The media this past week has been filed with stories around obesity,  from debate about the impact and costs of new drugs such as Wegovy on a dedicated BBC Panorama programme to ongoing discussions about the impact of obesity on the costs of the NHS as a whole. Maybe not surprising as it was National Obesity Awareness Week from the 10^th to the 16^th January.

One of the reports this week referred to major research published in the Lancet which suggests that there needs to be “a more accurate” and “nuanced” definition with doctors suggesting that the overall health of patients with excess fat, rather than just measuring their body mass index (BMI), should be the starting point. The Lancet experts then suggest that those with chronic illnesses caused by their weight should be diagnosed with “clinical obesity” – but those with no health problems should be diagnosed with “pre-clinical obesity”.

More than a billion people are estimated to be living with obesity worldwide and there are particular challenges for those of us in Scotland.

It is not by any means an exaggeration to state that Scotland as a country is facing one of its greatest health challenges of the modern era in terms of obesity. For the worlds of social care and in particular older persons care and support there are especial challenges which I would like in this blog to briefly explore.

For many of us, ageing is associated with frailty, undernourishment, or the loss of physical health. The popular image is not one that imagines weight to be an issue in older age – nothing could be further from the truth. Among Scots aged 65 and over, a significant and growing proportion are classified as overweight or obese. This is no longer an issue confined to the young or middle-aged; it is a challenge that increasingly shapes the experience of older adults and those who care for them.

Obesity in later life brings with it a host of complications: reduced mobility, increased risk of type 2 diabetes and cardiovascular disease, and a greater likelihood of needing personal care. These health conditions exacerbate the complexity of care delivery, placing additional demands on a social care sector already under pressure.

Recent data from an important study by Obesity Action Scotland highlights that overweight and obesity are more prevalent issues than underweight among older people in Scotland, emphasizing the need for targeted interventions. Their report indicates that obesity rates among older age groups in Scotland are substantial and sadly growing. In 2023, 32% of adults were living with obesity, the highest level recorded and an increase from 24% in 2003. In 2020, among those aged 65-74, 77% of men and 70% of women were classified as overweight or obese and for individuals aged 75 and over, 73% of men and 62% of women fell into these categories. These are scary statistics which tell us an uncomfortable truth but not the whole story.

For care homes and home care providers, the implications are far-reaching. Obesity is not just a medical issue – it’s a practical one, affecting how care is delivered day-to-day from design to staffing.

For instance, many care homes were not built with an increasingly obese population in mind. From the width of doorways to the strength of hoists, providers often need to make substantial investments in adapting their environments and this is only going to increase in what is an ageing built estate in all sectors. In addition, obesity often comes with a range of comorbidities, requiring enhanced medical oversight. Social care teams both in homecare and in residential care need to work closely with healthcare providers to manage these complex needs effectively. As a result, there is a direct impact on staffing and training.

Supporting someone with obesity can be physically demanding for staff. Proper training in manual handling and the use of specialised equipment is essential to prevent injuries and ensure dignity in care. And inevitably all this boils down to the adequacy or the inadequacy of resources and prioritising expenditure. Obesity-related conditions are likely to increase the time and resources required for individual care, from personal hygiene to mobility assistance, placing additional strain on already stretched teams and care budgets.

As in so much the problem is that we often start to address issues of concern too late in the day. We have a brief window of opportunity to try to address the issues of obesity before they completely overwhelm us. We have to look upstream to address the root causes of obesity in older age. Prevention should not stop at retirement. Encouraging healthier lifestyles through community programmes, targeted interventions, and national health campaigns is critical.

Addressing obesity in later life is not just the responsibility of care providers – it is a challenge for society as a whole. It requires partnership: between individuals, families, communities, and the care sector. Most of us celebrate the truth that we are living longer as Scots, but what we all need to be striving for is healthier ageing and that critically includes addressing the obesity epidemic which we are currently enduring.

Part of that challenge is addressing issues of stigma and stereotype which often prevent older individuals from addressing the impact of obesity and being overweight. I came across this anonymous poem on the web recently – it is entitled ‘The Weight of Us’ and for me it captures the real ache at the heart of obesity for all ages and a call for all of us not least those who work in social care to share that burden and load.

“The Weight of Us”

We carry it, silent, unseen,

The weight of what has been and what will be.

Not just the heft of bodies shaped by time,

But the burden of whispers, the unkind rhyme.

A mirror reflects, but does not forgive,

The years we’ve eaten to feel we live.

Comfort wrapped in layers tight,

Hunger quieted in the dark of night.

The world stares, but rarely knows,

The stories tucked beneath the clothes.

A lifetime of battles, silent, profound,

In each heavy step, a muted sound.

For age adds years and pounds alike,

A slower pace, a harder hike.

Joints creak, breath fades, yet hearts still yearn,

For acceptance given, not made to earn.

This is not just a number, not just a size,

But a measure of pain behind weary eyes.

Let us see more than scales and charts,

Let us weigh the truth in human hearts.

For in every body, a story resides,

Of how we stumble, where love collides.

So let us carry each other with care,

A lighter world when kindness is shared.

Donald Macaskill

Photo by Angelo Pantazis on Unsplash

I have just spent the last couple of days in London and have held various conversations with colleagues in the social care world in England. It has been a busy few weeks – what with the ongoing disastrous intervention of the Chancellor and the uplift in National Insurance payments which still threatens to devastate the social care sector in Scotland, and plans for a Commission on Social Care in England being announced just last week.  It is the latter which I would want to focus on in this week’s blog.

Despite all the previous reports and commissions, research papers and independent analyses, the new Labour Government has decided to establish an independent commission to develop sustainable, long-term solutions for the adult social care system. Chaired by Baroness Louise Casey, the commission’s primary objectives include:

• Assessing current challenges by evaluating the existing social care framework to identify critical gaps and inefficiencies.
• Engaging stakeholders by collaborating with care providers, service users, and industry experts to gather diverse perspectives and insights.
• Proposing reforms by recommending actionable reforms to enhance the quality, accessibility, and affordability of social care services, and lastly if not critically,
• Ensuring sustainability by means of developing strategies to ensure the financial and operational sustainability of the social care system.

The Commission will operate in two phases with medium-term recommendations to be reported by mid-2026, focusing on addressing immediate challenges within the social care sector. Then there will be long-term solutions with full and final recommendations to be delivered by 2028, outlining comprehensive plans for the future of adult social care in England.

At the heart of all this according to Wes Streeting, the Health and Social Care Secretary is the desire to fulfil a manifesto commitment and to create a “National Care Service” to meet the needs of people and better integrates social care with the state-funded National Health Service.

A sense of déjà vu comes to mind. Indeed, my colleagues in England whilst welcoming the Commission have bemoaned the length of time it will take to get to any sense of final recommendations, and I cannot help but reflect of a social care ball being well and truly kicked into the long-grass of forgetfulness.

But what has intrigued me more than the mechanics and aspirations behind the new Commission is the way in which both politician and pundit, policy maker and social commentators, by in large have viewed the Commission. Specifically, the debate and discussion evidence yet again a myopic fascination with seeing the world of health and social care through an NHS lens. Indeed, this reflects a lot of similar discussion in Scotland – social care only ever seems to get a mention when the NHS is in crisis, or the extent to which it is seen as being able to support the priorities of the NHS.

I’ve often reflected on the tendency to see social care as the understudy to the NHS – a supporting act rather than a leading role in its own right. This perspective, however well-intentioned, is profoundly flawed and ultimately diminishes the critical contribution social care makes to individuals, families, and communities.

Even social care practitioners – me included – have at times sought to enhance and sell the value of social care to a uniformed audience – by using its role in assisting the NHS as the vehicle for that conviction. We are so wrong to do so – and that’s why I am increasingly convinced that we have to stop talking continuously about the NHS and to start selfishly, consistently advocating for social care absolutely in its own right.

Social care is not – and cannot be – simply a handmaiden to the NHS. It is its own sector, with its own identity, purpose, and values. And yet, we persist in framing social care primarily as a means to ease pressure on hospitals, to prevent delayed discharges, or to free up beds. This narrative is not just reductive; it is dangerous.

