Behind every policy and legislation there is often a passion and a movement; behind every change there is frequently a vision and an aspiration. The world of social care and social work in Scotland is no less than any other sector. We have plenty of aspiration and hope, expectation and possibility.

The creators of the seminal and ground-breaking Social Work Scotland (1968) Act were inspired by the realities of deprivation, harm and failure evidenced in the 1950s and 60s across a Scotland impoverished by the trauma of war and the failed priorities of consecutive Westminster administrations.

The disability civil rights movements of the 1960s through to the 1980s declared that all people regardless of disability had equal rights to belong, to be included, to be heard and to be valued. They inspired and influenced policies such as ‘The Same As You?’ (2000) which led many of us to be involved in the closure of our long stay hospitals. And with an adequately resourced Change Fund it enabled a process of people with disabilities beginning to be included in their communities not shut away from belonging; it gave voice to people so that they could articulate their story and their hope; it rooted in practice and policy a change in orientation which recognised that it was mainstream society that disabled individual contribution rather than the labels and conditions by which we imprisoned individuals in asylums.

The desire to have control and choice, to be able to take charge of your own social care support and care, to be freed from the presumption that the Nanny State knows best and delivers best, to be able to become the director of your own decisions, all  under the umbrella of the independent living movement was that which provided the energy and spark which brought about perhaps one of the most dramatic changes in social care legislation and policy in the form of the Social Care (Self-directed Support) Act in 2013. Being present at the Ministerial launch I recall the passion and hope, aspiration and creative possibilities of designing a better tomorrow from the recognition that things were broken.

So too the creation of what became known as a health and social care ‘integration’ policy enshrined in the somewhat dry and limiting Public Bodies (Joint Working) legislation in 2014 – was centred around the aspiration that there would be one continuous pathway from first point of contact with social work all the way through support and care whether in hospital, community or care home, all the way to the end of an individual’s life. The dream and vision was that a person should not have to tell their story to multiple people, should not have to undergo multiple assessments which detailed and described the same thing because data was not transferred, professionals did not communicate and systems did not speak. Integration was primarily and always motivated by a vision of the person, the citizen, at the centre having control and agency.

Then most recently we have had the huge amount of commitment and shared vision and desire which made the Independent Review of Adult Social Care – also known as the Feeley Report – into a document whose words came off the page and painted a picture of possibility for the future of social care delivery in Scotland. It is a document which attempted to live up to the vision of a new beginning rooted in the at times painful experience of the pandemic and before. It was a vision of human rights and choice, of person-led agency and support, of contracts and commissioning of services which were equitable and fair, of reward and recognition of care as a career of potential – and so much more. It was less concerned with the structure more interested in the soul, less about the model more focussed on the energy.

The landscape of social work and social care in Scotland is indeed rich in movements of change and in voices of challenge. There is enough in text and legislation to motivate and inspire. The problem has always been implementation – the challenge and the failures have always been our ability to drain the vision from the text, to limit the possibility which progressive legislation offers. The sin has been to be tempted to make the system and the model, the vested interests of power and traditional practice, the familiarity of the known and the predictable – into the gods of the moment.

Our ‘implementation gap’ as Feeley termed it, has been the pit down which many an initiative, so much creativity, and so many hopes and aspirations have fallen. It is a deep hole but not an accidental one and it can be filled in!

This last week in so many conversations I have heard voices of fear and anxiety being raised about what the future of social care supports and social work might look like in Scotland. I share those very genuine fears and concerns but knowing and naming them, calling them out and recognising the risks, is part of the way in which we can avoid failing to live up to the aspirations which so many have articulated and so many hold.

The most obvious fear and this is well represented in much of the feedback and analysis in the consultation to the National Care Service is that we become so obsessed with the structures and systems, with the models and processes, with the titles and power-bases of a creating a massive new system that we lose sight of the vision and the energy which is necessary to ground real change into felt reality.

The First Minister has on a number of occasions articulated her desire to bring from the hurt of the pandemic a change which will be worthy of that pain – the creation of a National Care Service. A noble aspiration but one which has risks of falling into that implementation hole well before the summit of promise is reached.

One of those risks, I believe, is that the energy that directs success has to be fed by a proper awareness of what social care is and is not. Social care is not health care – we certainly do not want a shadow of the National Health System – and any attempt to achieve that would be a crippling failure and a massive denial of the hopes of those who use, work and deliver social care services and supports. We have all of us to be aware of and defensive against the creeping medicalisation and clinicalisation of social care and social work delivery. Such is an anathema to individual choice, citizen control, personal agency and an approach which is about enabling participation not fostering dependency, nurturing citizenship not limiting contribution. Social care can never be the maidservant of a National Health Service. What we want are the principles of choice and individual control, of independence and real engagement and involvement, of participation and personal control to be at the heart of what grows out of the next few years.

The danger is that legislation can either strangle aspiration or even if well formed can falter at the point of implementation. Integration became a bun fight between two goliaths – the NHS and local authorities – with Health and Social Care Partnerships the emasculated body in the middle and with Chief Officers engaged in a constant referee match between vested fiscal interests and power dynamics. As someone who examined why integration did not work – a lot of the time – the system failed the people by failing to make hard decisions when they were needed and failing to bring order to chaos when it occurred. Instead of the dream of integration with the person at the centre of a continuous pathway of consistent support and care – we have shamefully disappointed the dream.

Even if we get the legislation right – as we certainly did in the Self-directed Support Act – again the gap of implementation where fiscal limits and austerity, where power bases in senior management at local level, led to an inevitable suffocating of promise and a marginalising of creativity. Even today I hear the ridiculous scenario where people talk about SDS on the one hand and social care assessment and provision on the other – there is and should only be one way of accessing social care and that is through self-directed support. There is no excuse – and for my area of interest especially for older people – of citizens being denied the choice, budgetary control, individual say over which provider you want – in any place in Scotland today. Yet the reality is that in so many places choice is based on what age you are, who you know, what party colour the local authority political leadership is, and how much of a battle the local HSCP has managed to wage against the Big Two. We have shamefully disappointed the dream.

