Over the years I’ve written quite a few times about men’s health and some of the challenges that are faced in improving the health of the male population. I’m back on this theme this week as we sit towards the end of Men’s Health Week 2025 which runs from the 9th to the 15th June.

Amongst all the focus on male health there is a group which is even more forgotten about and that is the specific needs of and issues facing older men.

Recent data paints a concerning picture. Life expectancy for men in Scotland stands at 76.8 years, with a stark 13.2-year gap between the most and least deprived areas. Chronic conditions such as obesity, affecting 32% of adults, and cerebrovascular diseases, with incidence rates 32% higher in males than females, further exacerbate health disparities.

Physical activity levels are suboptimal; only 37% of adults aged 75 and over meet the recommended guidelines, with men in this age group slightly more active than their female counterparts but still not engaged in levels of activity which would bring real physical benefits.

Mental health is another pressing issue. Loneliness has been identified as a significant public health problem, with 58% of Scots over 50 experiencing loneliness most or all of the time . This sense of isolation is exacerbated by the fact that nearly 40% of Scottish households are single-person dwellings, the highest rate in the UK. Men in particular are more likely to face periods of loneliness in older age not least when a partner dies.

There is a great deal of appropriate emphasis upon preventative care and support, around interventions which can help address inequalities and enhance wellbeing and health. One area which can undoubtedly benefit from such approaches is male health, and a major strand in that approach are social care services.

However, the current system has been criticised for being fragmented and crisis prone. To better serve older men, social care must evolve in ways which are responsive to the needs of a distinct population and please, please, please the talk of prevention and early intervention must be backed up by an adequacy of resource even if it means realigning existing spend.

We know what works well and perhaps the model with the greatest success is the Men’s Shed movement. Such community-based approaches provide spaces for older men to engage in meaningful activities, fostering social connections and improving mental health. Similarly, the Sporting Memories Network uses sports reminiscence to connect with older men, particularly those living with dementia.

We know on the ground that targeted interventions are needed to combat loneliness among older men. This includes promoting social engagement opportunities and ensuring access to mental health support services. The crippling impact of loneliness will not be addressed by happenstance and a blanket one sized fits all approach – it has to be targeted. It is therefore really disappointing that there has been year on year cuts to the resources that third sector organisations require to keep these approaches and services going. To say nothing of the potential to address male loneliness if we ever allowed ourselves to fund a homecare system that gave time, conversation and space to the care and support of older  men.  Only with such support would frontline staff and social care organisations manage to be more equipped to understand better issues such as masculinity and cultural norms that may impact men’s health behaviours.

I have looked in vain for a cross policy and whole system Men’s Health strategy in Scotland. This is not to diminish the good work that is underway not least the focus on male suicide but I really do think the time has come for such an approach, not least as there is now a drive from the UK Department of Health and Social Care who launched a 12 week consultation in spring of this year to inform their first ever Men’s Health Strategy.

The reasoning for such an approach is not just the factual data that tells us that 1 in 5 men die before the age of 65 in the UK; that 3 out of 4 suicides are by men or that 37% of men admit to hiding their mental health issues from their partners.

The data is damning and inequalities are only growing and I would argue only a whole system wide cross-cutting, multi-disciplinary approach to men’s health will make real difference – especially if it is rooted in social care.

It would potentially help us to leverage our existing structures (community nursing, care-at-home) to proactively reach older men by offering check-ins, screening, and early support. It would potentially offer us a national approach to the expansion of existing community-based interventions such as Scottish Men’s Sheds, Sporting Memories, walking groups, book clubs and foster the development of new approaches to appeal to emerging generations of men.

A national Strategy would also critically help us to fill the huge knowledge gaps we currently have around male health. It would enhance the collection and public reporting of men’s health outcomes (e.g. life expectancy, mental wellbeing, social isolation) by age, gender, and deprivation.

And lastly but perhaps even more importantly such a Strategy could drive increased national awareness and knowledge. Public campaigns highlighting men’s‑health issues (e.g. heart health, mental wellbeing, cancer screening), with a focus on older men and reaching them via trusted community channels could all become a priority.

So, as we come to the end of Men’s Health Week for another year perhaps some of our political leaders and aspiring parliamentarians could take the lead in helping us to develop a national Men’s Health Strategy?

I leave you with some words from the poet and celebrant Marc Lemezma who beautifully captures the inner struggle many men face – hiding their pain behind pride, and the liberating power of someone simply asking with care. It’s a heartfelt reminder that support can start with a single question and that vulnerability is not weakness but connection.

Remember to ask and listen with care

For the most common of troubles are the hardest to share

They hide deep within us;

They never will show

Yet these are the feelings we need to let go

But we let foolish pride colour our eyes

And run from our burden till there’s nowhere to hide

We give them a home; yet they eat us away

We think they’re the answer; they’re just there to betray

You cannot imagine or begin to dare

How these are the feelings that every man shares

Yet all that it takes is for someone to ask

And the love of a friend can pierce through the mask

So remember to ask, for the silence may break

And may just be the lifeline they needed to take

Donald Macaskill

Next week the 9th to the 15th of June is the annual Carers,Week. This year the focus is all about ‘recognising our carers’ and a plea to acknowledge the invaluable contributions of unpaid carers.

Right across Scotland today, in tens of thousands of homes, a silent workforce labours tirelessly – these unpaid carers are the backbone of our health and social care system. They are the daughters, sons, spouses, neighbours, and friends who, without fanfare, provide essential care to loved ones. If the contribution of paid carers to Scottish society is massive and unrecognised, that of our unpaid carers is monumental and unsupported.

Recent data underscores the scale of unpaid care in Scotland. The 2022 Census recorded over 627,700 unpaid carers- a 27.5% increase since 2011. Their collective efforts are valued at approximately £15.9 billion annually.

These women, men, young people and children provide indispensable support, often stepping in where formal services fall short. Sadly, this is even more the case as savage cuts are resulting in the loss of so many formal lifeline social care services. Carers in their roles encompass a wide range of responsibilities, from personal care to managing complex medical needs. Without them, the formal health and social care systems would face insurmountable challenges and in truth would crumble.

Despite their critical role, unpaid carers face significant pressures. A 2023 survey revealed that over half (52%) of carers reported an increase in their caring responsibilities over the past year, with 75% unable to take a break when needed. Many feel overwhelmed, with 63% reporting feelings of being constantly overwhelmed due to their caring duties.

The health impacts on many unpaid carers are enormous with chronic stress, sleep deprivation, and isolation often reported. A Public Health Scotland report in 2022 found that unpaid carers are twice as likely to experience long-term health conditions as non-carers.

Financial strain is another pressing issue. Unpaid carers are 56% more likely to experience poverty and 60% more likely to be in deep poverty compared to those without caring responsibilities. This economic hardship often forces carers to reduce working hours or leave employment altogether, exacerbating their financial vulnerability.

The challenges faced by unpaid carers have broader implications for the social care system. As carers become overwhelmed and unsupported, the risk of care breakdown increases, leading to greater demand on formal services and at a time when demand is already soaring and the capacity to respond is diminished. This not only strains resources but also impacts the quality and continuity of care for those in need.

Moreover, the reliance on unpaid carers masks the true demand for formal care services, leading to underinvestment and inadequate policy responses. Recognising and supporting unpaid carers is therefore not just a moral imperative but also an urgent necessity for a sustainable social care system.

To address these challenges, a multifaceted approach is required and much greater political priority: I would argue that this would include amongst other things, that the Carer’s Allowance Supplement needs significant investment and increase, even with a recognition of the summer payment this past week. In addition, that respite should be seen as a fundamental right and such guaranteed breaks must be enforceable, not a postcode lottery. We also need to do much more in terms of workplace protections so that carers are not forced out of jobs, especially older carers.

