What price dignity? The state of social care in Scotland today.

This week’s blog is partly based on a talk given at the Care Roadshow, Hampden Park on Tuesday 18th April.

Dignity has always been an important concept and word for me. In part because having worked in the equality and human rights field it is one of the bedrocks upon which our modern ethical, moral, and legal frameworks have been built. Indeed, the opening words of the first Article of the United Nations Declaration of Human Rights declares:

All human beings are born free and equal in dignity and rights.

There are essays and books, PhDs and poems, written about what dignity means both legally, philosophically and in practice. Indeed, there is an important current debate about whether human rights as a whole and dignity specifically are indeed inherent and part of our DNA as human beings or if they only really become meaningful with our belonging to a State as citizens which enables their fulfilment and realisation. In truth we know that simply saying something does not make it true. Without the power of a State our rights are meaningless – and indeed as too many of us know even with the so-called validation of a Government our human rights can be but paper aspirations.

But I think there is something different about dignity – my belonging to a community may bestow me with human rights but if I lose citizenship or association for whatever reason – I do not I would contend lose my right to be treated with dignity.

Now however fascinating the philosophical debates might be I am not going to go there. I am going to assume that part of our humanity is our human dignity and the right to have that dignity upheld, protected, furthered and nurtured.

But what is this dignity? What does dignity mean to me and perhaps more importantly what should it mean in the context of social care and support.

The dictionary is clear and emphatic. Dignity is defined as

‘the state or quality of being worthy of honour or respect.’

And then there are a sample of other definitions. In fact, despite its centrality in the delivery of person-led social care there is no consistent universally agreed definition. I haven’t got a problem with that because the very nature of dignity and rights, should be about the dynamic of undefinable human relationships meaning that in different contexts, for diverse peoples, and in multiple dynamics dignity will mean different things. It truly is in the perspective of the beholder and the community in which they are living and relating. So it is that one group the Social Care Institute for Excellence (SCIE) states:

“Dignity in care means providing care that supports the self-respect of the person, recognising their capacities and ambitions, and does nothing to undermine it.

One homecare organisation, GoodOaks Homecare says:

“Giving people space and time to do things at their own pace. Giving people a choice over their care options and asking their preferences for care. Giving people autonomy over their lives – from the choice of what to wear, to what to eat and what to do. Making sure someone is not in pain.”

There are lots of common threads in most of the definitions you will come across– and I think they are each of them true up to a point. A few years ago I did an exercise in which I asked a group of participants two questions: What makes you feel that you belong, that you matter? Then I asked them if someone is treating you with dignity what does it look or feel like. The two lists were remarkably similar and both suggest a dynamic positivism to what dignity meant – it wasn’t something to be taken off a shelf – it was personal, active, participative and owned.

There are I think some key characteristics of dignity which appear in all the definitions and in what people themselves say. The group I worked with both described what it felt like and what it left them with a sense of:

  • I was heard and not just listened to.
  • They gave me time to talk and tell.
  • They treated me as an individual not as another case.
  • They spent time and got to know me.
  • They came up with really practical steps.
  • They believed what I was saying.
  • Nothing was too much for them.
  • I felt as if I had known them for years.
  • They allowed me to make mistakes.

So, dignity in care – in social care – is a really life-affirming experience that places the person not in the centre but in control – it is a dynamic of relationship which results in an altered experience for both supported person and carer.

Over the years I have increasingly come to know that dignity is at the heart of social care and support.  But dignity does not just happen; dignified and equal treatment isn’t an accidental occurrence but a determined action. Dignity has a price and a cost, and it is something that demands prioritisation, planning and focus for it to become the lived experience and encountered reality of citizens. The question therefore has to be asked, and continually articulated, is whether or not in contemporary Scotland the way in which social care and support is delivered meets the dignity standards – and whether given those come with a cost attached we have as a society been and are prepared to pay the price for dignity?

Three brief reflections to get a sense of the price of dignity today.

Actual delivery and value.

I have often commented in the weeks that have preceded this blog that I fear there is a lack of adequate appreciation of the value and contribution of social care support. One reason is that we continue to use the perspective of the NHS and clinical care as the means by which we assess and articulate the value of social care. That is a fatal error because it fails to recognise the potential of social care and its distinctiveness. Perhaps one of the reasons that integration has so often failed in some parts of Scotland is that key stakeholders have failed to understand the contribution, voice and distinctiveness of those who are not part of their world – be it acute/secondary NHS or social care.

For me you cannot work alongside another unless you understand or at least attempt to know their language, their contribution, skills and assets. Social care and support is about enabling independence, choice and control, autonomy and voice. Also, in no small manner the social is what really matters here – it is not just care or support on their own it is social care -connection, relatedness, community, citizenship – all matter. Coincidentally the minds behind the Social Work (Scotland) Act of 1968 were of similar orientation, rooting a communitarian focussed idea of the social at the heart of care support. Social care is not solely about supporting an individual it is about supporting their connectedness to citizenship and their ownership of place in relation to others.

I do not think anyone can understand modern social care and support without also being aware of the civil rights context most especially of the disability rights movement in the 1960s through to the 1990s.  Whenever I hear commentators say we should return to health running everything or turn everything over to the NHS I quake – for years people literally fought to get out of the clutches of the healthcare system, to escape a health oriented clinical model and approach to disability, lifelong conditions, and older age; to shut down the institutions and asylums, to move people out of geriatric wards and units.

The last thing we need is a return to a health-oriented approach to living independently. Social care is not health care. Dignity is at risk if we fail to protect the distinctiveness of social care. It is a price not worth paying even if it seems an illusory answer.

Workforce

In his first policy announcement to the Scottish Parliament on Tuesday last the former Cabinet Secretary for Health and Social Care and now First Minister Humza Yousaf intimated his desire to move towards paying frontline social care staff (though specifically he only mentioned staff in adult services) the £12 an hour which organisations like my own have been campaigning as the starting point for a just, equitable pay award. There was no timetable although I am led to believe that this is being urgently developed. Dependent upon the illusive timetable this is a step in the right direction. Whether it is in time to rescue the faltering and disintegrating social care sector needs yet to be determined. Sadly, in the last few weeks, as NHS colleagues are being rewarded over 19% more for doing the same work of care support compared to their social care colleagues, there has been a growing number opting to leave the social care sector, leaving us even more critically unstable and at risk. The failure to properly value All social care staff in the same measure as colleagues in the NHS has been a massive politically opportunistic error. It will unless urgently remedied fracture perhaps irreparably the social care and health cohesion of our communities. What is the price of dignity for our social care staff? Because at this juncture of time it would appear it is one that our political leadership is either very slow to pay or worse is simply not willing to pay. Even if we were to start paying workers £12 an hour tomorrow there would still be an unjustifiable gap of unequal treatment.

Lack of focus on those who require social care especially older people and their carers.

Lastly what of those who are the folks who receive social care and support, who use our care homes and are supported at home, our day services and opportunities, our housing support and sheltered accommodation. What of the tens of thousands of family and unpaid carers who have borne the burden of our community for so so long with but passing regard and recognition, and precious little support? This has been an especially hard winter and we are by no means out of its throes yet. Too many have sat in silenced hunger and in crippling cold for fear of debt and impoverishment. Too many have felt the dignity of compassion absent from their living. The price of dignity has been found to be not worth paying in so many ways not least as local authorities have chosen to make swingeing cuts to community-based services in order to balance their budgets, and I fear disproportionately these have impacted the older citizen in many communities.

