The following is based on a talk which opened the inaugural Scottish Care, Care Tech Assembly held in Glasgow on 19^th June 2025.

I want to share a few personal thoughts about technology within social care and to do so under a human rights umbrella. And I want to do so from the perspective of someone who has been fascinated by tech and its potential to enhance human connection and humanity for an awful long time.

And I suppose I am also making a bit of an assumption as I start these reflections that I am among people who believe that technology, when rightly held, can serve humanity rather than diminish it.

The Past: listening to the echoes

Let me take you back to a room in a care home in Glasgow’s west end, many years ago. I remember as a student sitting with Mary, a former schoolteacher, now living with dementia. She was holding a photo of her late husband. It was tattered at the corners from love and remembering.

There was no iPad. No voice assistant. No tech-enabled reminiscence therapy. Just two humans, sharing a moment.

Technology hadn’t yet found its way into her world – but care had. Deep, relational, person-led care.

That care home was just along the road from the school I went to and the school she had once taught in. We were on the edge of the University campus – the same University where years earlier I had walked with my classmates one afternoon to visit the Computing Dept. I’ve spoken before about that experience – about how our class was invited along one afternoon to see what was, at that time, reputed to be one of the world’s fastest computers.

It was a whirring series of metal cupboards which literally filled a room with a standard screen and keyboard to operate them. This was well before the era of the ‘mouse’, so all instructions were laboriously typed in by complicated code.

What struck me then was the sense of sheer wonder with which the technicians and scientists viewed their work and its creation. It filled me with both a lifelong fascination for, and indeed a fear of, the power and potential of technology to change the world I inhabit for good and ill.

One of the men working on the computer at the time mentioned that when we had reached his age – an elderly 40! – the computer we saw that day would be the size of a cigarette packet. We laughed then. Nearly 50 years later after my flirtations with a BBC computer, an Amstrad, and an enduring love affair from the earliest Apples, loads of floppy discs and CD-ROMs, I am no longer laughing. The truth of a processor 1000s of times faster and more powerful than the machine that filled that Glasgow room is in the laptop I carry every day and the smartphone whose presence is, reluctantly, my essential life tool.

But sitting with Mary just along from that room and maybe not much more than a decade later we were to a large extent in a technology free zone.

And I suppose if you had asked me then in the past, I would not have even contemplated that tech could be so contributive to and could potentially enhance care. It wouldn’t have been in my worldview.

Then over time myself and others would have expressed fears that technology let loose would replace that care – that somehow, warmth and connection would be coded out of our lives.

I reflected that in my own writing in 2017-18 when I wrote Tech Rights where I explored the interplay of human rights and the potential of machine learning, Ai and the internet of things and suggested that there was as much promise as well as danger in the future.

So, what of the present?

The Present: dancing with change

Today, we stand in a time of rapid digital transformation. In Scotland, digital social care records are becoming the norm, not the exception. We’ve seen technology bridge gaps, not widen them – when done well.

Care homes have used iPads to reunite families over FaceTime. Sensors now help monitor health in the background, offering dignity and safety without intrusion. People living in their own homes are using smart tech to remain independent for longer.

But the truth is, this progress wasn’t born from a boardroom or a policy paper. It was born from pragmatic intent and a ground-up desire to do things differently – and yes let’s be honest also to do things with an economy of time and cost. The current and I suspect the future design of tech will be responsive and reactive to circumstance and to need more than planned intent and policy.

And when the history of tech in care is written the influence of the pandemic will be clear and transparent.

Our present was born from a pandemic – from necessity, from desperation, and yes sometimes even from love.

We had to learn quickly that technology must never be the master of care. It must be the servant of humanity- and especially of the most valuable.

What does the future hold?

It holds possibility. But only if we choose it wisely and in some places that future is already happening…we are already witnessing circumstance where an older person’s voice activates not just a light, but a lifeline of connection and assurance. We are and can create a future where digital tools aren’t cold, but compassionate. Where artificial intelligence doesn’t make decisions for people, but with people. A future where every innovation asks not “What can this do?” but “Whom does this serve?”

But it is how we build that future, design that tomorrow, which is all important and which an event like today contributes so much to.

Many of you will know of the work of the Oxford Institute for Ethics in Ai and the Digital Care Lab and how after over a year of creative collaboration and co-production, a framework for the responsible, ethical and rights based use of Ai in social care has been developed. That work is progressing, growing and becoming even more influential and I would commend it to you.