The next few weeks and months will be critical for the formation of the National Care Service and the much wider hopes and dreams of the Feeley Review. The concerns and fears I am hearing are that we will focus so much on structure and process that we lose the passion and purpose. We will be so concerned on achieving the model that we will lose sight of the necessity to really involve and include, engage and engender the energy of the people who need to make that journey with us. There is a real fear that the necessary leadership with real world knowledge rather than acquired  awareness to achieve this change is simply not there either politically or operationally. Such leadership demands inclusivity and involvement, not partisanship and a failure to engage. There are too many whispers and behind the door conversations. Indeed, this is perhaps especially the case in the bringing together of health and social care – especially the providers of the latter – a reality that in the last calendar year has barely happened at all. Meaningful change is never achieved by siloed management.

There has always been an energy and movement in social care across Scotland. It is one at its best that has mirrored our humanity and hospitable concern for the other, to include and involve all, to be open to the challenge of the new and the creativity of the different. It is a social care world which has rooted equality and fairness, human rights and dignity at the heart of all that is delivered. It is also one which has authentically talked the talk and been real rather than fictional whether that be about fiscal reality or delivery challenge.

We are about to start a whole series of political debates on the creation of a National Care Service – in these I hope our leaders will listen, not to the rhetoric of political echo chambers, but to the people who use social care supports, the workers who deliver them, and the providers and employers who are the organisations by whose agency most social care support is enabled.

When all is said and done change is born out of a vision of betterment and of new possibility, of a new and better way of being and belonging, of caring and compassion. The current Poet Laureate Simon Armitage in his poem ‘A Vision’ warns of the possibilities of our visions landing in the landfill site of disappointment. But the way we prevent the architectural dreams of a changed world becoming the missed opportunity of our future, is to work hard; to involve all; to listen deeply; to learn openly and to create together rather than apart. The future of social care deserves no less.

A Vision

by Simon Armitage

The future was a beautiful place, once.

Remember the full-blown balsa-wood town

on public display in the Civic Hall.

The ring-bound sketches, artists’ impressions,

blueprints of smoked glass and tubular steel,

board-game suburbs, modes of transportation

like fairground rides or executive toys.

Cities like dreams, cantilevered by light.

And people like us at the bottle-bank

next to the cycle-path, or dog-walking

over tended strips of fuzzy-felt grass,

or model drivers, motoring home in

electric cars, or after the late show –

strolling the boulevard. They were the plans,

all underwritten in the neat left-hand

of architects – a true, legible script.

I pulled that future out of the north wind

at the landfill site, stamped with today’s date,

riding the air with other such futures,

all unlived in and now fully extinct.

From:  Tyrannosaurus Rex Versus The Corduroy Kid

Copyright ©:  Simon Armitage

A Vision poem – Simon Armitage poems | Best Poems (best-poems.net)

Donald Macaskill

At the current time the UK Government is undertaking a consultation on major proposals to change the provisions of the UK Human Rights Act – a piece of legislation which covers Scotland. The proposed changes are being presented as insignificant, but the reality is the complete opposite, and they should be a matter of concern to anyone concerned with the protection of rights in Scotland.

In his preface to the changes the current Justice Secretary, Dominic Rabb, asserts in passing that there are no plans to depart from the European Convention of Human Rights (ECHR) but he then states:

‘…our system must strike the proper balance of rights and responsibilities, individual liberty and the public interest, rigorous judicial interpretation, and respect for the authority of elected law-makers…

We make far-reaching proposals for reform, with a particular focus on those quintessentially UK rights, such as freedom of speech and the right to trial by jury.’

All sounding innocent enough and a blatant appeal to a perspective where the essential ‘values’ can be enshrined in a defence of freedom of speech even if the understanding of what that freedom is is frequently absent.

Throughout the narrative of the consultation plays to the crowd and a sceptic if not hostile audience and attempts to dress significant change in the clothes of acceptability.

It states later an aim to:

‘… overhaul the Human Rights Act passed by the then Labour government in 1998 and restore common sense to the application of human rights in the UK.

…The Bill of Rights will protect essential rights, like the right to a fair trial and the right to life, which are a fundamental part of a modern democratic society. But we will reverse the mission creep that has meant human rights law being used for more and more purposes, and often with little regard for the rights of wider society.

I will leave it to commentators far more qualified in the law to describe the detail of the proposals and why they are so concerning. Indeed, in that regard I would strongly recommend you look at the work of the British Institute of Human Rights and their campaign to defend the Act.

I want to, however, reflect on why in 1998 the Human Rights Act was one of the first pieces of the new Labour Government.

Anyone around in the 1980s and 1990s, as I was, would be well aware that if you believed for whatever reason that your human rights were being diminished or broken, abused or removed that the recourse you had open to you was to take a case all the way to Europe. From the women who fought for protection during pregnancy and won statutory support of their employment to the young people who fought to outlaw corporal punishment in our schools – Europe was the seat and source of protection and legal justice. It was a destination both distant and costly – a justice hard won over many long delays and years.

The creation of the Human Rights Act was under the banner ‘Bringing Rights Home.’ That phrase said it all – its essential core purpose was not to change or add to the human rights which were the fruit of the sacrifice of our forebears and which found voice in the UN Convention or the European Convention. No, the gift of the Human Rights Act was to bring those rights close to each of us. The Act made it possible for every citizen who felt the need for protection of their rights to have recourse not to a distant European court but to local courts. It sought to bring justice to your doorstep.

The Human Rights Act was about making human rights meaningful and relevant to every citizen. If you felt aggrieved, you had the potential to fight your case in your own community.

But even more important the Human Rights Act was about changing the way we talked about and used human rights. It was about taking these principles out of the courtroom and making them the conversation of community and relationship. The HRA was about making human rights mean something for the education you receive, the care you were given, the decisions made by your government – it was all about making human to go to relevant and real.

Over the years contrary to what some newspapers and some parts of the media might wish to portray human rights cases were to do with defending people with disabilities or making sure of equal treatment regardless of gender in terms of pensions – much less than prisoners, or foreign terrorists – they were about the issues of living together in modern community.