Faced with what has been for so many perhaps the hardest winter to live as an older person in Scotland in recent times, it was unbelievable to witness the failure of our new Government to continue to support a distinctive Government post of Minister for Older People. Some have questioned the value of the role, but I would suggest that regardless of the postholder that having someone at the table of decision-making who ‘should’ be advocating for older persons is critical. That is one reason I and others have enthusiastically supported the campaign launched by Age Scotland.

What is the price of dignity? From eligibility criteria which are so high you need to be close to death to the failure to recognise the distinctive and unique mental health challenges faced by older people; from budget cuts at the heart of older person services and a lack of prioritising of older person issues – it would appear a price again too high to pay.

The Portuguese Nobel laureate and writer José Saramago once opined that:

“Dignity has no price, when someone starts making small concessions, in the end, life loses all meaning.”

I wonder if in terms of social care and support in Scotland in regard to our valuing of the sector and what it offers and is; the valuing of our workforce, and the valuing of older persons in general, whether we have long since stopped paying the price of dignity?

Donald Macaskill

The arts and ageing: an invitation to connection, inspiration and reflection.

The following blog is the text of an address given on the 28th March 2023 at the Luminate ‘Arts and Ageing’ Gathering at the Festival Theatre in Edinburgh.

 

When I was asked to say a few words at the start of this event I did I have to confess wonder what I could say that I haven’t said already to a good number of you over the years – and although I’m a great believer in re-cycling I thought I should at least say something new lest I fall foul to the accusation that with age comes the repetitiveness of remembrance. That’s not to say that what I have said in the past isn’t worth repeating – he says defensively – indeed at the start of this contribution I want to underline a challenge I have often given – especially on the first full day of a new First Minister.

I want to ground all that I say in a few minutes in the earth that the human right to creativity, the right to self and artistic expression, is a fundamental human right. And we need to see that right visibly and vocally articulated in the new Scottish Human Rights Act when it eventually appears. This is not the stuff of occasional opt in, less important than other interventions, do when you can or when resources allow – all that we do today and reflect upon is as fundamental and as intrinsic and as critical as the adequate resourcing of the rest of our civic and individual belonging.

But I have decided to hang some reflections this morning on the words of invitation to join this event – because for me – amongst other things the arts and ageing are about exactly what we hope to get from the event today – namely connection and inspiration and reflection.

Connection is intriguing especially for us solitaries in the room. Yes, I recognise in the words of the poet that no one is an island and that we are all part of the main – but I’m sure I’m not the only one who you know sometimes just wants to be alone! I want to find that corner in the room that encloses me in the security of encounter on my own terms.

I was chatting to someone contemplating going into a care home recently and the one thing that was putting him off – was the thought he would have to be with people 24/7 – that there would be loads of groups and forced camaraderie. That there would be no place for privacy to hide to take off the mask of pretence we all show the world and simply just to be! Now of course that’s a stereotypical fear – and I’m with him – but the truth is much more complex and subtle.

The creative arts whether they are used in care facility or community setting; in one’s own home or in your local – do indeed have the potential to connect, to meet loneliness and break down isolation but they also have the capacity to offer privacy, to help you to discover your individuality and become stronger in your sense of self and identity – in truth the arts are for both islanders and mainlanders.

When I think of connection the image that comes to mind is Avril Paton’s Windows in the West – you probably know it – as someone brought up for many years in a Glasgow tenement it expresses for me what that uncoordinated accidental connection is and portrays the mess of living in community in all its glory.

I could spend a morning exploring the story behind each window, the children fighting, the lovers yearning, the couple settled into slippered age, the partners re-designing avoidance, and so on  – it’s a painting that for me represents a deeper truth about connection, living in community and in proximity with others;  the truth is that people who come together under the canopy created by the creative arts are able to be empowered to be themselves, to live their lives anew and afresh, to choose to be in connection or apart. But always to be changed. The creative arts have both the ability to affirm individual identity and creative community, collective cohesion and passion.

Connection cannot be forced – you just create the moments for happenstance  – the creative arts are the hospitality makers of place and space that enable connection and which provide the nourishment to keep it going when the being one with another becomes tough and challenging.

So today as we connect to one another – can we also think about how we use our work to allow others to connect. Are we creating enough emptiness for connection to happen or are we predictable in our design of the moment; have we created enough silence for language to be heard or have we suffocated the echoes of personal story by intrusive commentary? Do we create the space and place for being in community and the even harder moments of nurturing the aloneness which is essential for connection?

Inspiration is the second expectation and hope for today. For those of us in this room the connotation of age with inspiration is self-evident and natural. We know that the art of imagining and the power of the imagination to restore and renew does not have a use by date. We have witnessed folks in very late age discovering for the first time or anew the power which the creative arts can bring to their sense of self, their image of the world, they have refreshed the person, people and community they want to be.

We have seen the moments of pure joy when someone discovers inside themselves the words they have always wanted to articulate; when someone paints the image that has struggled to take form and substance; when in touch and movement a new expressiveness is born, and a new story is told.

We know that just as it’s important to ask older people how they want to live in their future, so we need to make sure we are nurturing the imaginative dimension of human living and loving well into older age.

The creative arts at their best are the midwives of an imaginative birthing that brings new possibilities, unimagined dreams and unheard-of possibility to older age.

Even in the latter days of breath there is still a desire to be someone to someone; to do something new; there is still a yearning to find, to discover, to experience, to be changed and to explore.

The power of imagining the places beyond the known and the realities beyond the possible do not decline as we age. They just take a different form and more than anything they need the creative arts to foster and nurture their birthing.

But as Anne Gallagher in her opening address has challenged us are we in danger of making our art fit into a clinical science; to perversely limit the boundaries of creativity by being too focussed on outcome and discernible benefit; by using the metrics of identifiable and quantifiable science instead of the dynamic of experience and moment, intuition and instinct, encounter, and expression?

I have always and continue to believe that there is a massive primary nontherapeutic value in the arts – they are valuable in their own right not as something which improves one or changes you – and I know that there is a fine balance there – but when I listened to Mozart in my twenties, Springsteen in my thirties, Natalie Merchant in my forties, Taylor Swift in my fifties – my primary motivation was enjoyment and the experience – is there a danger I wonder especially in resource constricted times that we develop too reductionist an approach to the creative arts in terms of ageing?

And I wonder if maybe there is one specific area where more than any there is a risk that we turn our creative arts and their contribution into therapeutic value and outcome – and indeed that we are only funded and resourced where we can show benefit and improvement in a neurological and clinical sense – and that is in terms of dementia?

A diagnosis of dementia as most of us in the room will know is not a full stop in the grammar of creativity but a new paragraph – but we must be wary of the dangers of presumptive response – I think we must give space to be shocked and surprised – to be pulled away from predictable expectation and onto a journey with the person into new territories of the mind and landscapes of the heart. Life with dementia is not about maintenance it is about living to the full.

