As the calendar turns and we stand at the threshold of a new year, I find myself drawn to reflection not least on what I consider to have been the significant changes and developments in social care in the last year, and what this new one might bring. That for me has undoubtedly been in the arena of Ai in social care. I am reflective of the journey so far, the companions who have shaped my thinking, and the ethical crossroads that lie ahead for social care in Scotland.

The rapid advance of artificial intelligence in our sector is not just a technical story; it is, at its heart, a human one. And as we look forward, I believe it is essential to ground our ambitions in the enduring values of dignity, autonomy, and justice. I offer this extended thought piece as a contribution to that ambition.

My first instinct is gratitude. The conversations and collaborations of the past year, especially with the Institute for Ethics in Ai at Oxford, the Digital Care Hub, and Casson Consulting, have given our sector a shared language for what ‘responsible’ Ai should mean in social care. Their Summit and White paper gave us a shared language for dignity, autonomy and equality in the age of automation. I am equally grateful for the practical clarity offered by the AI & Digital Regulations Service (AIDRS), which brings together NICE, MHRA, CQC and HRA in England to help health and social care organisations navigate regulation. And I acknowledge UN human‑rights experts who have insisted, I think quite rightly, that the procurement and deployment of AI must be grounded in robust human‑rights due diligence.

All this work has served to remind me that human rights and ethics is not an afterthought, but the very foundation of innovation.

Why a human‑rights approach to AI in social care is non‑negotiable

Ai is already here in adult social care. We see systems that transcribe and draft notes and care assessments, support language translation, monitor movement to reduce falls, and triage requests for support. These tools hold promise, but they also reach into the most intimate spaces of life, our homes, our relationships, our routines. That depth of reach demands a depth of ethics. Oxford’s work in our field is clear: responsible use means Ai must support and never undermine human rights, independence, choice and control, dignity, equality and wellbeing. UN guidance adds the necessary governance spine: carry out human‑rights due diligence across the Ai lifecycle, engage those most affected, and ensure access to remedy.

Regulatory currents are shifting underneath us. The EU’s Artificial Intelligence Act is now law, with staged obligations and a risk‑based structure that bans certain “unacceptable‑risk” practices (for example, systems that exploit vulnerabilities or enable unlawful mass surveillance), sets transparency duties for limited‑risk systems, and imposes stringent requirements on high‑risk uses. Even for Scottish providers, this matters: EU rules apply whenever AIisystems or their outputs are placed on the EU market or used in the EU which is an extraterritorial pull that many supply chains and software subscriptions already trigger.

In the UK, there is as yet no single Ai Act. Instead, a regulator‑led approach asks sector regulators to enforce five core principles (safety, transparency, fairness, accountability, redress) under existing law. For health and social care, AIDRS and NHS information‑governance guidance have become the de facto playbooks: proportionate assurance, safe evidence, clear data rights, and ethical oversight. In short: the EU sets a high, codified floor; the UK expects context‑based governance through existing duties. Scotland must live comfortably with both. I would particularly commend here the blog written by John Warchus which unpacks some of this hinterland.

PANEL: how I turn “rights” into decisions

In a previous article I argued that this is an ethical and rights space that benefits from the implementation of the well-recognised PANEL human rights framework. Nothing that is happening now has changed that perspective and personally I would commend the continued use of the PANEL principles: Participation, Accountability, Non‑discrimination, Empowerment, Legality, to move from slogans to practice. Let me illustrate some of this:

Participation

People who draw on care, unpaid carers and frontline staff should shape Ai before it arrives. Participation is not a survey at the end; it is co‑design at the start and dialogue throughout. The Oxford collaboration modelled this: bringing people with lived experience into the room, defining “responsible” in the language of care, not merely in the grammar of compliance. In my view, participation must include real choices about trade‑offs, say, between night‑time safety and the sanctity of the home, because these are moral choices, not merely technical settings.

Mrs M lives with frailty and prefers to sleep with her door ajar. Her care home trials a thermal‑imaging night monitor to reduce falls. In a participation session, residents and families ask: Can we disable the device in private moments? Where is the data processed? Who can review it? The home agrees to local (on‑premise) processing, automatic masking of faces, visible “privacy on” indicators, and a resident‑controlled off‑switch. The result is not the absence of technology; it is what Jenna Joseph calls consented technology.

Accountability

We need an accountability map for every deployment: who is the provider/deployer and who is the vendor/importer; who signs off risks; who investigates incidents; how can residents and staff escalate concerns; what goes into the public learning log? The EU AI Act gives practical scaffolding, namely roles, risk management, post‑market monitoring, all of which I would contend Scottish providers can adopt to make accountability legible even in a UK regime that leans on existing law.

A local authority pilots an LLM that drafts care assessments from worker dictation. After several weeks, managers notice the model confidently inserts “no risk of self neglect” where the worker had simply paused. An incident is logged; the authority’s accountability map lets a resident, a worker and the vendor meet to replay the transcript and model output. The authority introduces a “yellow banner” policy: any AI generated statement about risk must be explicitly confirmed by the social worker, or it is struck out. This example builds on some of the excellent ethical considerations espoused by Rees and Edmonson.

Non‑discrimination

Bias audits must be routine. Predictive models trained on skewed data can channel more surveillance toward some groups than others, or depress service offers without anyone intending harm. NHS ethics work emphasises countering inequalities; UN guidance insists on HRDD with those most at risk. In social care, we should publish fairness metrics, not hide them in procurement files.

A homecare provider uses an Ai scheduler. Complaints rise from women working school‑hours who get fewer paid visits. A fairness audit shows the model equates “availability” with a 12‑hour window and penalises constrained patterns. The provider resets the objective function to value continuity of relationship and paid breaks, not only distance and minutes. Complaints fall; retention rises.

Empowerment

Human rights require capability. We must make explanations understandable, options visible, and opting‑out feasible. Generative tools should lower barriers for those who do not speak English as a first language, or who want draft letters in accessible formats, without locking people into systems they cannot question. UK information‑governance guidance is clear: professionals remain decision‑makers, and individuals retain rights over their data.

Amira, recently arrived in Scotland, struggles to draft a support request. A co‑produced LLM assistant helps her write in Arabic and produces a plain‑English summary for her key worker. The service’s policy, shaped with users, states that the assistant never submits letters; Amira reads, edits and approves every word. Empowerment is the difference between a tool that writes for me and one that lets me say what I want to say.

Legality

We must separate lawful bases for direct care from those for training or improving systems. We need Data Protection Impact Assessments (DPIAs), contracts that say what data can (or cannot) be used for, and documentation that shows how we manage risk. For high‑risk uses, the EU AI Act expects a full risk‑management system and technical documentation; UK guidance expects the same good governance, anchored in GDPR and equality law.

A supplier proposes to “improve accuracy” by training on de‑identified care plans. The provider’s DPIA flags re‑identification risk for small island communities. The contract is amended: no secondary use without explicit, revocable permission from the individual; only synthetic or federated approaches may be used for model refinement; independent re‑identification testing is required before release.

 The human rights we must actively protect (and how AI touches each)

When I talk about a human‑rights approach, I mean specific rights not vague goodwill.