If the UK Government Commission becomes dominated by the political concern (and the public one) for the NHS, then we will take two steps backward into the past.

It is unashamedly time to robustly advocate for social care even if that means talking less about the NHS.

The heart of social care is relational, not transactional. It is about enabling people to live meaningful, independent lives. It is about dignity, choice, and human rights. Social care supports people not just when they are unwell, but throughout their lives, whether they are living with disability, managing long-term conditions, or simply seeking support to thrive in older age. It is not as so many English commentators have said in recent days – about the vulnerable – because that categorises and diminishes – it is rather about our most valuable citizens, of all ages and characteristics, of all needs and none, and what enables them to flourish and thrive in life and citizenship.

Unlike the NHS, which often intervenes in moments of acute crisis, social care is rooted in the rhythms of everyday life. It is about helping someone to get out of bed, to share a meal, to reconnect with a loved one. It is about companionship as much as care, empowerment as much as treatment. This is why it cannot and should not be judged purely in terms of how it serves the NHS’s objectives.

When we view social care solely through a medical lens, we risk losing sight of its wider purpose. We reduce people to patients and care to a clinical function. We forget that social care is about living – not just surviving.

This medicalisation of social care (which I moaned about a lot during the pandemic) also fuels structural inequalities. Funding decisions, workforce strategies, and political attention become skewed in favour of acute and secondary healthcare. Meanwhile, social care – despite employing more people than the NHS and supporting just as many lives – remains underfunded, undervalued, and misunderstood.

We have seen this imbalance starkly in recent years. While billions have been rightly poured into strengthening the NHS, social care has struggled with chronic underinvestment, rising demand, and a workforce crisis. The pandemic exposed the fragility of the sector, but instead of learning lessons, we have often reverted to seeing social care as an adjunct to the NHS rather than a pillar of society in its own right.

This lack of recognition has real-world consequences. It perpetuates low pay, poor conditions, and limited career pathways for the social care workforce. It fosters stigma and misunderstanding about what social care does and who it supports. And it weakens the case for long-term reform, leaving the sector stuck in cycles of crisis management and yet another damn Commission.

Most worryingly, it marginalises the people who rely on social care – those whose voices are too often drowned out in debates about targets, efficiency, and systems integration.

We need to shift the narrative. Social care must be recognised as a sector of equal value, complementary to but distinct from the NHS. It must be funded and supported in ways that reflect its transformative role – not just in keeping people out of hospital, but in enabling them to live the lives they choose.

All this requires the same things I have been talking about for aeons – a human rights-based approach where care is seen not as a commodity but as a fundamental part of a just society. It requires fair funding and an end to the chronic underinvestment in social care by Government providing long-term funding settlements that match the scale of need. An end to the cap in hand approach of social care providers and users to gather the leftovers from a bare fiscal table. It shouts out for the need to recognise the workforce and to treat social care staff as skilled professionals, with fair pay, proper training, and clear career pathways. And lastly and critically and at the heart of this piece it needs a mature public understanding where we shift public perceptions through education and advocacy, challenging outdated views that reduce care to charity or dependency.

The NHS will always be vital. But so too is social care. They are partners, not hierarchies. The more we invest in social care – not as a crisis response but as a foundation for well-being – the more we build a society where everyone is supported to live with dignity and purpose.

Social care doesn’t just save hospital beds; it saves lives in their fullness – their hopes, connections, and possibilities. That is why it deserves recognition, investment, and respect. It’s time we stopped viewing social care through the lens of the NHS and started seeing it for what it truly is: the beating heart of our communities.

Let’s value it. Let’s protect it. And let’s give it the future it deserves.

Donald Macaskill

Photo by Jason Leung on Unsplash

Well, that’s another year started and with the predictability of a well-worn tradition we are getting the adverts for our summer holidays appearing in all our usual media alongside those irresistible offers to join our local gym, start a class, and start the year as we mean to live it, with fitness and vigour – and of course sobriety, for Dry January.

In the UK January driven not least by New Year resolutions, is typically the month in which most people chose to take out a gym membership – yet the initial surge usually means that at least half of the new intake will have quit within the first six months, and of the remaining only 6% will attend more than once a week.

Now the gym sector has done a lot of work on why so many drop out including unmet expectations, waning motivation and a growing lack of time – all of which should be insights for other sectors, but what interests me in this week’s blog is the health and wellbeing of the greatest asset social care employers and organisations possess and that is its workforce. In the coming weeks and months this space will no doubt reflect on what I personally consider to be the most challenging period for social care in Scotland that I have ever known, but at the heart of all those considerations will be the health and wellbeing of the over 200,000 Scots who work in social care organisations to say nothing of the tens of thousands of unpaid carers.

In what follows I want to suggest that despite or perhaps more because of all the challenges facing social care frontline workers and managers that attending to self-care and personal wellbeing has never been more important for those who work or deliver paid or unpaid care and support.

But it would be massively disingenuous and hypocritical not to couch and premise that discussion on the reality which is that we have to recognise that one of the primary factors behind exhaustion, burnout, fatigue and mental ill health in social care and in unpaid care is because of the total and utter failure of successive governments and society at large to properly compensate people for the critical role of care and support which they deliver whether as professional workers or unpaid carers.

We now have a plethora of recent research showing just how critical pay is to the mental wellbeing of staff in social care.

For instance, a survey of over 5,000 social care workers last year in Wales revealed that while many feel valued in their roles, the main reason for job dissatisfaction and the primary contributor to people leaving the sector is inadequacy around pay.  I could add to the Welsh study others by the Universities of Surrey or the Manchester Metropolitan and several others where the link between job satisfaction, self-value and pay and reward are inextricable.

These research studies collectively underscore the truth that inadequate pay in the social care sector detrimentally affects worker well-being, job satisfaction, and retention. More than that they show that there is a direct and negative impact on the quality of the care and support experienced by the supported person, when staff are inadequately paid.  Addressing compensation issues is therefore essential for improving the mental health of social care workers and ensuring the delivery of high-quality care services.

So please do not read this blog and its focus on wellbeing as suggesting that if we only look after our own wellbeing as individuals that we are more able to ignore the lack of proper fiscal reward – nothing could be further from the truth. We must continue to expend all our energies in 2025 in campaigning for proper pay and reward for frontline social care workers in Scotland – and as I have often said to highlight just how inadequate the Scottish Living Wage is as a level for such aspirations to settle at.

So why a focus on self-care you might ask?

Well, there are many reasons why in January people begin to focus on their own self-care, and we should not lose the opportunity on building on these realities for the benefit of individual workers and carers. I have already referred to the cultural influence of resolutions, and then there is the psychological impact of starting a new year and wanting to plan to do things differently. But there are other motivating factors which should lead organisations and employers to build on personal influences to focus on self-care in this month.

These include the fact that people reflect a lot on their own choices and life during the holidays and often people are more likely to re-assess their personal and psychological health when they have had a break. If it is evident to them that there is little scope for wellbeing and self-care/development or indeed motivation in an organisation, then they are much more likely to look elsewhere for such a focus. It is also true that in a social media influenced era with influencers and commentators, that January has become even more so the ‘re-set’ month with clear programmes of targeted goals and challenges which once again organisations can tap into. But of course, whatever the motivation and reasoning what all such activities require is a supportive and affirmative environment and community which a good provider and employer can offer albeit that it is much harder for unpaid carers to access – though even that provides care organisations with an opportunity to nurture and build community.

The campaign for just pay can sit alongside the prioritising of self-care and wellbeing for carers and workers and assist not only personal health but also enhance the experience of those who are being supported. Again, there are numerous studies which show how engaging in regular self-care practices can lead to improved job satisfaction, better mental health, and enhanced resilience against work-related challenges.

Whilst acknowledging that achieving self-care for Scotland’s social care workforce in the context of poor funding and low pay requires creativity, collaboration, and systemic change, it can nevertheless be achieved. There are potential practical and sustainable approaches that organisations and leaders can adopt to support staff well-being.