I feel an increasing sense that especially in the way in which we support people with advanced dementia that we spend too much of our time in the country of yesteryear – that too much focus is placed on memory and moments and experiences and tools of recollection and remembrance. There is clear neurological benefit in that – I am in no way denying that – but there is also clear benefit neurologically in enabling people to discover the new as well as re-discover the old, to create anew as well as to re-member, to begin afresh rather than re-visit – there is a warmth and comfort in the familiar but there is also a liveliness, an energy, a passion and joy in the new sound, the new place and in the new creation.

The last of the three themes is closely related to what I have just said, and that is reflection.

Reflection in older age is palpably different from the reflective snatches of living we have when younger – and so it should be – because to deny the reality of a life well lived is absurd. The pace slows and changes – rhythm finds a new beat and novel movement – but what glorious richness we have in older age!!! A lifetime of the raw clay of encounter and experience to be moulded into the creation of the present moment pregnant with time lived and lives loved.

We need to give people the opportunity to find their own expressiveness and to discover the language that may have lain dormant within them or indeed to have been deliberately suppressed because of negative stereotypical attitudes to the arts or the contribution and worth of the arts in society.

I think at times we are fearful; of leaving people who are older to reflect lest the pain of memory grip too hard – but there is nothing truly to be feared from the quietude of age; there is no coldness in the absence of activism; for so many it is in the space between the sounds that we learn to understand a new language, form a new way of looking at the world, and to feel restored and renewed in our own selves.

Conclusion

So active creativity has a unique place in the ageing of our society, in active, passive, accepting, challenging age. But we are not talking about waiting for the tick tock of finality as if we are passive recipients of the inevitable. No way.

I believe for all ages the creative arts are a call to purposefulness and decision. One of my favourite poets is the American Mary Oliver who in 2020 wrote in ‘The Summer Day.”  It is a rich poem which describes life and existence from the perspective of a grasshopper. It finishes with these words:

‘I do know how to pay attention, how to fall down into the grass, how to kneel down in the grass, how to be idle and blessed, how to stroll through the fields, which is what I have been doing all day. Tell me, what else should I have done? Doesn’t everything die at last, and too soon? Tell me, what is it you plan to do with your one wild and precious life?’

You will quite possibly have seen the last two sentences quoted in many places. But for me –  for later age the power of the poem is in the question

‘Tell me, what else should I have done?’

What else is there but “falling down in the grass, being idle and blessed, strolling through the fields all day.”

As others have argued this is a ‘provocative question. What is a purposeful productive day as you age? Is it not the contradictory wild impressiveness of the idle industry of a grasshopper? Is it not the creativity of the self for the single outcome of energising the moment? Is it not about the surprise of the encounter, the binding of belonging and the silence of reflection?

Everything dies at last Oliver reminds us – alas ‘too soon’ – the creative arts at their best I believe encourage us to live intentional and not accidental lives, to be the directors of our own play rather than actors for another’s text, to mould the clay of our being into the shape of our desire, to pen the language of our yearning and to dance the steps of our choreography.

What do you plan to do with ‘your one wild and precious life’??

That is a question for all ages.

The creative arts perhaps especially for older age more than anything I know pose that question every day and give the whisper of an answer in response.

Keep adventuring for you do not know the change and contentment, the joy and exhilaration, the pathos and the soothing you bring in the work you do. And let us today and all days connect, inspire, and reflect together.

Thank you

A video recording of this talk as it was delivered can be found at https://luminatescotland.org/resource/arts-and-ageing-gathering/

 

 

A spring of potential: social care lies dormant.

Yesterday along with what felt like the whole of the west of Scotland I went to Culzean Castle in Ayrshire. On a gloriously bright sunny even if not hot day this National Trust treasure on the Ayrshire cost was alive with thousands of individuals. In no small part I was there to find the treasure at the end of an Easter Egg Hunt, as I was walked around the estate searching for the 14 clues that would lead to the prize of chocolate delight. But as I left hours later foot-sore but renewed and refreshed it was not the chocolate that was uppermost in my mind (okay just a bit) but the beauty of the sights and visions which I had witnessed. And as I left and reflected the entire day was summarised for me in one word, dormant.

I don’t think I have ever before felt that one word described so fully the panoply of images that I had seen in the hours I spent at Culzean. Dormant is defined in the dictionary as ‘having normal physical functions suspended or slowed down for a period of time; in or as if in a deep sleep.’ ‘alive but not actively growing.

Everywhere I looked there were signs of buds coming through the hard earth, of trees wakening with fruitful promise, roses yawning into the early steps of a summer of blooming beauty. The whole place felt like I had walked in on the final minutes of a deep long winter sleep, as signs of spring and life beckoned the viewer into the beginnings of something new, unique and radiant. I have never before in such a complete sense caught that sense of spring, of hopefulness, of expectation.

I am sitting here writing this very aware that this is the Easter weekend where for millions across the globe the sense of expectation is one of anticipating tomorrow Easter Sunday, a day re-orientating the worlds of believers once again to re-direct people to hope, to new life and resurrection. It is a season for creative new beginning, restoration and renewal.

Whether because of a religious festival, or because of the visible realities around us there is indeed today a sense of the dormant. Of a world birthing possibility into being, of pregnant hope about to be born into possibility.

These last few weeks I have spent much time writing and talking about the challenges facing social care in both the care home and homecare sector in Scotland. As I sit here this Easter weekend, I have too much evidence before me that we are at a point of real criticality where the next few days and weeks and the political and fiscal decisions made during them will have a profound and lasting effect on our whole society and not just upon social care.

But I am also increasingly aware of the dormant nature of social care in Scotland. This is a sector whose tens of thousands of paid workers and whose tens and thousands of unpaid carers, exhausted, diminished and drained as they are have so much indescribable passion left and so much untapped and unappreciated potential. This is a sector who like a volcano lying dormant through decades has so much potential to burst into flame and fire. This is a sector which like the butterfly lying dormant has the potential to take flight into beautiful creativity.

Social care is not and never has been a set of transactions and tasks, it is a way of relating to another which enables someone to be supported to live their lives as they want and need to, to achieve their potential, to flourish, thrive and come alive. Social care is not about budgets and balance sheets, its about relationships and the realities of loving and living in community. Social care is about connection and aloneness, about being heard and hearing absence. Social care is the giftedness of skilled professionals who have the capacity to be with others at the cutting points of pain and emptiness, and the skills and gifts of being able to grant assurance, offer direction, and uphold despite all.

There is so much potential in our social care workforce if only they were better valued and recognised, rewarded and remunerated. There is so much giftedness in those who support and care for a loved one in family home and neighbourhood, if only we valued and recognised them better and gave true respite and support to their loving and giving. There is so much that the women and men who live in our streets and villages and do so by support and care have to give their communities and neighbours. There is so much more that those limited by age and disability, by condition and circumstance, have to give to their local places and people, if only we could as a society and political leadership allow that offer to be made through our action of establishing a properly resourced and prioritised social care system

The potential of social care in this spring weekend, to transform the whole of our society and community is enormous. The ability of this sector and its talented workforce to be the agents of a wider societal renewal and re-orientation is beyond description, if only we treated it and them as a sector worthy of investment, priority and economic recognition.

Dormant is a word which today describes social care in Scotland but that which is dormant can either come to life, and resurrect the whole of living, or it can stay untapped and unreleased, a potential lost by the failure to recognise its contribution. It is time to wake up the sleeping potential of social care for the whole of Scotland. In this season of hope and expectation, it is time for social care to be allowed to come alive and change us all.

