful and cautious, most especially in our care sector.

Throughout all this the ability to listen, to empathise and to work collectively in authentic partnership must be at the heart of how we move forward both as a care sector and as a wider community.

The brilliant Maya Angelou has long been a personal favourite and many of her poems are poems of ‘transition’ – they occupy the liminal spaces of life between love and hardness, emptiness, and joy. One such is her poem ‘Late October’ which describes life as a cycle and uses the seasons of the year as a metaphor for life describing the ‘special insight that lovers have into endings and beginning.’

Life as we have known her has disappeared into the summer mists, from our future comes the hope of a new way of relating one to the other, it is a hope we build by addressing the fear and anxiety of the moment, it is a hope we nurture by walking with those who fear rather than abandoning them. I know not what the weeks will bring and hope that the pandemic will come under control once more, but the price of ‘freedom’ can never be at the cost of the harmony, hope and peace of others.

“Only lovers
see the fall
a signal end to endings
a gruffish gesture alerting
those who will not be alarmed
that we begin to stop
in order to begin


Donald Macaskill

Virtual reality – should we care?

Last Tuesday I was invited on to Radio Scotland to talk about the benefits of ‘Virtual Reality’ for older people in Scotland especially in our care homes. As regular readers of this blog might know I am someone who has long held an interest in all things technology and digital, not least artificial intelligence and robotics.  Both during and after this week’s programme I began to reflect on the extent to which we have not fully tapped into the potential of VR for both older people living in care homes but maybe especially for those in our communities. This will be an issue which we will be considering in a lot more depth during the Scottish Care hosted virtual Care Tech 4 event which will be held this coming Thursday and Friday. It promises to be a great couple of days which folks can drop in and out of with a range of up-to-date demonstrations, presentations and exhibits as well as fascinating panel discussions. For more details see https://scottishcare.org/care-tech-4/

But for now, as my title asks should we care about virtual reality?

A lot has been said and written about VR over the years not least about its role in gaming technology, of which Scotland is one of the major centres of innovation, development and invention. There has been less written about the benefits and drawbacks of VR for the care and support of citizens regardless of their age. Indeed, there have, I believe, been around 5,000 academic articles in the last three years alone about VR but few of these have been about the use of VR in our care and support sectors.

We can make some general conclusions from the research that has been done to date along with anecdotal evidence in Scotland which in broad terms suggests that VR is of real benefit, in some instances of very significant benefit. One of the reasons research suggests that VR is an asset is because of the immersive interaction capabilities which VR enables and allows.

In my experience I think we can broadly suggest there are the following positive benefits of using VR in care homes and in someone’s own home:

Firstly, there are clear health benefits to be gained in terms of exercise, increased physical mobility and movement. So, the recently developed innovation from an Edinburgh entrepreneur working with local care homes has helped individuals to remain mobile and to exercise. See https://www.edinburghlive.co.uk/news/edinburgh-news/edinburgh-entrepreneur-uses-virtual-reality-21228219and https://www.digitechtive.co.uk/care-home-vr

Readers might also be interested in the work of the Norwegian group Motitech which enables people to exercise whilst re-visiting parts of the country which they might be familiar with and evidences real positive outcomes re increased muscle strength, balancer and breathing.

More research needs to be undertaken in this area because studies have tended to focus on rehabilitation and physical function including gait, balance, falls prevention and pain management. They have also tended to focus on settings such as care homes where there is support in their use but the real potential future benefit for physical health will undoubtedly be in the community and ensuring people can remain as independent for as long as possible.

VR in any of its formats is not a panacea but studies are detailing increasingly significant benefits especially if used as part of a wider programme os health and wellbeing, rehabilitation and exercise. See https://www.jmir.org/2020/6/e17331/

Secondly, there is growing evidence to suggest that the use of VR can improve psychological health and well-being. The use of VR in the support and care of many people with dementia has led to a reduction in agitation, improvements in behaviour which challenges, and a reduction in the use of psychotropic interventions.

Thirdly, the use of VR as a memory tool has heralded real benefits. Used well it can bring people back to experiences and encounters, to places and events, which have been significant in their past and which can help in terms of cognitive recall and stress alleviation.

Fourthly, VR has great strengths as an educational tool, enabling its immersive approach to support any individual regardless of their age, to gain new understanding and knowledge. Contrary to popular opinion and stereotype many older people both in care homes and in their own homes, thrive on new experience, learning and insights.

Lastly, they enable people to interact and be in touch with people they know or those who they might want to get to know. Whilst pad technology has been dominant in maintaining contact especially during the pandemic there is a real potential in the use of VR.

Now there are clearly challenges but these are capable of being addressed and overcome. Wearing a headset for too long can cause confusion or headaches; there is an importance of being aware of factors which might impact balance and hearing. There needs to be an emphasis on adequate support and maximising accessibility for individuals with reduced cognitive abilities.

But perhaps the biggest challenge for the use of an VR is cost. Whilst basic headsets are now retailing for below £30 some devices can stretch into the 1000s. More pragmatically excellent headsets can be purchased as part of support packages for the low £100s. Nevertheless, there is a clear fiscal cost both in equipment and in the support needed for people to sue them to their maximum benefit. Therefore, when we are designing and developing services and supports, we should now as a matter of priority be considering the cost benefits of using VR alongside a whole suite of other technologies.

Doubtless the above and many issues will be explored during CareTech4 and throughout Scottish Care’s work on technology and digital.

Technology and VR especially is here to say – it is too important a tool to be left to gaming alone – we really need as a whole community to start caring about VR.

Donald Macaskill