• Dignity: The first test is always whether the person’s sense of self is enhanced or eroded. Ambient sensors and “smart” cameras risk reducing people to data points, especially older adults. Dignity is preserved when surveillance is not the default; when there are off‑switches; when people choose how technology shows up in their home.
• Privacy: Home should remain a sanctuary. Data minimisation, local processing, strict retention limits and audit trails are the ethics that make sanctuary possible. The EU AI Act’s bans and transparency duties give guardrails, but we must reach for the higher standard of trustworthiness experienced by the person.
• Autonomy and Informed Consent: Consent for direct care is not consent for model training. People should be able to say “yes” to one and “no” to the other. Explanations must be understandable, and meaningful alternatives must exist. UK IG guidance is explicit about these distinctions in care contexts.
• Equality and Non‑discrimination: Age, disability, race, language and socio‑economic status can interact with AI in harmful ways. UN experts call for HRDD with at‑risk groups; NHS programmes focus on countering inequalities. Make fairness testing public and fix disparities quickly.
• Participation and Voice: People affected by Ai must have a say. Co‑production is a right, not a courtesy. Oxford’s co‑produced guidance shows how to do this well in social care.
• Accountability and Remedy: Grievance routes should be accessible and non‑retaliatory, with independent escalation. Document AI incidents (privacy breach, discriminatory output, harm to autonomy/dignity) and publish learning. AIDRS provides pathways for when regulatory notification is required.
• Workforce right and professional judgement: AI must augment care and support work, not deskill workers or micro‑surveil them. Scheduling and productivity analytics need limits and worker voice. Oxford’s governance work and sector commentary both underline this.

Scotland’s digital and policy context: making rights operational

Scotland’s Data Strategy for Health and Social Care emphasises data ethics, interoperability and “better use of data” in preventative care, with work underway toward an Ai policy framework. This is precisely where PANEL and HRDD must be baked in, not as an afterthought, but as the organising principle for design, procurement and evaluation. The Scottish AI Alliance has moved the public sector toward greater AI transparency, and that same ambition should explicitly extend to adult social care.

Scotland’s continuing debate on social care reform and international human rights incorporation is a reminder that law matters when resources are thin and systems are stressed. As the Health and Social Care Alliance have  clearly articulated Ai  must never become a technical shortcut for structural under‑investment. Efficiency that erodes relationships or displaces human judgement is not progress; it is a re‑statement of the very problems we claim to solve.

On a Hebridean island, a care provider is offered a “smart home” package: video monitoring, voice analysis, predictive alerts. The team ask residents to join a design circle. The answer that emerges is: “No, unless it is privacy‑first, entirely local, and unless our crofts feel like crofts, not clinics.” The vendor re‑engineers the solution: devices process on‑device; cameras are replaced by door sensors and pressure mats; and a human call‑back is guaranteed within 10 minutes of any alert. Rights shape the technology, not the other way round.

 

How EU and UK legislation will impact social care in Scotland

Let me put this plainly and practically.

EU AI Act: what Scottish providers must understand accepting the comment above about best practice and legal requirement given our non-membership of the EU at present.

• Risk‑based duties: The Act bans certain uses outright (e.g., systems exploiting vulnerabilities, certain emotion‑inference and untargeted biometric scraping), requires transparency for limited‑risk tools (like chatbots), and imposes heavy governance on high‑risk systems (risk management, data governance, technical documentation, post‑market monitoring). In social care, high‑risk categories often include systems that materially influence access to services or safety, or that manage workers in consequential ways.
• Who is on the hook? The Act distinguishes providers (those who develop or place a system on the market) from deployers (those who use it), as well as importers and distributors. A Scottish care organisation using a vendor’s tool is typically a deployer but may inherit provider‑like obligations when customising or substantially modifying a system. Contracts must make these roles explicit.
• Extraterritorial pull: If your system or its outputs are used in the EU – perhaps because you serve people funded from an EU jurisdiction, or your vendor markets the same configured product into the EU- you can be brought under the Act’s scope. Care technology is global; procurement must assume cross‑border obligations.

A Scottish care home adopts a falls‑prediction platform from a vendor whose product is also sold in the Netherlands. The vendor classifies the system as high‑risk under the EU Act and asks the home to contribute to real‑world performance monitoring. The home agrees on conditions: the vendor provides the conformity assessment and post‑market monitoring plan; the home captures outcome data only with resident consent and publishes a lay summary locally. The result: the home benefits from better safety while remaining on the right side of both EU and UK expectations.

UK approach: what anchors apply in Scotland

• Principles via existing law: The UK expects regulators to apply five core principles through current frameworks rather than creating a single AI statute. For social care, this means leaning on UK GDPR, equality law, and sector IG rules, plus clear, proportionate assurance. AIDRS acts as the navigational aid across NICE, MHRA, CQC and HRA.
• Health/social care specifics: NHS information‑governance guidance clarifies consent, data minimisation, and the continuing role of professionals as decision‑makers. The NHS AI Ethics initiatives and MHRA’s “AI Airlock” are developing practical safety and evidence expectations, useful anchors even when tools are used in social care rather than the NHS.
• So what for Scotland? Health and social care are as we know devolved, but UK regulators and guidance still shape market behaviour. Scottish providers should adopt the highest applicable standard: use EU AI Act role definitions and documentation discipline, follow UK IG rules on data and consent, and align with Scotland’s Data Strategy commitments on ethics and transparency. This “belt and braces” approach reduces risk, builds public trust, and future‑proofs practice.

Practice patterns I commend:

• Co‑produce from the outset: Assemble standing forums of people who draw on care, unpaid carers and staff to review proposals, test interfaces, and agree consent flows. Treat this as governance, not engagement.
• Publish an Ai register: What systems do we use? Why? What data do they process? What is the lawful basis? Who is accountable? How can people complain? (If you only have a procurement file, you do not have accountability.)
• Bias and equity routines: Run fairness tests at go‑live and on a schedule; commission independent audits for consequential systems; correct disparities and publish fixes.
• Privacy‑by‑default architecture: Prefer local processing; minimise retention; create human‑readable logs so that residents and families can see what happened and why.
• Explainability for humans: Build short, accessible explanations; train staff to challenge the model and to document overrides; avoid any fully automated adverse decision.
• Contracts that protect rights: Require vendors to disclose training data sources, known limitations, bias mitigations, and incident response plans; prohibit secondary use without explicit permission; align role allocations with EU AI Act definitions.
• Remedy pathways: Offer simple reporting for residents and staff; classify incidents (privacy, bias, harm to dignity/autonomy); share learning in public. Use AIDRS to judge when to notify regulators.
• Worker voice and wellbeing: Set boundaries on algorithmic monitoring; involve staff and unions in tool selection; invest in digital and ethical literacy; design for augmentation, not substitution.

Closing reflection: the humanness of care

I hope you have found the above useful as we start to navigate Ai in social care in 2026 from a human rights and ethical perspective. There is a lot more to say in this conversation. But essentially social care is a human practice and art before it is a service. Ai will be judged not by how clever it seems, but by whether it helps people live the lives they choose, surrounded by relationships that dignify and sustain them. The frameworks are now at hand, the Oxford values‑led guidance, the UN’s HRDD expectations, the EU Act’s structure, and the UK’s principle‑based oversight. Our task in Scotland is to make them lived reality: to ensure that, in our homes and communities, technology becomes a tool for care, not a technique of control.

Donald Macaskill

Photo by Luke Jones on Unsplash

Four days before Hogmanay, Scotland feels like a country holding its breath. The streets glisten with frost after what feels like weeks of rain, a growing number of hills wear their winter shawls, and the air oozes with anticipation. The rush of Christmas has ebbed, leaving behind a quieter rhythm and a time for reflection, for counting what matters, for dreaming what might yet be.

Hogmanay is not just another New Year’s Eve. It is a threshold, a liminal space steeped in tradition. We sweep the hearth, we lay out coal and shortbread, we wait for the first-foot – that lucky soul who crosses the door after midnight, bearing gifts of warmth and sustenance. Bells will ring from church steeples and smartphones alike, whisky will pour amber into glasses, voices will rise in song.

But beneath the revelry lies something deeper: a belief in renewal, in the possibility of beginning again.