For instance, the creation of Peer Support Networks perhaps within a care home or amongst community homecare teams help workers to share experiences, offer emotional support, and reduce feelings of isolation. It might work by allocating 30 minutes per week for reflective practice or group check-ins.

Introducing flexible working arrangements – which are already evidenced strongly across Scotland’s social care sector are a further support to self-care and wellbeing. Introducing flexible rotas or job-sharing options allow some staff to achieve better work-life balance, thus reducing stress and enabling people to achieve personal as well as professional responsibilities.

More recently I have come across many more employers who have introduced and developed Mental Health First Aid training into their organisations which has led to a core group of staff being trained to provide immediate peer support for those experiencing stress, anxiety, or burnout. Others have created Well-being Champions within teams to advocate for and coordinate self-care activities. Again, this promotes a culture of self-care and raises awareness about mental health resources. Champions can organise activities such as yoga, mindfulness sessions, or walking groups during breaks.

Further examples of organisational support for self-care and personal wellbeing include those organisations that have introduced low-cost perks and recognition schemes all of which helps to boost morale and makes staff feel valued despite financial limitations. Employers who work with partner organisations to offer reductions in areas such as reduced access to reflexology, meditation, yoga or more directed psychological and talking therapies; or discounted schemes for food and products – all are illustrating initiatives designed to make staff feel that their health and wellbeing is critical and central.

Investing in self-care, even in the face of funding constraints, is about fostering a culture where social care staff and those who are unpaid carers feel supported, valued, and empowered. By focusing on low-cost, high-impact strategies, organisations can help sustain the workforce, improve retention, and enhance the quality of care provided across Scotland. This approach also strengthens the call for systemic funding reforms to create a more sustainable sector for the future.

Unlike those who join the gym in January and forget how to access it within six months I earnestly hope that the focus on staff wellbeing and self-care which many organisations begin to explore this month becomes embedded as evidence of quality care and compassion.

Whatever techniques or tools, models or methods are used – self care is fundamental to the delivery and nurturing of all care and support; it is a lifelong process which nurtures of living and loving as much as our working and achieving, and yet as the Anglo-Irish poet David Whyte reminds us – it is not always easy:

Self Portrait

It doesn’t interest me if there is one God
Or many gods.
I want to know if you belong — or feel abandoned;
If you know despair
Or can see it in others.
I want to know
If you are prepared to live in the world
With its harsh need to change you;
If you can look back with firm eyes
Saying “this is where I stand.”
I want to know if you know how to melt
Into that fierce heat of living
Falling toward the center of your longing.
I want to know if you are willing
To live day by day
With the consequence of love
And the bitter unwanted passion
Of your sure defeat.
I have been told
In that fierce embrace
Even the gods
Speak of God.

David Whyte

Self Portrait: A Poem by David Whyte | High Road Artist

Donald Macaskill

Photo by Marc-Olivier Jodoin on Unsplash

The time between Christmas and New Year has always been a bit of a strange one. In the past I travelled a lot to see family and friends and got caught up in the tradition of the Boxing Day sales, but both those activities are much depleted now for diverse reasons – so I find myself with a lot of time on my hands; a commodity which is usually somewhat rare. Inevitably my mind starts to race with thoughts about the year ahead. Now in the past I have reflected on the strength and challenge of coming up with New Year resolutions, but it seems a bit different this coming year, 2025.

One of the reasons for that sense of difference is that I have discovered that 2025 has been declared as a Year of Jubilee by the Roman Catholic Church. I have to confess that I knew little about the concept of ‘jubilee’ other than a faint memory that it had to do with poverty, and an even fainter memory of days off school for the Queens Jubilee in 1977!

I have discovered that the concept of Jubilee is a very ancient one, particularly within religious, economic, and social traditions. Its origins lie in ancient societies, most notably in the Hebrew Bible, where it was codified as a radical vision of social justice, restoration, and renewal. Over time, the idea of Jubilee has been reinterpreted and adapted by various movements to address inequality, debt, and oppression.

The term ‘jubilee’ derives from the Hebrew word yovel, meaning a ram’s horn, which was sounded to announce the year of Jubilee. The Jubilee Year occurred every 50th year, following seven cycles of seven years (the Sabbath years). It was a year which was marked by the requirement for a community and people (especially a predominantly agricultural one) to release burdens, redistribute resources, and create opportunities for those marginalised by systems of inequality. The ancient practice was quite radical with for instance people who had sold themselves into servitude due to debt being freed; land was returned to its original owners to prevent perpetual inequality and environmentally no or limited agricultural work was done during the Jubilee year, allowing the land to rest and regenerate.

The concept of Jubilee changed down through history with a much more spiritual interpretation within Christianity, with a particular focus on charity and forgiveness.  By the medieval period the Year of Jubilee became associated with an opportunity to buy your forgiveness. Later, the Catholic Church used Jubilee years to address crises, such as wars or famines, blending the original themes of renewal with ecclesiastical goals.

More modern interpretations of Jubilee have developed the concept into a broader metaphor for societal transformation and justice, including the Jubilee 2000 Campaign which advocated for the cancellation of unpayable debts in developing countries.

The Catholic Church has declared 2025 as a Holy Year of Jubilee (or Anno Santo), following its tradition of celebrating a Jubilee every 25 years. This marks a year of spiritual renewal, forgiveness, and reconciliation, encouraging pilgrims to seek grace and engage in acts of faith and charity.

Pope Francis has announced that the theme for the 2025 Jubilee will be “Pilgrims of Hope”, emphasising hope, healing, and the rebuilding of communities and on Christmas Eve he inaugurated the Year by throwing open the Holy Door of St Peter’s Basilica in Rome.

With all this focus on jubilee I have begun to consider what this might mean for social care in Scotland and so instead of a set of resolutions I would like us to consider how we can use the next year to reimagine the social care sector to prioritise equity, dignity and community. I suspect all three contain the essence of what social care is and is meant to be.

A social care Year of Jubilee could emphasise the critical importance of not just talking about how we value workers but actually doing something about it as a government and society. Celebrating that someone is paid the Living Wage is a start but should never be the destination of our ambition. So let us properly fund and introduce fair working conditions, adequate pay that values professionalism, and opportunities for real respite for workers who are tired and simply exhausted, burdened by mental health fatigue and stress. Let us allocate and prioritise the critical role that respite provides for those who are unpaid and family carers.

A social care Year of Jubilee should lead to the necessary re-distribution of resources and societal wealth. We need to finally recognise social care as an economic asset and driver rather than a drain and deficit; to value those who receive care and support as equal citizens, whose contribution is as critically important as that of any other, and whose voice needs to be finally heard. So let us advocate for equitable funding for social care across Scotland, ensuring no community is left behind, and re-balance both fiscal and societal prioritisation of the NHS, by enhancing our shared understanding of the critical role of social care. And in this year let us prioritise investment in neglected areas, including rural communities and underfunded care providers, to address historic inequities. It is a simple nonsense that we do not see social care as a community asset worthy of economic investment.

A social care Year of Jubilee can also serve to reflect the ancient practice of freeing of slaves and the forgiveness of debts, with a symbolic and practical liberation from systemic oppression. For social care, this translates into dismantling barriers that prevent people from accessing the support they need. The whole system of charging for care and modelling the true cost of care needs to be radically overhauled in Scotland. Failure to recognise that we are currently not paying the true cost of care as a society by placing that burden on individuals needs to be challenged once and for all. This is also profoundly the case for unpaid carers who carry a disproportionate burden and for whom we need as a society to offer better financial, practical, and emotional support.

And a personal wish from me is that we recognise the tradition of Jubilee was one that focused on the restoration of human dignity and relationships. So, a Year of Jubilee for social care in Scotland should be enshrined in a clear human rights paradigm – which means a refreshed and re-introduced Human Rights Bill. But it also means that we embed human rights as the foundation of social care, ensuring every individual is treated with dignity and respect. It means that we create co-designed care and support systems and models where the voices of those receiving care and those providing it are central to decision-making. None of this can happen in a fiscal vacuum without focus and investment.