And lastly, I have lost count of the tables I’ve sat at and rooms I have been in which have been critical to social care provision and the voice of unpaid carers is absent. Unpaid carers and their representative organisations require formal recognition as being integral partners in the health and social care system, involving them in decision-making processes.

By implementing these measures, we can slowly begin to alleviate the pressures on unpaid carers and build a more resilient and compassionate social care system.

To close, I leave you with a poem which reflects on the fragility and impact of unpaid care:

I’m holding it together

 

I’m holding it together – just.

The fragments of those days when

you made all the decisions, and I

was pleased just to follow

are there, fragile but still.

I’m holding it all together – I think.

The tears inside swelling to leave

when I watch you fracture every moment,

knowing I cannot come with you

into that place beyond hope.

I’m holding it all together – in pain.

As my body aches with the routines of

morning, noon and the light on night

with pills, cups of tea and soundless TV,

when nothing but emptiness sits between us.

I’m holding it all together – just.

No-one knocks the door or calls anymore.

Because I’m coping with the care

they can rest assured and at ease, that

I’m holding it all together.

Donald Macaskill

This extended blog is the substance of a speech given to the EVH conference on the 17th May.

Thank you for being here. Thank you, too, for turning up to a conversation which if surveys are anything to go by, people either ignore or would frankly rather avoid.

I want to talk to you today about ageism, what it is and how it has developed over time; to consider its extent and pervasiveness in Scotland today, and what if anything can be done and is being done to address it.

Why is it important? – well for me: ageism is a stain on our collective soul.

We wrap it in polite assumptions and patronising jokes, in gentle mockery of forgetfulness, or in the economic rationalisation of “dependency ratios.” But make no mistake – when we speak of older people as if their worth is tied to productivity, when we design communities that exclude, when we limit aspirations rather than nurture them – we deny the dignity that belongs to every human being, at every age.

So, what do we mean by ageism?

Technically the term “ageism” was first coined in 1969 by Dr. Robert N. Butler, a pioneer in gerontology. He defined it as

‘the systematic stereotyping and discrimination against individuals based on their age, particularly targeting older adults.’

Butler’s observations highlighted how society often marginalises the elderly, viewing them as less capable or valuable.

But ageism and negative attitudes towards older age in particular pre-date Butler by a long way and can be seen across history, art and science – though intriguingly there is a real variety in the way in which diverse cultures and traditions view ageing and older age.

Ageism is not merely a social bias; it reflects deeper philosophical notions about value, productivity, and worth. Historically, Western societies have often equated worth with economic productivity, sidelining those who are retired or less active in the workforce. Even in my own lifetime and memory I am aware of attitudes which assumed that when someone retired their value was of limited societal benefit.

To be young is full of potential and contribution, ability and creativity, as we age and when we are old our potential is over, our contribution worthless, our abilities limited by frailty and our creativity mere a re-treading of our earlier abilities. We worship at the societal cult of youth and beauty.

Whether it is in literature or art we are all inheritors of negative stereotypes and beliefs about ageing and older age.

Ageism in Western art and literature has often reflected cultural biases that devalue aging and old age, especially when associated with decline, irrelevance, or grotesqueness. However, it can also reveal moments of reverence and wisdom. Here’s a cross-historical look at examples of ageism – both explicit and implicit – from classical antiquity to modern times:

As far back as the Greek philosophers such as Aristotle we see the stereotype of the elderly as overly cautious, suspicious, and cynical.

“They are cynical; that is, they always tend to put the worst construction upon everything.”

In the origins of classical theatre whether Greek or Roman we see elderly characters often mocked for their physical decline, sexual impotence, or irrelevance, playing comic or foolish roles. The Roman satirist Juvenal ridicules elderly women for clinging to youth or engaging in vanity.

“No one is young after forty, but men are sometimes delightful afterward.”

In political and civic life, it went even further – the best (or worst) example being in Ancient Sparta (c. 5th century BCE) where older people who were no longer able to serve in military roles were often sidelined and in a society that prized physical strength and youth older individuals who could no longer contribute to military life were seen as less valuable.

Things didn’t get much better as time went by – in the medieval allegory the Dance of Death / Danse Macabre we see older figures depicted as frail and near death, reinforcing the notion that aging is a prelude to judgment or decay. And the famous “Wife of Bath” is both empowered and mocked in Chaucer’s The Canterbury Tales (1387–1400) as she subverts norms but is also portrayed as sexually manipulative and “past her prime.”

Perhaps we reach our negative peak with good old Will – in his King Lear (1606) we see the eponymous character of the King descend into madness after relinquishing power which for Shakespeare was interpreted as a warning about the instability of old age.

“Age is unnecessary.” – King Lear

In the visual arts – say for instance in Caravaggio or Goya old age is frequently shown as grotesque or pitiable- highlighting sagging flesh, blindness, or senility- especially in contrast with youthful beauty.

Even the Enlightenment didn’t bring much enlightened positivity – with folks like Voltaire and Rousseau who often depict older people as resistant to progress or trapped in outdated thinking- reflecting the Enlightenment’s fetishisation of youth and rationality.

The Industrial Revolution (18th–19th century) saw a sharp reorientation in attitudes around age – as economies shifted from agrarian to industrial, older workers were pushed out of the workforce in favour of younger, faster, more “productive” labourers. (of course, including children!). Older people often became dependent on family or charity and were increasingly seen as economic burdens as capitalism began to consider worth not to age but contribution and physical economic capacity.

This reached its peak with the 19th Century Poor Laws which remained until the 1960s in Scotland at least as the attitudinal bedrock for the way in which we dealt with those who whether because of age or infirmity were not contributive.

The British Poor Laws institutionalised ageist policies by providing only minimal support to the elderly, who were often sent to workhouses if they had no family support. These institutions were harsh, with the elderly frequently treated with suspicion and disdain.

And the closer we get to our own cultural reference points the more embedded stereotypes around older age become. Who can forget the Dickens characters like Miss Havisham (Great Expectations) who represents old age as twisted by bitterness and isolation; or Scrooge’s transformation in A Christmas Carol which suggests redemption from the moral rigidity associated with age.

More horrific the Nazi regime developed and continued negative views of older age – and whilst we remember the attempted eradication of Jews, homosexuals, communists and many others we often have failed to talk about and recognise that the Nazi regime systematically devalued the lives of older adults, particularly those with disabilities. Under the T4 euthanasia programme, thousands of older people were forcibly sterilised or killed, deemed “unproductive” or “useless eaters.”

And closer to our own time the 20^th and 21^st cinematic representations not least from Hollywood offer persistent preference for youthful protagonists, with older characters (especially women) often portrayed as irrelevant, evil (the “crone” trope), or comic relief.

In terms of wider society whilst we may have closed the workhouses across the Western world, including the UK and US, mandatory retirement ages were introduced in the early 20^th Century, sometimes as early as 55. Effectively older people were excluded from economic participation regardless of their abilities or desires.

And even when in the latter part of the last century while pension systems were introduced to support older people, they often reinforced a stereotype of older adults as passive dependents, rather than active citizens with ongoing potential. Public policy tended to “manage” ageing, rather than celebrate it.

Time immemorial then we see some standard stereotypes and tropes around ageing and older age (and with very unsubtle gender biases)

• The Crone / Hag (e.g. fairy tales, Macbeth’s witches): aging woman as witchlike, manipulative, or grotesque
• The Foolish or Bitter Elder (e.g. Lear, Miss Havisham)
• The Discarded Elder (e.g. King Lear’s banishment)
• Idealisation of Youth (common in romantic and modernist visual art)
• Aging as Decline vs. Aging as Wisdom: The former dominates in mainstream narratives; the latter appears in select moral or spiritual texts.