And so, as we stand on the cusp of 2026, we ask the question that Hogmanay demands: What will we carry forward? What will we leave behind?

This past year has been a hard one for social care. We have seen dedicated workers stretched thin, families navigating impossible choices, and communities stepping in where systems faltered. We have heard the language of crisis so often it has become a drumbeat. And yet amid the strain there were and are today sparks of light. Neighbours checking in. Volunteers delivering meals. Carers delivering compassion even in the fragments of commissioned time. Care homes finding creative ways to keep hope and joy alive. These moments remind us that social care is not a service to be rationed; it is the heartbeat of our humanity.

As Hogmanay approaches, we are invited to make resolutions. Too often, they are about waistlines and wallets, about doing more, being better. But what if this year, our resolutions were about something deeper? About the kind of Scotland we want to wake up to on January 1st – a Scotland where care is not a postcode lottery but a shared promise.

Here are three resolutions for a Scotland that cares:

1. Speak of care as infrastructure. Care is not an optional extra; it is the foundation of a good society. Let us resolve to talk about social care with the same urgency as roads and schools because without it, nothing else stands.
2. Invest in people, not just systems. Technology can help, but it cannot replace the human touch. Let us resolve to honour and reward those who care, the professionals and unpaid carers alike, and to do so with fair pay, respect, and recognition.
3. Make community our first footing. Hogmanay’s tradition of first-footing reminds us that the first person through the door brings luck for the year ahead. What if our first step in 2026 was towards deeper community? Towards knowing our neighbours, supporting local initiatives, and weaving networks of kindness?

Picture it: the bells ringing out across Edinburgh, their echoes tumbling down the closes and wynds. The clink of glasses in kitchens from Shetland to Stranraer. The hush before midnight, when the old year lingers like smoke and the new year waits like a promise. A lump of coal on the hearth, symbol of warmth and continuity. A dram of whisky passed from hand to hand, the colour of hope. Laughter spilling into the frosty night as doors open to welcome the first-foot, carrying gifts of bread and salt, symbols of sustenance and friendship.

This is Hogmanay: a ritual of connection, a declaration that we belong to one another. And if that is true in our homes, should it not also be true in our policies, our priorities, our politics?

For me, Hogmanay is never just about fireworks or whisky. It is about standing in the cold night air, listening for the bells, and asking: What kind of Scotland do I want to wake up to? My answer is simple: one where no one feels forgotten. Where social care is not a crisis but a covenant. Where the measure of success is not GDP but the dignity of every life.

Four days to Hogmanay. Four days to decide what matters. What will your resolutions be? And how will they help build a Scotland where social care is not just a service, but a shared value?

Hogmanay is a time for words as well as deeds. So I leave you with this:

New Year

No fireworks needed, no grand display,

just a quiet shift from night to day.

A message sent, a hand held near,

a whispered truth: We’re still here.

Forget the lists that fade by March,

the hollow vows, the rigid arch.

Begin instead with what is real,

a promise made, a wound to heal.

Not coal, but care to light the fire,

not luck, but love to lift us higher.

Bring voices strong, bring laughter clear,

bring hope enough to last the year.

The future waits – no distant star,

it starts with us, right where we are.

So open wide the door of now,

and let the new year teach us how.

Donald Macaskill

Photo by Chris Flexen on Unsplash

 

 

The frost clings to the windows of a care home. Inside, a carer hums a carol, her voice soft against the hum of an oxygen machine. A resident stares at the tree lights, wondering if her family will come. Across town, an unpaid carer sets down her shopping bags and begins the evening routine of lifting, washing, soothing, all the while as the kettle boils in a kitchen that feels both sanctuary and prison. In another village, a homecare worker drives through sleet to reach an older man who waits for help with his supper.

This is the paradox of Christmas in social care: joy and fragility intertwined. For Scotland’s care homes, homecare services, and unpaid carers, this season arrives amid deep uncertainty, the reality of staffing shortages, savage cuts because of Government under-funding, loneliness that lingers like winter fog. We long for certainty, for answers that will fix the cracks. But what if certainty is not the gift we need? What if hope, fragile yet fierce, is the light that can guide us?

The Scottish social care sector stands at a critical place as we come to the end of this year. Reports speak of workforce crises, rising costs, and the emotional toll on carers stretched beyond measure. Families worry about quality and continuity; providers wrestle with sustainability and even survival itself. Homecare services struggle to recruit and retain staff, lack of commissioned care means many older people are waiting for visits that never come. Unpaid carers, often family members, carry invisible burdens, sacrificing careers, health, and rest to keep loved ones safe.

In such a climate, the instinct is to seek certainty, and to do so through rigid policies, technological fixes, or predictive models. But life, especially life at its twilight, resists such neatness. Prognoses shift, needs evolve, emotions defy algorithms. Whether in a care home, a living room, or a carer’s kitchen, uncertainty is the constant companion.

Last month I was privileged to take part in a workshop and to attend a session delivered by Dr. Ariel Dempsey. It was during the always wonderful Scottish Partnership for Palliative Care Conference and this past week I was fortunate to meet up again with Ariel when I was in Oxford.

Ariel’s doctoral work at Oxford reframes uncertainty not as a problem to be solved but as an experience to be palliated – soothed, softened, and held with care. In her thesis, Palliating Uncertainty: Tools from the Pragmatism of William James, she argues that uncertainty causes suffering akin to physical symptoms and therefore deserves the same compassionate attention as pain or breathlessness. Traditional responses – over-investigation, over-medicalisation – often amplify distress rather than relieve it. Instead, Dempsey proposes an approach grounded in the ethos of palliative care: acknowledge uncertainty, orient toward meaningful action, and cultivate relational support.

Drawing on William James’ pragmatism, Dempsey frames uncertainty as an invitation to act rather than a barrier to truth. James wrote of “the will to believe”; the idea that when evidence cannot decide, hope becomes a genuine option. For Dempsey, this means clinicians (and by extension, carers) must act with humility and courage when certainty fails. We cannot eliminate uncertainty, but we can meet it with grace.

Her practical steps include managing expectations: naming uncertainty openly rather than masking it. It also means turning attention to action: asking, “What matters most now?” instead of “What will happen next?” And most importantly it means relational holding: building communities of care where uncertainty is shared, not borne alone.

This is not abstract philosophy. It is deeply relevant to social care. For homecare workers, it means entering each home with openness, knowing that plans may change and emotions may surge. For unpaid carers, it means finding strength in the ordinary, in the ordinary acts of making tea, sharing stories, all the time while living with questions that have no easy answers.

Liz Lochhead captures this time of yearning and longing in her winter verse from Festive Poems:

“These are the shortened days
and the endless nights.
So wish for the moon
and long for the light.”

In care homes, in kitchens, in cars parked outside rural cottages, these shortened days are literal and metaphorical. Yet the act of wishing – the audacity of hope- is itself a form of resistance against despair.

Hope, in this frame, is not naïve optimism. It is active, relational, embodied. It is the quiet courage to believe that even in the shadowed places, light can still break through. In social care, hope takes shape in small acts: a carer learning a resident’s favourite song; a homecare worker pausing to share a laugh; an unpaid carer finding respite through a neighbour’s kindness.

William James reminds us that hope is a moral choice when certainty fails. To hope is to act as if goodness is possible, even when the evidence wavers. For Scotland’s care homes, homecare services, and unpaid carers, this means investing not only in infrastructure but in relationships. It means training carers in presence, not just procedure; designing systems that honour the mystery of life, not just its metrics.

Another Scottish poet Josephine Neill’s A Christmas Poem offers a vision of hospitality that mirrors the heart of care:

“Step ower the straw
Draw ben tae the fire
Afore the day daw.”