Now in truth there have been times when they have not achieved what they might have. There have been moments when we have paid lip service to our human rights laws- perhaps most poignantly during the pandemic. That is not the fault of the law but of those who have failed to live up to the higher aspiration and morality that human rights laws hold before ys.

The politicised attempt to diminish our human rights affects everyone for whom access to justice impacts on the care they receive or the life they would live. It impacts on decisions about treatment and medicine, around health and housing, about justice and the environment.

I hope we can all find the voice to keep human rights close to home. We dare not allow others with proposals ostensibly limited to allow the eviction of our human rights from our homes. It’s time to make sure we keep human rights at the centre of our homes. The Human Rights Act is the closest thing I know that makes sense of and roots the promise of the famous words of Eleanor Roosevelt from 1958:

‘Where, after all, do universal human rights begin? In small places, close to home—so close and so small that they cannot be seen on any maps of the world. Yet they are the world of the individual person; the neighborhood he lives in; the school or college he attends; the factory, farm, or office where he works. Such are the places where every man, woman, and child seeks equal justice, equal opportunity, equal dignity without discrimination. Unless these rights have meaning there, they have little meaning anywhere.’

Donald Macaskill

See also https://www.bihr.org.uk/blog/why-the-human-rights-act-matters-to-me-donald

At times during this pandemic a word, phrase or concept just seems to appear from nowhere to occupy a position of dominance in debate and discourse. This last week everywhere I looked I have seen the word ‘trust’ or heard it mentioned on radio or television, in meeting or exchange.

Trust is a fundamental characteristic of our being with one another in so many dimensions of our living. It is a word rich in meaning and possibility. The dictionary describes it as a ‘firm belief in the reliability, truth, or ability of someone or something.’ It denotes a sense of confidence, belief, and faith. All of these are concepts which are inter-related and inter-changeable. In my blog this week I want to consider the various dimensions of trust as they have struck me this past week and how fundamental a moral ethic of trust is especially during pandemic times.

Political trust.

In the job I do at Scottish Care representing a wide range of members with diverse perspectives I have always sought to refrain from direct comment on the merits or otherwise of any political party either in Scotland or in the United Kingdom but have hopefully been consistent in a critique of policies, behaviours and practices which have acted against the best interests of the care sector and those who receive care and support especially older individuals. Let’s face it there is not exactly a shortage of areas of social care failure across the UK on which there has been the requirement for critique!

When there is a time of crisis and challenge like all individual citizens, I have looked to political leadership to make decisions and act in a manner which upholds the best interests of the whole population, especially those who might not be able to advocate for themselves. Confidence and trust in political leadership during the pandemic has been essential, and whilst there have been areas where it has been necessary to be critical and to highlight shortcomings, what has remained as a strong expectation is that sense of trusting political decision-makers – however hard the decisions might have been – as having the best motives, intentions and aims. As we continue to take measures which reduce restrictions and mitigations to protect public health the extent to which we trust our political leadership has become if anything even more important, especially as the spirit of consensus and mutual agreement has diminished.

The events of the past few weeks at Westminster, the language of scurrilous accusation and demeaning diatribe, the occurrences of behaviours inconsistent with a required morality and social ethic, have diminished all those involved and have brought so much that we value in our political system into the most profound disrepute and deepest disrespect. We cannot move forward as a society to face the challenges of the future with a deteriorating political trust. We must be able to have confidence that the interests of the population are advanced ahead of the partisan self-interest of a few. Just as we trust that the bank notes in our pocket will be redeemed for their true value, we require a trust in political leadership which lives up to the highest values of public service and ethical practice.

Pandemic trust.

We have spent a lot of time in the last 23 months becoming amateur experts in epidemiology and the science of infection and pandemics. There has been no shortage of scientific commentary and some of it has been conflicting and contradictory. Some have been unable to deal with the fluctuating stances of scientific opinion believing that science provides clarity in definitive black and white colours. If anything, the pandemic experience has taught us that ‘trusting the science’ or ‘being led by the science’ is not a simple act of reading then implementation bur rather is one of analysis and interpretation. Trusting the science has been critical at various stages of the pandemic and there have been diverse responses to the same data because the nature of analysis is that there will always be degrees of interpretation and subjective opinion. But regardless of nuance and divergence, I do believe that as a whole we have both at an individual and collective level elevated the role of scientific analysis to a position of critical importance. But this has not come easily and the challenges of the next few months and weeks as we come out of Omicron will test the degree of trust perhaps beyond breaking point.

For those of us who are not able to scientifically verify the truth of statements and assertions made by ‘experts’ we have to ‘trust’, to be confident in the motivation and skill, the assertion and articulation of those who have been appointed to give advice and influence decision-making. That is not always a comfortable experience and perhaps gets to the heart of the nature of trust. Trust is always relational, it is the human letting go of self-defence, it involves the risk of encounter and exchange which might threaten and reassure in equal measure. Think of any meaningful human relationship you have ever had and at some point you enter into a landscape of trust and belief, when you lay down what you ‘know’ and can ‘verify’ and have to develop the hope and positivity which confidence in another over whom you have no control, begins to develop and grow. The cost of loving another is trusting beyond knowledge and living in hope and assurance.

Partnership trust.

Trust also has to do not only with individual person to person relationships but with the encounters we have with organisations and individuals who we work alongside and relate to. In the workplace trust is fundamental to the achieving of shared outcomes and aims. But as anyone who has ever worked on any shared ventures knows only too well, the reality of trust is something which has to be worked at and strived for – it does not just happen. Telling someone to trust you and to agree with your position or stance has to be grounded in the reasonableness of their prior-knowledge of you and the conviction that you have their best interests at heart.

The worlds of social care and health have not always ‘trusted’ one another – not that they have enmity or disregard for one another – but rather their mutual knowledge and awareness of the other has been limited or at times absent. Integration of health and social care services was meant to change all that. We were all meant to be developing systems and processes which had the person receiving care and support at the centre, and indeed in the lead as the director of their lives. We have fallen well short of that aspiration as the ground-breaking Independent Review of Adult Social Care Report indicated when it was published a year ago on Thursday last. The Feeley Report as it became known was received with the warmest and most extensive of welcomes by disparate parties – partly because through its author Derek Feeley – bonds of trust had been developed that suggested that its words were authentically the aspirations and hopes, dreams and vision of those who use social care supports and that it offered the promise of a reformed social care system for adults in Scotland.