Donald Macaskill

Turning hope into reality: social care’s aspiration.

When I was growing up, I was often accused of being a dreamer – of spending too much time imagining a world of possibility that never seemed to come true. As I have aged, I suspect I dream less but I probably spend a lot of my time hoping and trying to make my dreams and visions into some sort of reality.

Last Tuesday I watched the four party political leaders in Scotland’s Parliament putting themselves forward as candidates for First Minister, albeit that there was an inevitable theatre around the coronation of Humza Yousaf. Later that day I was attending an event in the Scottish Parliament as Chair of the Board of Trustees of the community development organisation Outside the Box. During that parliamentary reception we heard from individuals who had struggled to be noticed and included because of discrimination against their race or because of a disability they had but with the support of Outside the Box they had discovered voice, direction and had addressed discrimination. It didn’t happen by accident but by action. The hope for a better Scotland is birthed by the hands of positive change.

As I sat there in parliament a place where every visitor is told that ‘this is your parliament’ I reflected back on watching that very building take shape and form years before, and of the words spoken, speeches made, and laws and policies articulated within its walls. It has been a momentous and historical week with the departure of our longest serving First Minister and a new incumbent embodying diversity. We have witnessed a new Cabinet with a majority of female ministers and in the case of Health and Social Care both a new Cabinet Secretary and Minister. A lot of change.

I could not help on that day as I sat in the Parliament and in the days since but think about one of my grandmother’s favourite Gaelic words ‘dòchas. Technically it means hope and in so many contexts she would often finish a sentence with the phrase ‘I hope so’. She didn’t use is as an expression of resigned fatalism or wishful thinking, no she used it as a commitment to make sure her aspiration was grounded in the action necessary to bring about its fulfilment. ‘Dòchas carries with it a sense of purposeful expectation, trust and reliance. It is that sense of determined hope which I want to briefly reflect upon here.

Over the last few weeks in this blog, I have written about some of the challenges facing the social care sector in Scotland. The challenge of a workforce which feels devalued and unappreciated because for doing a similar job in the NHS you are likely from today to be paid around 19.8% more. The challenge of a workforce continuing to expend its energy and creativity in care home and homecare and yet it does not feel fully appreciated or valued as the professional, registered and qualified individuals that they are. I have written about the urgent need to recognise social care as a sector of tremendous societal, economic and community value and the urgency of seeing social care as essential in its own right rather than just seen through a myopic lens which values the NHS above all else. So I have to say it was with disappointment that I read NHS Recovery in the job title of the new Cabinet Secretary – as if yet again social care and its need for recovery was marginalised and unrecognised.

In the last month my own organisation supported by numerous others has argued and campaigned for the urgent need for the whole of Scottish society to #careaboutcare and to #shinealight on the amazing women and men who work in social care the length and breadth of Scotland.

It has been a stimulating and inspiring month of March as I have heard and been told first hand of some of the amazing, pioneering, innovative and entrepreneurial work which social care providers and their staff are undertaking across the country – work that makes a real difference to older adults and communities every single day. Work that fosters personal independence and restores community.

We stand at a point in time with a new Government and new Ministers when the horizon is both one of possibility but also one of very acute and anxious challenge. I am weary of the fact that it feels as if some of us in social care have been arguing the same things for so long, and the lack of resource for our workforce and sustainable investment into provider organisations seems to go from bad to worse.

But just as last Sunday the clocks leapt forward we have the real opportunity to collectively work together to make a real difference.

The next few weeks will be critical for social care in Scotland. If we have the courage and political ambition, then we will overcome what appear to be insurmountable barriers to progress. If we do not collaborate and collectively find that direction of purpose then I fear we are on the edge of system collapse and real failure which will primarily affect those who are supported and cared, and also those who work in the sector and who operate services.

‘Dòchas in the words of my grandmother is a hope pregnant with possibility, an aspiration which carries within it an intentional energy. So in the coming days and weeks we must all, politician and provider, unpaid carer and supported person, frontline carer and social care nurse, commissioner and regulator, act in such a way to positively put the verbalised hope into reality. I really do hope so because it is only then that the dream and vision of a Scotland the cares becomes the lived reality of all  and that we might finally achieve a social care sector which is valued, recognised, resourced and celebrated.

The Gaelic poet Myles Campbell expresses it well:

Dòchas –

rionnag anns na speuran.

Dùil –

rocaid agus rionnag anns na speuran.

Creideamh –

adhar làn rionnagan.

Cinnt –

grian a’ deàrrsadh

translated into English:

Hope –

star in the skies.

Expectation –

rocket and star in the skies.

Faith –

sky full of stars.

Certainty –

sun shining.

Source: Translation from Ronald Black (ed.), An Tuil (Polygon, 1999), by permission of Birlinn Ltd

From https://www.scottishpoetrylibrary.org.uk/poem/dochas/

Donald Macaskill

Creating a care and compassion economy

Within three days we will know who the new First Minister of Scotland will be and I am sure we will all be pleased for a degree of settled reality after what has felt to be quite a few turbulent weeks.  I have used this blog in the last few weeks to reflect on some of the priorities for the social care sector and to identify the critical needs of the care home, homecare, housing support and day services sector in Scotland, not least for our older citizens. I have attempted to articulate the urgent need for our incoming leader to address the critical issues of workforce terms and conditions and to be blunt the near collapse of many social care providers regardless of whether or not they are a charity, private organisation nor employee-owned organisation.

In the last few days, the candidates have been talking a lot more about their ideas for the economy. Clearly what they say on this matter has huge import for our ability as a nation to both prioritise and afford the sort of urgent reforms that I have argued for long are needed in the social care and health space.

One of the phrases that has been much used is the idea of a ‘wellbeing economy.’ Now there are many different definitions for a concept which has developed over the last 15 years or so, to the point at which it is now at the heart of the previous Scottish administration.

In a report published by the Scottish Government in late November last year, which provides a toolkit to support economic policy and strategy a fuller description is given:

“Wellbeing can be defined as ‘living well’ and is about ‘how we’re doing’ as individuals, communities and as a nation – and how sustainable that is for the future.

While definitions vary, a wellbeing economy can be described as an economic system operating within safe environmental limits, that serves the collective wellbeing of current and future generations first and foremost.

It is a system that empowers communities to take a greater stake in the economy, with more wealth generated, circulated and retained within local communities, while protecting and investing in the natural environment for generations to come. It provides opportunities for everyone to access fair, meaningful work, and values and supports responsible, purposeful businesses to thrive and innovate.

The approach recognises that reducing inequality and improving the lives of citizens through a human rights-based, social justice approach can also make the economy more resilient. It supports the transformations in our economy and society needed to thrive within the planet’s sustainable limits and capitalises on the opportunities this creates for improving people’s mental and physical health and wellbeing, tackling inequalities and supporting green jobs and businesses.”

It is rooted in certain core principles of Dignity, Participation, Fairness, Nature, and Purpose. Not much that could be disagreed with in all that. But what does it really mean? How can it be achieved? And is it all not just window dressing? Certainly, there seemed to be a bit of difference amongst the candidates for leadership of our nation not least in the role of wealth creation in such an economic modelling.