And my final Jubilee for Social Care wish for 2025 is that we give especial focus to approaches and models that seek to restore and rebuild community. I have in previous recent blogs argued about how we need to re-design the way in which we deliver care and support in rural and remote communities, and the need to re-imagine aged care in residential and nursing environments.

In 2025, social care can lead the way in reconnecting communities fractured by inequality and isolation. It can seek to do so – again with political and fiscal investment – by strengthening community-based care models that prioritise connection and inclusion, reducing loneliness and isolation. It can continue to celebrate and support intergenerational initiatives, where care and support becomes a shared community responsibility, fostering understanding and solidarity.

Just as the ancient religious and economic concept of Jubilee represented a radical shift in how people viewed justice, relationships, and resources, we must approach social care in Scotland with the same transformative spirit. 2025 can be the year we move into a future where social care reflects the values of restoration, fairness, and shared humanity.

Here’s to a year of progress, compassion, and justice for social care in Scotland; a Year of Social Care Jubilee.

Such a vision is encapsulated with the last poem I leave you with for 2024, the wonderful Burning the Old Year by Naomi Shihab Nye.

 

Letters swallow themselves in seconds.

Notes friends tied to the doorknob,

transparent scarlet paper,

sizzle like moth wings,

marry the air.

 

So much of any year is flammable,

lists of vegetables, partial poems.

Orange swirling flame of days,

so little is a stone.

 

Where there was something and suddenly isn’t,

an absence shouts, celebrates, leaves a space.

I begin again with the smallest numbers.

 

Quick dance, shuffle of losses and leaves,

only the things I didn’t do

crackle after the blazing dies.

 

Naomi Shihab Nye, “Burning the Old Year” from Words Under the Words: Selected Poems. Copyright © 1995 by Naomi Shihab Nye.

Donald Macaskill

 

Photo by engin akyurt on Unsplash

As the festive season descends upon us and just a few days out from the big day itself, our surroundings are full of twinkling lights, sounds of carols or bygone hits, parties and gatherings by the day, and if you’re lucky moments of stillness and reflection amidst the chaos. Part of that chaos has been the very real challenges that are now facing both those who provide and work in social care in Scotland and more important those who receive care and support. We are living in times of unprecedented challenge and considerable uncertainty.

Recently at a gathering of professionals those present were asked to identify the social care needs of the moment and more than one voice agreed that we are all desperately looking for hope. It is a truth, I would suggest, that faced with all our challenge that the concept of hope becomes not just an aspiration but a necessity.

A short time ago I came across Jamil Zaki‘s book ‘Hope for Cynics’. The title appealed to me because, in truth, it wouldn’t be the first time that I have been accused of being cynical and pessimistic about the nature of our current political and social care discourse.

Written by the Stanford psychologist Jamil Zaki, whose work on happiness some might be familiar with, the book examines the rise of cynicism in modern society and its detrimental effects on both individuals and communities. He differentiates cynicism – a blanket assumption that people are inherently selfish and dishonest – from scepticism – which involves critical thinking and openness to evidence. Zaki argues that cynicism is not only a misinterpretation of human nature but also a self-fulfilling prophecy which fosters distrust and negative behaviours.

Zaki’s research suggests that cynicism has been increasing over time. For instance, in 1972 about half of Americans believed that most people could be trusted; by 2018 that figure had fallen to a third. This growing distrust has significant implications, as cynicism is associated with higher levels of loneliness, depression, and even reduced life expectancy.

To counteract cynicism Zaki proposes the practice of ‘hopeful scepticism’. This approach involves critically evaluating information while remaining open to the possibility of human goodness. By adopting human scepticism, he suggests, individuals can foster trust and cooperation, which are essential for personal wellbeing and societal cohesion.

His book offers a compelling exploration of hope not as naive optimism but as a disciplined practice, a muscle that grows stronger the more we use it. For those of us who live and work in social care in Scotland I suspect this resonates deeply. Our work is not built on the illusion that everything will ever be perfect instead it is grounded in the belief that despite imperfections we can create moments of individual connection, shared dignity and community joy. Social care is the bringer of hope for those who feel little ground for optimism.

Now lest you think of this as simply naive optimism, as a seasonal fairytale, it is also worth pointing out that Zaki’s conclusions are supported by extensive research in social psychology and neuroscience, including studies on empathy and prosocial behaviour. His work emphasises that our beliefs about others can shape social reality; expecting the worst in people often brings about negative behaviours whereas expecting the best can encourage positive actions.

Another key strand in Zaki’s study is the continual reminder that hope is not a solitary pursuit but a communal one. This is particularly true in social care and I think is an urgent need for our moment. Whether we are care workers, managers, family members or policy makers, the work we do is woven together by shared intentions and actions. It is in the small everyday acts of kindness – helping someone feel at home in a new care setting, ensuring their voice is heard, that they feel they matter, or simply sharing a laugh over a cup of tea – that hope finds its most powerful expression.

At Christmas these moments seem to take on a heightened significance. They remind us that the core of social care is profoundly human: it is about relationships, about seeing and being seen, about creating spaces where hope can flourish, even in the face of adversity.

The challenges we face in social care and around which I often comment in this blog are undeniable: the workforce shortages and inadequate terms and conditions; funding uncertainties and the ongoing need for systemic reform that puts the supported person first – are not issues that we can ignore but Zaki’s reflections encourage us with what he calls ‘grounded hope’ – a recognition of reality paired with a determination to change it. This is not about turning away from the hard truths, it is about facing them with courage and creativity.

As we gather around trees and tables this Christmas let us remember that hope is not just something we feel – it is something we give in social care. Hope often takes the form of creating moments of normality amidst hard times and extraordinary emotions. It is found in the festive atmosphere in a care home where staff weave memory into future; it is found in the gift of presence a homecare worker shares beyond contract; it is found in all that enables people to discover the chance to thrive.

These small acts are not insignificant. They are the threads of a larger tapestry of care and compassion, woven together by a shared commitment to ensuring that everyone regardless of age, ability or circumstance, feels valued and seen.

At this time of year, especially I think there is much to learn from Zaki’s ‘Hope for Cynics’. Let us embrace hope not as a passive feeling but as an active choice – a way of being that empowers us to re-imagine what is possible.

For those of us in social care, hope is both our gift and our responsibility. It is the spark that lights our way through all those dark days, reminding us that even the midst of uncertainty and what feels like a chaos out of our control, that we have the power to make a difference to both individuals and whole communities.

So this Christmas let us celebrate hope, not as a fleeting emotion but as the enduring foundation of the work we do and the world we strive to create. And let us do so together, with courage, kindness and an unwavering belief in the value of every human life.

My favourite poet of 2024 Jackie Kay once said “If human beings don’t have hope, then why do we live?” and so I leave you with her poem ‘Optimism’ which I came across recently:

Optimism

By Jackie Kay

The day is starting out well.

The sun shines on the rain

like a watery promise.

The cat washes itself

with its little rough tongue,

content as anything.

 

A bird flaps its wings

and you think, go on, fly,

you can do it.

The world is out there waiting.

You look at your own hands,

how they rest on the table—

 

small miracles of bone and skin.

And you think,

I have done this before,

I have lived through a dark night

and come out smiling.

 

Today I will take the first step,

hope, like an open door,

a shaft of light on the floor.

 

Donald Macaskill

Photo by Kelly Sikkema on Unsplash

 

Last Tuesday, the 10th of December was the annual international Human Rights Day. It’s a day which gives the global community an opportunity to focus on the importance of protecting the human rights of all citizens. Here in Scotland in a video message for the day I mentioned that it’s important on the international stage that we don’t lose sight of the work being put together to create a Convention on the Human Rights of Older Persons about which I wrote a few months ago. But I also reflected in my message on why it was important that Scotland should seek to re-introduce the Human Rights Bill which had earlier been proposed and around which I have already written. The decision of the current Scottish administration not to continue with the Human Rights Bill is very disappointing not least because in times of straightened budgets and real challenge in the world of social care the rights and dignity of older persons needs a special attention and focus, and a legal framework of rights enables that to happen with a sharper intensity.