This past week has also seen the publication of the responses to the Scottish Government’s consultation on the envisaged National Care Service which was a key part of the Feeley Report. There are many of them but having read quite a few they also share a sense that the time is right for change and that this is a once in a generation opportunity to achieve that. But there is also a sense that we must not in our focus on processes and structures, on systems and models, lose the vision and energy of the Feeley Review. This is where the trust comes in – those of us who for years have campaigned for a change to the delivery of adult social care which creates care support models sensitive to the people who use them, appreciative and valuing of the frontline workforce, realistic in the required resource and costs involved, and yet dynamic in inclusive flexibility – we have put our trust in our political leadership to bring these dreams to birth. We are trusting our political leadership to overcome partisanship, both at local and national level, and do what needs to be done to deliver a sustainable social care system that works for all citizens and treats all with equality, fairness and dignity.

Trust – whether political, for a period like a pandemic, or as the energy of partnership in change and reform – is the most essential of ethical values and commodities. Its marks are the ability to include and involve all, to hear the voices that disturb and unsettle, to soothe the concerned and fearful, to be consistent in compassion and courage. We all of us deserve to live as citizens in a land of trust.

This last week I was honoured to hear a reflection by the distinguished American social care leader Stuart Kaplan. In it he said that in a world of such uncertainty we can all have to be true and sure to our word. ‘Trust is our essential currency.’

And in relationships built on trust we can find hope and restoration, renewal and reform. The contemporary American poet Thomas R Smith puts it well:

Trust

It’s like so many other things in life

to which you must say no or yes.

So you take your car to the new mechanic.

Sometimes the best thing to do is trust.

The package left with the disreputable-looking

clerk, the check gulped by the night deposit,

the envelope passed by dozens of strangers—

all show up at their intended destinations.

The theft that could have happened doesn’t.

Wind finally gets where it was going

through the snowy trees, and the river, even

when frozen, arrives at the right place.

And sometimes you sense how faithfully your life

is delivered, even though you can’t read the address.

Poem copyright © 2003 by Thomas R. Smith from Trust by Thomas R. Smith | Poetry Foundation

Donald Macaskill

One of the first tasks I undertook when I started in my role as CEO of Scottish Care nearly 6 years ago was to go around the country and take part in a research project which involved me interviewing a number of frontline nurses in care homes. It was an amazing, humbling, and inspiring experience. Along with colleagues what came out of those conversations was developed into a report called ‘Voices from the Nursing Frontline.’ It told the first-hand experience and stories of nurses who had chosen to work in social care and care homes in particular. It was raw and honest, but also celebratory in valuing the exceptional importance and distinctiveness of care home nursing.

I have re-read the report and the words of these nurses in the last few days, sparked off in part by the publication of a survey from the Royal College of Nursing in Scotland, but also by comments from nursing colleagues in the sector. The RCN survey indicated that as many as 60% of nurses are actively considering leaving the profession. In what follows I want to share some thoughts on the current status of care home nursing in Scotland and why I believe it to be in very real crisis and in need of specific and targeted attention.

The Voices report articulated the breadth and extent of the role which care home nurses undertook. If I had not known before, I certainly knew after these conversations that the job entails an astonishing array of skills and requires real depth of expertise and knowledge.

Nurses in care homes are often the only nurse on a shift and as such a great deal is placed on their shoulders not least as the acuity and clinical needs of residents has risen so sharply in the last few years. They are frequently individuals who occupy leadership roles in our care homes whether as senior staff or often as managers responsible for the smooth running of the home not just exercising a clinical oversight role. Added to this they are the effective leaders of and support for social care staff. These are highly skilled professional leaders dealing with a whole range of clinical needs in residents including dementia, neurological conditions, delirium, palliative and end of life care, pharmaceutical interventions, frailty, rehabilitation, late-stage cancers and so much more. The care home nurse is a specialist in a considerable number of areas and not a generalist. They do so much often without the peer support that is available in an acute setting.

After being involved in the Voices report, along with others, I argued that both nursing regulatory bodies and nursing academic schools needed to create and value social care nursing as a distinct specialism in the same way as is done for paediatric, learning disability or mental health nursing. I hope one day that will be undertaken in earnest because in a very real sense all nurses need to develop the skills a care home nurse is required to evidence and display.

Yet having just noted the advanced clinical and social care skills required I cannot but reflect on an undercurrent in the Voices report which has become not only more pronounced but has grown in recent times in Scotland. That is the issue of value, respect and professional regard. One nurse stated in 2016 that:

“In hospitals, nursing homes were considered second class establishments. Our skills are undermined by the NHS due to us not using IV drips! The complex nature of communicating with those with dementia is not recognised.”

I well remember a nurse saying to me that her NHS colleagues thought she would become de-skilled, was taking an easy route out and that the care home sector was a dead end for anyone interested in career progression. She told me that the disdain from her former acute sector colleagues was palpable, as someone told her, ”It’s not real nursing is it?”

Now you might say that any one person’s experience is not always reflective of the whole. That is undoubtedly true were it not for the fact that for the last few years and especially in this last year I have continually heard from frontline care home nurses their growing dismay at their sense that others in the health and care system disrespected their professionalism, expertise and skill base.

Over the last few days there has been a lively social media debate about care home nursing, and you cannot read some of the comments and not conclude that these women and men have been made to feel less valued, de-skilled and dis-respected even more than other nursing colleagues in other services.

One experienced nurse stated:

@andreawyllie : When I first started out on my nursing journey, older people & mental health nursing were considered “Cinderella” services. CH nursing wasn’t even included in that category. Not much has changed in attitudes in 25yrs. It’s not just the nursing it’s how we as a society value people

Others commented:

@Justacarehomeg1 : The impact on social care staff at all levels has been largely ignored. Working front line with covid, with restrictions which cause moral dilemmas to staff day in and day out.