Alongside the concepts of a wellbeing economy there are other models and some of these are more focussed upon practical dimensions of human living. One such is the idea of recognising, valuing and in some instances creating a care economy.

This has and is gaining much prominence in the United States. One definition describes it as:

“the paid and unpaid labour related to caregiving such as childcare, elder care, and domestic chores—is a critical sector that enhances economic growth, gender equity, and women’s empowerment.”

The World Economic Forum has recently begin to argue that we need to reconceive our views of the importance of care as an economic driver, motivator and priority, not least since the impact and effects of Covid19. It argues:

“The care economy comprehends those activities that people perform daily, often in our homes, including chores or taking care of other persons, such as infants or the elderly. These chores, such as cleaning up a house or shopping for groceries, are typically not paid, and even less are considered productive.”

It is refreshing to read such a re-prioritisation. Is it time for Scotland to begin to explore the concepts behind a care economy? This goes way beyond those who deliver care and support to a re-conception of our whole economic framework into one whose central direction is the care cohesiveness aof the whole nation. It understands care as a critical economic driver with a primary aim which is inclusive of wellbeing but goes further both ecologically and economically. That is why compassion sits alongside care – the purpose of a care economic model is to ensure that all fiscal decisions are rooted in a compassionate ethic and morality. The weight of such a statement will not be lost on many who are facing the impacts of the savage cuts into social care and other provision being announced this last week by a number of Scottish local authorities. Perhaps the most distressing – in part because of volume has been those cuts to social care being accepted by Glasgow City Council who announced a £22m cut in budget. But there are other council areas proposing and planning even larger percentage cuts. There are going to be inevitable real losses as a result of these plans which will profoundly affect the lives of those being cared for and supported and those who work and care for and support them. In every sense they will limit care and cause harm.

There is a real opportunity at the start of a new administration to explore our whole economic modelling. The World Economic Forum has started work on the whole concept of a care and compassion economy. It has stated that whilst the care economy is usually not considered as a productive activity, because it is chiefly carried out by women, nevertheless data collected by the Colombian government demonstrates that the care economy could have a significant impact on a country’s GDP. It has with Colombia suggested a reform in the payment norms behind the care economy which would benefit women that can’t take other jobs due to time constraints. It has gone further by indicating that unpaid care which is fundamental to the cohesion of most economies should become paid or remunerated for in some ways.

A radical re-design of our economic basis is required which recognises that social care is a major economic contributor to the Scottish economy and as I have oft said should not be considered as a drain or deficit but should be reconsidered as an economic driver and asset to be built, developed and nurtured. Such a feminisation of economic priority would be a massive contributor in the re-design of our civic responsibility and economic modelling.

In the last month my colleagues and myself at Scottish Care have sought to #shinealight on the amazing women and men, organisations and bodies who deliver social care support across Scotland. We have sought to increase a message centred around the importance of us all beginning to #careaboutcare. That is in part an economic response which involves a re-prioritisation and a re-allocation of the limited fiscal resources we have as a country. I have argued against the injustice and inequity of social care staff being treated so discriminatorily and unfairly when compared to colleagues in the NHS.

If our new First Minister is to start to #careaboutcare then there are immediate practical first steps they can take to re-balance our health and social care systems. But in the medium to long term there are real opportunities to re-conceive our economy not solely on the basis of a wellbeing approach but one which explicitly advances and develops the ideas behind the ‘care economy’. I like the idea of living in a society where a care and compassion economy limits the likelihood of people having to decide to limit, cut or end the delivery of life-affirming care and support.

Donald Macaskill

 

 

Mothering absence: a reflection

This coming Sunday is Mothering Sunday or Mother’s Day. It is an opportunity to celebrate the role of mothers and women at this time of year which is not exactly a new thing. Indeed, Wikipedia tells us that such events date back to the time of the ancient Greeks who would celebrate Rhea, the Mother of the Gods and Goddesses, every spring with festivals of worship. The Romans also celebrated a mother Goddess, Cybele, every March as far back as 250BC.

It was under the Christian churches especially since the 16th century that Mothering Sunday began to be held on the fourth Sunday in Lent, exactly three weeks before Easter Sunday and was originally a day to honour and give thanks to the Virgin Mary. With it across the UK the practice of returning to the Mother Church to visit the mother church of your area and to see your mother began to be celebrated. The coming together of families and uniting children who had moved a distance away or who had been in service and work elsewhere was one that was much appreciated. It was in the time of few ‘holy-days’ an opportunity to have a day off and to spend it with your mother.

Yet it was not until the last century with an influence from the United States and Anna Jarvis that Mother’s Day began to be celebrated annually so much so that Constance Penswick-Smith created the Mothering Sunday Movement in the UK, and in 1921 she wrote a book asking for the revival of the festival.

It has grown and grown and there are few places you could go in a shopping street today in Scotland without seeing reference to Mother’s Day. For some that might induce feelings of guilt that they have not got a card or flowers or a gift, but for many others as I heard at first hand this week, it is a very visible reminder of absence.

In my work on bereavement, I have become increasingly aware of just how hard public anniversaries and celebrations are for those who are grieving the loss of a loved one. Mother’s Day has a special poignancy because of its presence in our communities and in the media at this time of year. For some it is a fantastic opportunity to remind themselves of the care and nurturing they have received from their mother. And after all that isn’t easy. There are no ‘How to’ books in terms of being a mother or indeed a parent. It is a journey made in the steps of love with all the trips and obstacles that a growing child experiences and a maturing mother knows. But for the vast majority who in adulthood have a healthy and positive relationship with their mother, it is a nurturing and bond which will remain with us forever. And that is what for so many makes this a hard weekend.

I have met Gary on quite a few occasions, and we communicate on social media. He is a widow with two children under the age of ten. He absolutely dreads Mother’s Day because it is such a visible reminder of absence and emptiness. But this year he has decided to face it head on and to use the day as a moment to mark memory, to celebrate the mum who is no longer around; through the tears of recollection to talk with his girls about their feelings and the aching soreness they feel that mum is not there to watch their dancing display, to read to them at bedtime, to go to the shops and chose clothes or jewellery with them and so so so much more. So this week he has helped his children to make mother’s day cards not to give on a breakfast in bed tray but to place at her gravestone.

This is a hard day for those who have lost their mothers and for mothers who have lost their children and for partners who have lost their lover and for grandparents who have lost their grandchildren. I hope we give one another space to capture a sense of the original Mothering Sunday which had to do with reconnecting to what and who were important in our life; less to do with cards and cakes. More to do with company and togethernes.

And today I cannot but think of all the folks I know, one of whom I spent some time with this week, for whom mum is still present but absent in a way that break’s their heart, taken into a space where dementia holds court and where memory sits apart. For them I think of Bob Hicock’s poem, Alzheimer’s.

Wherever our mothers are, be they beside us or inside our hearts, I hope tomorrow is a day of memory that makes life worth celebrating and love worth holding even closer.

“Chairs move by themselves, and books.

Grandchildren visit, stand

new and nameless, their faces’ puzzles

missing pieces. She’s like a fish

in deep ocean, its body made of light.

She floats through rooms, through

my eyes, an old woman bereft

of chronicle, the parable of her life.

And though she’s almost a child

there’s still blood between us:

I passed through her to arrive.