More broadly, however, the issue of human rights in social care and aged care in particular has been uppermost in my mind. I’ve been very honoured to have chaired a small working group of individuals who have been concerned about the developing role of artificial intelligence in the delivery of aged care. The group has been working under the auspices of the Oxford Institute for Ethics in AI and the Digital Care Hub. It has developed a set of principles and guidance together with case studies to describe what we considered to be the key components which should lie behind and influence the use of artificial intelligence models and tools in the delivery of Adult Social Care.

This I think is really important because it is in the interface of technology and social care that there can be a danger that the rights and dignity of older persons or indeed any other group of people can be at risk. This is especially, I think, the case in these current times when decisions might be made on economic grounds rather than on the basis of the best interests of individual citizens.

So, I want in what remains of this blog to explore these principles but also to examine what is happening in the wider world of Ai around the practice of ethics and human rights not least in the various codes and conduct documents which have been developed to reassure those outside the tech industry that there are appropriate balances and safeguards which are there to protect us. Whilst many of these are indicative of a robust approach, I want to suggest that for those of us who operate in the world of social care that we need to increasingly be watchful and therefore the Oxford ethical approach and model for social care is all the more important.

The first thing to note is that it is certainly true that for bodies such as the United Nations and leading tech firms the establishment of frameworks to guide the responsible use of Ai has become an issue of real importance in the last couple of years. Take the United Nations for instance. In September 2022 the UN System Chief Executive Board for Coordination endorsed what they called the Principles for the Ethical Use of Artificial Intelligence in the United Nations System. In essence these ten principles emphasise the following:

• ‘Do No Harm: Ensuring Ai applications do not cause harm to individuals or communities.
• Defined Purpose, Necessity and Proportionality: Utilising Ai for clear, legitimate purposes aligned with UN values.
• Safety and Security: Safety and security risks should be identified, addressed and mitigated
• Fairness and Non-Discrimination: Preventing biases and ensuring equitable Ai outcomes.
• Sustainability: Artificial intelligence should be aimed at promoting environmental, economic and social sustainability
• Transparency and Explainability: Maintaining openness about Ai systems and their decision-making processes.
• Responsibility and Accountability: Assigning clear accountability for Ai operations.
• Privacy and Data Protection: Safeguarding personal data within Ai applications.
• Human Autonomy: Ensuring Ai supports human decision-making without undermining autonomy.
• Inclusion and participation: Organisations should take an inclusive, interdisciplinary and participatory approach and promote gender equality.’

We have also witnessed similar frameworks being developed by the major tech companies such as Microsoft who adopted ethical Ai principles focusing on fairness, reliability, privacy, inclusivity, transparency, and accountability. Google established AI principles emphasising socially beneficial Ai, avoiding harmful applications, and incorporating privacy design and IBM have sought to implement Ai ethics guidelines prioritizing trust and transparency.

This flurry of ethical activity led to eight global tech companies in February 2024 committing to applying UNESCO’s Recommendation on the Ethics of AI, integrating these values into their Ai development processes.

The Oxford Institute for Ethics in AI outlines seven ethical principles for AI in social care: truth, transparency, equity, trust, accessibility, responsiveness and humanity. These align closely with both UN and tech companies’ frameworks:

Truth and Transparency: Correspond with the UN’s emphasis on transparency and explainability, and tech companies’ focus on open Ai operations.

Equity: Reflects the UN’s fairness and non-discrimination principle and tech firms’ stated commitments to unbiased Ai.

Trust: Parallels the UN’s responsibility and accountability, fostering confidence in Ai systems.

Accessibility: Aligns with inclusivity efforts, ensuring Ai benefits are widely distributed.

Humanity: Echoes the UN’s human autonomy principle, ensuring Ai supports rather than replaces human roles.

Despite these alignments, certain gaps persist which I think will pose particular challenge and priority for those of us who work in social care in the months and years ahead, specifically

Implementation and enforcement: While principles are established consistent implementation and enforcement across very different contexts remains a challenge. What will be really important for the Oxford Principles is that they are continually evaluated, tested and assurance is sought that they are being implemented in as robust a manner as they should be.

Secondly addressing bias. There needs to be an ongoing effort to identify and mitigate biases in the Ai systems in order to prevent discrimination. It is sadly the experience of many of us who work in and deliver aged care services that the unconscious and sometimes subconscious age discrimination bias which exists within wider society is evidenced in so many of the systems of support and models of intervention. We need to make sure that Ai systems aren’t just non-discriminatory in terms of other characteristics but that they are definitively age unbiased.

In addition, it is important that we prioritise global inclusivity ensuring that Ai governance includes diverse perspectives from the whole global community and not solely those nations often described as being ‘developed’.  We risk a real marginalisation of communities and nations in the ongoing development of Ai not least in aged care if we do not ensure global inclusivity.

And lastly, transparency. Operationalising transparency and complex Ai systems requires continuous refinement. We are some distance away from that degree of sophistication which would ensure the absence of bias, consistent application and the enforcement and robust adherence to ethical principles whether that be the ethical framework developed by the UN or by the major technology companies.

I would suggest that these all to some extent align themselves with the common ground which the Oxford Institute Principles for Social Care describe. It is positive that there is such a convergence, but that reality also highlights the need to engage in continuous dialogue between those who are developing Ai tools and models, those who commission, contract and purchase such tools and fundamentally those who are impacted in the way in which they live their lives as individuals who use and access social care support.

There is a real possibility that Ai can positively revolutionise the support of some of our most valued citizens but if Human Rights Day shows anything it shows us the urgent continuous need to be ever watchful to ensure the realisation of human rights for all across our shared world.

Donald Macaskill

Photo by Markus Spiske on Unsplash

The Scottish Budget was published on Wednesday and to say that the social care sector in Scotland was disappointed would be a massive understatement.

I think it is fair to say that regardless of organisation type, charitable, public or private most people involved in social care delivery in Scotland at this time are deeply troubled at the failure of the Scottish Government to own up to the crisis currently being endured by and the risks being faced by the sector.

The reality on the ground behind the rhetoric of claims of additional spend and funding for social care is that Health and Social Care Partnerships in order to balance their budgets are having to make horrendous decisions to cut services. It seems truly perverse that whilst there is significant additional funding going into the NHS (including into delayed discharge work) that the social care sector is facing some of the most savage cuts it has ever had to endure. That means only one thing – people will die.

Now that might sound like scaremongering, but it is sadly what has always happened when social care services are cut and withdrawn. I have written before about this, indeed nearly a year ago I shared the data which shows that every day two people die in Scotland whilst waiting for or not receiving the social care support they need to stay alive. Anyone at the frontline today knows that a year on the situation is so much worse.

The truth behind the fable of parliamentary debate is that care providers and employers will enter this winter not by increasing services and meeting the growing demand, including from delayed discharge in hospitals which are at record levels, but instead will be making staff redundant, closing units in care homes and handing back packages of homecare to local authorities who have themselves no capacity to meet the needs of those who are desperate to be supported. And this is all without the nightmare caused by the UK Labour Government through the changes in Employers National Insurance which unless mitigated risks whole system collapse.

If you turn on the television screens in the last couple of days you will hear frontline clinical staff in the acute NHS sector talk of the pressures being faced across the UK, and that includes Scotland, from what has been termed a ‘quademic’ of RSV, influenza, Covid and norovirus cases. Respiratory conditions at this time of year put inordinate stress and pressure on our social care and health systems so one would have hoped for a targeted and specific focus on social care in this week’s Budget.

What we got instead on Wednesday was the reality of a lack of priority. In a parliamentary debate lasting most of the afternoon social care was virtually invisible – it was mentioned 12 times in the thousands of words and only four times by the Finance Secretary who did, however, acknowledge that:

“social care funding,… is absolutely vital if we are to tackle delayed discharge and look at the system as a whole system, including both the NHS and social care. That is why we have put record investment into social care, including, of course, by ensuring that our social care workers get the pay that they deserve.’