Now all that is the ground in which the seed of ageism has flourished and spread.

All these historical examples show that ageism is not a new problem, but a structural issue shaped by economics, culture, and power. Today’s challenge is to unlearn these biases and create a world where ageing is seen not as decline, but as continuity, contribution, and worth.

Scotland

So, what about Scotland, after all we are the land of inclusivity, open welcome, and positive affirmation. Well not surprisingly we have not been immune to the challenges of ageism and arguably given our particular demographic profile some might suggest we have embedded both a policy and cultural ageism without robustly tackling it.

What is Scotland’s demography – well I suspect, many of you know this already.

Scotland’s 2022 Census reported over one million people aged 65 and over, surpassing the number of individuals under 15 by more than 250,000. This demographic shift underscores the importance of addressing ageism, especially as older individuals constitute a growing segment of the population.

We are an ageing population with a declining birth rate, and with a working age population which is becoming older and as a result less productive – as my sector – social care – knows only too well.

As of mid-2023, over one million people in Scotland are aged 65 and over, accounting for approximately 20.3% of the total population.  This marks a notable increase from 16% in 2001.

Projections indicate that this trend will continue. By mid-2047, the number of individuals aged 75 and over is expected to rise by around 341,300, representing a substantial growth in this age group.  This ageing is primarily due to longer life expectancies and declining birth rates. Since 2015, Scotland has recorded more deaths than births annually, a pattern projected to persist.

The demographic shift has significant implications. The dependency ratio – the proportion of individuals not in the workforce (under 16 and over pensionable age) compared to those of working age- is projected to increase from 60 per 100 in 2014 to 68 per 100 by 2033.  This suggests increased pressure on healthcare, social services, and economic support systems.

Addressing these challenges requires strategic planning, including policies that support healthy ageing, encourage workforce participation among older adults, and adapt public services to meet the needs of an older population.

But can this be down in a non-discriminatory and non-ageist manner – if it can we have potential to become a society that values ageing – that doesn’t see things as demographic time-bombs, or age tsunamis – but as potential, contribution and silver opportunity.

But is that our reality?

Well in truth my experience of Scottish culture, politics and public life is that if anything we are becoming more ageist and more discriminatory on the grounds of age and not less.

I would contend this position on several grounds.

Firstly, Employment Tribunal Awards: In the 2023/24 reporting period, there were 12 age discrimination cases in UK employment tribunals. The average award was £102,891, with a median of £86,349. Notably, six of these awards exceeded £50,000, indicating significant financial implications for employers found guilty of age discrimination.

Surveys suggest that many people either believe they have been or fear discrimination in seeking work if they are over the age of 55.

Secondly, in terms of growing incidents of hate, Age Scotland reports through its work that there are growing incidents of direct hate and harm being experienced by older persons. Following the implementation of the Hate Crime and Public Order (Scotland) Act on April 1, 2024, recorded hate crimes in Scotland rose by 63%. Approximately 300 of these were age-related, marking a significant increase and highlighting growing concerns about age-based prejudice.  You have to remember the recording of age as a characteristic in hate is new.

Further a survey by Age Scotland revealed that only 7% of respondents felt older people are represented positively in the media. The organisation emphasises that ageist portrayals contribute to negative societal attitudes and self-perceptions among older individuals.

Of even greater concern that media representation a recent survey by Age Scotland (in late 2021) reported that a significant number of older Scots have reported experiencing ageism. The survey found that more than a third of respondents (36%) felt they were made to feel a burden to society. Additionally, 34% said that life was getting worse for older people in Scotland. One in five (21%) felt valued by society. The survey also revealed that 12% of respondents had experienced age discrimination in the workplace.

Lastly, my own personal experience of the pandemic and our national, governmental response is one that suggests that age discrimination was not far from the table, even if it was subtle, and as a backdrop rather than in the foreground.

The evidence heard to date before both the UKL and Scottish Covid Inquiries would at least give us pause for thought.

During the pandemic, many countries, including the UK, prioritised younger populations for hospital resources and ICU beds. That is – for me at least – an inescapable truth not least in the ‘clearing of our hospitals.’ And in the development of highly questionable and unethical emergency clinical decision tools and approaches. In some instances, blanket DNACPR (Do Not Attempt CPR) orders were applied to older care home residents without consent. Certainly, that has been the view of experts such as the United Nations.

More broadly I think ageism and age discrimination is evidentially rife in our societal failure to prioritise social care.

These examples illustrate the multifaceted nature of ageism in Scotland, affecting employment, media, legal systems, and societal attitudes. Addressing these challenges requires concerted efforts across sectors to promote inclusivity and respect for older individuals.

So what can be done?

In Scotland Age Scotland and other organisations including my own has advocated for the establishment of a Commissioner for Older People in Scotland. This role would aim to amplify older individuals’ voices, ensure their rights are protected, and address issues such as ageism, access to services, and digital exclusion.

At the United Nations in Geneva following a significant decision this April, work has started on the creation of a Convention on the Rights of Older Persons, but this will take a considerable period of time.

But I think we can do more …

This is not just about challenging obvious prejudice – it’s about unlearning deeply embedded assumptions about value, beauty, purpose, and potential.

We can and must do more to combat ageism effectively, especially within the context of Scottish society. Scotland needs a renewed, bold and unapologetically ambitious strategy for positive and active ageing. One that is not a subsection of health and social care, but a whole-of-government, whole-of-society commitment.

Let me offer a few extra steps we must take if we are serious:

Redesigning communities through the lens of age inclusion

This means accessible transport, intergenerational housing, safe public spaces, and services that work for everyone from 8 to 88. This is not utopian — it is simply just.

Education and Awareness

We need to integrate discussions about aging and ageism into educational curricula to foster understanding from a young age. Intergenerational work is critical and a benefit to all.

Policy Reform

We need to implement policies that protect against age-based discrimination in employment, healthcare, and social services. And not just have the policies and legislation but to robustly enact them. We can start by auditing all existing policies and practices – ideally through an independent Commissioner.

Reimagining work and contribution

We must challenge retirement as the end of value. Many older people want – and need – to continue working, mentoring, creating. Let us support flexible models of work, lifelong learning, and volunteering that respect the diversity of older lives and don’t just let us continue to play at this.

Community Engagement

We need to encourage intergenerational programmes that promote mutual respect and understanding between age groups. And not just encourage resource and fund because so many third sector organisations are being stripped of cash.

Media Representation:

And critically we need to advocate for diverse and accurate portrayals of older adults in media to challenge prevailing stereotypes.

Tackling digital exclusion as a rights issue

The digital divide is not just a gap in access – it is a denial of participation. Every time we design a service that assumes digital literacy, we risk leaving people behind. Inclusion must be designed in from the start.

All of this will take political will, social courage, and cultural change.

But most of all, it will take a radical reorientation of our values — one that refuses to tolerate systems that reduce people to years, needs, or costs.

You see, I believe that how we treat our elders is not just a social policy issue – it is a measure of our national character.

Do we see older people as burdens to be managed?

Or as citizens to be honoured, included, and celebrated?

That is the question at the heart of ageism.

We need a Scottish society where ageing is not something to be endured but embraced. Where care is not a transaction, but a relationship. Where every life is seen as whole, from the first breath to the last.

And what about the housing sector? How age blind is the sector? Are we build to enable accessibility or building to perceived demographic demand? We should remember the power of the silver pound, and the reality that the generation of tomorrow – our older generation will not sit down and accept the limitations of others upon their lives. They will – I have every confidence – act and demand, work and achieve equal treatment.