This is what care should feel like: an invitation to warmth, a shelter against the cold. In a world obsessed with efficiency, such gestures are revolutionary.

Christmas itself is a story born in uncertainty: a child in a manger, a family far from home, a future unwritten. And yet, hope arrived not as certainty, but as promise. This is the hope we need in social care: not the brittle assurance that all will be well, but the resilient trust that love can flourish even in fragile places.

The true gift of Christmas is presence. For those who live and work in care homes, for homecare workers driving through winter nights, for unpaid carers who give without measure, that gift is you – the carers, the families, the communities who choose to love in the face of the unknown.

As we look to renew our communities and social care and support, let us not seek perfect answers but better questions. Let us shape care, whether in homes or residential homes, into sanctuaries of meaning, where uncertainty is met with grace and hope is practiced daily. Let us remember that policy and funding matter but so do poetry and presence, song and silence, firelight and friendship.

This Christmas, may we embrace the dance of uncertainty. May we choose hope not as sentiment, but as strategy, not as illusion, but as moral courage. For in that choice lies the future of care.

In the hush of winter’s breath,
Where questions linger, answers flee,
Hope is not a fortress strong;
It is a candle, trembling free.

It does not banish all the dark,
Nor silence every fear we keep,
But in its glow, we find the strength
To love, to listen, and to weep.

Donald Macaskill

Photo by Leni on Unsplash

 

Social care in Scotland stands at a critical juncture. Rising demand, workforce shortages, and financial pressures have created a system under strain.

For years, reform efforts have focused on structural fixes, the introduction of integrated boards, new governance models, and performance targets. We even came up with the ill-fated National Care Service. Yet, the lived experience of many remains fragmented. Why? Because we have been trying to manage complexity with tools designed for simplicity.

Occasionally there are times when certain parts of your life and worlds come into creative engagement. I recently had such a moment when I listened to a superb speech being delivered by Professor Toby Lowe and recognised the synchronicity of his words with my role as Chair of NDTI who are continually trying to promote and develop creative ways of addressing broken systems in their work, not least the failures to deliver citizen-led and controlled social care and support.

Professor Toby Lowe’s work on Human Learning Systems (HLS) offers a radical alternative to a lot of traditional and normative social care reform approaches. It begins with a simple but profound truth: outcomes can not delivered – they emerge from complex systems of relationships. This insight challenges the dominant logic of control and invites us to design systems that learn, adapt, and serve human flourishing.

Traditional public service management, shaped by New Public Management philosophy and practice (beloved of civil servants and Prince 2 learning systems) assumes that outcomes can be specified, measured, and purchased through contracts. In reality, social care outcomes which are after all wellbeing, independence, or dignity, are created by hundreds of interacting factors: family support, housing, community networks, health services, and personal resilience. Holding providers accountable for outcomes they cannot control leads to gaming, stress, and worse results.

It turns professionals into bureaucrats and people into cases. Scotland’s experience with integration shows this clearly: structural change without cultural change achieves little.

Lowe’s Human Learning System approach rests on three principles:

• it is Human – see people as unique, not data points. Design bespoke responses that start with individual strengths and aspirations.
• it is Learning – make learning the engine of improvement. Use cycles of inquiry and adaptation, not rigid plans and targets.
• it is about Systems – nurture healthy systems: trust, collaboration, diversity, and shared stewardship across organisational boundaries.

Instead of asking, “How do we deliver outcomes?” HLS asks, “How do we create the conditions for good lives to emerge?”

In his talk Toby Lowe cited the innovative work being undertaken in Leeds. There Leeds City Council have embraced a strengths-based approach that aligns beautifully with HLS thinking. This has led to a liberation of social work and social care. They have moved from care management to relationship-based practice. Social workers became “travel companions, not travel agents.” It has as a result reduced bureaucracy, by cutting assessments from 52 pages to two conversational pages. It has led to real community investment through small grants for local initiatives that build resilience and belonging. And critically it has been rooted in system stewardship with senior leaders giving a clear mandate: “Do no harm. Don’t break the rules. Don’t break the budget. Otherwise, go for it.” This created psychological safety for innovation.

The result was social workers reporting feeling empowered, and citizens experiencing care as something co-created, not imposed. For those who were around at the start of Self-directed Support in Scotland, this is what we dreamt of and we can only yearn for such achievements.

I mentioned my work with NDTI and it is through their work that some of these principles are becoming more rooted in parts of Scotland. The National Development Team for Inclusion (NDTi) has helped spread these ideas through its Community Led Support (CLS) programme. CLS creates local hubs where people can have “good conversations” about what matters to them, reducing bureaucracy and connecting them to community resources.

In Scotland, CLS has been implemented in East Renfrewshire, South Ayrshire, Scottish Borders, Fife, and South Lanarkshire, with measurable impacts. Waiting lists have been reduced (e.g., Scottish Borders saw a 37% drop). There was evidence of improved staff morale and reduced bureaucracy; of better outcomes for people as a result of quicker access and more community-based solutions. And CLS also demonstrates cost-effectiveness by preventing crises and reducing reliance on statutory services bringing clear economic benefits.

These changes echo HLS principles of trust, learning, and human-centred design.

I think Lowe’s approach has clear potential for Scotland as we struggle with complexity by too often delivering simplistic responses. Applying these lessons means:

1. Commission for learning, not control – fund organisations to adapt with people, not hit arbitrary targets.
2. Invest in relationships and communities – strengthen local capacity and trust, because outcomes emerge from networks, not contracts.
3. Create connected learning systems – link insights from frontline practice to policy, so reform grows from lived experience rather than top-down design. And stop obsessing with the mistruth that the only people with ‘lived experience’ are those who are currently using care and support. Cast the net wider to the users of tomorrow, to the workers of today and the employers of the moment. They all have invaluable lived experience to teach a failing system.

This is not about importing a model wholesale. It’s about embracing principles that honour complexity and human dignity. Leeds and CLS show that when you trust professionals, invest in communities, and make learning the core of improvement, transformation happens.

Imagine a future where a district nurse, a social care worker, and a community volunteer co-design support around a person’s life. Where local teams share learning openly, shaping policy through lived experience. Where success is measured not by throughput or cost per case, but by stories of flourishing.

This is not utopian. It is already happening – in Leeds, in many other places in England as well as in Scotland. The question is whether we have the courage to scale it.

As Toby Lowe reminds us: stop pretending the world is simple. Embrace complexity. Learn together. Build systems that serve human freedom and flourishing not that feed the gods of performance and the cult of system outcomes.

Donald Macaskill

 

Photo by Armand Khoury on Unsplash

On Human Rights Day 2025, which will take place this coming Wednesday on the 10^th we are called to remember not only the rights enshrined in law but the relationships that make those rights real. In the realm of social care, this is not a theoretical exercise but rather it is a daily, lived reality.

On reflecting upon this I was reminded of a great speech I heard whilst in Boston for the Global Ageing conference a few weeks ago. It was given by the essayist and journalist David Brooks. Several times during his contribution he used the word ‘beholden.’ It sent me searching the dictionary for its origin and meaning.

I discovered that beholden comes from Middle English, originally the past participle of behold. It was a word which did not mean simply to see rather it meant to hold, to keep, to be bound to another. To be beholden is to live in obligation, not as a burden, but as a bond. It is to recognise that our lives are entangled, that our dignity is shared, and that our rights are sustained not only by law but by love.

In an age that prizes autonomy and self-sufficiency, beholden sounds uncomfortable. In our age of individualism, beholden sounds archaic. We prefer autonomy, independence, self-sufficiency. Yet in the realm of social care, and indeed in the moral ecology of our communities, perhaps it is a word we most need at the present time. Because care is not a transaction but rather it is a covenant. Care is profoundly about relationship not task.