No one is denying the record sums but if they are not enough, they are not enough no matter what records are broken. Equally no one is going to deny the importance of paying the Living Wage to frontline care and support staff though in truth that level is a very very low level to seek to be pleased to be achieving.

But it seems nonsensical to be faced with the reality that care staff and care home nurses are being laid off this past week not because there is no work to do but because organisations cannot afford to deliver the care needed by what they are paid, and commissioners cannot afford to allocate packages because they have run out of money. Knowing you are getting more money tomorrow rings hollow when you lose your job today.

Paradoxically today is Small Business Saturday which is now in its 12th year and has a focus every year on encouraging an increased awareness of the needs of small local businesses.

The vast majority of social care provision in Scotland is not delivered by large corporate organisations but by small businesses, whether charitable, not for profit or private. Many of these are small family run businesses with some being in families across the generations. They are often in remote and rural parts of the country but also in areas where in the town or village concerned they are the largest employer.

I find it increasingly ironic that we hear our political leadership emphasising the criticality of small businesses to our economic wellbeing as a nation, and yet at the same time one of the largest sectors in the small business world are our social care providers.

Indeed the Scottish Government recognises that small businesses are a critical part of the Scottish economy and the Government’s own national strategy asserts that:

‘We aim to grow our economy by making Scotland one of the best places in the world to do business. This means supporting and listening to small and medium-sized enterprises (SMEs) and working to deliver the right support at the right time.’

I find this fiscal silence around Scotland’s small business social care employers and providers truly baffling if only because it makes no economic sense whatsoever to say nothing of its lack of health whole system thinking.

Investing in small and medium-sized enterprises (SMEs) within Scotland’s private social care sector offers substantial economic and societal benefits. Indeed, the Independent Review of Adult Social Care in Scotland – the Feeley Report – emphasised that social care support is an investment that creates jobs and economic growth.

It makes complete sense to invest in small social care businesses not just as economic contributors and drivers in our communities, but critically as a key partner in the nation’s health and wellbeing. Instead of investment at this time we are faced with restriction and closure.

The Budget last week has failed Scotland, it has failed our small social care businesses and the sector as a whole, and shows that there is little or no understanding of the critical issues facing those who deliver care and support or indeed those who use social care services.

In the discussions and negotiations, the debates and deals before the Budget is settled in February, we simply have to put social care as a whole sector at the centre of our focus rather than the invisible sector it has been turned into.

Donald Macaskill

It isn’t often that there is a happenstance coming together of events – on the 2^nd to the 8^th December next week we will mark National Grief Awareness Week and then it will be UNESCO World Futures Day on the 2^nd December. The latter is a day which is a global event inviting countries to embrace the future and develop their capabilities in terms of foresight and readiness, ‘and proactive policy-making to ensure sustainable development for future generations.’

I am struck by this juxtaposition because of conversations I have been having recently about the nature of bereavement and grief especially as it relates to the emerging concept of synthetic resurrection.

Synthetic resurrection can be described as the use of advanced technologies, particularly AI, digital media and holography to recreate aspects of deceased individuals. This can include generating digital avatars, voice replicas, and interactive personas that simulate the presence and behaviour of a deceased person These are now astonishingly life-like and wholly believable and are only going to get better.

One of my recent discussions mentioned the work being done by the organisation Deep Fusion Films to create a podcast series called ‘Virtually Parkinson’ which features an Ai-generated version of the late Sir Michael Parkinson. In the publicity and discussion around the announcement of the project in late October, Deep Fusion made it clear that they were not trying to deceive anyone and would make it very clear that this was Ai-generated, the result of analysing over 2,000 interviews. But with the aid of a generated synthetic voice these will be new and unscripted interviews with contemporary celebrities.

Undertaken with the consent of his son and family, these interviews will no doubt bring the idea and reality of synthetic resurrection right before the public when they are aired.

It is perhaps stating the blindingly obvious that synthetic resurrection raises complex ethical, human rights and moral considerations. But it is also stating the obvious to say that these cannot be ignored and that the growth of such techniques and approaches is here to stay. How we manage the ethical questions they raise and how we adjust our societal and individual expectations is what will determine whether new approaches will bring individual and societal benefit or not. Wishing the science had not been invented will not make the reality of existence go away.

I want to explore what the future use of such approaches might augur in terms of both positive and negative aspects.

First some ethical and human rights considerations:

The most obvious issue is the extent to which a deceased person has control over consenting to the replication of their image or personality. Who actually owns the digital likeness of a deceased person and the whole issue of digital legacy is at the moment an area fraught with contradictory views and the legality is as yet unresolved.

However, we still retain certain though not full rights of privacy posthumously. The use of personal data including voice recordings, texts, videos or photographs both of the deceased or anyone else they may interact with including family could be a breach of the fundamental right to privacy.

Then who decides that such synthetic modelling should happen. It is one thing if it is the deceased in an informed and consensual manner it is another if it is other family members or even strangers. And even if one member of a family agrees to synthetic resurrection, what about the risk of disputes or family breakdown?

There is also the risk as technology develops and the possibility of commercialising avatars and associated models becomes commonplace that grieving individuals might be emotionally vulnerable and susceptible to exploitation from those who offer synthetic resurrection services. Such services could make an individual dependent upon them – perhaps for fiscal benefit.

It is a natural stage of grieving to work through the pain of loss and to learn to live without the deceased and to re-orientate your living. What if you started to use a synthetic resurrection service which prevented such a critical part of mourning and grieving? What emotional and psychological harm could result in such ‘avoidance’ of grief? Is a grief delayed, and a resolution started something which could result in greater psychological and physical harm? What would be the risk of psychological harm as a result of such over-dependency and the inability to move on in life?

Because these technologies are so new there is limited research available about their impact on an individual or upon their grieving. Is there a risk that such synthetic resurrection might pathologise ‘normal’ grief and foster an unhealthy attachment where a person could not ‘let go’ and indeed where the very finality of death was ignored?

Death and grief are culturally sensitive and rooted experiences, not least in terms of many religious and belief traditions. What does synthetic resurrection say to the Christian understanding of resurrection? There are other cultural traditions and humanistic philosophies which emphasise the finality of death as part of the human experience. Is there a danger that the very sacredness of life could be turned into a programmable phenomena? Synthetic resurrection might conflict with these views and result in a changing of moral norms.. Nothing wrong with that in principle but it is often desired such change occurs through popular and common consent.

There are also a whole host of considerations behind the nature of the interactions with synthetic resurrection services. We have referred above to the risks within the bereavement journey, but they also surely raise issues relating to the authenticity of human relationships and dialogue per se. What is the meaning of a relationship which one fosters with a piece of technology, it is after all not the ‘real’ person, even if a sense of response may become so sophisticated that it could portray masked reciprocity? What impact might the use of such technologies have on the exercise of authentic human memory when true physical interactions are masked with inauthentic constructions of the moment? Is there a risk that such interactions become uni-dynamic and are not shared with others? Are there not also questions around the potential misuse of such technologies to create misleading content or a risk of the exploitation of the likeness of the deceased?

So far, I have detailed ethical and human rights concerns and objections, but there are strong advocates of the use of such synthetic resurrection approaches who state that there are clear benefits.

It is argued that they could offer comfort, and potentially closure in situations where death and loss was traumatic and sudden, where the person was not enabled to resolve issues, and where that lack of resolution is preventing them from moving on in life.

Others have suggested that the use of such approaches enables a family to preserve the legacy and share the memories of those who have died not least with generations, perhaps a child who was unborn to a deceased parent, and that such sharing and creating of memory can bring real benefit.

One could also see the way in which the use of such avatars and synthetic models of famous individuals and personalities could enhance the continuation of history within educational and learning environments.

It is further stated that if properly used with clear ethical boundaries they could be tools that helped an individual create self-healing personal and individual experiences that benefitted them, and that with appropriate ethical and human rights standards that there is no reason why such services could not be safely utilised. This might especially be the case in the support and care of those living with neurological conditions such as dementia.

