This has been an unprecedented and horrendous year. This very latest chapter in the story of care has for many turned out to be the hardest as new strains of the virus stole our chances of remobilisation.

Yet, when I think of those who work in social care, 84% of whom are women, the feminist phrase ‘nevertheless she persisted’ comes to mind. March 8th is international women’s day. This year’s theme is #ChooseToChallenge making it a good time to consciously recognise and raise the role that gender politics have played in the long-term under recognition of social care and the pernicious effect of paternalistic structures and systems on all those who provide, work in, and access care and support. Pandemic response has been a microcosm of that experience, leading to scrutiny, division and blame at a time when what is needed is respect, collaboration, and support.

The voice and expertise of skilled social care professionals, when listened to, offers routes to manage the pandemic in situ. We have seen this in the embedding of the most recent guidance, finally co-produced with sector experts.

In the Engender report ‘Sex and Power in Scotland 2020’ we read that only 2 out of every 50 people who head up the top Scottish Companies are women. This is quite a comparison to the 2 out of every 3 who hold CEO and Director level posts in social care. There are two ways that we must look at this. First, we must celebrate a sector which has championed and supported so many women into leadership roles. This is not purely down to statistics, but because of a sector which very often applies its expertise in person-centred and person-led care and support to workforce development. There is much that other sectors could learn from this approach.

Secondly, we must note the vast difference in the number of men in senior rather than frontline roles. Diversity is a greatness, and this highlights the need to welcome more men to frontline social care. But also, not to rest on our laurels, 2 out of 3 is impressive, but not representative of the 84% in frontline roles. There is still more to be done about that proverbial glass ceiling.

I recently heard Dame Stefanie Shirley speak and she said that ‘you can tell ambitious women by the shape of their head – it is flat by being patted patronisingly’. Now my first reaction was to laugh out loud, but this was quickly followed by a sharp intake of breath as its accuracy hit home.

So many assumptions are made by those outside of the sector about what social care is and does. We have no better spotlight than now to showcase our expertise, skills, and professionalism. I ask my fellow flat headers and those that they work with, to #choosetochallenge by sharing a story about what you do in social care. We have an opportunity to change perception, it is our responsibility to take it.

Thanks to the SSSC for providing social care workforce data.

Karen Hedge

National Director

@hegeit

I originally wrote this piece in November 2019, but for a variety of reasons, it was never published. There always seemed to be a greater emergency in social care which took precedent; supporting the social care workforce, promoting human rights, challenges of financial sustainability and of course now, a global pandemic.

However, I have decided to go ahead and publish today. Not just because this afternoon I am on a panel at the Health and Social Care Alliance, as they publish their report: ‘Sustainable Health and Social Care: Climate Change and COVID-19’ in which they call for £25 million to support a climate change innovation fund for social care, and the forthcoming hosting of COP26, but also because it is becoming increasingly obvious that the right time must be now.

Pandemic response has in many ways improved our environments, we have reduced our travel for instance and while this should be celebrated and even maintained, we must also consider the impact of increased use of chemicals and disposable equipment such as PPE. These items are of course essential but will have a long-term impact on our environment. Additional to that is the theory that with our natural resources now struggling to maintain balance, we will experience an increasing number of pandemics. Horrific to conceptualise proving to me that the time is indeed now so here is that piece from 2019, perhaps even more relevant today than ever:

In the last few weeks, the plastic cotton bud ban came into force in Scotland.

Over the last 25 years, the Marine Conservation Society has collected 150,000 plastic cotton buds from beaches in Scotland. This legislation follows the microbeads ban in 2018, with further climate environmental related legislation expected in 2021. Scotland’s Government initiative ‘Action Against Plastics’ is in line with the EU Single-use Plastics Directive, in an attempt to reduce the use of single-use plastics and the impact they are having on the planet.

The climate change issue is no more pertinent to me than on seeing the findings from a childhood friend and climate change expert who has recently returned from an expedition to East Greenland where she documented some of the irreversible changes resulting from climate change. Melting glaciers which can never be replaced, whole ecosystems disrupted. It’s funny how more real things seem when they happen to someone you know.

Originating from a perspective of infection control, single-use plastics are everywhere in social care, from cotton buds to protective equipment, to packaging for our medicines and food. There is a real opportunity for the care sector to play a role in leading the way to reduce waste, but also to find other ways to uphold safe high-quality care, in a more environmentally sound way by changing practice, and exploring new materials. The mantra of ‘Reduce. Reuse. Recycle’ has much to offer in this space and some care staff have been involved in adopting and embedding such a culture in their organisations. Via the Scottish Care Strategic Nursing Group, we will also ask the ‘Infection Control’ team at NES for suggestions and resources that they may be able to share.

However, single-use plastics are not the only contributors to the increasing climate change crisis. Health Care Without Harm estimates that measuring the greenhouse gas emissions solely related to heating and cooling the worlds healthcare providers (using the WHO definition so including social care) would make it the fifth-largest contributor in the world. Their report ‘Towards Sustainable Healthcare’ outlines 5 areas where change can be made for the sector as a whole. It covers energy, procurement practices, chemicals, pharma and food, all of which have implications and opportunity for social care. Whilst we can choose how and where we draw our energy, the chemicals we use and the food we buy, but overall, the biggest implication is currently outwith our control. Where external agencies have authority in terms of commissioning and procurement practice, it more often favours cost over quality and sustainability in all definitions.

Across the UK and beyond, organisations have been making eco-conscious changes, but this can often be more achievable at scale. Given that most care providers in Scotland are SMEs, despite desire this can seem a more daunting task.

For care homes and housing support, there are many options that providers have been implementing for over a decade – better insulation, water and lighting efficiencies such as eco taps and aerators, and LED lighting installed where they meet the expectations of creating a homely environment. Last week I met an architect with whom I discussed ‘smarter design’. They have particular expertise in optimising natural light in care homes thus reducing electricity use, but they also described to me the effect this can have on regulating body functions such as your heartbeat and even when you urinate. Design affects the widest definitions of the environment. Structural change is of course more difficult if you have an older property, as to retrofit can present challenge and cost. However, as some of these changes are cost saving in the longer-term, they may also be financially worthy of investment. Whilst access to such resource can be compromised because of the prolonged underfunding of the sector, it is clear that issues of environmental sustainability are just as important for our Commissioning Authorities as for providers and staff.

Whilst some of this also applies to homecare offices, the opportunities for care at home providers lie more in clinical consumables and PPE, and in travel. Smarter route planning can reduce emissions, as well as reducing travel time for employees and reduced vehicle costs.

Indeed, digital and technological developments such as care planning tools may be a significant answer to a range of challenges as they have the opportunity not only to reduce paper waste but also to develop into citizen-owned and controlled systems, making data sharing and data analysis much simpler to experience and access. Projects such as medicines waste reduction which can be enhanced by using digital systems such as E-MAR not only reduce waste, but significantly reduce costs, not to mention the impact of reducing the transport required to issue and deliver scripts.

Scottish Care’s Executive Committee recently revisited the communique written at the Five Nations Care Forum over a year ago, on the role of a sector already renowned for its impact on humanity in extending its activity to include sustainability. We discussed the actions of some providers towards achieving this and would like to hear from you on what you have been doing to support the sharing of good ideas across Scotland. Whilst a culture of environmental audits can help organisations to regularly review their practise, access to a resource full of ideas may offer suggestions to enable other providers to identify and act on areas for improvement. It is also a fantastic way not only to showcase your own work but to positively showcase the sector as a whole in actively addressing the challenge head-on.

I look forward to hearing from you.

Aware, Awaken, Action.

Karen Hedge

National Director

@hegeit