@andreawyllie: Just discussing this very thing with this morning and what the lasting impact may be for social care as we add in the lack of respect and value given to social care staff and the blame culture that has also had to be managed through the pandemic

@YvonneSManson : All these new NHS based oversight groups that got set up only further compound that stigma of NHS is better. Imagine setting up teams to oversee, make decisions on care homes with people who didn’t work, live or visit care homes can you imagine that happening the other way around!

I would encourage you to read the debate because it is inescapably blunt in its analysis that we are failing care home and social care nursing in Scotland.

The pandemic has been crippling and hard for frontline care staff, nurses perhaps especially so because of their leadership roles. Many have shared with me a sense of abandonment, the stress and emotion of dealing with loss and death, the fear of whether they would carry the virus into the care home or back to their own homes; the constant struggle to balance the need for restrictions with their desire to help residents enjoy their life; the continual requirement to be strong for colleagues; to be always up to date with the avalanche of new Guidance arriving just at the point of exhaustion; the disproportionate scrutiny from those who know not what they were talking about; the demands of reduced staffing; and their own inner questions about the level of care possible in situations such as forced isolation and separation from families with which so many disagreed.

Many have shared their real pain at the constant barrage of criticism and blame directed at care home nurses and managers not least from sections of our political and media worlds. And add to this, and uniquely in Scotland, the nature of constant investigation from Operation Koper where every single Covid death up to this day is investigated in care homes, thus putting immense pressure and stress on nurse leaders – a process consciously and subconsciously constantly demanding they ‘prove’ they did not make any errors or at least one which instils fear, guilt and anxiety. They have felt as if they were fighting a battle against a virus with one hand tied behind their back. Can you even begin to contemplate the outcry if this process of continual investigation and scrutiny and limiting of professional integrity was happening to nursing staff in an NHS ward?

The specific and personal observations quoted above and there are a lot more on Twitter and other social media are also clearly evident in the report on oversight and inspection published by Scottish Care two months ago and around which thankfully there has commenced some shared work to address the issues highlighted. That report stated quite clearly that we were seriously getting things wrong in the way we are allegedly supporting the care home, and specifically, the nursing care home sector.

I would contend that the comments expressed online this week and in the report are not accidental but rather are reflective of a damaging failure at senior health leadership level in Scotland both politically and operationally to value the professional integrity of and to seek to appreciate the role specialism of care home nurses most especially during the pandemic. Interventions might have been ‘well-intentioned’ and designed to ‘support’ but they have backfired and only served to compounded the problem and sense of disrespect, not least because of the lack of real engagement with, involvement of, and partnership with care home nursing professionals and the sector. No other professional group I know in social care or medicine would tolerate what is now happening in care home nursing.

The RCN report stated baldly the risk of us haemorrhaging real talent from the nursing profession in the NHS – I would go as far as to say that that worrying analysis can be multiplied ten-fold when one considers the social care nursing workforce. There is an urgent need for attention and action, but that must start with the development of trust and respect for the individuals who work as care home nurses. That respect seems singularly absent.

The Voices report some 6 years ago made 12 recommendations. It is an indictment on all of us involved in health and social care leadership that each and every single one of them remain unaddressed in large part to this day. We have not progressed matters with any positivity, rather in the last 22 months we have made matters significantly worse. The twelve were:

• Identify what are the core skills mix for nursing in social care
• Develop a career pathway with NHS nursing
• Develop nursing in social care as a positive career choice
• Address the inequalities in terms and conditions
• Rebalance the level of scrutiny and inspection
• Resource development in nursing specialisms in social care nursing e.g., dementia, neurology, geriatrics, mental health, palliative care etc.
• Develop and promote a positive image of nursing in care homes
• Work with HEIs to promote nursing in a care home setting as a positive career choice
• Positively address workforce issues such as emotional fatigue, mental wellbeing, stress and distress
• Address the issues of nurse recruitment and use of agencies.

If we start to work together, around a table of mutuality, from a position of professional regard rather than sector and clinical superiority, then we just might manage to prevent a crisis from becoming a collapse. Most importantly we will begin to give the amazing frontline care home nurses a sense of value, autonomy, respect and regard.

Donald Macaskill

Miss Duncan, Miss Allan, Mrs Randall and Mr Hollywood. Names etched on my memory – they were four of my primary school teachers. There are others too especially in secondary school who if I close my eyes, I can still see them and hear their voices. I know I was lucky. I loved my school experience – well most of it. It opened a world to me of learning and imagination, of escape and possibility. The people who took me on that journey were individuals who through their professionalism and dedication sowed in me a hunger and desire to know and to discover. I have always had the fullest admiration for those who teach. A good teacher opens a door of possibility and lets you enter a world of potential. Rolled up in one person, a good teacher is an inspirer, dramatist, communicator, creator, listener, carer and so much more. But it was only later in life as I began to teach and train adults that I really appreciated just how hard the work of a teacher is. So, I am always so proud of the fact that my eldest daughter is a primary school teacher – I can think of few roles more rewarding and fulfilling yet challenging at the same time.

I’ve been reflecting on education and teaching a lot in the last week partly because I have been involved in discussions on learning and training but also because this coming Monday we will be celebrating the International Day of Education, which is a celebration of the role of education across the world.

It is a day which amongst other things, is a reminder of how critical education is in tackling so many of the injustices and needs of our world. As the United Nations has stated:

‘Today, 258 million children and youth still do not attend school; 617 million children and adolescents cannot read and do basic math; less than 40% of girls in sub-Saharan Africa complete lower secondary school and some four million children and youth refugees are out of school. Their right to education is being violated and it is unacceptable.’

Education and learning are critical for the future of society, and that includes for the future of social care in Scotland. This past week we have seen in an Audit Scotland report some substantial critique of the lack of leadership and focus on social care and its necessary skills. Given that social care is a major contributor to the whole Scottish economy, if we are not getting training and learning right for this sector, then we are impacting the whole of our economy. But even more important than that we need to continually make sure that in our learning cultures around social care that we are reflective of the changing realities of care around us.

Two things have struck me this week.