At the moment it is likely that synthetic resurrection approaches will only be available to those who are wealthy – but that will soon change, and it is therefore really important that as a whole community and society we develop appropriate ethical and human rights frameworks that assist the bereavement and grief journey whilst being sensitive to the realities of technology that is here to stay.

In this coming National Grief Awareness Week, we are already faced with the challenges of World Futures Day and of a future of grief and loss unlike anything we could have imagined a decade ago.

Synthetic resurrection offers profound opportunities for grieving and psychological support, yet its ethical, human rights, and moral implications demand thoughtful consideration, regulation and ultimately respect for the sacredness of the human experience.

Donald Macaskill

Well winter has well and truly arrived in the past week. Chatting to care providers in parts of Scotland they have been reflecting to me the struggles of staff getting through snow and ice to work in local care homes or to deliver care and support in the homes of their fellow citizens. Every year I am reminded of the astonishing professional dedication and no little sacrifice of those who in all weathers epitomise the essence of caring compassion and who get through to their place of work despite all the seasons throw at them.

As the first frosts of November glisten on the grass, there is also a sense of our communities moving into the quiet, reflective rhythm of winter as we hunker on down from cold and ice and today as I sit and write this also as we batten down the hatches from the gales and stormy blasts which seem to take up residence at this time of year.

All this meteorological change is resonant of years gone by and is uppermost in my mind as I reflect that tomorrow is Stir Up Sunday, the day traditionally set aside for preparing the Christmas pudding. The tradition dates back to Victorian times when the family would gather five weeks before Christmas to stir the Christmas pudding and, on a Sunday, church congregations uttered the prayer ‘Stir up, we beseech thee, O Lord, the wills of thy faithful people; that they, plenteously bringing forth the fruit of good works…’

Maybe not so much now but in the past families would gather, sleeves rolled up, each person taking their turn to stir the mix, add a wish, and fold in the ingredients that will mature into something rich and sustaining for the festive season. Nowadays I suspect with the pressure of time we simply have to get the job done or there will be no pudding or cake on the main day.

But if you allow me this week, I want to use Stir Up Sunday as a metaphor to share some reflections on social care in Scotland – a sector and community in urgent need of collective action, vision, and hope. Much like a pudding, the care system relies on a delicate balance of ingredients, each essential, each contributing to the whole. But as frost signals the arrival of winter, the cracks in the system remind us that some key elements are missing, and time is running out to prepare for the challenges ahead.

So, what are the ingredients we must urgently focus on to ensure the resilience and future of social care in Scotland?

Workforce: the flour that holds it all together.

No pudding rises without flour, and no care system thrives without its workforce. Across Scotland, dedicated care staff are the backbone of our communities, and evidence that dedication as I said, in all weathers and conditions. Yet they are overworked, underpaid, and often undervalued. This winter, we are faced with the bizarre situation that we risk losing some highly skilled individuals because we are not recognising and rewarding them sufficiently. How can we with any sense of achievement declare that paying the Living Wage is the pinnacle of our ambition? We should and could value social care and its workforce by paying so much more, and that inevitably means that as most social care is bought by the public purse that the Scottish Budget needs to recognise this with adequate funding for local authorities.

Scottish Care is soon to publish a statement on the Scottish Budget which will be presented to the Scottish Parliament on the 4^th December and I hope at the heart of that Budget will not just be an agreement to fund the Living Wage but to seek to go much further and truly embed Fair Work commitments.

We also need the UK Government to urgently address the failing immigration system which is preventing people from being attracted to work in social care in Scotland. It appears to me that the current Labour administration at Westminster is just repeating and carrying on the failures of their Conservative predecessors – just doing it more quietly and subtly and all to the demerit of Scotland in particular.

We must stir with urgency to address fair pay, improved conditions, and recognition for the critical role care workers play.

We need more than words of gratitude. We need investment that reflects the true value of care, creating a sector where workers are supported, respected, and empowered. Without this fundamental ingredient, the structure collapses, and the system crumbles.

A sustainable sector: the sweetness of inclusion

The dried fruit in our pudding brings sweetness and depth, much like a human rights-based approach brings dignity and fairness to social care. As we work towards embedding the principles of Scotland’s National Care Service, we must remember that all parts of the sector need to have a voice at the table around which decisions will be made about its future.

The recent debates around the National Care Service have been fractious and territorial and one thing I am clear on is that reform is urgently required and that cannot be the continuation of a status quo where control and power are vested in the interests of local government. There needs to be a power-shift towards those who use and work and deliver care and support and not those who contract and commission, and control in their own vested interest.

There needs even more immediately to be a recognition that the charities and private organisations that deliver the majority of social care in Scotland, must be heard when we say that we are simply not sustainable. Urgent attention to the National Insurance issue both in terms of Westminster mitigations but also in terms of the Scottish Budget is an imperative. The media has rightly picked up our concerns about the care home and hospice sector, but it is even more fundamental that we address the fact that without intervention large parts of our homecare sector will simply collapse.

If a care home dedicates around 75-80% of its running costs to staffing that figure is closer to 90-95% for most homecare organisations. If you are as they are then faced with a 30% increase in staffing costs because of the UK Labour Government Budget including NI then the sums simply don’t compute and there is only one answer and its closure. If care at home organisations close in large numbers in Scotland, people who require support in their own homes will have to be admitted to hospital and those in hospital will not be able to return home. The scenario is nightmarish in proportion.

Integration and collaboration: stirring together for strength.

A pudding’s ingredients only become cohesive when stirred together with care and intention. Similarly, social care cannot operate in isolation. The urgent need for true integration between health and social care must be prioritised – not as an afterthought but as a foundational principle. We are light years away from such integrated, cross sectoral working and it dismays me that work in this area is the first to be cut when budgets are stretched.

Stirring collaboration means breaking down silos, aligning policies, and ensuring that care is seamless across every stage of life. From hospital discharge to home care, the journey should feel like a single, supported path. Winter reveals the weaknesses of disjointed systems; we must mix and work together for strength. If we are not all working together, we are working apart.

Community and solidarity: the binding spirit.

Finally, no pudding is complete without the touch of brandy, whisky or spirit to bind it all together. In social care, that spirit is community – our shared responsibility to care for one another. This is not about maintaining people as they are but working to enable them to live their life to the fullest in care home and own home.  As the frost deepens, the cost-of-living crisis bites harder, as people really begin to experience the devastating and potentially deadly effects of the withdrawal of the Winter Fuel Allowance as a universal benefit in Scotland, and vulnerable individuals face greater challenges, the power of community becomes even more vital.

Social care is not just about services; it’s about people, relationships, and connection. We must weave solidarity into every decision, ensuring that no one is left behind, whether they are a unpaid family carer, a supported person, or a family member navigating the complexities of the system.

As Stir Up Sunday approaches, let us each take a turn to stir the mix for social care in Scotland. The ingredients are before us: workforce investment, a sustainable and funded system, integration and whole system working, and community. But it will take collective effort, political will, and a shared vision to create something that truly nourishes and sustains us through the challenges ahead.

The frost may be appearing, but winter is not a time to despair. It is a time to prepare, to strengthen, and to stir hope into our efforts. Together, we can ensure that social care in Scotland rises to meet the needs of its people – rich, robust, and full of promise.

I leave you with some of the words of the Scottish poet Gerry Cambridge who captures the interplay between winter’s harshness and the promise of renewal in his poem “Processional at the Winter Solstice.” The poem portrays the desolate end of the year, with imagery of darkness and frost symbolising death and stillness. However, it also hints at the return of light and the rebirth of the sun, reflecting a sense of hope and the cyclical nature of seasons.

Now, let us roll up our sleeves. The pudding won’t stir itself.

Processional at the Winter Solstice.

He has gone down into darkness at the wrecked end of the year
And is lying, gaberlunzie, in the needled nest of frost.
The arctic thrushes call for him although he cannot hear,

And the worm too understands him in the chilled grip of its dark,
And the ptarmigan in blizzards where no thought is worth a crumb,
And treecreepers in shivering puffs in Wellingtonias’ bark.

