One thing we seem to do very well in Scotland is to produce well written legislation and policy intervention perhaps with the recent exception of the National Care Service Bill! Our problem is always in the poor implementation!

Another thing we do well is food and drink. As a nation we have a rich culinary heritage with world-class produce respected the world over. Food is woven into the very fabric of who we are.

An example of good legislation and progressive policy is the Good Food Nation Act which became law in 2022. Yet here too despite the aspiration there are very real concerns about its implementation, not least when it comes to older people – particularly those receiving care at home or in care homes.

This coming week is Nutrition and Hydration Week, with its annual focus on the criticality of both for all our health and wellbeing. For me the week and indeed the potential of the Good Food Nation Act poses some hard questions. Are we truly doing enough to ensure that every older person in Scotland, regardless of where they live, has access to nutritious, enjoyable, and culturally appropriate food? Do we see mealtimes as a moment of dignity, connection, and pleasure – or simply as another task to be ticked off? And as Scotland moves forward with the Good Food Nation Act, are we making sure that older people – who are too often invisible in food policy – are placed at the heart of the conversation?

Because let’s be honest: malnutrition and dehydration in older age are not just clinical issues. They are issues of human rights, dignity, and quality of life. Critically we too often overlook the most basic truth: good food is fundamental to good care.

For many older people in Scotland, food is a source of joy, tradition, and memory. But for too many, it has become a daily struggle.

In care homes, stretched staffing means that mealtimes can become rushed, reducing what should be a moment of social interaction to an exercise in efficiency. The challenges of chewing, swallowing, and declining appetite are not always given the attention they deserve. Too often the amount we allocate financially to the purchase of food as a State when we buy care packages is grossly inadequate. I am not at all convinced that as a society we are paying care providers an adequate amount to ensure appropriate nutrition.

For those receiving care at home, the situation can be even more precarious. Many older people in the community live alone, with limited mobility, making it harder to shop, cook, or even remember to eat and drink. Homecare workers – already pressed for time – may have only minutes to prepare a meal, leaving little opportunity for encouragement, companionship, or the careful support some people need to eat well.

And at a policy level, food and drink are too often treated as afterthoughts in social care planning rather than as core elements of wellbeing. We have guidance. We have frameworks. But what we lack is a joined-up, rights-based approach to food in care and support – one that ensures no older person is left behind when it comes to good nutrition.

Scotland’s Good Food Nation Act is a landmark piece of legislation. In the words of the quite excellent Scottish Food Coalition it is ‘ a groundbreaking piece of legislation that requires Scottish Government to think about food as an interconnected system. However, legislation alone will not create the changes we need to see.’

We see that in the failure to tie down the right to food as an explicit human right with all that entails were it to be incorporated into Scottish law. It is as the Coalition argues also critical that resource and support is given to make those on the ground achieve the aspirations of the legislation.

If the vision of the Good Food Nation Act is to become a reality, older people’s food needs must be fully recognised in every part of its implementation and that sadly to my mind is simply not happening.

This means that care homes and homecare services must be included in national and local food planning. It means social care providers must be given the resources – not just guidance – to improve food provision. It means care workers must be trained and empowered to support nutrition and hydration, recognising these as essential, not optional, parts of their role. And critically, it means that older people themselves must be heard. A Good Food Nation cannot ignore those who rely on social care.

If we are serious about tackling malnutrition and dehydration among older people in Scotland, then we need to move beyond words and into action.

We need to see better funding and training for care staff. Homecare workers, in particular, must have the time and skills to support people with eating and drinking. You cannot do that in the increasing number of commissioned 5- or 15-minute visits.

The Good Food Nation Act underlines that the right to food is a human right. But for that to be more than words it means that every older person, whether in a care home or at home, should have access to nutritious, appealing food that meets their personal and cultural needs.

Nutrition and Hydration Week is an opportunity to shine a light on these issues, but the conversation must not end here. The Good Food Nation Act gives us a once-in-a-generation chance to make food a true priority in social care.

Good food is not just about nutrients. It is about dignity, joy, and human connection. And no one – no matter their age, their health, or their circumstances – should be denied that.

As the American First Nation poet Joy Harjo says food and nutrition are not just about substance they shape our world and that is as much about older age as any age. Her poem is ‘Perhaps The World Ends Here’

The world begins at a kitchen table. No matter what, we must eat to live.

The gifts of earth are brought and prepared, set on the table. So it has been since creation, and it will go on.

We chase chickens or dogs away from it. Babies teethe at the corners. They scrape their knees under it.

It is here that children are given instructions on what it means to be human. We make men at it, we make women.

At this table we gossip, recall enemies and the ghosts of lovers.

Our dreams drink coffee with us as they put their arms around our children. They laugh with us at our poor falling-down selves and as we put ourselves back together once again at the table.