Reading a bit more about his writing I have discovered that David Brooks, in his work on the Weave Project and in The Second Mountain, as he did in his speech, speaks of a society fraying at the edges. One that is lonely, tribal, spiritually hollow. His response is not technocratic but relational. He calls for a “relationalist” ethic, one that sees people not as consumers or clients, but as neighbours, as kin.

Brooks writes of “radical mutuality,” of lives built not on independence but on interdependence.

In The Second Mountain, in particular, Brooks argues that the first mountain of life is about personal success, but the second is about moral joy found in commitment to others, in covenant, in community. To climb that second mountain is to become beholden – not in weakness, but in strength. It is to say: I am because we are.

This is not sentimentality. In this view, social care is not a service – it is a covenant.

This is not weakness. It is strength. It is a strength those who work in social care will easily recognise. It is the strength of carers who show up day after day, often unseen and underpaid. It is the strength of communities who hold their elders not as burdens but as bearers of wisdom. It is the strength of a society that says: I am because we are.

In Scotland, we are facing a crisis in social care. But it is not only a crisis of funding or infrastructure – it is a crisis of moral imagination. The centralisation of care contracts, the economic fragility of rural care homes, and the bureaucratisation of support have eroded the relational soil in which human rights grow.

As I’ve said before, “You would be, quite frankly, insane to waste your money building a private care home in any part of Scotland, unless you were guaranteed 100% of private income.” But the deeper insanity is imagining that care can flourish without community.

The National Care Home Contract has failed not only economically, but relationally. It does not reflect the reality of being beholden – to elders, to carers, to the land and its people.

In my writing on the local democratisation of social care, I have argued that we must move from a model of delivery to one of relationship. The Self-directed Support Act of 2013 was meant to empower individuals, but its implementation faltered because it did not embed itself in the moral soil of community.

We need a care system that is not just efficient, but beholden – to the values of dignity, inclusion, and human rights. We must move from a model of delivery to a model of relationship. From care as service to care as covenant. From rights as entitlements to rights as responsibilities held in common.

Ageism, as I’ve explored in recent speeches, is a symptom of a society that has forgotten what it means to be beholden. When older people are seen as burdens rather than bearers of wisdom, we lose not only their stories but our own moral compass. The rise in age-related hate crimes, the media’s portrayal of ageing as decline, and the economic marginalisation of older workers – all point to a rupture in our social fabric.

To repair it, we must reclaim the ethics of obligation. Not obligation as duty alone, but as relationship. To be beholden is to recognise that our lives are entangled, that care is not charity but reciprocity.

On this year’s Human Rights Day, I’d love us to reclaim beholden as a word of moral power. Let us say we are beholden to those who age, not as problems to be solved, but as people to be honoured. We are beholden to carers, whose labour is love and whose work is justice. We are beholden to communities, whose strength lies in their capacity to hold one another.

David Brooks reminds us that moral renewal begins not with systems, but with stories. And in Scotland, we have stories of care that stretch from croft to coast, from ceilidh to care home. They are stories of people who are beholden and proud to be so.

Let us write policy, yes. But let us also write poetry and story. Let us build care systems but let us also build kinship. Let us be beholden, not as a relic of the past, but as a radical vision for the future.

Human rights are not sustained by policy alone. They are sustained by people who are beholden to one another. By carers who show up. By neighbours who listen. By governments who remember that dignity is not delivered but that it is held.

Let us be beholden. Not as a relic of the past, but as a radical vision for the future of social care.

Because to be beholden is not to be bound – it is to be human.

In his poem The Poet’s Obligation the great Pablo Neruda shares a declaration of the poet’s moral duty to awaken others to the vitality of life. Neruda sees himself as beholden to those trapped in routine, pain, or isolation. His obligation is not merely artistic but rather it is human, spiritual, and communal. The sea becomes a metaphor for freedom, and the poet a conduit for its liberating force.

I leave you with his words as we approach Human Rights Day in the spirit of beholden.

 

The Poet’s Obligation

by Pablo Neruda

(Translated from Spanish)

 

To whoever is not listening to the sea this Friday morning,

to whoever is cooped up in house or office, factory or woman

or street or mine or harsh prison cell;

to him I come, and, without speaking or looking,

I arrive and open the door of his prison,

and a vibration starts up, vague and insistent,

a great fragment of thunder sets in motion the rumble of the planet

and the foam, the raucous rivers of the ocean flood,

the star vibrates swiftly in its corona,

and the sea is beating, dying and continuing.

So through me, freedom and the sea

will make their answer to the shuttered heart.

 

https://www.tnellen.com/cybereng/poetry/obligation.html

 

Donald Macaskill

Photo by Andrew Hall on Unsplash

The following extended blog is the substance of an address delivered to the Scottish Partnership for Palliative Care conference on the 13th November.

I want to begin not with policy, nor with strategy, not even with the practice of social care itself. I want to begin with a poem.

It is for me one of the great poems of the twentieth century, written in Gaelic, by Sorley MacLean who was born on the island of Raasay just off Skye. His work has been credited with restoring Gaelic tradition to its proper place and reinvigorating and modernising the Gaelic language.

His poem Hallaig, published in 1954, achieved an almost “cult like status” outside Gaelic-speaking circles for its supernatural representation of a village depopulated in the Highland Clearances. For those like me who had grown up with grandparents who were the children of the thousands who were ‘cleared’ off their land to make way for sheep and the profits of landowners, his words echo a truth of painfulness.

Hallaig is a poem about place, about people, about presence and absence. A poem that carries both lament and hope, both grief and rootedness.

In translation part of it reads:
“Time, the deer, is in the wood of Hallaig.
The shadow of the birch is in Hallaig,
and the trees are standing tall
where people once stood.”

When you walk into Hallaig, the cleared village on Raasay, you see no houses, no children, no hearth smoke. The people are gone. And yet in MacLean’s vision, they are still there. Their memory abides in the birch trees, in the glen, in the silence that is alive with absence.

I want to take Hallaig as our guide this morning. For in considering what social care contributes to palliative and end of life care I want to start by saying that I believe it is precisely that: presence in absence, the rootedness of memory, the holding of community when it seems no longer there.

Right at the start it is useful to say what social care is

One definition I work with is this:

“The enabling of those who require support or care to achieve their full citizenship as independent and autonomous individuals. It involves the fostering of contribution, the achievement of potential, the nurturing of belonging to enable the individual person to flourish.”

It is not about maintenance but about life in all its fulness.

It is delivered by around 212,00 people that’s over 50, 000 more than in the NHS

It is witnessed in care homes, in people’s own homes, in housing support across the country.

We do not, in Scotland, like to talk of death. We do not, if truth be told, like to talk of decline, of diminishment, of ageing, of endings.

We are a nation of euphemisms.
“She’s passed on.”
“He’s away.”
“She’s no longer with us.”

We avert our eyes. We walk on the other side of the road.

Yet absence, I believe, is not void. Absence can echo. It can hum with memory. The room of a dying person is heavy with memory, with love, with stories still untold.

Death is not avoidance. Death is presence. It is as real as breath. It is as much part of life as birth itself.

I met Mairi in a care home on Skye. She was a woman with silver hair, her mind drifting like mist – but her hands knew the old Hebridean psalm tunes. Her carer, Eilidh, sang with her each evening. When Mairi could no longer recall the words, Eilidh sang to her, and Mairi’s eyes filled. Even as memory slipped, presence remained. In that moment, social care was a sanctuary. The birch trees, living memory.

MacLean’s Hallaig captures the paradox – that absence can be full of presence. That a glen emptied of its people can still echo with their laughter, their footsteps, their lives.