It is time to celebrate age – and I intend to grow old disgracefully but with dignity

Dignity has no use-by date.

It does not expire when we retire.

It does not fade with memory.

It is not conditional on mobility, nor appearance, nor the capacity to contribute to GDP.

It is rooted in being human — and that is enough.

Donald Macaskill

Photo by Ksenia Emelianchik on Unsplash

I’m always sensitive about using my weekly blog and podcast to talk about issues which might be considered to be of a political nature. One in particular is almost guaranteed to have a line-up of angst and approval in equal measure. That is the subject of immigration.

I’ve spoken and written before about migration and about how I personally see immigration as being an asset and benefit to Scottish society. Over decades, as a culture and community, we have benefited from the gifts and insights of those who are not indigenous to these lands. Indeed, I have reflected of my own family story which though it can be traced back for hundreds of years originally in the mist of time was one of migration. I have reflected of how as a nation we have been a people who have migrated, especially from the Highlands and Islands. We have always ‘gifted’ people to the world sometimes as a result of pressure, persecution and poverty.

I am sensitive to the concerns of those across the country in relation to migration but in this piece I want to answer some of the questions which are raised around social care and migration, hopefully challenge some myths and also reflect on the personal impacts of a growing negativity and anti-migrant rhetoric not least that which has occurred in the last fortnight.

The primary and critical issue, for me at least, is the need to recognise that the demography of Scotland is different and distinct when compared to other parts of the United Kingdom.

Over one million of our citizens are now aged 65 or over, accounting for more than 20% of the population – a figure that has grown by over 22% since 2011. By 2043, it is projected that one in four people will be aged 65 or over, with the number of people over 75 increasing by 59%.

This ageing trend is not just a statistic; it represents a profound shift in our societal structure, with significant implications for our health and social care systems. It is one, I would suggest, that should be viewed positively because it means we are most of us living longer. So let us banish words and phrases like ‘demographic timebomb’ or ‘age tsunami’!

Sadly, however though we are living longer we are not becoming healthier into older age. Inevitably then the ageing population brings with it a surge in demand for social care services.  Research by Public Health Scotland highlights that the number of people requiring complex care is rising faster than the capacity to deliver it. Without sufficient staffing, individuals face delayed support, increased hospital admissions, and poorer health outcomes.

At the same time as our population is ageing and demand for social care is rising, our social care workforce is itself ageing. The majority of adult social care staff fall within the 45-54 and 55-64 age brackets, comprising approximately 21.5% and 22.5% of the workforce, respectively. In addition, a report published by the workforce regulator SSSC a couple of months ago using data from the end of 2023 showed that 48% of registered care services reported having staff vacancies and that in 12 of the 32 local authority areas, 50% or more services reported vacancies. These are really critical levels of vacancy and mean that there are already parts of the country where care homes have closed and homecare services have had to be withdrawn.

It is often argued that all we need to do to attract a new care workforce is to recruit from within the country by improving terms and conditions. This is not as simple an argument as it might appear. First of all, a care worker in Scotland is paid the National Living Wage of £12.60 an hour as a minimum and organisations like my own have long argued that if we want to retain and better value our social care staff then we need to at least see £15 an hour as a starting point – though I would argue that figure is now £18 an hour. Most providers of care, most employers would agree with that. The problem is that whether you are a charity, not for profit or private business you need money to come in the door in order to enhance the terms and conditions of the workforce. Given that in Scotland the vast, vast majority of care is bought by the Government, (whether we see that directly as local government contracting or national government financial allocation) – if there is not enough money to pay increased salaries to staff then it simply cannot be done. That is a challenge for both UK and Scottish Governments – the former is engaging in empty words if it says improve pay when it knows it is the major block to that.

Concomitant with this is the fact that to be a social care worker in Scotland (unlike elsewhere in the UK) you need to be registered with a regulator, qualified (after a specific period) and be willing to be subject to regular continuous learning and development whilst working under a regulatory environment. That is not easy and does not suit everyone even if terms and conditions were enhanced, and at the moment it is often the reason (together with pay) why people choose to work in retail, hospitality and other sectors.

On top of all this the work of care is hard, emotionally and physically. It demands great skill and aptitude and a special sort of humanity that is able to be with people at their best and worst, through their highs and lows. It is clearly not for everyone and anyone who suggests that it is a professional role that people can be trained for within weeks is naïve, dangerous and has never worked in care. Worst still is anyone who offensively suggests that care is ‘low skilled’ or ‘unskilled.’

Faced with all these realities and the truth of an ageing workforce, coupled with increasing demand, a skilled and technical role and terms and conditions which are not as they should be, there is immense pressure on the sustainability of care services.

But despite all this – the work of care is one of the most rewarding roles anyone can fulfil. There are very few roles if any that allow you to make a real difference in people’s lives, supporting their dignity, independence, and well-being. Social care offers meaningful human connection, a sense of purpose, and the satisfaction of helping others live fuller lives.

It is when all is said and done essential that we have enough women and men, skilled and equipped with the humanity and emotional intelligence, available and willing, to work in social care. That is why given the fact that there are not enough people available within the Scottish workforce (given low levels of unemployment not least) that international recruitment has always, for decades, been important. Not to plug gaps but to contribute skills, aptitude and abilities. These professionals bring invaluable skills, experience, and cultural perspectives that enrich care delivery and meet the diverse needs of our ageing population.

The changes announced recently which aim to remove the ability of employers and organisations to recruit internationally are potentially devastating. My own organisation, Scottish Care has published research this past week to suggest that over a quarter and perhaps a third of all workers in care in Scotland are international colleagues. This in ordinary times should be celebrated rather than regretted. But in these toxic times when there is so much negativity and anti-migrant rhetoric it is a cause of concern and anxiety, both for employers, frontline workers and those international colleagues themselves.

It has been a bruising couple of weeks for people and quite a few have reached out to me through social media to express their concern about their own status, the wellbeing of themselves and their families and to wonder aloud whether or not they want to live in a country which appears to value them so little.

Precious is from Ghana. She came to Scotland under the Care Worker Visa route. She is a qualified nurse with considerable experience, but she wanted to improve her and her family’s life and opportunities and to move out of a situation where because of her religion she felt under constant pressure. So, she applied for the Visa and after a long, difficult and expensive process arrived in Scotland. For the last couple of years, she has been working as a Senior Carer for a care home in a remote part of the country. During that time, she has become an essential part of the team, the quality of care and compassion, the standard of her professionalism and skill is beyond measure. She was able to bring her family, and their presence has transformed the village they stay in because before she arrived the local school was at risk of closing. She is a classic ‘New Scot’ (though I’m not sure of that term) and has become the backbone and lifeblood of her new community. But she spoke movingly to me about how when she leaves there, when she travels elsewhere, she is increasingly feeling unwanted, unwelcome and afraid.

Political leaders at Westminster need to understand that there are distinctive needs in Scotland, that our care sector which is already fragile is teetering on the edge, and that if it collapses it is people across the country who are some of our most valuable citizens who are at risk, to say nothing of our industries and communities. They also need to know that the impact of language that excludes hurts and damages social cohesion. I hope sense will arrive in the place of rhetoric, that sensitivity and value will replace crassness and exclusion.

In contemplating the role of migrants in our society, I am reminded of words from Jackie Kay which encapsulate the spirit of inclusivity and warmth that defines our Scottish nation:

“It’s not where you’re from, it’s where you’re at.

It’s not who you were, it’s who you are.

You are welcome here.

You are welcome here.”

 

These lines resonate deeply, reminding us that our strength lies in our openness and our commitment to caring for one another, regardless of origin.