But the art will be, the essential requirement will be, how do we turn such frameworks and models into the automatic and instinctive actions of a system and of stakeholders who in straitened economic times and faced with the demands of immediacy might be tempted to take short cuts, go for the cheapest or easiest option, both of which usually risk the rights, autonomy, control and agency of the citizen?

The Oxford work and others have shown that the critical way in which you embed an ethical and human rights-based approach has to be through the democratising of design and the granting of control and agency to citizens. Too often I fear we pay lip service to this fundamental principle – the sense of individual citizen control over data – even a discussion I had this week on the principle of revocability – showed just how hard it is for systems which get too big, too distant from the user, from the citizen whose story is the data, to be open to approaches where citizens can re-write, change, edit and remove their data.

The excuse often given for the radical individualising of control around Ai, tech in general as well as in care and support, is that it is too difficult to get to the individual level – that’s an excuse I heard so often during the blanket decision making of the pandemic – and it is today tosh and nonsense.

A colleague recently told me about the work of Pol.is and the more I have looked at it the greater its potential for democratising decision and consent seems to me. Some of you might know of the Pol.is work which has been going on and developing in Taiwan.

Pol.is is a digital tool used in Taiwan to facilitate large-scale public deliberation. It was notably employed by the Taiwanese government as part of the vTaiwan and Join platforms to gather public input on complex policy issues.

‘How it works:

• Citizens respond to open-ended questions and vote on other people’s comments.
• Pol.is uses machine learning and data visualisation to group participants based on shared opinions, highlighting areas of consensus and disagreement.
• Unlike traditional polling, it avoids polarization by encouraging constructive dialogue and surfacing common ground.’

It is a tool which already has helped to bring democracy and decision making to very small and local community levels – its adaptation and use in settings such as residential care, community groups has, I think, huge potential, not least in its approach to inclusivity and achieving consensus and agreement.

Just imagine how such an adapted tool to enable individual participation and decision making could be used in a social care context around data control, management and use?

When I wrote my extended thought piece on TechRights I was very clear that the future developments of Ai, machine learning, the Internet of Things and robotics could and should only be enabled through a robust and ethical human rights framework – everything I have seen in the intervening 8 years convinces me even more of the validity of that assessment.

Human rights have to be the baseline not just bolted on; we need person led tech not just person-centred design.

And we continually need to re-design how we implement rights in technical practice. I think it is the task of all of us, no matter where we are in the pathway of design and development, in use and implementation in care environments, to consider our human rights and how they impinge in the use of tech and digital.

Here is my latest musing: a Human Rights Framework based on the acronym H.U.M.A.N.I.T.Y.

H.U.M.A.N.I.T.Y. Framework

H – Human Dignity

• AI must enhance, not replace, relational care.
• Systems should respect inherent human worth, prioritising the individual over efficiency.
• Insist on the truth that care is a human act, not a mechanical function.

U – Understanding

• AI must be developed with contextual awareness of care realities.
• Systems should reflect the lived experience of people receiving and giving care.
• Understand the cultural, emotional, and social nuance, which are vital to ethical care.

M – Moral Responsibility

• Those designing and deploying AI must act with ethical integrity.
• Care providers have a duty to ensure AI is used in ways that align with care ethics and human rights.
• There needs to be a stress on values-led leadership and responsibility in the care sector.

A – Autonomy

• Individuals have the right to make informed choices about how AI affects their care.
• AI systems should promote control and consent, not paternalism.
• Autonomy is essential for citizenship and empowerment in care.

N – Non-Discrimination

• AI must be designed and tested to eliminate bias and promote equity.
• It should support inclusivity, particularly for those often excluded: older adults, disabled people, ethnic minorities.
• There should be a built in commitment to social justice and fairness.

I – Integrity

• Use of AI must be transparent, honest, and accountable.
• Integrity means being able to explain and justify AI decisions, especially when they affect people’s lives.
• Create a sense of moral coherence in digital and care governance.

T – Trust

• Build trust through co-design, openness, and clear communication.
• Trust is sustained through relationships, not just systems.
• Trust is the glue of good care and support – and it must be protected in tech use.

Y – You-Centred

• AI in care and support must be person-led, not system-led.
• It must serve the individual’s rights, values, and story – not just operational efficiency.
• Care and support are affirmed as a deeply personal, relational, and human experience.

Last year, I visited another care home. There, a woman named Ishbel had started using a voice assistant. She said, “I call her Alexa, but I treat her like she’s my lassie. I tell her goodnight, and sometimes, she tells me the weather. But mostly, she makes me feel I’m still part of the world.”

That’s the heart of it.