So I protect her from knives,

stairs, from the street that calls

as rivers do, a summons to walk away,

to follow. And dress her,

demonstrate how buttons work,

when she sometimes looks up

and says my name, the sound arriving

like the trill of a bird so rare

it’s rumored no longer to exist.”

from Plus Shipping, Copyright (c) 1998 by Bob Hicock. Reproduced by permission of The Permissions Company, Inc., on behalf of BOA Editions, Ltd., published at Alzheimer’s by Bob Hicock – Scottish Poetry Library

Donald Macaskill

Dear next First Minister of Scotland.

Dear next First Minister of Scotland.

I am writing this open letter to you all appreciating currently that you are very busy campaigning for the role as leader of the SNP and as a consequence as First Minister of Scotland.

You may not be aware that today is the last day of National Careers Week. It is a week where right across the country schools and colleges have been focussing on supporting young people and others to think about their next steps and future careers. In some senses for each of you the campaigns you are all now engaged are about taking your own careers to the next level.

You will therefore doubtless appreciate that the importance of helping young people and others who might be seeking a change in their job role or career is a key part of the work of organisations such as Scottish Care, representing as we do hundreds of charities, private providers and employee-owned organisations in social care who employ tens of thousands of our fellow Scots. As part of our month-long campaign #careaboutcare this past week we have been publishing videos and stories of those who work in homecare and care homes across the country. Who better to tell others of the amazing valuable role of care and support than those who are doing it every day!

Working in care and support is a job like no other. Yet what a care worker does today is unrecognisable to what might have been happening ten or twenty years ago, but we suspect that many people still hold an outdated view of the job of care. Care and support roles are regulated, they require the person to be registered and also over time demand that person gains a qualification. The women and men who work in social care are highly skilled professionals who undertake such important work. This is the life-changing work that helps people remain independent, live the sort of life they want, and if they require additional support to provide that in a way that values their voice, treats them with dignity and which places their control and choice at the centre. Working in care and support is an amazing role. That is why we spend so much time encouraging others as we have with young people this past week to consider a career in care. There are few jobs or careers which allow an individual to change the lives of others quite literally and to be with folks through the hardest and most challenging moments of their life.

I am sure you will therefore have no difficulty in agreeing with me that our frontline carers model the best of who we are as a society and that it is the responsibility and duty of those who lead us, who make decisions around budgets and how we spend our resources, to in turn treat our frontline social care staff with equal dignity, respect, and value.

Yet sadly that is not what we have been hearing in the days since we started our campaign. We are instead hearing from workers who are contemplating leaving the sector because they have been told that all they are worth is £10.90 an hour which is as you know is nearly 20% less than someone doing the same job in the NHS. It doesn’t much feel to them that there is value and respect. We are hearing that the lack of fair contracts and low levels of resource are stopping employers from offering better terms and conditions, including secure salaries to frontline workers. We are hearing that people are exhausted and tired because they continue to face so many challenges and risks to their health, yet they do not have the protections that others have. We are hearing of dedicated skilled individuals growing weary that years of promise and  declared priority have come to nothing.

Our simple ask of you is ‘How much do you really value social care both in terms of its workforce and its organisations?’

 I know that campaigns are often full of rhetoric and promises but the women and men who are struggling through snow and poor weather conditions today at all times of the day to go out and care for others – they deserve to know what you plan to do about social care if you become First Minister? How much in very straight terms are you prepared to pay our frontline carers? Will you continue to say £10.90 is all they are worth because that is what you can afford? Will you find monies as you did for the teachers and our NHS colleagues or do social care staff not count in the same way and are somehow lower down on the scale of value?  So please tweet, speak or announce what your plans for social care are.

Those who are contemplating a career in social care regardless of their age deserve to know under your leadership the extent to which you value them, the organisations that employ them and perhaps most of all the people who receive the care and support they provide. Is it worth making social care a career for life? Are we going to see our frontline care and support staff receive a pay award that treats them with dignity and respect?

 

Thank you.

Donald Macaskill

Time to Shine a Light on Social Care: the time for action is now.

On Wednesday 1st March I was delighted to be able to attend the virtual launch of the Scottish Care led social care campaign which runs the month of March. It is a campaign which whilst led by Scottish Care is involving a range of others – its primary purpose is to raise the profile of all the key issues facing the social care sector at the present time. In a week which has witnessed so much debate and discussion around social care the need for this campaign has never been more necessary and urgent.

There are several main themes in the campaign and one of them is to help us all have a greater understanding of what social care is. Regular readers of this blog will know how much I bemoan the way in which social care is continually – not least by the media and by our political leaders – seen through the lens of the NHS. Yes social care when it is functioning at its best is able to reduce the demand on our acute and secondary health services. Yes, social care can help to address the huge number of people who are unnecessarily delayed in hospital. But in truth if you only see social care through an NHS lens then you will effectively be blind to its extent and to its promise.

Social care is many things but at its heart it is a set of services and supports, whether for children, adults or older people, which enables people to live to their fullest; allows them independence, purpose, control and choice and helps all our communities to flourish and thrive.

To achieve this, we have some of the most progressive policy and legislation anywhere in the world but have sorely failed to implement these in practice. This week we have heard that the plans to create a National Care Service are now on pause which in itself was an attempt to address the gaps between aspiration and implementation, rhetoric and reality.

But in truth social care in Scotland has not been reaching its potential for a very long time – the patient has been in intensive care and in need of resuscitation – and the major reason for that is the lack of appreciation and value which has for years resulted in a woeful inadequacy of financing and investment in not only the workforce but in the organisations that employ them. It is reflected in the fact that there are hundreds upon hundreds of individuals living in our communities who have social care needs, some assessed , many not. The high level of unmet need is just as critical and dangerous as the delayed discharges in our hospitals but receives a tenth of the attention and focus it deserves. The inadequacy of treatment is especially seen in the way in which we reward, recognise and pay our frontline social care staff. I think it is frankly obscene at a time when the massive recruitment challenges facing social care are talked about so openly and so frequently that we have in the last few weeks created such a chasm between social care and the NHS.

The pay offer which has been negotiated for NHS colleagues and which has been much lauded (even if to date not formally accepted) has rightly valued our nurses and health care workers. But what might have escaped those patting their own backs is the real world effect which means that from April 2023 a social care frontline carer will be paid nearly 20% less for doing the same job as a frontline healthcare assistant in the NHS. This chasm is shameful. What about all the talk of integrated services – of one system – of co-dependency, and an appreciation that the NHS without social care is like a one-sided coin? What are we going to do about this arithmetic of disgrace?

We find ourselves in the midst of a leadership battle within the SNP and in the weeks up till the 27th March we seem to have entered into a no-man’s land of decision paralysis – meanwhile social care organisations are losing staff hand over fist and frontline workers are looking over at colleagues in the NHS and wondering why is there such unequal treatment. After all social care staff are registered, regulated and require to be qualified. Why no equality? Why no level playing field?

And lest someone reads this and falls foul of the easy trap of blaming charitable or private providers they need to be reminded that over 70% of social care is paid for by the public purse at rates of contract that make it impossible to pay staff what they deserve and still remain sustainable as a charity or a private provider. That is why every week in the last few weeks I have had owners and directors of charities, care homes and home care organisations in tears telling me that they will have to close, hand back work, refuse to accept any more Council funded residents because they pay at least 40% less than what the true cost is, or indeed stop receiving any new residents. You cannot ever reach the land of fair pay for workers if you do not have fair contracts and commissioning. We are reaping the harvest of fiscal neglect and a lack of strategic priority.