This table has been a house in the rain, an umbrella in the sun.

Wars have begun and ended at this table. It is a place to hide in the shadow of terror. A place to celebrate the terrible victory.

We have given birth on this table, and have prepared our parents for burial here.

At this table we sing with joy, with sorrow. We pray of suffering and remorse. We give thanks.

Perhaps the world will end at the kitchen table, while we are laughing and crying, eating of the last sweet bite.

From https://www.poetryfoundation.org/poems/49622/perhaps-the-world-ends-here

Donald Macaskill

Photo by Annie Spratt on Unsplash

 

Today is International Women’s Day and the theme for this annual day in 2025 is “For ALL Women and Girls: Rights. Equality. Empowerment.” It’s a theme which calls for action to unlock equal rights, power and opportunities for all and to ensure no one is left behind.

I have commented before on a number of occasions about the way in which the Scottish social care sector is dominated by the contribution and capacity of women across all ages and yet that contribution is both societally and economically devalued and unrecognised.

A day like today provides us with an opportunity both to reflect and celebrate the extraordinary contributions women have made to Scottish society as a whole but most especially in the realm of social care. It should also encourage us, I believe, to challenge the ongoing negative stereotyping and diminishing of the contribution of women and not least in social care in Scotland.

We still live in a societal and cultural context where it is assumed that the complex professional and critical role of care and support is ‘women’s work.’ Such lazy, misogynistic stereotyping enables society to devalue and diminish the essential role of care and support in our society and must be continually challenged.

I think at times we make the false assumption that things have changed and that today the majority of people in Scotland recognise that it is everybody’s responsibility regardless of gender to contribute to the care and support of all our citizens. But in truth research and surveys paint a very different picture.

A 2025 report by UN Women UK highlights that women still perform the majority of unpaid care and domestic work and constitute the majority of paid care workers in the UK. Data varies but taken together over 80% of both paid and unpaid care responsibilities are undertaken by women and girls. Indeed, in Scotland data on paid and professional care regularly a level of between 86 to 88% of staff being women.

This is not an accident of history but a reflection of deeply ingrained societal norms that have over time assigned caregiving roles to women. These norms have shaped expectations, limited opportunities, and perpetuated the idea that care is a “natural” role for women, rather than a skilled and essential profession.

These lazy stereotypes also seem to advance the opinion that care is of lesser importance and value and therefore it is ‘okay’ for women to dominate the sector. Few would articulate that sentiment openly, but it is clearly present.

We know that care is not secondary or lesser; it is the foundation upon which we build a society of compassion, dignity, and interdependence. In Scotland, social care is the backbone of our communities. It is the quiet force that enables individuals to live with dignity, families to thrive, and society to function.

And at the heart of this sector are indeed women. Women who, for generations, have stepped forward to provide care – not because it was expected of them, but because they recognised its profound value. They have been the carers in our families, the nurses in our hospitals, the support workers in our communities, and the leaders in our care organisations. Their contributions are immeasurable, yet too often, they are invisible or simply ignored.

We need to be very clear that care is not “women’s work.” Care is ‘human’ work. It is the work of compassion, empathy, and expertise. It is the work of building relationships, solving complex problems, and supporting individuals in their most vulnerable moments. To frame it as gendered is to diminish its value and to ignore the potential for all to contribute equally to this vital sector.

What we need, instead, is to challenge the assumption that care is an instinctive duty for women rather than a skilled profession, a career of choice, or a domain of leadership. We must move beyond the idea that women enter care because they are naturally more compassionate or inherently more nurturing. These are skills- honed, developed, and practised – and they deserve the same professional recognition as any other field.

So, how do we address this presumption without talking down care? How do we elevate the status of caregiving while ensuring it is seen as a role for all, not just women?

I think one of the ways we do that is to celebrate care for what it is: a profession of skill and significance. The narrative around care needs to shift from one of obligation to one of value. Care workers – the majority of whom are women – deserve recognition for the expertise they bring to their roles. Whether it is supporting someone with dementia to live well, enabling a person with disabilities to achieve independence, or providing end-of-life care with dignity, these are tasks that require training, empathy, and resilience. Let us talk about care as a career of choice, not a default.

I also think that we have to challenge the structural barriers that perpetuate the gender imbalance in social care. This means addressing the pay gap, improving working conditions, and creating pathways for career progression. It also means addressing some systemic biases within the care sector itself. For while women make up the majority of the care workforce, they are still underrepresented in decision-making roles. True equality means ensuring that women have pathways to leadership, that their voices shape policy, and that care work is seen as a space for ambition, progression, and influence.

Now on the evidence of some research which has been published this last week, we are making some progress in this regard in Scotland, but we have a considerable distance to go.