We’re not building devices. We’re building belonging.

So, as we look ahead, let us walk forward not with fear of what we might lose, but with hope for what we can gain.

Let us shape a future where digital doesn’t dim the light of care, but reflects it—brilliantly, boldly, and beautifully.

Let us- together- hold hands with tomorrow.

 

Donald Macaskill

 

Photo by Robs on Unsplash

The last few weeks and indeed the month of June has seen a hive of activity in the world of policy and politics around health and social care. From the passing of the Care Reform Bill to the publication of the Health and Social Care Service Renewal Framework alongside the Population Health Framework there has been no shortage of meaty content for the policy and political anoraks to feast upon. Sometimes these actions can seem very distant from the delivery of care and support and even more so from the recipients of social care and health services. Just occasionally the words are worth taking note.

In what follows I want to reflect on some of the major events and key publications. Admittedly this is an initial reflection because I think it will take some time for the full range of ideas and plans to come to their fullest fruition.

The aspirations of the Health and Social Care Service Renewal Framework (2025–2035) are to be admired. Its aims are to take a fresh, strategic leap toward a future where Scotland’s health and social care are integrated, prevention-led, and digitally enabled. Few of us would find fault with this – grounded as they are on the almost forgotten work of the Christie Commission. They are anchored by five principles – Prevention, People, Community, Population, and Digital. Again, few would object to such a focussed analysis and the aspiration and tone which desires a decade of transformation.

Meanwhile, the Population Health Framework commits to closing health inequalities, shifting resources to upstream social determinants, and embedding place-based prevention. Together, these documents sketch a bold vision: health and care built not just for people, but around them.

I read both reports against the backdrop of the discussions I and others have been having which were contained in an Open Letter published in The Scotsman. This letter co-signed by leading clinicians and practitioners across health and social care in Scotland, and informed by Enlighten, argues that our system is “unsustainable, overly complicated, difficult to navigate” and goes on to demand long-term, collaborative reform.

I am therefore pleased that taken with the two published reports there seems to be an emerging ground for consensus and indeed collaboration.

The shared and consensual path forward seems to be growing, it is one which envisages:

• Shifting services upstream, reducing reliance on acute care, and investing in community-based surroundings – all hallmarks of smart, modern reform.
• Principled planning -moving from siloed service design to networked, population-focused approaches.
• Digital-first ambition – a necessary catalyst for efficiency, access, and personalisation.
• Cross-sector unity, echoed in the Open letter’s plea for independent, third sector and community partners to be full co-designers of reform.

There is real potential therefore in the work that has been and is being done, but it would be disingenuous of me to not also comment about what strikes me as being missing so far, not sufficiently emphasised and what steps, I believe, could make progress upon the shared aspirations more likely to succeed.

Bold though it is, the Framework underplays the significant contributive role which social care can deliver for Scotland and most importantly from my context for the health and wellbeing of all, not least older Scots. At times both documents are written too narrowly from an NHS centric lens – maybe inevitable given their origins, but I think they can also be improved by using a more communitarian and social care lens.

Take for instance Scotland’s world-leading and seminal legislation and basis of accessing social care, the Self-Directed Support (Scotland) Act (2013, amended 2025) and the new Care Reform (Scotland) Bill (passed June 10, 2025). Both I would suggest offer powerful mechanisms to enhance the Service Renewal Framework and the Population Health Framework – especially for improving care for older Scots in care homes and at home. Allow me to illustrate some examples:

Self‑Directed Support Act (SDS)

Choice and control are central and key principles of the way in which social care is delivered in Scotland. We have not always got it right and have not always adequately empowered those who use supports – but be that as it may – that these two principles are central is of very real importance and should not be brushed over or set aside. There was a long struggle to shape the SDS legislation and to base it on principles of greater personal autonomy, control, and empowerment. SDS enshrines the rights of people who receive care to shape how, when, and by whom it’s delivered – vital for older Scots wanting autonomy in diverse settings. The absence of its centrality in the new reports is more than disappointing.

One of the major goals of the new Framework is to re-align service provision – SDS if properly embedded (and not in the resource deprived and patchwork way of the moment) can genuinely shift services upstream by centring individual needs, supporting the Prevention, People, and Community principles of the Framework. The recently renewed statutory guidance for SDS can be used to extend SDS into care homes, enabling residents to even more than they do now to better direct elements of their own daily lives – activities, meals, visits – empowering both dignity and quality. Others and I have long argued that to limit the ability of older people in residential care to have full control through SDS is a limitation of their rights.