The first is that having spent the last few weeks highlighting the very real challenges that the social care workforce has been facing because of Omicron someone asked me, ‘Then why do the work of care?’. Now before I get accused of rose-tinted glass wearing, I am not denying and would strongly argue that we need to substantially improve the reward and remuneration, the terms and conditions of those who work in social care. We are slowly getting there although at times I think our national and governmental response has been more focussed on headlines than addressing the baseline issues of sustainability, structure and process which affect the social care system in Scotland. We cannot have fair work conditions, a workforce valued and respected, professional and recognised, if we have systems in place which make their organisations and employment unsustainable, forced to sacrifice quality on the basis of cost, and to continually be treated as outsiders in partnership and collaboration.  There is no point in having a better paid carer if the organisation that employs them has gone to the wall. The social care system in Scotland is in a perilous state and will only be changed by the sort of radical transformation which requires partnership, mutual respect and collaboration. The best teachers inspire not by instruction but invitation, by authenticity rather than acting, by offering possibility rather than predictability. Such change is not just systemic – for instance creating a National Care Service – it is profoundly attitudinal and cultural. Have we in Scotland the ground in which to sow a change that involves and includes, that respects diversity and difference, nurtures choice and capacity? I sometimes fear we do not because too often I witness partisanship and defensiveness, a desire to keep things as they are, to hold onto power-base and predicability.

The way we support and care for others is changing all the time, I very much hope that when we talk of skills in relation to social care in the months and years ahead, that firstly we will value the existing professionalism of those working in care, and secondly that we will give equal attention to the softer skills of affectiveness and compassion, communication and relationship, as we often do to functional and transactional activities and abilities.

We also need to ensure that the potential of a career in social care is talked up. And that change has to start early – we need to start inspiring the children now at primary school to consider care as a career of choice and as of huge societal value. That is up to all of us who are adults to be the enablers of that inspiration. My answer to the question I was asked is what I have heard so often – that there are few jobs in life, despite the challenges, that enable you to support someone else to change their life, to achieve their potential, and to live to their fullest until the end of their days. For many it is the best job in the world and surely that is worthy of all focus and attention, of our value as a society and respect as a community?

As we seek to inspire the young with the attractiveness of social care, can I suggest you look at sharing with the children you know the fantastic ‘ When I grow Up I want to be a Carer.’ written by Jenni Mack. It is superb!

The second main reflection about teachers and education that I have had this week is personal and that is that I probably am learning more now than at any other stage in my life. In other words education and learning, knowledge and insight did not stop when I left school or university – it just took on a different form. Now I hope that that is stating the obvious, but I suspect as a society it probably is not. There is a terrible presumption about older age in particular which suggests that learning and teaching have sell by dates. What nonsense – and I am thankful that increasingly I read of people in their eighties and nineties graduating with degrees or going back to school to learn a new subject or discover a new skill. We learn until we die and it is a fundamental part of our society that we should enable such learning into later age, and value the contribution that the gaining of such knowledge offers to our society. Education is too important and liberating for it to be the preserve of children and the youthful.

I conclude with one of my favourite children’s writers, Allan Ahlberg who write the poem ‘The Supply Teacher’. I said at the start that I enjoyed most of my school experience except perhaps one supply teacher who put the fear of the divine into me every day she appeared. If nothing else she made me appreciate the brilliance of those who had become my routine, and for me all teachers in school, care home and community, open our hearts to the essence of what it means to be in relationship with one another, in care and compassion. The best teachers, wherever they are, and whatever job they do, help us to reach our potential and flourish.

The Supply Teacher

Here’s the rule for what to do
If ever your teacher has the flu
Or for some other reason takes to her bed
And a different teacher comes instead

When the visiting teacher hangs up her hat
Writes the date on the board, does this or that
Always remember, you have to say this,
OUR teacher never does that, Miss!

When you want to change places or wander about
Or feel like getting the guinea pig out
Never forget, the message is this,
OUR teacher always lets us, Miss!

Then, when your teacher returns next day
And complains about the paint or clay
Remember these words, you just say this:
That OTHER teacher told us to, Miss!

Donald Macaskill

It has been another significant week in the Covid pandemic. I will leave it to others to comment on the shameful goings on at Number 10 Downing Street, but alongside these events and the commentary attached to it, one of the announcements that I took note off with a degree of regret was the news that the English Deputy Chief Medical Officer, Prof Jonathan van Tam will soon depart to return to his substantive post at Nottingham University.

I cannot have been the only one that liked van Tam’s metaphorical turn of phrase, not least his footballing analogies, as he attempted to convey the meaning behind complex information, science and data. One of his best moments, for me, was when he said:

“It is a bit like being 3-0 up in a game and thinking we can’t possibly lose this now. But how many times have you seen the other side take it 4-3? Do not wreck this now. It is too early to relax.”

Having been ‘that fan’ at too many Scottish lower division games I know precisely what he meant! It has, therefore, intrigued – and I will be honest irritated me a bit – that this last week so much of the discussion has been about ‘learning to live’ with the virus and moving from a pandemic to an endemic stage. I accept the hopeful prospect of both, but these are phrases which it is self-evident mean so many different things to many people, and I cannot but feel at times that we are in danger of scoring a few own goals. Indeed, the irritation I mention is that for tens of thousands of social care staff right now work and life is about surviving exhaustion and fatigue as they spend themselves in supporting those who use services in the greatest crisis anyone can remember, and not just since the start of Covid19.

It is also important to acknowledge that yesterday we passed the horrendous toll of 10,000 of our fellow Scots who have died because of this Covid virus. Talk of ‘moving on’, of ‘learning to live’ and the ‘end stage’ has to be wholly sensitive to the grief and pain, hurt and abandonment so many feel today. For so many the rawness of reality does not make us feel that life now is any easier than it has been, quite the reverse.

In this blog, therefore,  I want to reflect a little bit about these concepts of ‘living with the virus’ and the endemic phase and specifically what they may potentially mean for social care services and those who use social care support.

Language, as van Tam powerfully illustrated, is always important and there has been a sense in the past week that in the rush back to ‘normality’ that the  careful use of language and appreciation of its subtlety has gone out the window.