The responsibility for the enduring long-term crisis in Scotland’s social care system is the culpability of national and local government. What else can you call a 20% differential between the NHS and social care? What else can you call the reality that in-house local authority care homes on average spend £1,200 plus a week to support a care home resident and yet the same authorities pay private or charitable care homes around £830 a week for nursing care and support which is about £5 an hour to care for some of our most valuable citizens.

There is a deadening hypocrisy which has for years corrupted the social care landscape and we have now reached a stage where unless central Government funds an adequate pay reward for frontline social care staff, invests resource in meeting the energy and cost of living crisis, works with the sector to make Scotland’s small often family run private care businesses and smaller care charities sustainable, then we might as well say goodbye to any local social care provision, forget about economic growth because families will have to give up their jobs to support their relatives, and start accepting the reality of an unsafe NHS. And let us not forget the neglect of the thousands of unpaid family carers for so many years.

Everyone will rely on social care at some point in their lives, and it is a truism that the sector only becomes important when that happens. But in truth the urgency of this hour means that there might not be a sector around to provide the support you and I might need in the future unless we act now. We want to see action taken to tackle the social care crisis.

I dearly want the leadership candidates for First Minister to start telling us what they are going to do to rescue social care because it is going to be, whether they recognise it or not, a top priority in the early weeks and months of their time in office. I want them to tell us beyond campaign soundbite how much they value social care staff – and let it not be £10.90 an hour. I want them to show me how much they value social care away from the shadow of the NHS? I want them to show me they really understand why hundreds and thousands of talented professionals are leaving the sector and to commit to working with  with us to support the organisations that employ them. If a factory closes or a major employer ceases to operate we set up a Task Force – we urgently need such priority in virtually every community across our land. A slick paid-for TV campaign to recruit people to work in a sector that cannot afford to retain them won’t cut it.

Now is the time to #careaboutcare. Now is the time to #shinealight on the social care sector; to get beyond the myths and discover the amazing women and men who are the cradlers of compassion within all our communities. They deserve so much more than Scotland has given them. They and the charities and private organisations that have kept social care afloat in Scotland are weary, tired and exhausted but they know that now not a future land of promise, is the time to save social care in Scotland.

Join our campaign and find out more at https://scottishcare.org/social-care-campaign/#1669210952025-1e98646a-819e

Donald Macaskill

Technology thoughts for social care: positivity and threat.

It’s been a busy week in the world of technology, data and social care in Scotland. I managed that rare thing of attending the whole of a conference event and to listen to some insightful and interesting speakers. The event was the annual Holyrood Digital Health and Care Technology event. It brought together hundreds of delegates from the health, social care, technology, and data sectors to talk about the priorities of the moment, hear about some amazing innovations and be suitably challenged to think creatively and with imagination. It also combined an Awards evening which celebrated the cutting edge of excellence across Scotland in health and social care. I was honoured to have been one of the judges at an occasion where every nominee really was a winner.

Inevitably one leaves such an experience with a head full of thoughts and feelings, some of which were conflicting and contradictory. I want to share a few of them in this brief blog.

One of the key moments in the two days was the launch of the Scottish Government’s latest data strategy.  In many senses the title of this joint document with local government body COSLA says it all – ‘greater access, better insight, improved outcomes.’ The aims are clear and aspirational and are well articulated within a strategy which hopes to enable a better health and social care experience by the means of an ethical and human rights based use of data. The focus on autonomy and citizen ownership is laudable. The conference contained a lot of debate around data and how valuable our personal story through data was in our achievement of change and progress and yet along with many I was uncomfortable about the extent to which the disparity between the worlds of social care and health were highlighted in much of the debate around data and its use. My colleague Nicola Cooper who was also at the event articulated this in a succinct and prescient manner in a tweet yesterday where she said:

“‘Something has been troubling me. Data, data, data…….mentioned 10,564 times (felt like) at #digihealthcare2023 Conference… So are we saying that Social Care is less mature in its use of data, compared to health?’ The premise being it is…I’m not sure I agree. Here’s why.Social Care data is collected over & over, in different formats, to please different masters, and shared routinely for scrutiny & oversight, scrutiny & oversight (yes, I know I am repeating myself). It invokes negative + disempowering associations…Task driven, de-professionalising, risk averse, overwhelm – get it? Good data, often qualitative, helps with person-led high-quality care. It’s there but buried under the weight of reporting + regulation…. Data is the new gold at the end of the rainbow – always out of touch.

This is where maturity lies. In data driven innovation. Grass roots, by those closest to the challenge who are the most likely to know how to do better – improvement, service redesign, innovation… Will social care achieve data maturity is less of the question than IF social care in its current state is sustainable? (hint, the answer is NO).”

The social care sector has an abundance of rich often qualitative data, and this is immeasurably useful for the improvement of the individual experience of citizens and for the benefit of the whole health and care system but it is only useful if there is an adequacy of priority given to social care providers and staff to enable them to be the harvesters and users of such data in a way which is sustainable and beneficial to the rights and lives of the individual. It is only useful if the data tells the whole story and if social care is enabled to be autonomous and unique in its articulation and not be forced to utilise a data dialect which is not fit for context or purpose – thus the huge significance of the narrative as well as the number within data. Qualitative data matters as much to the outcome of a story as quantitative measures! Yet again the imbalance in strategic priorities between health and social care illustrates the failure of a whole system approach within Scotland.

My second observation of the conference was the extent to which there was a continual reference to the need to develop a digitally trained and competent workforce. At Scottish Care we are no strangers to the necessity of equipping our frontline carers with the tools to enable them to maximise the benefits of technology and digital in order to achieve the best possible outcomes and lives for the people who are supported in their own homes and in our care homes. The Care Technologist programme is an adventurous and innovative approach to ensuring that frontline social care is at the forefront in the challenge of championing that people are enabled to use technology to maximise their personal control and choice in their lives and in their care support. But if such innovation is to become mainstream, it demands an adequacy of resource priority to ensure our care workforce of the present and future is properly equipped, supported, and encouraged to undertake these progressive approaches. And all this at a time when social care providers are struggling to recruit and to retain frontline staff because of the embarrassingly shameful rates of pay which are predicated on inadequate Scottish Government pay awards. You cannot build and equip a technologically confident workforce on the deficit scale of reward and remuneration. There is a massive risk that the future of social care technology and digital usage in Scotland will be a shameful lost opportunity because of a lack of investment in and priority for the care workforce.

My next observation relates to the criticality of cyber and data security. After landing home after the event, I got an alert along with many parents at my local school around on-line security and threat. In this instance it was related to concerns which had been raised around the potential for cyberbullying, grooming or unwanted contact through the Roblox chat functions.  Roblox allows users to create and share their own games, as well as play other users’ games. As any user can create a game, an individual may create or invite a user to join a game that contains adult themes that will expose the child to content inappropriate for their age. No-one with a young child in their family will be unfamiliar with such warnings, and concerns – the world we inhabit is as full of technological threat as it is with digital promise and positivity. To ensure that those who work in and use social care are properly protected and aware both at an organisational and individual level is a massive challenge. This coming week (27th February to the 5th March) is Cyber Security Scotland Week which is an important initiative to make sure that we are all much more aware of the critical issues of cyber and online security. This is a fundamental element of ensuring our futures are one of positivity rather than abuse. The future promise of technology not least in the sensitive arena of health and social care will rise or fall on the extent that we prioritise both awareness of and investment in the protection of data and the development of our cyber security.