Donald Macaskill

The following is based on a speech given at the Scottish Care Homecare Conference on the 16^th May.

Well since I picked the title of this brief talk, I’ve been told that I shouldn’t be using the word ‘crisis’ because the constant talk about social care being in a state of ‘crisis’ is a real off putter for the general public – they don’t like it – even if it might be true.

So, I could just drop the word like any good follower of research on public opinion or just go for it.

I’ll do the latter if you don’t mind and I’ll explain why.

The first reason is that anyone – never mind someone like me standing here in front of several hundred experts in homecare and housing support – who didn’t own up to the painful raw reality of a sector facing innumerable challenges would be rightly accused of naive escapism if not delusion.

The second reason for calling our current state a moment of ‘crisis’ is that I also want to suggest that because of not despite the challenges- that this moment has the potential to be like a turning point.

Dragging memory into the now I’m reminded from my old school lessons of the fact that the word crisis comes from the Greek krisis, meaning decision, turning point, or judgement.

A crisis is not the end.

A crisis is a crossroads.

It is where choices are made, values are revealed, and futures are forged.

And in that spirit, I want to speak not only of the pressures that homecare faces – but of the possibility that lives within it.

Because homecare and housing support – for all its complexity, its fatigue, and yes, its fragility, remains one of the greatest expressions of love and solidarity we have as a society and its potential as a moulder of the moment, as a shaper of society and as an economic driver for Scotland is – I believe – huge!!

But to begin with let us speak plainly:

Yes – we are operating in a climate where public finances are constrained if not drained and exhausted. Scottish Care published research earlier in the year which has shown the savage cuts which are resulting in a sharp drop of packages of care and support being purchased – a loss of essential services or at least the reduction of critical services for thousands of those who urgently require care and support – we know the fractious failures resulting in work being reduced – we know and it’s now well publicised the huge level of debt being carried by HSCPs – around £500 million – which is simply meaning that services are not being bought

Yes – there is continued uncertainty around reform, regulation, and the shape of the future National Care Service if we are even allowed to use that word – and with others Scottish Care has recently been involved in publishing a report which gives some indication of what we consider to be essential steps ahead – at the heart of which has to be an assurance that not just invited guests but all stakeholders will be around the table to make decisions and enable reform to happen ..

Yes – recruitment and retention remain critical challenges. The increase in NI together with the absurdity of thoughtless and callous recent announcements by UK Government to the care worker visa seem both designed to make it harder for businesses to be sustainable and for us to attract a workforce skilled and capable in doing the job.

Yes – too many workers are underpaid, undervalued, and overburdened – it is not enough to say the NLW is the level of our aspiration any more – fair work – employee demands – all show that we need and can do better – with terms and conditions that speak to a skilled, qualified, and professional group of women and men – that address decades of low esteem, low value and low pay – and terms and conditions that are urgently needing to change.

But despite these truths, something remarkable persists.

Care continues.

In homes across Scotland – behind tenement doors, in croft houses and city flats – human connection is happening. Dignity is being protected. Meals are prepared. Medications administered. Hands are held. Laughter echoes down hallways, and tears are shared in silence.

Despite the growing obscenity of 5 or 15-minute visits – a truth remains – care is being delivered and quality care almost against the odds and certainly not because of the system and unethical contracts and commissioning practices.

The fact of faithfulness – the truth of the dignified routine of relationships protected and compassion delivered is a light we need to hold on to.

This is not failure. This is resilience. This is the hope of homecare to transform not just individuals but communities, not just lives but society.

When we talk about homecare, we are not just describing a service – we are not talking about a set of functions, or tasks or actions – we are describing a philosophy of life.

One that says:

• People should be supported in the places they love,
• That independence is not the absence of support, but the presence of the right kind,
• That relationship matters as much as task,
• And that a home is more than bricks and mortar – it is where identity, memory, and selfhood live.

So, in this so-called crisis, what new beginnings might we choose?

Let me offer some:

1. Revaluing the workforce as the heart of homecare

Not as deliverers of minutes, but as enablers of life. Let us raise their pay, yes – but also raise their status. Let us offer them careers, not contracts. Let us listen to their wisdom and build reform around their insight.

2. Refusing the false economy of underinvestment

A stitch in time doesn’t just save nine – in homecare, it saves hospital admissions, mental health deterioration, loneliness, and loss of independence. Every hour of care at home is an investment in human flourishing. It literally saves and shapes lives with purpose and meaning. This is what prevention is all about – and aren’t we supposed to be focussing on that?

3. Create an economy which values care.

I want to quote the Prime Minister – no not that one – but Mark Carney who in his quite excellent book ‘Value(s)’ argues that shared values – such as solidarity, fairness, responsibility – should underpin economic systems AND that we need to see a clear distinction between ‘market value’  and ‘human value’ and must not assume the former should be dominant.

He has written:

“The pandemic has reminded us of the true value of essential services and those who provide them.”

But as he also highlighted a crisis like the pandemic exposes who bears risk and who benefits from value.

Those of us in the world of social care have long argued that our economic foundations are misguided – that as the fourth economic contributor to the Scottish economy – why is social care not even mentioned in our economic strategies? Why do we not see the care and support of others as an economic contributor and driver in our society, rather than continually to use the language and character of cost, drain and deficit.

There is a real danger in straitened economic times that we lose sight of this contribution and engage in a perverse drive for market results. Homecare services should be rooted in wellbeing, autonomy, and human rights, not just contracts or outputs. Carney’s push for “mission-oriented capitalism” backs models of care delivery that prioritise social value and ethical leadership.

“Purpose is not a slogan; it must be embedded in governance, strategy, and culture.”

If this is a crisis then it is also an opportunity to re-shape, renew and re-orientate – to utilise the innovation, the insight and imagination which is so abundant in the independent care sector to point to a new way of being community.

This is our hope. It is the seed of revolution and change.

It does not march through streets or always make headlines, but it changes lives every single day. It lets people remain rooted in their stories, surrounded by their familiar things, free to live – and not just survive.

So let us see in this crisis – a chance to decide again who we are, what we value, and what kind of Scotland we wish to build.

In a couple of days’ time on the 12th May we will mark International Nurses Day 2025, and once again people will be invited on the birthday of that inspirational pioneer Florence Nightingale, to celebrate the skill, the compassion, and the profound contribution of nurses across the globe.

But as we do so I want to invite us to consider a category and field of nursing that is often ignored and forgotten about – at least in Scotland – namely the contribution of the social care nurse.

They are the nurses who work not in the flashing urgency of emergency rooms, but in the quieter spaces of social care – in care homes, in communities, in the places where people live their last, their first, their everyday moments.

This is a nurse whose workplace is not always a ward but a lounge, a kitchen, a bedroom – places filled with the memories and belongings of a life.

The nurse who knows that caring is not an event or a shift but a relationship woven through countless small encounters, each one layered with trust, vulnerability, and human connection.

Social care nursing as I have written and said on many occasions is distinctive. Often, we struggle to identify that distinctiveness but for ease of argument and at risk of simplification – for me social care nursing is distinctive because of the unique emphasis on human relationships at its heart.

Social care nursing is about profound relationships rather than an encounter. It is about relationships – built carefully, patiently, respectfully over time. It is about becoming known to another human being, and knowing them not just in their illness, but in their fullness: their fears and frailties, yes, but also their laughter, their dreams, their stubborn determination.

It is not about quick fixes or hurried interventions.

It is about presence. It is about patience.

It is about bearing witness to the slow dance of ageing, the gradual progression of dementia, the complexity of lives shaped by trauma, disability, or chronic illness.

Social care nurses are not simply providers of treatment; they are companions of the soul.