Over two decades ago I was involved in a project which was attempting to challenge the stereotype of care and gender across Europe. It recognised that things would only change if from early years or kindergarten onwards to secondary education, that we challenged the presumptions around care being female which lie at the heart of our education system. Despite continued efforts, I think we are critically short of where we need to be.

From an early age, children should be taught that caregiving is a universal responsibility, not a gendered one. Boys and girls alike should be encouraged to develop the skills of empathy, communication, and collaboration that are at the heart of care. By normalising care as a shared responsibility, we can create a future where the sector is truly inclusive.

Too often, the experiences and insights of women who care are overlooked in policy discussions and decision-making processes. Too often when we are developing economic strategies for our society, we ignore the contribution of social care as a whole and I suspect that is a subconscious gendered ignorance. Too often when we consider the importance of valuing women as entrepreneurs and as business leaders, we conveniently exclude social care from such debates and discussions failing to recognise that this is a sector which is dominated by entrepreneurial, gifted and skilled women par excellence.

This International Women’s Day, we need to honour and celebrate the women who have built, sustained, and enriched our care sector – not just as workers, but as leaders, advocates, and visionaries. But let us also commit to building a future where care is valued as it should be – as a shared responsibility, a skilled profession, and a cornerstone of a compassionate society.

Care is not women’s work. Care is everyone’s work. And it is time we all stepped up to recognise that.

 

Donald Macaskill

World Hearing Day is held on 3 March each year to raise awareness on how to prevent deafness and hearing loss and promote ear and hearing care across the world.

This year’s theme, “Changing mindsets: empower yourself to make ear and hearing care a reality for all!” emphasises how by encouraging individuals to recognise the importance of ear and hearing health, people can be inspired to change behaviour to protect their hearing from loud sounds and prevent hearing loss, check their hearing regularly, use hearing devices if needed, and support those living with hearing loss. Empowered individuals can drive change within themselves and in society at large. Part of the outputs this year is a new WHO global standard for safe listening in video game play and sports.

Anyone working in the care home or home care sector in Scotland will know just how significant the issues of hearing loss are for so many individuals who receive care and support. Indeed, according to Scottish Government data, around 850,000 people in Scotland have hearing loss, which is roughly one in six of the population; with estimates suggesting that 70% of those with hearing loss are over 70 years old. This number is projected to increase significantly in the coming years.

The very hiddenness of hearing loss is one of the many reasons why there is less societal focus on the necessary adjustments and changes which can be made to ensure that individuals are more included and involved and to ensure that those living with hearing issues are able to play their full part as citizens in their communities.

Hearing loss is not just a health condition; it is an issue which affects virtually everything about an individual’s life and how they relate to others and their sense of belonging whether in residential care or their own community. It shapes how people experience the world, how they connect, how they express themselves, and how they are included – or excluded – from society.

For too many older people, hearing impairment is a slow erosion of connection, a gradual retreat into isolation. And in a sector that prides itself on person-led, relationship-based care, this presents a fundamental challenge and one – if I am being completely honest – in the midst of other competing priorities does not receive sufficient attention.

A recent study by the British Irish Hearing Instrument Manufacturers Association (BIHIMA) found that while many older people benefit from hearing aids, 40% of those who need them do not use them effectively. Batteries go flat. Devices get lost. Staff may lack training in how to support residents with hearing aids, leading to frustration and a loss of confidence in the very technology that should empower them.

And then there are those for whom hearing aids are not the answer – people who have been Deaf since birth or who have profound hearing loss requiring British Sign Language (BSL) or other communication support. In truth the care sector across the UK has been slow to adapt to their needs, with BSL provision remaining patchy at best and little resource allocated by commissioners and funders to release staff for training and development.

Imagine living in a care home where every conversation around you is muffled, distorted, or completely inaudible. Where announcements about mealtimes or activities do not reach you. Where staff – however well-intentioned – speak too fast, do not face you, or assume you can hear because you have a hearing aid.

The result? Many older people with hearing loss become socially withdrawn. They stop participating in group activities. They disengage from conversations. They are mislabelled as confused or unresponsive, when in reality, they simply cannot hear what is being said.

And let us be very clear: hearing impairment is a risk factor for cognitive decline, depression, and even increased mortality. This is not a marginal issue – it is central to dignity, quality of life, and fundamental rights.

So, what can we do? The answer is not complicated, but it does require cultural and systemic change. It also requires yet again a targeted resource and finance that allows people to address the discrimination that happens when resources are absent.

As a society we should develop a Charter for Inclusion – and for me the primary action for deafness is staff training and awareness raising. Every care home and homecare provider should ensure staff receive training on hearing loss awareness. This includes understanding hearing aids, learning basic communication strategies (such as speaking slowly, facing the person, and reducing background noise), and being aware of the signs of undiagnosed hearing loss.