And that is the role of social care in palliative and end-of-life work.

We are the companions of presence. We are those who stay when others turn away. We are those who sit in silence when there are no more words, those who hold a hand when there is no more cure, those who listen to the laboured breath and still hear the human story.

I have seen in care homes across Scotland what I can only call sacrament. A worker, exhausted at the end of a shift, bending down to kiss the forehead of a woman who is dying, whispering in her ear, “You are not alone…You are not alone.”

I have watched in a cramped tenement flat a home carer arrive with a flask of soup, not just to nourish but to bless. To remind a frail man that he is still part of a circle of care, still someone, still himself.

In those moments, social care is Hallaig. We are the birch trees. We are the presence that stands where absence seems overwhelming.

In places and at times when there are no definitive answers to profound questions the role of the carer is like the potter with raw clay – searching for the story inside, for truth to find its shape, for the moment to appear.

I think this is especially the case in the care of those who are very old and those living their end days with dementias.

I am reminded in that regard of the words of another poet David Whyte, who writes:

“The only choice we have as we mature is how we inhabit our vulnerability, how we become larger and more courageous and more compassionate through our intimacy with disappearance.”

Care, in all its forms, not least social care, – is an intimacy with disappearance. It is the daily act of standing beside someone as they change, decline, recover, or die. It is the art of presence in the face of absence. And it is in this space – this vulnerable, sacred space – that care is being created.

It is important, I think, to say something that is not always heard in the public square.

Palliative care is not only about hospices. It is not only about hospitals. It is not only about the skilled interventions of doctors and nurses, invaluable and irreplaceable though those are.

Palliative care is also, distinctively, deeply, profoundly, about social care.

What makes social care distinctive in the work of dying?

It is not equipment, though we sometimes bring that.
It is not medicine, though we often support its use.
I think it is relationship, it is ordinariness, it is continuity – all of which are about enabling presence in absence.

The carer who has washed your hair for two years is the carer who knows how to wash it when you are dying.
The support worker who has shared your laughter at Christmas is the one who knows how to comfort you when you face your final days.
The care home manager who has phoned your daughter every week is the one who phones her when you have only days to live.

This is not incidental. This is the very heart of what makes social care distinctive.

We do not walk into someone’s life at the eleventh hour. We walk alongside them through the long days of ageing, through the seasons of frailty, through the slow diminishment of memory. And when the time of dying comes, we are already there.

There is, in social care, an intimacy, an ordinariness, that is profoundly palliative.

It is in the cup of tea.
It is in the blanket tucked round legs.
It is in the song sung softly, the prayer whispered, the silence held.

Care homes at their best are communities of memory. They are places where life is lived until the very last breath. They are places where birthdays are celebrated even when candles are hard to blow out, where Christmas trees sparkle even when vision fades, where the ordinary rhythms of life continue right up to the threshold of death.

Care homes are not passive spaces – they are living, breathing communities.

At an Edinburgh care home, the staff celebrated Hamish’s 100th birthday with cake, accordion music, and stories. A month later, Hamish quietly passed away, mid-dance. No medical machinery, just life flowing to its close, and presence, still.

Home care is even more intimate. To die at home, with your own curtains, your own wallpaper, your own cat curled on the bed – this is what many people long for. And it is social care that makes that possible. It is the carer who comes at seven in the morning, at midnight, at dawn, who makes that choice real, not just theoretical.

In a Fife care home, a man called George loved fish suppers. Every Friday, for years, staff brought in a bag of chips from the local chippy. Even when swallowing grew difficult, they still brought the chips. They placed them near his bed, so he could smell the vinegar and salt, the comfort of familiarity. George died one Friday evening, with that scent in the air.

Medical charts or care records did not record that moment. But it was a palliative act – ordinary, rooted, profoundly human.

This is what the national palliative care Strategy calls “timely, co-ordinated care based on what matters.” But to me, it is simply social care – ordinary love made visible.

In all these moments, it’s not just what we do – it’s who we are. Social care brings ordinariness, relationship, continuity.

The new Scottish Government strategy, Palliative Care Matters for All, affirms a vision:

‘By 2030, everyone in Scotland, adults and children, should have equitable access to well-coordinated, timely, and high-quality palliative care, care around dying, and bereavement support based on what matters to them – including families and carers.’

The strategy also calls for Scotland to be a place where communities support each other, talking openly about serious illness, planning, dying, and bereavement. This is our calling: to turn avoidance into conversation, absence into presence.

For these ambitions to be realised in social care, workers must be seen, trained, guided, supported – and the lived, ordinary moments honoured in policy as much as the specialised ones.

When people ask me, “What does social care do in palliative care?” I answer: it makes dying human. It makes dying ordinary. It makes dying part of life.

But let us be clear: this is not just sentiment. It is not just good practice. It is a matter of human rights.

For me to die well should not just be a privilege for the few.
It is a right for all.

The right to dignity does not end when disease progresses.
The right to autonomy does not vanish when memory falters.
The right to participation does not fade when speech is lost.

As most of us in this room know the majority of people die not in hospitals, not in hospices, but in care homes and in their own homes.

Most palliative care in Scotland is delivered through social care.

• 89% of people in Scotland will need palliative care.
• Over 30,000 frail older people receive care at home each week.
• Most people in care homes are in their last 18 months of life.

And a critical part of that social care contribution is the work of unpaid carers who are the Invisible Backbone

They are the mothers, fathers, daughters, sons, neighbours, and friends who provide the majority of palliative care in Scotland – not for pay, not for recognition, but out of love and duty.

The 2025 Carers Update estimates that there are 694,000 unpaid carers in Scotland, including 27,000 young carers.

Unpaid carers carry the weight of love and loss, often in silence. They need more than our gratitude – they need our support, our policy, our resources.

And yet – and yet –  policy, funding, public discourse all too often overlook the reality of both paid and unpaid social care and support.

Let us not enshrine policy without teeth. The Strategy must be backed by funding, staffing, equity. The ambition of the strategy is right. But ambition without investment is poetry without music.

Unless palliative care in social care is resourced, unless the workforce is valued, unless communities are engaged, then those words risk becoming another uninhabited village, another Hallaig of policy – present in name, absent in reality.

This is not simply unfair. It is unjust. It is a violation of rights.

And so we must ask: how do we make sure that Isa or George, are not exceptions, but expectations?

The trees of Hallaig remind us: absence does not mean invisibility. The people are still there, even when the state forgets them. And in social care, we stand with them. We make them visible.

Of course, it is not easy.

Our sector is stretched. Staff are underpaid, undervalued, exhausted. Recruitment is hard. Retention is harder.

We cannot talk about a “dignified death” while those who enable that dignity are themselves denied a dignified wage.

And we also have as everyone in this room knows only too well to acknowledge that death itself is demanding. To sit with dying day after day takes a toll on the soul. To lose people you have loved – and make no mistake, carers do love – is to carry grief upon grief.

Yet despite the hardness I also see hope.

In Inverness, a care home created a “memory tree” in its hallway. Every time a resident died, a leaf with their name was hung upon it. Families came back months later to see their loved one’s leaf still there, still part of community.

In Dundee, a team of carers took it upon themselves to bake scones every Saturday morning for a dying woman who had baked all her life. Even when she could no longer eat them, they baked. They filled the house with the smell of her past. That was hope in flour and butter.

In my own island of Skye, I have taken part in many a vigil. Neighbours gathered outside a croft as someone lay dying inside. They sang psalms in the dark, their voices carrying through the wind. Social care and community entwined, ancient and modern, grief and love in song.

This is our hope – not abstract, but real, rooted, ordinary.

I see hope despite the hardness of days.