They are fluent in the languages of silence, of sadness, of stubborn resilience.

They understand that true care is as much about what cannot be measured as about what can – the reassurance in a glance, the comfort of familiarity, the dignity in the smallest choice which is honoured.

The social care nurse does not simply visit a person; they come alongside a life.

They nurse not just the wound that can be seen, but the grief that lingers unspoken, the loneliness that hangs heavily in the air, the hope that flickers still.

Their practice is clinical excellence infused with human intimacy. Their care is scientific, certainly – but it is also relational, ethical, compassionate.

In a world that prizes speed and efficiency, social care nursing reminds us of another way: the way of deep listening, of consistent presence, of stubborn hope in the face of decline.

It is work that demands and achieves clinical excellence, yes – but also emotional courage, ethical clarity, and relational genius.

To be a nurse in social care is to be entrusted with lives at their most fragile and their most fierce.

It is to tread softly into the private worlds of others, carrying not only knowledge and skill but humility and respect.

It is to know that healing often looks like relationship, like recognition, like being truly seen.

So, when Monday comes – on International Nurses Day, let us say loudly and clearly:

Social care nurses are the beating heart of a compassionate society.

They hold the line of humanity when systems creak and strain.

They remind us that care is not about power but about partnership; not about managing lives but about valuing them.

In social care, nursing is a long walk alongside another’s humanity. It demands more than technical skill: it demands courage, patience, emotional intelligence, moral resilience. It demands the willingness to stay, when staying is hard; to listen, when words are few; to hope, when days are short.

To every nurse working in social care – in care homes, in community supports, in supported living, in day services – thank you.

Thank you for your patience when the world rushes.

Thank you for your courage when others turn away.

Thank you for the relationships you nurture, the rights you uphold, the dignity you protect.

Thank you that you continue despite the strain and stress, the under-resourcing and inadequacy of funding.

You show us, every day, what it means to be truly human.

You are more than nurses; you are guardians of relationship, stewards of trust, ambassadors of love.

Today, and every day, we honour you.

Happy International Nurses Day 2025.

Donald Macaskill

There are a lot of journalists in my extended family and indeed journalism and writing has always been very important within the wider family. At one time as much younger person I even toyed with the idea of becoming a journalist influenced as I was by the heroic endeavours of the Washington Post writers Carl Bernstein and Bob Woodward who exposed the scandal of Watergate and played a massive part in the downfall of Nixon.

More recently in my professional life I have had more than most people’s experience of dealing with both print and other media journalists – and by in large it has been a positive experience – because I have found them to be individuals whose primary focus was to enable you to tell your story and if investigation was required for a piece they did so with an approach which was as respectful as possible.

I’ve found myself thinking about journalism as today is World Press Freedom Day or simply World Press Day – as it is each year on the 3rd of May. It is a moment to reflect on the importance of a free and independent press, the courage of journalists who speak truth to power, and the role of media in holding society to account.

Sadly, as too many know there are parts of the world where the freedom to speak truth to power is one that costs the lives of too many journalists. In 2024, a record number of journalists and media workers lost their lives while performing their duties. According to the Committee to Protect Journalists (CPJ), at least 124 journalists were killed globally, marking the deadliest year since the organisation began tracking such data over three decades ago.

World Press Day for me is also a moment to ask – whose voices do we not hear? Whose truths remain unspoken? Whose story is rarely told in both printed and visual media?

In the world of social care, we work every day with those whose stories too often remain hidden behind doors marked “vulnerable,” “elderly,” or “complex needs.” We serve people whose words may be soft and quiet or whose communication may not come in familiar forms. People whose voices, whether through age, illness, disability, or marginalisation, are too easily ignored in the national conversation.

In Scotland, as I have stated often – we pride ourselves on being a nation of compassion and community. But compassion must include the act of listening – really listening – to those on the margins. A truly free society is not only one where the press can publish without fear, but one where all voices are amplified, especially those who experience silence imposed not by censorship or deliberate design, but by neglect and invisibility.

I think of the individuals I’ve met in care homes who have led rich lives – teachers, poets, nurses, labourers – now facing the end of life almost unnoticed and some with so much to say but no one interested in listening. I think of the incredible care staff, often undervalued and overworked, whose experiences should shape public policy, yet they rarely find space in national debate. I think of unpaid carers who give their days and dreams to support those they love, rarely asked for their opinion by decision-makers.

Right across social care services there are stories that rarely see the light. Stories of resilience, of love and heartbreak, of injustice and of quiet triumph. Stories that tell us more about the soul of our society than any press release or political speech.

But these stories are not often told – because the individuals who live them are too often viewed as recipients of care, not as narrators of their own lives.

At the same time the media narrative about social care remains stubbornly stuck in crisis. And I must confess I probably in part have been responsible for contributing to those column inches.

Social care appears in the news when things go wrong. When budgets are slashed. When someone dies. When a ‘scandal’ breaks. Rarely are we told of the joy in care homes, of the laughter when someone is supported in their own home, of the small, sacred moments of connection between carer and supported person. They are not ‘news’ – they are the ordinariness of relationship as being in community.

I think we need a new kind of press freedom – one that seeks out not just political controversy, but human truth.

We need journalists who will sit beside someone who uses social care and ask not what’s broken, but what matters to you?

We need editors who will give column inches to care workers, who will treat the voices of people who use services with the same weight they give to ministers and CEOs.

We need a Scotland where the press plays its part in ensuring that care is not only reported but understood.

Because in a truly free society, everyone’s story matters.

So, on this World Press Freedom Day, I certainly want to fight for the protection of journalists around the world but also want to shout out for the amplification of those whose stories go untold.

The freedom of the press is not simply the right to publish. It is the duty to listen.

And if we are brave enough to listen to the voices in social care, we might just learn something profound about who we are, and who we could become as individuals and as a society.

I leave you with some of the words of an American poet Patricia A Fleming. Raised in Trenton, New Jersey, she pursued a career as a psychiatric social worker, dedicating 36 years to supporting individuals facing mental health challenges. Upon retiring in 2016, Fleming rekindled her passion for writing, channelling her life experiences into poetry that offers inspiration and solace to readers. She has argued that it is critical that those on the margins must be given opportunities to tell their story and know that it is seen and being listened to. In December 2023, Fleming published her first poetry collection titled Being Human In This Crazy World.

The following poem encapsulates the power of storytelling, especially in the context of personal experience and resilience,

The Legacy of My Words

By Patricia A. Fleming

 

My words are like my heartbeat.

They tell the world that I’m alive.

They recite the tale of who I am

And of all I have survived.

 

My words reveal my deepest pain.

They betray my greatest fears.

They share moments of my laughter,

As well as moments filled with tears.

 

They are the legacy I leave behind

When my time on earth is through.

They’ll offer others hope and strength

To help them make it too.

 

So I’ll write my words with courage,

And I’ll speak them loud and clear,

For in the telling of my story,

I find my purpose here.

 

https://www.familyfriendpoems.com/poem/the-legacy-of-my-words

Donald Macaskill

 

“It is more than just a jag for some of us it has meant a new lease of life.”

Those were comments which I heard many years ago from someone who every year had been faced with debilitating respiratory conditions and for whom vaccinations had made a huge difference to their quality of life.

They came to mind to me recently when I read on the BBC a story which showed that there had been a massive increase in deaths this past winter as a result of the flu. National Records of Scotland data for the first 14 weeks of this year showed that the flu was the underlying cause in 463 deaths. In the same period last year there were 240. As well as these an additional 567 recorded deaths have had flu mentioned on the death certificate so far in 2025.