Routine hearing checks should be part of life plans for those who receive care and support services, just as vision and oral health assessments are. Care homes should have direct referral pathways to audiology services, ensuring that hearing aids are maintained and adjusted as needed.

Not all hearing loss is the same. Some people need written communication, others benefit from visual cues, and some require BSL or lip-reading support. Care providers should be proactive in tailoring communication to each individual.

We live in an era of smart hearing technology and assistive devices. From amplified telephones to captioned video calling, there are many tools that can enhance communication – if only they are made available and integrated into care and support and fiscal resource prioritised to make their purchase and use possible.

One of the greatest failings in this space is the lack of robust data on hearing loss in Scotland’s care sector. Most of the data we have is years out of date and there has been little focus to address this.

We simply do not know how many care home residents are experiencing undiagnosed hearing loss; or how many are not using their hearing aids correctly and how many care staff have had training in communication with Deaf and hard-of-hearing individuals.

This data gap is a real system and clinical, social care failure. Without accurate information, we cannot plan services, allocate resources, or advocate for the change that is so desperately needed.

If we are serious about person-led care, then hearing loss must be on the agenda. We must listen to the unheard. We must identify adequate resource and funding to ensure real inclusion.

Despite all the undoubted challenges facing it I believe it is possible for Scotland’s care sector to lead by example. To embed hearing care into the heart of what we do. To ensure that no one in a care home or receiving homecare is left in silence.

Because in the end, this is not just about hearing – it is about being heard.

The American poet Camisha L Jones reflects on the transformative impact of hearing aids, celebrating the newfound access to sounds and the emotional resonance they bring. Being heard changes your life.

 

Ode to My Hearing Aids.

 

Then God said

let there be sound

and divided the silence

wide enough for music

to be let in and it was a good groove

 

And God said

let there be overflow

sent sound in all directions

pin drops & children’s laughter

phones ringing & plates clattering

and it was kind of good but too much at times

 

So God said

let there be volume control

let there be choice how loud life should be

and there came the power to fade

the voices, the annoyances, the noise

and that was mighty good for all the unnecessary drama

 

Then God said let there be surprise, startle even

at the bird’s chirp, the ice maker,

the cabinet slammed shut

let there be delight

at the first calls in months

to father & best friend

and these were such good reasons for choking back tears

that God saw

the dark & the light

dangling brilliantly from each ear

and God whispered amen

then smiled when it was heard.

 

From Flare (Finishing Line Press, 2017). Copyright © 2017 by Camisha L. Jones. Used with the permission of the author.

 

https://poets.org/poem/ode-my-hearing-aids/print

Tuesday next (the 25^th) sees the Scottish Parliament debate and vote on the Scottish Government’s Budget. It is something of a fait accompli with the votes of the Scottish Liberal Democrats and the Green Party in the bag, and Scottish Labour sitting on its hands. Any sense of self-congratulation, however, should be short lived because not for the first time this administration has seriously let down the social care sector and the tens of thousands of women and men who rely on social care services and supports.

Yet again I find myself writing about the lack of real prioritisation being given to social care by the Scottish Government – in that, however, they are not alone – the UK Government in its new Labour iteration is doing exactly the same. In Scotland there will be defence statements made that the current administration has never given as much as it is now allocating to social care – and indeed it would be churlish not to congratulate them for continuing to finance the Scottish Living Wage which comprises the largest proportion of the additional revenue that has been given to the system this coming year. But such positivity rings hollow when the perilous reality of disintegration becomes apparent.

Social care is not a luxury. It is not an optional extra or a line item to be trimmed when budgets are tight. Social care is the foundation upon which the dignity, independence, and wellbeing of thousands of older people and individuals with disabilities rest. It is the means by which we affirm the intrinsic worth of every individual, ensuring that no one is left behind, no one is forgotten, and no one is stripped of their humanity.

Yet, the 2025 Budget tells a different story. It tells a story of missed opportunities and misplaced priorities. It tells a story of a government that has chosen to turn away from those who are most valuable, those who have contributed to society throughout their lives, and those who now depend on us to uphold their rights and dignity.

The failure to prioritise social care funding is not just an economic decision – it is a moral failing. It is a failure to recognise that the right to live with dignity, to access essential care, and to participate fully in society are not privileges to be rationed, but fundamental human rights. The United Nations Principles for Older Persons and the Convention on the Rights of Persons with Disabilities are clear: states have an obligation to ensure that older people and those with disabilities can live independently, with access to the support they need. By underfunding social care, the Scottish Government is failing to meet these obligations.