Shop windows glint in city lights like ice and sky, but still
No tinsel gifts can touch him, freed to silence like a stone’s;
His face is white as paper’s white in miles-high midnight chill.

He lies as plain as frost-dust where those starving thrushes call,
And his lime and ray-struck armoury could hardly be less small
On the anvil of beginnings in the sun’s gate on the wall.

Gerry Cambridge

from Notes for Lighting a Fire (Glenrothes: HappenStance, 2012)

Processional at the Winter Solstice by Gerry Cambridge – Scottish Poetry Library

Photo by Bruna Branco on Unsplash

Donald Macaskill

There is never a dull moment in the world of social care in Scotland. In the past week we have ongoing debate about the National Care Service culminating in the decision of the Scottish Government to pause the Bill Stage 2 process and to return to the matter in 2025. This decision has been met by some who think it means the end of the Bill and by others who wish it did, and yet others who are both confused and disappointed.

I mention all this because yesterday was the Scottish Care Care Home conference. This annual event brought together care home providers, managers and workers, together with other stakeholders and partners from across the country. It was also an opportunity to hear from some of our political leaders, including the Cabinet Secretary Neil Gray, about their position on a whole range of issues, not least the National Care Service.

However, for most of those there the number one issue was not the future shape of social care (however critical that is) but whether they would be around to see it. Yesterday Scottish Care published a summary of some of our latest consultation with our members about the implications of the Westminster Labour Government’s intention to increase the National Insurance threshold and rates. Our research indicated that of those who responded to a survey in the past week, nearly half (48%) of care home and homecare organisations noted the very real possibility of service closure as a result of this increase.

In our media statement I said that:

“These additional pressures on social care providers created by the UK Budget announcement are unworkable in the current climate and a solution, either through exemption or funding, must be found in order for the social care sector to be sustained. Scottish Care is incredibly alarmed at the figures presented in our survey, not least around service closures, with many providers indicating that this may very well be the straw that breaks the camel’s back. It is no exaggeration to say we will lose swathes of social care provision in Scotland unless urgent, practical and resource-based solutions are progressed for the sector. If not, the impact on individuals, communities and public services will be catastrophic.”

It was in the context of such a troubling background that together with my colleague, Scottish Care’s Deputy CEO, Karen Hedge we ended the conference by focussing on the Four V’s which lie at the heart of Scottish Care’s recent Strategy document. What follows is a summary of what we shared:

Visible​

Social Care that works for Scotland ​

In order to move forward you need to know who you are …

Scottish Care is essentially a membership organisation – we represent the greatest diversity and range of providers of social care in Scotland indeed probably in Europe – from care home to homecare, housing support to respite support. From small single operators to large corporate organisations; from rural to remote and urban to town.

We are an organisation driven by social values. We aim to ensure that social care in Scotland is not only sustainable but also exemplary, reflecting the high standards and compassionate care that our communities deserve.

The problem is that a lot of people do not know what social care is – we have got to the stage of it being seen as the release valve for the NHS on the one hand (not least around delayed discharge and avoidable admission) or as a set of services which is about maintenance and keeping people safe – it is so much more.

It is about flourishing and thriving – about citizenship and contribution, it is about challenging the discrimination of age and the limitation of conditions such as dementia.

social care is rather:

‘The enabling of those who require support or care to achieve their full citizenship as independent and autonomous individuals. It involves the fostering of contribution, the achievement of potential, the nurturing of belonging to enable the individual person to flourish.’

It is time for social care and care homes to be seen for what they are  – contributors and not costs, enablers of life and not limiters of freedom, places of thriving lives and not ante-rooms of the end days.

As a society we need to shout loudly about the brilliance of compassion and the dedication of our care homes staff and managers in the delivery of a society which values all.

We are here to build the possibility of a society that truly values care, and walks the talk of the rhetoric of priority.

Viable

Scottish Care also published yesterday our report on Ethical Commissioning which states clearly that we need to radically reconceive the way in which we commission and contract care services into a model which embeds human rights at its heart. It centres its focus on rights, respect and redistribution. People deserve high quality social care and support focussed upon human rights

Social Care is experiencing an increase in demand at the same time as a decrease in resource and it remains a net contributor to the economy. It is time to think differently and sustainably.

We need to start thinking about the potential for social care to be an economic and societal driver rather than using the language and mindset of cost and drain.  We need to focus on human rights – work collaboratively across the health and social care system in the preventative space and beyond, to make sure that people can live with autonomy for longer.

This all requires that we approach each other with mutual regard and transparency, creating trust in a system built upon robust cost of care modelling and funding this by reducing duplication and bureaucracy, bridging the implementation gap through a redistribution of funds.

We also need to support our amazing social care workforce through the implementation of Fair Work principles and sectoral bargaining, but we need to do this in a planned way with appropriate procurement measures. The implication and implementation of the Employee Rights Bill and the UK Budget have to be recognised both at Scottish and UK level. Almost half of our members responded to a survey on the budget saying that they may not be viable with the changes to National Insurance contributions alone, if these are not carried through into funding.

What we have stated before of net-zero is true still of commissioning:

“Many of the concerns circle back to the long-standing issue of insufficient funding available in the sector and the undervaluing of social care. Changing mindsets to focus on sustainability in the commissioning and procurement processes would be beneficial to implementing long-term change”

We no longer have a National Care Home Contract which is fit for purpose ands indeed the financial gap between true cost and public funding is between £4-500. Such a contract limits and the moral step away from funding the true cost of care cannot be excused.

​Valued​

At some point, everyone in Scotland is likely to experience care and support either directly themselves or indirectly for their loved ones.

It’s time to celebrate social care, a sector that makes a difference every day for the people of Scotland, whether you access, work in or provide it.

Despite the shelved human rights bill, we put human rights at the front and centre of our work, we know that value lies in people, not process but we need to do more to address discrimination in our society. Discrimination in our legislation which excludes older people living in care homes from access to self-directed support,  discrimination which has become so pervasive against older people we do not even notice it is there.

And societal discrimination in the form of microaggressions which for instance maintain that it’s women’s work, worthy only of a living wage, rather than a professional wage for professionally qualified and regulated individuals. That it’s women’s work, thinking which a recent study as part of IMPACT showed that deters men from considering a role in social care because they are too worried what their family might say thus perpetuating the myth.

Everyone in this room knows the worth of social care and support through the significant contribution it makes to society and our economy. Through the difference that it makes to our lives and in the measurement of humanity.

It’s time we broke through those barriers and set things right. It’s time for a care revolution to bring us social care that works for Scotland.

​Visionary​

All of us recognise that the seeds of change are rooted in the present moment, that the future is not an alien country but one we must all be citizens of. We can never stand still, we must always be re-imagining our today in a new direction.

So that is why Scottish Care is continually committed to asking the hard questions – what will a care home need to look like? How do we make services and support truly person-led with the citizen in charge and our services and staff there to enable them to direct their living?

That’s why technology and digital solutions and the emerging role of Ai are not a fad or a distraction but central and critical for the delivery of quality and rights-based care and support.

That’s why we will use design approaches to work with a range of stakeholders so that the people in this room and those who use services and support in care homes are at the forefront of coming up with a vision of tomorrow.

Whether through our work on data or research and policy we will continue to listen to the best the world of aged care has to offer in all corners of our globe, bring insights into this place and help to re-shape plans and possibilities into realities and revolution.

An American actor once said:

“Tomorrow is the most important thing in life. Comes into us at midnight very clean. It’s perfect when it arrives and puts itself in our hands.”

We all of us have the potential to create a vision of the possible for social care in Scotland, we can work together from all political standpoints to put aside short term self-interest and partisan positioning and identify what we can agree on and re-shape that tomorrow.

Tomorrow is fresh and full of possibility, if we dare to allow all that stops us from working together to be set aside.

Donald Macaskill

Karen Hedge

Photo from Joshua Sortino from Unsplash