These are huge numbers but more than that these are lives of people of all ages some of which could have been prevented had individuals only been vaccinated. Campaign groups like Asthma and Lung Scotland argued that a decision to raise vaccination eligibility to 65 meant an additional half a million people were not offered the jab this winter. Flu deaths are at the highest number since 1979.

Information from Public Health Scotland shows overall flu vaccinations this winter are down by a fifth compared to the previous winter, with over 350,000 fewer vaccines administered. In 2023/24, almost 1.65m people received a flu vaccine, with numbers falling to under 1.3m in winter 2024/25.

This strikes me as a worrying and concerning trend which clearly needs to be addressed as a matter of urgency.

World Immunisation Week runs from the 24^th to the 30^th April. Run under the auspices of the World Health Organisation (WHO) it aims to highlight the collective action needed to promote the use of vaccines to protect people of all ages against disease. ‘The ultimate goal of World Immunization Week is for more people – and their communities – to be protected from vaccine-preventable diseases.’

There is something profoundly symbolic about a vaccine. A tiny vial. A momentary pain. And yet it speaks volumes – of science, of solidarity, of hope. This World Immunisation Week, I want to focus not just on the immunological mechanics of vaccination, but on what I personally consider to be the moral imperative it carries, especially for those who are older in our communities.

The low and declining levels of vaccine uptake are and should be a considerable matter of societal and public health concern, not least for our older population.

We have come through years in which misinformation has taken root like an invasive weed within our public discourse. Anti-vaccination sentiment has not only reared its head in dark corners of the internet and social media platforms, but it has been given a voice, if not a megaphone – even in positions of power.

The recent data which has revealed a concerning increase in deaths linked to seasonal flu are not just numbers. These are lives. Mothers, fathers, carers, grandparents. People who contributed to the common good for decades. People who have earned the right to live with dignity and with every protection that our modern world can offer.

I am increasingly concerned that despite the fact that we have the vaccines, that we have the expertise to prevent more deaths through targeted immunisation programmes that we seem to lack a clinical and political priority, and to lack, at times, the collective will to address what feels like a failure.

Let’s be clear: vaccines save lives. The data is irrefutable. Vaccination against flu, COVID-19, shingles, and pneumococcal disease drastically reduces hospital admissions, long-term complications, and yes, death. But even more than that – it protects the experience of ageing. It protects community, continuity, and connection. It protects stories, memories, and wisdom that we so often say we value – and then forget to act to preserve.

When we allow anti-vaccination rhetoric to go unchallenged – whether it comes from TikTok pseudoscience or from high-ranking officials – we risk turning a blind eye to preventable harm. We risk undermining one of the most successful public health interventions in human history. We risk failing those who trusted us to care.

This World Immunisation Week it is a matter of urgency and priority that every policymaker, every care professional, every family member: reclaim the societal narrative. Let’s drown out the noise with compassion and facts. Let’s centre older people in our public health planning – not as afterthoughts, but as equal citizens whose protection matters.

I am increasingly of the view that we need a campaign in Scotland that is bold, inclusive, and deeply human. One that does not patronise but empowers. One that is shaped by the voices of older people themselves, by care workers on the front line, and by community leaders. A campaign that does not whisper but shouts: Vaccination is protection. Vaccination is solidarity. Vaccination is love in action.

Too often in the last couple of years in particular we have whispered the benefits of vaccination and have reduced the fiscal spend on advertising and promotion. Too often I hear the phrase ‘vaccine fatigue’ without the counter argument that you address fatigue not by walking away but by enabling concerns to be addressed and improving access and accessibility. I am not at all convinced that we have made it easier to access vaccines – in fact I think we have made it harder. If I am honest the world of winter vaccines now is massively complicated whether it is for Covid or for flu. See a recent BBC information site as an example of this complexity.

The Scottish Government minister Maree Todd is recently quoted on the BBC as stating that:

‘ “vaccine fatigue” and “anti-vax sentiment” may also have played a part in reduced vaccine uptake.

The minister said there was high uptake from children and those at high risk, but there was “poor uptake from adults right across the board”.

She said the government would “certainly reflect” in the coming months on the decision to exclude the 50 to 64 age group.

“The JCVI look very carefully at the evidence and made the recommendations according to the clinical evidence,” she added.

“I think its very wise for governments to pay attention to the experts in this area and absolutely we listen very carefully to the recommendations that the JCVI gives us and follow them.” ‘

Inevitably as with any public health intervention there is a cost/benefit analysis. We have, I feel, to argue within the wider public arena that such assessments cannot solely be based on clinical benefit alone, but upon wider sociological and communitarian grounds, and in addressing systemic and subtle discriminatory practice.

Vaccines are not just a health tool. They are a human right. Let’s honour that -together. We cannot afford another winter where deaths from flu increase unnecessarily. We must protect those we can regardless of circumstance or age. That requires consistent and coordinated effort and World Immunisation Week strikes me as a good time to start.

Donald Macaskill

Photo by John Cameron on Unsplash

Well, here we are at the Easter weekend – and on that intriguing day of Easter Saturday – lying as it does between pain and promise.

Recently I’ve been doing a considerable amount of media and commentary trying to draw attention to what I consider to be the critical and perilous state of social care across Scotland.

Several of the articles and journalists have remarked upon and have indeed used the phrase that I have shown increased ‘anger’ at what is happening. Indeed, one colleague joked recently with me that I seem to be becoming much ‘angrier in my older age’. It’s made me reflect on the nature of anger and whether showing emotions of that kind are appropriate or not.

In truth there are days when frustration becomes too familiar. Days when the words spoken about social care in Scotland sound like echoes from decades ago. Strategies are launched, promises made, consultations held – and yet the needle barely moves. People wait. Carers bend under the weight of fatigue. The system holds – just – but creaks at every joint. And all the while, we wrap it in bureaucratic language and call it “complex.” But complexity should never be an excuse for injustice.

And then someone tells me to calm down. To be reasonable – not to get carried away and constantly criticise. To be patient. To wait for reform and change and new direction.

No.

There is a time for calm. But there is also a time for fire. And yes, I think and feel ever more that there has to be a time for anger.

We don’t speak enough about anger in public life – certainly not the good kind. But maybe we should. Because there is, I believe, a positive role for anger in the Scotland we are trying to shape.

I’m not talking about fury that burns everything in its path. Not the destructive kind that wounds and withers. Not the rage that lashes out in bitterness. But the righteous anger – the kind born not of ego or outrage for its own sake, but of love. Love for people who are being left behind. Love for a vision of care that is compassionate, dignified, and real – and not forever deferred to the next Parliament, the next review, the next economic upturn. The anger that refuses to accept what is as all that will be.

This is not a policy point. It is a moral one.

We grow used to the statistics, the delayed reforms, the “next budget,” the whispered apologies from policymakers that “now is not the time.” And yet – in the quiet of this Easter Saturday – I feel the growing heat of a deep, simmering anger. Because the way we treat social care in this country is nothing short of collective societal abuse.

And when all’s said and done, I suspect that there is something profoundly Scottish about a people who will not stay silent in the face of injustice – who keep going back to the doors of power, not with shouts alone, but with stories, tears, spreadsheets, and quiet fury. That kind of anger doesn’t destroy. It builds. It unearths. It refuses to let a broken system bury the truth.

I’ve just spent a few days back ‘home’ on the island of Skye and have walked some of the places, visited some of the ruined villages and empty glens where people refused simply to back down, to be silent, to go along with what was happening. Maybe it’s the oxygen of that renewal that makes me in my own ‘settled’ life angry at the intransigence, the waste, the lost opportunity, the missed connection, that so many people are having to endure by the absence of social care.