I fully recognise that government is about choices and one of the most damaging choices made by the UK Government is its decisions not to exempt social care providers (and hospices I might add) from the forthcoming increases in National Insurance rates. This is a tax on jobs and a tax on care and will drive many care organisations to the wall. It is a political madness entered into with an ignorance of consequence and a lack of compassion. Despite there being a debate on the issue again on the 25th of February in the House of Lords the Chancellor remains deaf to the desperate pleas of those who care and support tens of thousands of people and those individuals themselves.

The consequences of this political failure in both London and Edinburgh are stark. Care providers, already stretched to breaking point, are being asked to do more with less. Staff, who are the lifeblood of social care, are undervalued and underpaid, leading to chronic shortages and burnout. Older people and those who use social care services are left waiting for essential support, their lives diminished by delays and inadequacies. Families are forced to pick up the pieces, often at great personal cost.

We cannot accept this. We must demand better. We must demand a budget that reflects our values, that invests in social care as a cornerstone of a fair and just society. We must demand that the Scottish Government recognises the urgency of this crisis and takes immediate action to address it.  It might not be able to do much about a deaf Westminster, but it must do more to invest the limited resources it has available to it in social care provision. Yes, it will be hard, and decisions taken will not go down well in other sectors – but a society that does not care is not one worthy to be governed. It might even mean, heaven forfend that we invest less in the NHS and take some of the resources we have to prioritise social care over acute and secondary NHS services. Budgets are all about hard decisions – I together with thousands of others cannot accept the fiscal choice that continues to marginalise social care.

Ultimately though this is not just about money. It is about who we are as a society. It is about whether we are willing to stand up for the rights and dignity of every individual, regardless of their age or ability. It is about whether we are willing to say, with one voice, that social care matters.

The time for empty promises and half-measures is over. The time for action is now. Let us not fail those who depend on us. Let us not fail ourselves.  Let us see investment and resource reallocated and let us spend on the lives of those who remain the heart of our communities. To do otherwise is a betrayal of dignity.

Donald Macaskill

 

Photo by Christopher Bill on Unsplash

 

 

Next Thursday is the United Nation’s annual World Social Justice Day 2025. A quick look at official calendars shows that there will be lots of events around the country and across the UK on issues of gender, migration, poverty and inclusion.  But at least for me the day asks some uncomfortable questions. In Scotland we often pride ourselves on being a nation built on fairness, dignity, and equality – the very bread and butter of social justice. We are after all the nation of ‘A Man’s a man for all that.’ Yet, when it comes to social care the sector that should be at the very heart of our social justice efforts – we continue to neglect, undervalue, and overlook it.

Social care is not just about helping people live their lives with dignity; it is a profound expression of our shared humanity. It embodies the very principles of social justice: equity, human rights, and the belief that everyone, regardless of age, ability, or background, deserves to participate fully in society. Indeed, as I have said on more than one occasion the distinctive nature of social care as understood by Scottish legislation makes explicit the social justice dimension of social care. And yet, despite all the fine words and policy commitments, social care in Scotland remains on the margins, rather than at the centre, of our social justice agenda.

For me it could not be more plain social care IS social justice and social justice without social care is empty and vacuous.

Too often, social justice is discussed in abstract terms – poverty, inequality, exclusion – without recognising that social care is where these issues play out most starkly. Social care supports older people, individuals with disability, and those living with mental health conditions. It ensures that people are not trapped in their homes, isolated from their communities, or living in fear of not having their most basic needs met. It is the safety net that allows people to thrive, not just survive.

Good social care is the difference between an individual being able to choose how they live their life and having that choice stripped away. It ensures that human rights are not just a theoretical construct but a lived reality. A society that fails to invest in social care is a society that perpetuates inequality, particularly for women, disabled people, and those in poverty, who are disproportionately affected by the gaps in the system.

So why, I ask myself, despite its fundamental role in achieving social justice, does social care continue to be underfunded, undervalued, and underappreciated – at least in Scotland? Why is it that this week we have discovered again that the economic value of adult social care to the Scottish economy is £5.2 billion; that for every £1 spent there are £2 worth of additional socio-economic benefits. Social care is not a drain but a massive driver and contributor to our economy yet it hardly ever appears in any official economic strategy as such.

I suspect the primary reason for this neglect – yet the one that most would not confess to or admit – is the uncomfortable truth that social care is still seen as ‘women’s work,’ as an extension of informal family caregiving rather than a critical professional service. The chronic undervaluation of care work – both paid and unpaid – is a stark reflection of gender inequality in our society. You can also add to this the insidious ageism which pervades attitudes to social care – only this week we have witnessed the casual stereotyping of older age and the dismissal of contribution from the elderly by some political figures including a UK Minister who had been working around adult social care!

It is also not helped by the failure to accept the critical preventative role of social care but instead to continually focus on social care as a reactive response. Instead of recognising social care as a public good, policymakers and political leaders continue to treat it as an emergency response, something to be patched up rather than properly invested in. This short-termism ensures that the system lurches from one crisis to another, rather than addressing the structural inequalities that create the need for care in the first place.