I see it in the resilience of staff who turn up every day, who walk into rooms heavy with breath and do not flinch.

I see it in the creativity of care homes that hold vigils, that sing, that weep, that honour the dead with dignity.

I see it in the rituals of remembrance – the photographs, the memory books, the trees planted, the candles lit.

In our Gaelic and Scottish traditions, we are not strangers to grief. We have keened, we have sung laments, we have told stories round the fire. We have known how to hold loss as community.

Social care, I believe, continues that tradition.

We are the keeners of today.

We are the singers of lament in the corridors of care homes.

We are the holders of memory in the tenement flats of Glasgow, in the crofts of Skye, in the bungalows of Dundee.

And there is hope in that.

For a Scotland that can face death is a Scotland that can face life. A Scotland that can accompany the dying is a Scotland that will value the living.

In closing let me turn again to poetry, for it is in poetry that we find the language for what is hardest to say.

Sorley MacLean, in Hallaig, reminds us:

That is what social care does.

We make the dead present in memory.

We accompany the living into death with dignity.

We stand as trees in the glen of absence, rooted, ordinary, beautiful, enduring.

A poem:

Beneath the Trees

Beneath the trees, where birch and rowan speak to the wind,

the memory of people flows like the sound of water—

gentle as peat, strong as oak roots

holding the earth together.

Social care is the quiet road,

threading through the glen of living and leaving,

where human hands become branches,

offering shade, shelter,

and courage when the light draws to its close.

Palliative care is not an ending,

but a circle drawn in kindness—

a hearth of listening,

where pain is met with presence,

and loneliness with love.

Let us be the forest,

deep and interwoven,

where no one dies alone,

and where every breath is honoured

as part of the song of the hills.

Let us never forget:

Life is a forest, and every leaf matters.

Donald Macaskill

Photo by Ann on Unsplash

As the UK Chancellor prepares to deliver the Budget next Wednesday, Scotland stands at a crossroads. For too long, social care has been treated as an afterthought or as the underling of the NHS, yet it underpins everything we value: dignity in later life, support for unpaid carers, and the ability for people to live independently and participate fully in society.

This is not a marginal issue. It is the infrastructure of compassion that sustains our communities. And right now, that infrastructure is collapsing.

Scotland’s social care system is at breaking point. Workforce shortages, rising costs, and chronic underfunding have created a perfect storm.

In rural areas like the Highlands, geography compounds the crisis: delayed discharges cost millions, care homes close, and families face heartbreak as loved ones are sent hundreds of miles away because there is simply nowhere local to go. This is not dignity rather it is systemic failure.

Audit Scotland has warned repeatedly that urgent action is needed to change how services are delivered. Yet despite record allocations on paper, the reality is stark: councils and health and social care partnerships are in year debt to the region of around £500 million. Providers are closing. Skilled workers are leaving because they cannot afford to stay in a profession they love.

When I think of the two main sectors that my membership comprises both are on their knees in the majority of locations.

Homecare is the backbone of independence, but it is collapsing under financial strain. The latest Minimum Price for Homecare in Scotland, as calculated by the Homecare Association for the financial year 2025–2026, is £32.88 per hour. No Scottish council meets the minimum price. Notice it’s a minimum price not a fair price!

To add insult to injury providers report late payments averaging £300,000 per organisation, threatening viability and continuity of care. And the obscenest occurrence is the explosion in 15-minute visits when we were supposed to be seeing the end of this practice which is an absolute assault on dignity.

Every hour of care at home is an investment in human flourishing. It prevents hospital admissions, reduces loneliness, and sustains wellbeing. Yet this lifeline is fraying if not already broken.

The independent care home sector provides 86% of all registered places in Scotland yet has seen a 34% decrease in residents since 2014. Over the past decade, 476 care homes have closed or changed hands, sometimes forcing families to travel 100 miles or more to visit loved ones. This is not just inconvenient, it is cruel. Any fair analysis shows the £1,027 per resident per week for intensive 24/7 nursing residential care is a good £500-£1000 short of the true price of dignified care and even that ties return or profit to 4%, way below what most economists argue is needed to keep a business, be it charitable, not for profit or private going.

Empty beds today mean closures tomorrow, and every closure strips communities of choice and dignity.

Delayed discharge is the most visible symptom of a whole system paralysis. More than five million bed days have been lost since 2015 at a cost of £1.5 billion. Hospitals are gridlocked because social care is starved of funds.

But the invisible cost is what really matters. It’s the thousands who are waiting up to 18 weeks to be assessed for the care they need; it’s the hundreds who die without the dignified end of life care they deserve; it’s the burnt out and exhausted thousands of family and friend carers who are at their wits end with fatigue and emptiness.

And just in case you think I’m engaging in hyperbole and exaggeration – the avoidance critique of those made uncomfortable by the raw truth of political failure, others are in agreement.

COSLA, the representative body of local government in Scotland, has issued a clear warning: without fair and sustainable funding, we risk the viability of services that people rely on every single day. Their manifesto calls for an additional £750 million investment in social care and an end to 15-minute visits in homecare.

More immediately they have also called for the urgent reconvening of the Financial Viability Response Group of which providers through Scottish Care and CCPS sat on at the start of the year and which in April offered a truthful report with recommendations to the Cabinet Secretary.

Councillor Paul Kelly put it bluntly:

“Local Government cannot do this alone. Demand is increasing, costs are rising, and the workforce is under immense strain.”

Yet we have been faced with silence from the Scottish Government other than a statement to address winter pressures by giving £20 million to NHS Boards to address ‘social care’ needs. An allocation not to local authorities or HSCPs but to the sacrosanct NHS.

Scottish Care has consistently argued for a budget that values social care not one that kills reassurance and forces closures. As I said recently, people are dying because they cannot get the social care they need. This is not hyperbole; it is happening now. Services are closing, staff are being made redundant, and communities are losing lifelines.

The UK Government must also shoulder responsibility. Immigration policy changes such as scrapping social care visas, raising salary thresholds, and increasing sponsorship costs are reckless and inhumane. In rural Scotland, internationally recruited workers make up more than 25% of the workforce. Removing this lifeline will devastate communities and put lives at risk.

Both governments must act decisively. The UK Government needs to reverse damaging immigration changes, exempt social care from National Insurance hikes, and deliver Barnett consequentials that prioritise care. The Scottish Government needs to commit to COSLA’s £750m ask, deliver multi-year funding agreements, and accelerate reform that values workforce and community-led care models.

This is not about party politics – it is about people. Every delay deepens the crisis. Every cut costs lives.

Social care is not a drain on resources; it is an investment in humanity. It is the infrastructure of compassion that sustains our communities. As we await the Budget, let us demand a budget that cares; a budget that restores dignity, strengthens the workforce, and ensures that no one in Scotland is left without the support they need.

I appeal to our political leaders to stop the rhetoric and start the rescue.

To the public I say, raise your voice for those who cannot.

Social care is the foundation of a fair Scotland. If we fail to act now, we will not just lose services but inevitably we will lose lives, communities, and trust in the very idea of care. “Social care is not a cost – it is the currency of compassion.”

We cannot afford another winter of reactive measures. We cannot afford to lose more care homes, more workers, more trust. The UK Budget must deliver for social care. The Scottish Government must match ambition with action.

This is not just about funding. It is about the kind of country we want to be. One that values its elders, supports its carers, and builds communities of care rooted in dignity, belonging, and hope.

This Saturday, before the Budget, let us make one message clear: Scotland demands a budget that cares. Nothing less will do.

Donald Macaskill

When I was growing up, there were a few select books that appeared every year with faithful regularity on my grandmother’s bedside table. One of them which is still going strong with its distinctive purple cover was The Friendship Book.