Then when we consider the Care Reform (Scotland) Bill again there are numerous and very real opportunities to bolster the reform goals.  This is most obviously the case in the new rights to respite for unpaid carers. Indeed, one of the glaring omissions of the Strategic Reform Framework is the virtual absence of recognition of the critical role unpaid carers pay in the whole health and social care economy. The new law mandates Councils to assess carers and provide funded breaks which aligns with the emphasis within the Framework upon prevention (by reducing burnout) and People (supporting caregiver health). It directly serves older Scots living at home.

The new Bill also furthers the aims of the new Frameworks in its emphasis on the continuity of care which secures stable care packages even if individuals move across local authorities -reducing disruption and supporting independence and long-term care planning, which is again in line with Population Framework aims.

But it is perhaps in the wider area of reform that there is an emphasis which can potentially help to properly achieve the aims of both the Frameworks. There is a real opportunity over the next few weeks and months for the whole system to build on the Bill’s emphasis on ethical commissioning, to embed Fair Work standards, sectoral bargaining, and clear progression ladders – all key to staffing stability across both home and residential care. And most obviously the significant digital and data achievements and innovations of aged care in both homecare and residential care have much to teach the wider acute, secondary and primary care communities.

The SDS Act and Care Reform Bill aren’t just legal formalities- they are levers to deliver the visionary ambitions of the Frameworks. When applied strategically, especially in care homes and homecare, they can drive real change, embed prevention, increase autonomy and frame stability and sustainability.

The Frameworks show we’re on track. The open letter tells us we have to be bolder, faster – and more inclusive. But without a social care turnaround and emphasis, I fear, this ambition remains incomplete. That will inevitably mean that we need political courage across the Parliament in making fiscal decisions that truly see the balance of care and support, move from the acute and secondary NHS hospital sector to community health and social care. We have talked about this for a long time and now we must see action rather than aspiration. How that is done and whether additional funding comes from re-alignment of other priorities is clearly a political decision, but the necessity of action should be inescapable. We cannot continue to see social care solely through an NHS lens, care and support in community offers true preventative advances and it is that we need to focus on rather than a singular obsessive focus on delayed discharge. Social care is more than that.

It is surely our mutual collaborative responsibility to now start to transform strategy into practice and go beyond grand vision to tangible improvement in the daily lives of older Scots. I am certain the independent and third social care sector is up for that task.

Donald Macaskill

Photo by Alex Skobe on Unsplash

 

Today (21^st June) is World Music Day – a time when across the globe, communities gather to celebrate the universal language of melody, rhythm, and song. When radio stations take advantage of the day to entice us to listen more and when a plethora of local events celebrate the day.

I have been an avid listener to so much music since my earliest childhood days when like so many of us the music our parents listened to shape our eardrums and taste. For me it was a mixture of Gaelic song filtered by Jim Reeves, Elvis, the Beatles and Johnny Cash. Then with the maturity of age the eclectic mix of Crowded House, Abba, Runrig and my source of all inspiration to this day Bruce Springsteen and the E Street Band. Our music shapes, moulds, inspires and conditions us.

So, as I reflect of World Music Day, I do indeed think of all the gigs and events I have been lucky enough to attend but I also think of the less grand and quieter, more intimate spaces where music has exerted its power over me, from my family front room to student flats and outside buskers.

But over the last few years in particular I have grown to appreciate the tremendous power of music in places and spaces which are even more hidden and quieter than the usual performance venues we might be familiar with, in our care homes, in hospital wards, in the living rooms of those living with frailty, dementia, and decline. It is here, often behind closed doors, that the true miracle of music quietly unfolds.

For older people, music is not merely entertainment. It is connection. It is comfort. It is continuity of self. It is therapy. In these spaces, music is a vessel that carries the individual across the sometimes-frightening gaps carved by time, illness and memory loss.

As a young parent I was acutely aware of the work of music psychologists in terms of early brain formation, and you only have to look at the music catalogues to see the downloads from Bach for Babies to Mozart for Toddlers. It has taken us a bit longer to validate the significant role that music plays for older people care and support.

Modern research has increasingly begun to validate what many carers and families have long intuited: music accesses parts of the brain often untouched by disease. The pioneering work of neuroscientists such as Oliver Sacks, and more recently the international consortiums studying music and dementia, show us that the neural pathways involved in music processing – particularly rhythm and melody –  are uniquely resilient, often remaining intact even as cognitive faculties decline.