At the heart of social justice is economic justice yet whilst we often speak of fair work, of paying a real living wage, of tackling in-work poverty, we refuse to see that the low pay and poor conditions in social care are an economic justice issue. Until we properly fund social care services, we will continue to condemn thousands of care workers – predominantly women – to pay that does not reflect their professionalism, insecurity, and burnout.

And over all these the classic failure to see social care as an issue of social justice is the fact that social care has become a political football rather than a political priority. Social care in Scotland has been at the centre of political debates, particularly with the proposed National Care Service. But rather than being framed as a fundamental issue of rights and justice, it has too often been reduced to a question of bureaucratic restructuring. We need to ask: will any of these reforms (even the most recent) truly shift power into the hands of those receiving care and those providing it? Or will we continue to have a system where people feel unheard, unseen, and unvalued?

If we are serious about social justice in Scotland, then social care must be our starting point. We cannot claim to be a nation committed to fairness and equality while we continue to fail those who rely on and provide care.

On World Social Justice Day, let us move beyond rhetoric. Let us commit to:

• Fair pay, conditions, and recognition for care workers rather than self-congratulation about the Living Wage and promises tomorrow.
• A human rights-based approach to care that prioritises choice, dignity, and participation and has legislative bite with a new Human Rights Act and clear implementation of social care choice not the kind that is limited by budgets.
• A shift from crisis-driven social care that is there to rescue and patch up the NHS to preventative, community-based support

Social justice is not an abstract ideal. It is something we build through action, through policy, through investment. And it starts with ensuring that no one – whether they are receiving care or providing it – is treated as disposable.

Social care is social justice. It’s time we acted like it.

I leave you with some of the poetry of the contemporary American poet Jane Hirshfield whose works are enthused with a sideways look at the essence of justice. Her poem ‘For What Binds Us’ reflects on the various forces “both physical and emotional” that connect individuals and the resilience that emerges from shared experiences and healing.

For What Binds Us

By Jane Hirshfield

There are names for what binds us:

strong forces, weak forces.

Look around, you can see them:

the skin that forms in a half-empty cup,

nails rusting into the places they join,

joints dovetailed on their own weight.

The way things stay so solidly

wherever they’ve been set down—

and gravity, scientists say, is weak.

And see how the flesh grows back

across a wound, with a great vehemence,

more strong

than the simple, untested surface before.

There’s a name for it on horses,

when it comes back darker and raised: proud flesh,

as all flesh,

is proud of its wounds, wears them

as honors given out after battle,

small triumphs pinned to the chest—

And when two people have loved each other

see how it is like a

scar between their bodies,

stronger, darker, and proud;

how the black cord makes of them a single fabric

that nothing can tear or mend.

Copyright Credit: Jane Hirshfield, “For What Binds Us” from Of Gravity & Angels. Copyright © 1988 by Jane Hirshfield and reprinted by permission of Wesleyan University Press. Source: Of Gravity & Angels (Wesleyan University Press, 1988)

This poem is available on the Poetry Foundation’s website: For What Binds Us | The Poetry Foundation

Donald Macaskill

Photo by Ian Schneider on Unsplash

There has been a great deal of talk this past week about how important it is that we support and care for individuals as close to their home as possible, including yet again an emphasis on hospital at home – as well as an increased commitment to focussing on prevention and healthcare at home from the First Minister. Yet what is often missed in the political rhetoric and proclamation is a proper understanding of what it means to support and care for someone in their own home or in a homely setting.

Some of that reality was portrayed in research which was undertaken by Scottish Care, Care Forum Wales and the Homecare Association in conjunction with Sky News and which was published this past week. It made for distressing and worrying reading and made me personally question whether we have become blinded to the need for humanity in our national response to the current social care crisis.

Entitled ‘It feels like we don’t exist’ the Sky News item explored the human cost of the social care cuts happening across the country and not least in Scotland. I’ve mentioned these cuts to care more than a few times over the last few months, but they have – unless you receive care and support or work in the sector – gone largely unnoticed and under the radar of the mainstream media. What they mean is that effectively most Health and Social Care Partnerships – the bodies who oversee and pay for the majority of care home and homecare delivery in Scotland – are having to make savage cuts of tens of millions of pounds in order to make their books balance this year and certainly into the next fiscal year. What that means – is not that there are queues outside our hospitals for our politicians and media to see – but that there are invisible impacts which mean thousands of people are having their care and support cut, or are not being assessed at all and that less and less is being spent on the support and care of some of our most valuable citizens. This is a process of cuts to life which is going largely unseen.