Take for instance the commentary that we should stop talking about the Covid pandemic and start talking about a Covid endemic stage. As Wikipedia puts it:

‘In epidemiology, an infection is said to be endemic in a population when that infection is constantly maintained at a baseline level in a geographic area without external inputs. For example, chickenpox is endemic in the United Kingdom, but malaria is not.’

There are lots of viruses and infections which are endemic, but it is not true to say that those infections are harmless or not dangerous. Smallpox is endemic but it can and will kill. So being in an endemic stage does not mean there are no risks, does not mean there is no need for measures to protect or precautions which are required for safety to ensue.

Across Europe there has in the last seven days been much chatter about us moving into the endemic phase of coronavirus. This started off last Sunday with the English Education Secretary Nadhim Zahawi, who talked about the transition from a pandemic to Covid being treated as “endemic”. After his remarks news outlets began to reflect on what living with the virus and being in the endemic stage actually means.

Alongside this the Spanish Prime Minister declared a shift in policy away from counting cases and quarantining, towards a model of managing outbreaks of diseases like influenza that seeks to protect the most vulnerable. Others countries such as France and Switzerland have followed that lead in seeking to ‘manage and diminish restrictions’ because they believe the disease is entering an endemic phase.  However, in a word of caution the World Health Organisation stated on Tuesday that it was too early to believe we were entering an endemic stage as it warned that more than half of people in Europe would catch the disease over the next two months.

Covid is undoubtedly here to stay and we will over time have to learn to balance the risk from the virus with the requirement to live our lives. It will become less threatening and hopefully more like the ‘common cold’ as the vaccine discoverer Dame Sarah Gilbert, recently told a seminar.

But of course, life is not as simple as any politician going on air and declaring their belief that we are moving into the endemic phase, as Prof Christina Pagel, from University College London and member of Independent Sage, indicated on Sky News, the endemic stage will mean that Covid is :

“present, but you don’t get exponential rises in the absence of other measures”… We’ve literally just had a month of exponential rises of Omicron in our population – so we’re not at endemic stage… You can’t just say we’re moving from pandemic to endemic. That’s the virus’ timescale. It’s not ours.”

Of course, she and others are also right in asserting that it is a naïve presumption to assume that the progress of any virus, never mind one like Covid19, is inevitably along a trajectory of ever-decreasing threat. Our ability to reduce mortality during Delta as compared with the original Wuhan strain was because of the brilliance of vaccines not the fact that Delta was less severe. Virus threat fluctuates and just like that oft heard warning– they can go up as much as can come down. In Van Tam’s metaphor – the time you are most likely to lose a goal; is when you take your eye of defence.

So what does all this mean for social care?

This last week has been a really worrying one for many who use services and supports, especially those in their own homes. Last weekend’s Sunday Times carried a story suggesting that there would be an end to freely available Lateral Flow Tests (though of course they are not free as we pay for them in our taxes.) Although subsequently denied by Westminster ministers it has left many who are clinically vulnerable in our communities concerned that one of the key protections and mitigations may be removed from the Covid defence armoury especially as nothing was said in the ‘leak’ or ‘briefing’ about social care staff and service users in the community.

Then we had the announcement of a reduction of social isolation in England to five days with two clear LFTs. Whilst this may be acceptable it is argued for the majority population on ‘economic grounds’  (though personally the reality that over a third still remain positive and potentially infective after that time questions the morality of that assessment), the lack of robust safeguards for those who receive care and support in the community, or who have anyone from electrician to friend, come across their front-door, risks imprisoning a whole sector of the population into a perpetual isolation.

The balancing of the harms caused by lockdown and other restrictions cannot be at the cost of those who for whatever reason live with vulnerabilities and who need protection from harm. They deserve equality of citizenship and attention to their basic rights as anyone else.

Why is it that we believe that returning to ‘normal’ is inevitable? What is it in the presumption that ‘progress’ is always a continuum into the future? Perhaps progress is an acceptance that things can never be as they were, that difference is part of our tomorrow, and that maturity is living with that new reality? This time last year we were speaking about a ‘new normal’ of a way of living and being in community with one another that accepted that there may be some elements of behaviour and mitigation which will need to become part and parcel of our being with one another in society. Whether that is mask wearing or testing in defined circumstances and  environments I do not know but I strongly suspect that it will mean a continued period of awareness and support for those in our care homes and those who receive social care supports in their own homes. We will need to re-think social care support.

Living with the virus needs to become a state of being responsible in relation to others not an abandonment of the knowledge we have gained in the last twenty-one months. If the science is to continue to give insight, we cannot pick and chose the bits we like and ignore the evidence of challenge.

Living with the virus will for those working in social care undoubtedly mean an awareness that we have a workforce which is exhausted and drained, many of whom today as they fight the threats of Omicron are desperate for a rest, and many of whom might well be considering can they possibly go through this again.

Living with the virus will mean a necessary requirement to adequately resource the social care sector not solely as the appendage of the acute NHS sector, or even as the enabler of independent living and individual citizenship, but as a sector and workforce that equips the whole community to continue to remain healthy and which fosters the wellbeing of those who are at particular risk. The likely demand of continuing testing, IPC measures and other mitigations and precautions requires focussed planning and strategic attention now.

Living with the virus will mean that we have to acknowledge the massive extent of unmet social care need, the drained and diminished ability of family and non-paid carers to give any more, and their desperate need for real support and practical assistance.

Living with the virus should mean that we have especial regard for those who are at most risk, a characteristic of behaviour and priority because of the priority of those individuals regardless of age, disability or circumstance who are as vital a part of our place as we are, whose creativity and contribution need to be fostered and enabled as much as yours, whose rights and dignity require to be enhanced as anyone else’s in any day.

Living with the virus requires a re-orientation of all our lives, not just the lives of the few. It is one which can only be made together, in partnership and collaboration, in engagement and consent, and cannot be achieved by a rush to the exit door of caution and precaution. We are 3-0 up let us not lose the game.

Donald Macaskill

I discovered this week whilst listening to the radio that our national tourism agency Visit Scotland had launched the Year of Stories 2022 – a year which they describe as one where we celebrate stories inspired by, written, or created in Scotland. They go on to say that ‘stories are a vital part of Scotland’s culture, and every community has a different tale to tell. Shared stories, whether spoken, written, sung or filmed are what give a sense of place, history and belonging.’