And here is the truth: social care in Scotland is not broken because we lack evidence or expertise. It is broken because we have not yet decided, as a country, that care matters enough to act. That it is not a burden but a foundation. That it is not an afterthought but a starting point.

Public opinion matters. But public opinion only shifts when it is unsettled. When it is stirred. When it is forced to confront what it would rather ignore.

And anger – held well, spoken wisely – can be the match that lights that shift.

We have seen flashes of it: in care workers refusing to be treated as second-class citizens; in families fighting for support that should be their right, not their reward; in campaigners who turn grief into grit.

That anger is not dangerous. It is necessary.

It is the anger that refuses to accept the underfunding of human dignity.

It is the anger that sees the gap between rhetoric and reality – and calls it out.

It is the anger that remembers the names of those who died waiting

We are not asking for charity. We are demanding justice.

So let us not apologise for our fire. Let us tend it. Let us use it to forge something better. Because if we are to move public opinion, we must first speak with the voice of conviction – not as technicians of reform, but as citizens who care too much to stay quiet.

Anger, rightly held, is the voice of conscience.

And right now, Scotland needs to listen.

This Easter weekend I leave you with the words of the late American poet Adrienne Rich and her poem What Kind of Times Are These

 

‘There’s a place between two stands of trees where the grass grows uphill

and the old revolutionary road breaks off into shadows

near a meeting-house abandoned by the persecuted

who disappeared into those shadows.

 

I’ve walked there picking mushrooms at the edge of dread, but don’t be fooled

this isn’t a Russian poem, this is not somewhere else but here,

our country moving closer to its own truth and dread,

its own ways of making people disappear.

 

I won’t tell you where the place is, the dark mesh of the woods

meeting the unmarked strip of light—

ghost-ridden crossroads, leafmold paradise:

I know already who wants to buy it, sell it, make it disappear.

 

And I won’t tell you where it is, so why do I tell you

anything? Because you still listen, because in times like these

to have you listen at all, it’s necessary

to talk about trees.’

https://www.poetryfoundation.org/poems/51092/what-kind-of-times-are-these

Photo by ran liwen on Unsplash

Donald Macaskill

As regular readers of this blog will know there are very few occasions when I get the opportunity to be celebratory or even positive these days given the state of things! So, I hope you will excuse the moment of positivity when I highlight that nine days ago (3^rd April) in Geneva, we witnessed a step which many of us thought would never arrive – the United Nations at a meeting of its Human Rights Council voted (by consensus) to begin the process of drafting a new Convention on the Rights of Older Persons.

Some of you might recall that nearly a year ago I had the honour of speaking at the UN session in New York when a vote was taken to take matters to the next step – finally (and nothing happens fast in international diplomacy) we are there! For years – decades, in truth – advocates, campaigners, and older people themselves have called for a binding international instrument that affirms, protects and promotes the human rights of older persons. At last, the voices of those too often consigned to the margins are being centred in a process that could shape global and local policy for generations.

I’ve long argued that the way we treat our elders is the clearest mirror of our moral character as a society. In Scotland, we like to think of ourselves as progressive, fair-minded, and caring. And in many ways, we are. But even here, we cannot escape the creeping ageism that lingers in our systems and structures – the subtle assumptions that older people are passive recipients of care rather than active agents of change; the failure to adequately fund social care; the absence of older voices in decisions that affect their lives.

Some have argued to me that there are enough legal protections and safeguards for our older citizens and that we have protections on gender, on race, on disability etc that cover age. Yes, it is true there are protections, but I earnestly believe that there are gaps in the law which make it possible and perhaps even inevitable that peoples and societies have and will continue to treat older people less favourably and with negative discrimination simply because they are old, and because of the acceptability of ageism tied to a negativity around growing old. So, for those reasons alone we need international and national law to be more robust around older age.

I was reminded of this urgent need when I read a report which came out from Independent Age when the same week as the UN vote they published the first Older People’s Economic Wellbeing Index for Scotland 2024-25.

This is the first edition in an annual series of nationally representative polling designed to deliver further understanding of the financial wellbeing and lives of people in Scotland who are of State Pension age. The results are as they stated ‘concerning, demonstrating the scale of the income, costs and housing pressures faced by older people living in financial hardship, and the actions they are taking when faced with squeezed finances.’ In summary it showed that:

• One in five (19%) older people in Scotland have a household income of under £15,000 a year.
• One in five (21%) older people in Scotland say the State Pension is enough to cover basic living expenses.
• Almost one in three (29%) older people in Scotland have skipped meals in the last 12 months.

‘Some groups are disproportionately impacted – with women, people with caring responsibilities, and people who live with a health condition more likely to have cut back on essentials, have a lower income or more difficulty affording housing costs.

The issue of rising pensioner poverty goes to the heart of the criticality of human rights and the need for governments at national and local levels to take action to protect the rights of older persons and to take measures and mitigations to ensure that these rights are not further eroded and removed.

This report and so much of my own day to day experience of speaking with those who receive care and support in Scotland, who feel that they are treated less favourably because of their age or are limited in career or life opportunity because of age – belies the myth that we protect the rights of older people in Scotland. The first step towards any new Convention has to be the acceptance of the rampant currency and extent of age discrimination in Scotland.  But more positively, what might this UN Convention mean for Scotland? Allow me to dream after a week of spring sunshine!

Firstly, the creation of the Convention has the potential to be a call to action. It is an invitation to reimagine how we see ageing – not as decline, but as a continuing expression of citizenship and contribution. It is a chance to embed into law the principles we espouse in policy: dignity, participation, equality, and independence.

A Convention is not just words on paper – it is a statement of intent. It shapes expectations, guides funding, informs law, and holds governments to account.

But it must be bold. It must be brave. And it must be grounded in the lived realities of older people.

Here are eight of my asks.

1. A Right to dignity in ageing

Not as a nicety, but as a fundamental entitlement. This includes access to high-quality care and support, to autonomy and choice, and to a life free from neglect, abuse and discrimination.

2. A Right to participate

Older persons must not be excluded from political, cultural and social life. Their voices should be at the table – from community decisions to national policy, from the boardroom to the ballot box.

3. A Right to health and wellbeing

Comprehensive, holistic, age-appropriate health and social care services must be guaranteed, including mental health support, palliative care, and rehabilitation.

4. A Right to lifelong learning and employment

The Convention must challenge the arbitrary cut-off points that deny older people the chance to work, learn, volunteer, or contribute. Age must not be a barrier to opportunity. We must tackle and penalise those who use the workplace to discriminate.

5. A Right to protection from ageism

Explicit recognition of ageism as a form of discrimination is essential. We must name it to challenge it. The Convention should enshrine protections in law and promote public awareness campaigns across Scotland and the globe.

6. A Right to adequate income and social protection

Older persons must be protected from poverty through fair pensions and access to benefits. No one should grow old in fear of being forgotten or impoverished.

7. A Right to home and community

The ability to remain in one’s community, in accessible and safe housing, must be guaranteed. This includes access to digital infrastructure and transport.

8. A Right to digital and technological inclusion.

In the rapidly changing world of technology and data it is critical that older persons are able to exercise their full rights of inclusion, participation and empowerment to control rather than be controlled by technologies.

Scotland has an opportunity – actually if truth be told a responsibility – to lead in this space. We already talk of a human rights-based approach to social care, of embedding PANEL and FAIR principles, of shifting from transaction to transformation. But these aspirations must now find foundation in international law and local practice.

But heaven forfend we wait another decade for pen to touch paper – we cannot and should not wait for the ink to dry on the Convention. We should begin living its principles now.

So, let’s dream truth into action and let our nation and communities be known not just as a place where people live longer – but where people live better, with rights respected and voices heard, from the first day to the last.

Donald Macaskill