The Scottish Care research painted a sad and depressing insight into the reality of the current social care crisis in Scotland. Specific results from Scottish Care membership said that:

• Over 80% of respondents stated that councils have reduced the number of care packages that would previously have been awarded.
• 90% stated that councils have reduced the overall number of hours commissioned within care packages.
• Over 90% stated that councils have asked providers’ to complete care tasks that are unrealistic within the commissioned time.

Such reductions place untold stress on the sustainability of vital care providers across Scotland and diminish access to an adequate level of person-led care. As commissioning and procurement bodies cut packages beyond the true cost of adequate care for our communities, care providers are struggling to stay afloat.

A provider told me of the increasing pressure to do tick box care. One spoke of the request from a Council to support someone up out of their bed, to help them to have breakfast, to make sure they had a wash for the day and to do all this in 15 minutes! This is obscene and inhumane. Another provider spoke of the fact that their care organisation had been fined on numerous occasions because the carer had made a cup of tea or had taken out the rubbish for a supported person – all because it wasn’t in the ‘care plan’. All of this smacks of a system where money talks and compassion walks, where we have turned care and support into a functional set of tasks rather than what it should be – a relationship of dignified humanity which enables a person to flourish and thrive. Behind the rhetoric of more and more money being given to social care is the perverse truth and reality of a system of social care that should shame every Scottish citizen.

I am writing all this being very aware that when care is cut this impacts on not only the person themselves, on the workers but also the wider family who depend so much on a functioning social care system.

Tuesday next, 4^th February, is the annual World Cancer Day when we are asked to focus on the lives of those living with cancer and how we can improve health, and social care supports to enable people to live better with cancer. So often in these discussions the experience of older Scots living with cancer, and in large part supported in their own homes, goes missing from our focus.

With our ageing population more and more of those who live into older age are being diagnosed with cancer as well as the reality that positively those diagnosed younger are living longer with cancer. We often ignore the fact that older patients often present unique concerns, such as decreased tolerance to certain treatments, multiple co-existing medical conditions, and the functional challenges in daily activities which often come with age. These factors all necessitate a tailored approach to cancer care for the older citizen but in a system where we are struggling to do the basics humanely such focus and personalisation seems impossible. But it is urgent that we develop such cancer specific supports.

We know from recent research on cancer care that the role of homecare and social care is absolutely vital. Studies have shown that the benefits of home-based supportive care for advanced cancer patients is enormous. We need to resource social care to deliver more effective high quality cancer care.

What we have instead is the comments I hear from so many living with cancer, which is about rushed workers, staff constantly having to look at their watches, always on the move, and yet despite the care by the clock they are requested to make they still continue to show compassion, professionalism and care.

All our citizens, regardless of age deserve the best possible care and support in their own home or in a homely setting. This will not be achieved by ignoring the disintegration of social care across Scotland. We have to wake up to that reality and ignore the saccharine statements of assurance of a system that is working. We have to really accept that to care for someone in their own home, whether they are living with cancer or not, in a manner which affirms their rights and dignity – cannot and should never be done with a stopwatch in your hands.

Donald Macaskill

 

One of the joys of living in Ayrshire is the continual presence of the poetry of Robert Burns. I have to confess that I have not always loved the works of the Bard but the more I have got to know his poetry and his life the greater my appreciation.

So tonight, with others I will be partaking of that Scottish ‘tradition’ of haggis, neeps and tatties and no doubt will attempt – probably badly – to recite a few Burns’ words in the presence of friends and family. I am also well aware that today and tonight across not just Scotland but across the globe there will be gatherings bringing together families and friends to eat, drink and recite Burns on this his birthday. Despite the tides of modernity and social media influences Rabbie seems not to be going out of fashion – quite the reverse!

In one of those literary happenstance moments today also marks the beginning of National Storytelling Week. Story is as I have often written in this blog a powerful vehicle to communicate truth, to inspire, to challenge and to change. There is something almost timeless about the power of stories to change our world – the energy of tales to shape our understanding of our lives and connect us to one another.

Burns epitomises for many the ability to communicate truth, to tell a story, in verse and in poetry. The ploughman poet understood the enduring truth of storytelling. His verses captured the humanity of his time: the struggles, the joys, the resilience of ordinary folk. Through his words, the voiceless were given voice, and their stories, their truths, became immortal. He was able to speak uncomfortable truth to power and to seek to change and redirect the society in which he found himself – all through the power of story and words.

And that I believe is the urgent necessity and challenge for those of us who work and live in the world of social care. Rather than remaining silent, whispering to the interested few, the stories of social care – the unsung experiences of carers, the resilience and passion of those who receive care and support, the lives that are turned upside down and changed for the better, and the challenges faced by care organisations – all need to be told, shared, and celebrated. And the best way of influencing and changing minds is through the power of story.