As part of the Year of Stories there are already being organised hundreds of events across the country in museums, cinemas, community centres and visitor attractions which will focus on storytelling and the art of story. All of this in an attempt to capture the imagination, to entertain and inspire.  You can find out more on their website and by following the hashtag #TalesOfScotland.

I have written a few times about the power and importance of story and storytelling, not least in social care and in palliative and end of life care. I have reflected that stories are not just about a source of entertainment and escape, but rather that the real power of story is as a force for change and a tool to make a difference to our lives and communities.

But as I heard about the Year of Stories there were two stories which that day were uppermost in my mind, firstly Omicron and also the experience of living with dementia.

As I sat there I could not but reflect on the stories which I have been hearing and am still being told; these have been stories of this aching pandemic and of the response of the social care workforce and organisations to the Omicron virus. They have been stories of people separated again from loved ones in care homes struggling with outbreaks, of people in the community frightened of being supported lest someone brings the virus in to them, of family carers with nothing left to give such is their exhaustion.

This past week has been one of the hardest ever for anyone running a social care organisation or working in frontline care delivery. The levels of staff absence because of Covid have been crippling with some care organisations running with 25% absences, whilst the majority are experiencing absence rates of between 10-15%. What this means is not just a stretched service but an exhausted one especially the women and men who are now working double and sometimes triple shifts. They are drained to the bone of energy and yet they keep coming back to the frontline because they care and because they do not want to see those being supported whether in care home or community abandoned.

I have never before heard reports of such stress as those I have heard in the last week. And one of the things that is making it really hard for all involved is the constant drip drip of commentary that suggests that Omicron is a mild virus, ‘like the common cold.’ Now apart from the fact that we have been warned this week by experts such as the World Health Organisation that such comment is dangerous, the severity of Omicron does not really change the fact that because it is so infectious thousands of health and care staff are off ill or isolating and that those left are on their knees. A system can collapse through a mild disease just as quickly as through a severe one. In many of the conversations that I have shared this past week folks are despairing of the reality that as they are struggling ‘in the trenches’ the rest of the world has become dismissive and blasé believing that the pandemic is over, that we just have to ‘ride it out’, rather than taking the threat to our health and social care systems as seriously as they should. And that threat should absolutely worry us – any of us – who might sometime in the next few weeks want to call an ambulance, experience an emergency health incident, be worried about the health of a sick child or relative. If we do not take actions to protect others in this crisis then they will not be there to take action to protect us in our crisis.

As I reflect on storytelling in a week such as this I cannot help but remind myself that stories are not always works of fiction and make-belief, tall tales of impossibility and miracle. Stories are the happenings of our moments, the actions of our heart, the fruit of our relationships. We are not passive actors on a stage which we cannot control and using a dialogue we have no influence over. We are not the playthings of a writer beyond our ken, but rather we are the agents able to influence the outcome. In other words the real power of story is that the page is still unwritten and we have the ability to determine what is the ending to our most important stories. We have control in this Year of Stories of the story of our time, and that at this moment in this year is still the story of Covid. We can determine whether with the aid of reflection at the end of this year we look back and read of the folly of forgetfulness and the narcissism of self-interest, or we can read of collective solidarity and support, where once again we rolled up our sleeves and were present for others.

So as well as Omicron, as I sat listening to the plans for the Year of Stories, I could not but also think of the fact that it was my parent’s birthday that day. As a child it was a great benefit to have your parents’ birthday on the same day! Now that they are no longer alive inevitably it is now a day of reflection and remembrance. But it was also this year a day where – albeit on the margins of media stories covered that day – new research was published on dementia, the disease which took my mother from life and with which we had as a family lived with for years. The Global Burden of Disease report was the first international study of its kind and it was reported as stating that:

‘The number of adults living with dementia worldwide is on course to nearly triple to 153 million by 2050… Experts described the data as shocking and said it was clear that dementia presented “a major and rapidly growing threat to future health and social care systems” in every community, country and continent.”

It went on to state the substantial evidence indicating ways in which health and lifestyle could be improved and changed in order to prevent dementia which for the majority is not ‘inevitable.’ It also argued quite clearly that there was a need for major investment and research to ‘find a cure’ for a disease which will outstrip all as a threat to humanity and the quality of life.

To some extent this research tells us nothing those of us involved in the world of dementia did not know or at least fear. Its robustness and rigour is what is terrifying. But it also shows the way forward and the prospect of change offered to us.

I cannot be the only person who has marvelled at the way in which the global pharmaceutical and research community has come together and within an astonishing period of time has managed to find vaccines of such effectiveness and safety that we have prevented the Coronavirus pandemic from being even more disastrous than it has been, The vaccine discoveries have been an astonishing result of science and collaboration. Equally I cannot have been the only person, not least those whose lives are shortening as they live with dementia and those who love someone with dementia, who has not asked the question, ‘If they can do this for Covid, why cannot they do it for dementia.’

I am the last person to demean or diminish the dedication and energy of those over the years who have been involved in researching dementia and a potential ‘cure’, but I will be the first to question the moral priority of societies which continue to fail to invest and prioritise such research. I will be the first to call out the reality that when push comes to shove a disease that predominantly affects the old (but by no means exclusively) is deemed and viewed by society as less significant because of an inherent cultural and global ageism. That simply has to change. We must get serious and with the same international and national focus which brought us the Covid vaccines turn our attention to dementia.

In this Year of Stories, we need to be reminded that within us all is the ability to write a new page, to create a new ending which is of hope and change, restoration and light. In the dark winter days where in a care sector stress and exhaustion run rampant, we need to know that every change worthy of its name has been brought about by ordinary women and men deciding to change the story of their living. The power of story lies within each one of us to become a narrative which changes lives and improves community.

In this Year of Stories I hope we can use our words and actions for the betterment of all and not just the entertainment of a few. Because stories at their best, I believe, can change the world, re-orientate direction and motivate lethargy and tiredness.

Let us all therefore write a new story for this year and every year.