My last technology observation for the week relates to something which might seem antithetical to everything that has gone before and to a generally positivist approach to tech. It is simply that we must recognise that technology and digital are tools and not destinations. Like many people since the pandemic my world has become dominated by online meetings and Teams calls. In a very real sense attending a physical event is a rare treat and pleasure – it has become unusual for many of us to be out there with people in the way in which we used to be. This has had many benefits – we probably get more work done, we are more inclusive of those who live and work at a distance and we have managed to maximise participation and engagement in so many diverse ways. But – there is a cost. That cost is one I think we increasingly both individually and collectively need to challenge until we get to a point of healthier balance. The cost is personal interaction, dialogue, and honest communication. Online meetings allow those who organise and chair, those who lead and manage to control what happens, they drive out the directness of eye contact, the positivity of physical presence and the benefit of side exchange and networking. I am convinced in most meetings and group interactions they stunt innovative contribution and creativity. We have- not least in some governmental and statutory circles – reached a stage at which I am very worried about the way in which honest and healthy exchange and debate are being shut down by the dominance of virtual meetings and the absence of physical in-person interaction. It would be unfortunate in the extreme if the benefits of technology ended up leading to a situation of disingenuous exchange and the loss of freedom for speech and robust and honest contribution. I just wonder if that is the direction in so much of our working lives in which we are moving.

Enjoy your tech week.

 

Donald Macaskill

Leaving No One Behind In An Ageing World: the collective opportunity.

There are times when you might feel the struggles and obstacles you are enduring are unique to your own circumstances and situation. To be honest it sometimes feels like that in the world of social care in Scotland – that our challenges are unique and peculiar. But they are not. And both this week and in the last month it has become even clearer that there is a shared global set of concerns around social care and ageing but equally important a collective international desire and focus to do something about them. My reason for saying so is because of two reports which have been published in the last month.

The first is from the United Nations Department for Economic and Social Affairs (DESA) which in mid-January published its biennial flagship report that ‘aims to assess the world’s social situation by identifying emerging trends of international concern ‘. The World Social Report 2023 focuses on population ageing and the challenges and opportunities it brings as countries strive to achieve the 2030 Agenda for Sustainable Development.

It is called ‘Leaving No One Behind in an Ageing World,’ and takes its title from the commitment that as the world strives to achieve environmental sustainability that no-one especially the most vulnerable would be left behind. For the purposes of this report, it focuses on older age. It does so by celebrating the reality that we have made huge global strides in advancing health and older age but states quite baldly that there is much still to do to reap the benefit of this ‘demographic dividend.’

The report argues that older persons should be able to continue working for as long as they desire and are able, and it calls for ‘flexible retirement policies with guaranteed universal minimum benefits; eliminating barriers to older people’s participation in the workforce; and supporting learning and skills development throughout the life course.’

But it also advocates for a robust renewal of social care and health supports for our ageing population, stating that:

‘So far, public spending in most countries has not been sufficient to cover the growing demand for long-term care. The average expenditure by countries of the Organisation for Economic Co-operation and Development (OECD) was 1.5 per cent of GDP in 2019, down from 1.7 per cent in 2017. Insufficient funding means caregivers are undervalued, underpaid, and inadequately trained and often work in difficult conditions. A shortage of well-trained caregivers leads to poor quality care. Many countries, even wealthy ones, continue to rely on informal services by paid or unpaid caregivers.’

The report is well worth a read as it articulates a clear link between the economic success of a country and the degree to which it robustly addresses age discrimination and disadvantage. And when it talks about age discrimination it is explicitly referring to the discrimination against older age which is a global shame.

The second report which has highlighted for me our shared global challenge and potential came out a few days ago. It is entitled ‘Long Term Care: A Call for Action on a Global Scale.’ I know this work much better because I had the privilege over the last year of being part of the international group of writers who contributed to its development. That process and the conversations and discussions that were involved showed me first hand just how many shared concerns and solutions we share with one another across the world.

The paper makes many of the same arguments as the UN report but is primarily focussed on the aged care and social care sector and its condition across the world. It is a direct call to the governments of the world to act to address what is effectively an ageing emergency – one just as significant and challenging as our environmental emergency. It is a call to action to ensure that growing old is something which continues to uphold dignity, human worth and value, that celebrates individual autonomy and choice, and which enshrines the human rights of all regardless of age or capacity.  It states quite clearly that positive ageing does not happen by accident but through a clear strategic focus, prioritisation and planning which values ageing at its heart.

It especially states that we are globally, not just in Scotland, faced with very real challenges in terms of the declining numbers of caregivers and insufficient government support for services for older adults at the very same time as there are more and more older people requiring a greater level of support to remain independent, autonomous and valued. It also calls for a radical re-imagining of how we support people in older age, how we value them and how we provide care and support to those who may require it:

“As the aging population grows, there are too many challenges to keep doing things the way we have been doing them in the past decades. Informal family caregivers, who, in every country worldwide play a fundamental role in ensuring older adults’ well-being, are struggling with exhaustion, deteriorating quality of life, and loss of income that feed into negative macroeconomic impacts. We cannot leave this to families alone,” said Jiri Horecky, president European Ageing Network and board chair, the Global Ageing Network. “As the numbers of older adults grow, governments will have no choice but to invest in the supports older adults need, to give them agency and to protect their rights, including the right to long-term care.”

I consider that this international report is of real significance to those of us who care about older age in Scotland. It shows that many of the challenges we are facing in Scotland are global in nature, but it also suggests that the solutions of a better recognised and rewarded workforce, investment in older age care and support, and the innovative use of a human-rights based use of technology are ones we need to build on in Scotland and elsewhere.

If we are to truly ensure that no-one is left behind, we have to raise our heads from the horizon of our local and national concerns to work internationally on shared responses – this is as true of ageing and its potential as much as it is true of the environment and its challenge. Dozens of governments across the globe were presented with the report on Tuesday and I really do hope that they, ours included, will act on its call.

That is why I am delighted that Glasgow will welcome delegates from around the globe in this coming September to debate, talk, share, campaign, create and become active around the issues of ageing and care and support. The Global Ageing Conference will be taking place in the exact spot where COP26 happened – sustainable care and support for our growing ageing human population is as critical to ensuring a sustainable environment as perhaps any other issue. You can find out more details of this event at https://globalageing2023.com/

Both these international reports are appearing at a time when increasingly there is an acceptance of the intimate relationship between ageing and the environment, between celebrating and valuing older age and economic sustainability and success of communities and nations. Sadly, I think Scotland has some way to go to recognise older age as full of potential rather than cost. Scotland’s social care system and its very acute and real challenges can learn much from the insights of other places because there is much more that unites than divides our commonality. But wherever we are in the world the future is one where inescapably older people will increasingly find voice and agency, will demand change and innovation, will demonstrate new ways of being old – I very much hope we have the courage to listen to international voices and learn from global insights because those who are ageing will not allow themselves to be left behind.

Donald Macaskill