In functional MRI studies, regions such as the medial prefrontal cortex –  areas tied to autobiographical memory and emotional regulation –  show sustained activity when individuals listen to personally meaningful music, even in advanced stages of dementia. In one striking study published over a decade ago in 2015, researchers observed that musical memory can remain accessible even when other forms of memory are lost, offering individuals a bridge to their sense of self.

Music appears to activate broad networks of the brain simultaneously: motor areas, language centres, limbic regions responsible for emotion, and –  perhaps most importantly – the default mode network linked to self-awareness. It is no wonder that, in so many cases, individuals who struggle to recognise loved ones can nevertheless sing along, note-perfect, to the songs of their youth.

I have to confess that in not a few places I have argued that it is important that we recognise the sheer value in people being entertained and in taking enjoyment from sound and music. I also believe it is critical that we also recognise the profound benefits which can be gained by people at any age in life participating in and creating music. Life should not just be about passive receipt of the creativity of others but a participation in self-expression and creative musicality. But be that as it is , I sometimes feel we lose sight of the sheer therapeutic value of music and musicality, and do so at our cost.

Beyond the astonishing resilience of musical memory, a growing body of research has documented the tangible benefits of music-based interventions for older people.

Randomised controlled trials have consistently shown that music therapy can reduce symptoms of anxiety and depression in older adults, particularly those living in long-term care settings. The act of listening to, or creating, music stimulates dopamine release, contributing to improved mood and wellbeing.

In dementia care, personalised music playlists have been shown to reduce agitation, restlessness, and the use of antipsychotic medications –  a profoundly important finding in light of concerns over overmedication in care.

Even more so whilst music cannot reverse cognitive decline, engaging with music – whether through singing, drumming, or listening – provides meaningful cognitive stimulation, maintaining attention, language, and even aspects of executive function.

And perhaps most importantly, music offers a shared space for relationship, for communication beyond words. It creates opportunities for care staff, families, and care home residents to connect on a deeply human level.

Of course, not all music is created equal. The most effective musical interventions are not generic playlists of “golden oldies”, but carefully curated selections rooted in the personal histories and preferences of each individual. The song that stirred a heart in 1955 may not be the same as the one cherished in 1975. That is why the amazing work of Playlist for Life deserves every bit of focus and support.

In this sense, music care becomes an act of human rights-based care – one which honours the individuality, autonomy, and lived history of the person. We must resist the temptation to treat older people as a homogeneous category and instead engage in the work of listening to their life stories, through and alongside their musical tastes. I have no doubt a lot of my story is tied into by walking alongside Springsteen whilst others would run a mile from that journey !

If we are serious about reimagining care and support in Scotland and across the UK, then music should not be seen as an “add-on” or a luxury, but as an essential part of care practice. It has been easier to argue that point and case for residential care, it has been well-nigh impossible to convince commissioners and financiers of the value and merit in prescribing music and its therapeutic use in care at home. Yet, if the benefits of music not least as a preventative tool for decline and deterioration – are true of residential care then that truth sings even louder in someone’s own home. It is not fanciful or naïve to argue that we should have music as a core part of relational, time-flexible, person-led homecare. This is  surely the heart of social prescribing?

We need greater investment in training care staff to use music therapeutically; partnerships between care homes and professional musicians; research funding to deepen our scientific understanding; and national policy that recognises the centrality of the arts to wellbeing across the life course.

In the end, music reminds us that identity endures even as so much falls away. The rhythm of a waltz, the swell of a hymn, the first few bars of a favourite song – these can bring a spark of recognition, a light behind the eyes, a squeeze of the hand.

And that is why, on this World Music Day, I find myself filled not only with gratitude for the gift of music, but with a renewed sense of responsibility. To ensure that every older person, regardless of circumstance, has the right to their song. The right to be heard. The right to be remembered.

Because, in the words of the late neurologist Oliver Sacks:

“Music can lift us out of depression or move us to tears – it is a remedy, a tonic, an orange juice for the ear. But for many of my neurological patients, music is even more – it can provide access, even when no medication can, to movement, to speech, to life. For them, music is not a luxury, but a necessity.”

I will give the last word to The Boss, who speaks of the power of music in “No Surrender” (from the Born in the U.S.A. album, 1984):

“We learned more from a three-minute record, baby, than we ever learned in school.”

This line beautifully captures how deeply music can shape identity, inspire action, and teach us about life- often more powerfully than traditional education. It’s one of Springsteen’s most quoted reflections on the transformative force of rock and roll. And for those whose sounds are different – all music changes our worlds if we allow ourselves to hear.

 

Donald Macaskill

Photo by Marius Masalar on Unsplash

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