I’ve said before that social care exists in the background of society, quietly supporting lives, enabling independence, and nurturing community. It is the thriving energy of our community. But that constancy of presence often means that people do not properly value, notice or understand the importance of the sector. For lots of reasons it is a sector too often overlooked, undervalued, and misunderstood. Stories can change that.

The challenge is that those of us who seek to advocate for social care and its importance to society as a whole have to get better at getting our message across – less about numbers and trends, data and detail, more about heart and humanness, passion and the poetry of care. Through storytelling, we can humanise statistics, breathe life into policies, and remind the public, the media, and policymakers of the essential humanity at the heart of care.

I know at the present time there are very real challenges facing social care as a sector but I feel we too often miss the point if all we do (and it is important to do this) is to continually complain and paint a negative picture; to talk about numbers and statistics, to describe crisis and disintegration, to talk about organisations and structures (even about new plans for a National Care Service!) – to do all that and not to tell the truth of the human lives that are touched by social care and which at its best can be changed, renewed and revitalised by good quality care and support.

These are the stories of so many people I have met over the years. The young man who defied diagnosis and retreated into an inner world of silence yet learned to communicate and verbalise his emotions and thoughts because of the professionalism and care and support he was given by one single dedicated carer. The story of the woman whose whole life had been in her own words always ‘lived in the corner’, the victim of an abusive marriage and a neglectful family and yet who when she entered a care facility discovered her voice, her purpose and learned to live out her dreaming – all because she felt safe for the first time, was made to feel at home, and sensed a community of compassion cradling her in hope and kindness. The story of the carer who literally at the end of her shift goes the extra mile to bring comfort to a dying individual in their own home, of a person rediscovering their independence through compassionate support that helps them to take risks and find courage, or of a care home that becomes a true community where children and adults live as one community with shared hopes, dreams, distress and tears.

These are the narratives that can inspire change, challenge ignorance and the casual stereotype which suggests that social care is there just for the ‘vulnerable’ and those ‘whose lives are over.’ Social care has stories about children, adults, older people that are today, this moment, changing not only their own individual worlds but changing the communities and society around them. Social care is a place of revolutionary and relational change and disruption – if only we had ears to hear, and eyes to see.

Just as Burns captured the universal truths of his time, so too must we capture the truths of social care in ours. We must hear the voices of those receiving care, whose lived experiences too often go untold. We must amplify the stories of the care workforce, whose quiet dedication deserves loud recognition. And we must share the challenges faced by care providers, whose work is made harder by outdated perceptions and inadequate support.

By telling these stories, we can create a tapestry of care that reflects the dignity, complexity, and richness of human life. We can challenge ignorance, foster empathy, and inspire collective action.

So as we raise our glasses to Burns tonight, let us commit to listening to the stories of social care and sharing them with the world. Stories, like Burns’ verses, which have the power to move hearts, challenge minds, and spark change.

I leave you with a poem that captures the spirit of storytelling and its enduring power, words that remind us that stories are not just told but that they are lived, felt, and carried forward.

It is ‘The Storyteller’ by Mark Strand (1934–2014) who was an acclaimed Canadian-American poet, whose spare, elegant words should challenge us to tell the story of social care. Because these stories matter. They always have, and they always will.

“The Storyteller”

 

We are all caught in a story,

each one of us a narrative thread

interwoven into a vast, endless tapestry.

Our voices blend with the hum of the loom,

spinning dreams, fears, truths, and lies.

 

The storyteller knows this

and so shapes the tales,

crafting bridges with words,

turning time back upon itself,

making strangers kin.

 

For in the heart of a story

is the secret we all crave:

to be heard, to be seen,

to belong to the human chorus

of what has been and will be.

 

Donald Macaskill

 

Photo by Etienne Girardet on Unsplash

 

 

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

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

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

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

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

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

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

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

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

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

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

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

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

“The Weight of Us”

We carry it, silent, unseen,

The weight of what has been and what will be.

Not just the heft of bodies shaped by time,

But the burden of whispers, the unkind rhyme.

A mirror reflects, but does not forgive,

The years we’ve eaten to feel we live.

Comfort wrapped in layers tight,

Hunger quieted in the dark of night.

The world stares, but rarely knows,

The stories tucked beneath the clothes.

A lifetime of battles, silent, profound,

In each heavy step, a muted sound.

For age adds years and pounds alike,

A slower pace, a harder hike.

Joints creak, breath fades, yet hearts still yearn,

For acceptance given, not made to earn.

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

But a measure of pain behind weary eyes.

Let us see more than scales and charts,

Let us weigh the truth in human hearts.

For in every body, a story resides,

Of how we stumble, where love collides.

So let us carry each other with care,

A lighter world when kindness is shared.

Donald Macaskill

Photo by Angelo Pantazis on Unsplash

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Donald Macaskill

Photo by Jason Leung on Unsplash