First published in 1938 by D.C. Thomson & Co., it is an annual publication best known for its gentle reflections, uplifting prose, and moral wisdom. It offers a short thought, poem, or inspirational reflection for each day of the year. It is a book that doesn’t shout, but whispers comfort and companionship.

I once asked my grandmother how it was possible to have something new and different to say about friendship every day of every year. She replied, with a smile, that true friendship is a conversation that never finishes.

How much truth was there in that sentiment. Because in the world of social care, especially for older people, friendship is not a seasonal sentiment instead it is a daily necessity. It is the thread that binds together lives that have been frayed by loss, change, and time.

As we mark Book Week Scotland 2025, with its theme of Friendship, we are invited to reflect not only on the stories we read but on the stories we live. For those of us who work in social care, and for the thousands who receive it, friendship is not a luxury rather it is a lifeline.

There is a somewhat perverse irony that we live in an age when people have more opportunities than ever to make friends, thanks to technology, global mobility, and social networks. Digital platforms, online communities, and instant communication make it easy to connect with others across distances and cultures. People who might once have been isolated because of geography, disability, or social circumstances can now find like-minded communities online.

However, research suggests that many people today actually feel lonelier and have fewer close friendships than in previous generations. Social media can create connections but also foster superficial interactions rather than deep, enduring friendships. The way we live our lives, with busyness, frequent moving, and remote work, can make it harder to maintain long-term, in-person relationships. And culturally, former community structures like local clubs, churches, or neighbourhood groups that once supported friendship networks are often less central in people’s lives.

So while the potential for making friends is greater than ever, the quality and depth of those friendships may not always be as strong as in earlier, more community-based times. But the truth remains that friendship is intrinsic and fundamental to living in community with others, no less so than in older age.

Friendship in older age is not just a social nicety we know it also to be it a psychological necessity. Studies have shown that older adults with strong social networks experience lower rates of depression and anxiety; they have improved cognitive function and memory retention, possess greater resilience in the face of illness or bereavement and all in all have enhanced physical health, including lower blood pressure and better sleep.

These are not abstract benefits. They are real, lived experiences. I remember speaking to a woman in a sheltered housing complex who said:

“I’m 83, and I’ve just made a new friend. We walk together, we talk about books, and we laugh. I didn’t think I’d feel this alive again.”

Friendship is woven into the fabric of being in community. I’m struck by this every time I visit my family in the islands, where belonging to place and people still shapes lives. There, friendship is woven into the fabric of care. It is found in community-led initiatives where neighbours become carers, and where the boundaries between formal and informal support blur into something more humane.

In urban Scotland, friendship is the antidote to isolation. It is the volunteer who visits every Thursday, the care worker who knows the names of grandchildren, the fellow resident who shares memories of wartime Glasgow. These relationships are not incidental; they are central to wellbeing.

Yet, too often, our systems fail to recognise the value of these connections. We measure minutes and tasks, but not the moments of meaning. We audit medication, but not the comfort of companionship. If we are to renew social care in Scotland, we must place friendship at its heart.

But this is, after all, Book Week and we must affirm that books have always been companions. For older people, especially those living with dementia or facing bereavement, stories can be bridges to memory, identity, and connection.

I have sat with individuals who, though struggling to recall the present, can recite poetry from childhood or recount the plot of a novel read decades ago. Literature becomes a lifeline to the self.

In care homes across Scotland, reading groups are springing up not just as activities, but as communities. Residents read aloud, discuss characters, and share their own stories. These are spaces where friendship is nurtured through narrative.

A gentleman in one home told me:

“I never thought I’d read again. My eyesight’s poor and my hands shake. But every Tuesday, we gather and someone reads to us. It’s like being back in school but better. We laugh, we argue about the endings, and we remember who we were.”

Books also offer a bridge across generations. Grandchildren reading to grandparents, carers sharing poetry, volunteers bringing stories to life— all of these moments create connection.

The Scottish Book Trust’s annual publication, Scotland’s Stories: Friendship, is a testament to this. It gathers voices from across the country, including those often unheard such as older people, carers, those living in rural isolation. It reminds us that storytelling is not the preserve of the young or the literary elite. It belongs to all of us.

More positively, innovation in care technology is opening new doors for friendship. Digital storytelling platforms, virtual book clubs, and reminiscence apps are helping older people stay connected, even when mobility or geography pose challenges.

But technology must serve humanity, not replace it. The warmth of a shared story cannot be coded. A virtual hug is not the same as a hand held in silence.

As we look to the future, we must ask: how do we design care systems that foster friendship? How do we train carers not just in clinical skills but in the art of listening? How do we ensure that every older person in Scotland has the opportunity to be known, to be heard, and to belong?

Let me end with the words of Peter Mackay, Scotland’s Makar, whose work often explores the intersections of language, memory, and connection. In his poem Anamnesis, he writes:

“We are made of stories, stitched into skin,

Of voices that echo long after the din.

In the hush of a room, in the turn of a page,

Friendship endures, defying age.”

This Book Week Scotland, let us celebrate friendship not only in fiction but in the lived realities of those who depend on care. Let us honour the storytellers in our care homes, the poets in our communities, and the quiet revolutionaries who build connection in the face of loneliness.

Because in the end, it is friendship that makes us human.

Donald Macaskill

Photo by Sabinevanerp

At the Global Ageing Conference in Boston, I found myself not just attending a keynote but entering a new narrative; a reframing of ageing that challenges our assumptions and invites us to imagine a different future.

Dr. Joseph Coughlin, founder of the MIT AgeLab, delivered a speech that was both intellectually rigorous and emotionally resonant. It was, in his words, “a call to rewrite the story of old age.”

I then on Wednesday had the pleasure of visiting the Age Lab and spending time with Joe and his amazing colleagues including Fullbright Scholar Elisa Cardamone from Edinburgh’s Advanced Care research Centre where I am honoured to act as Chair of the Academic Advisory Board.

Coughlin’s work has long been about exploding myths. In The Longevity Economy, he writes:

“Oldness is a social construct at odds with reality that constrains how we live after middle age—and stifles business thinking on how to best serve a group of consumers, workers, and innovators that is growing larger and wealthier with every passing day.”

This idea – that ageing is not decline but transformation – resonates deeply with my own thoughts about how our Scottish Gaelic concept of dùthchas, the sense of rootedness, belonging, and identity shapes how we care.

In Boston, Coughlin reminded us that “after age 65, society says you’re done. But in reality, you’re very likely to live another 8,000 days.” That’s a third of a lifetime. What do we do with that time? What stories do we tell?

In Scotland, we are grappling with the crisis of social care. But as I’ve argued before, crisis can be the birthplace of creativity and the spark of innovation. Coughlin’s keynote and his recent book Longevity Hubs: Regional Innovation for Global Aging offer a blueprint for renewal. He and co-author Luke Yoquinto define a longevity hub as:

“Any hotspot characterized by a disproportionate level of innovative activity aimed at the older population and related markets.”

This is not just about technology it’s about storytelling spaces. Coughlin reminded us that “story is the most powerful technology in the world.” Storytelling spaces are the places where older adults co-create solutions, where care is not delivered but designed, and where ageing is not feared but embraced. He writes:

“Emerging longevity needs encompass not only health and wealth but also social and mental well-being.”

Imagine a Longevity Hub in the Highlands. A place where dùthchas meets digital. Where crofters, carers, technologists, and artists collaborate to reimagine ageing. Where the stories of elders are not archived but activated.

One of the most compelling metaphors Coughlin offered was that of a GPS for ageing. He suggests that the traditional map of ageing is outdated, built for a world where retirement was short, predictable, and largely passive. But today, with people living decades beyond retirement age, we need a new navigation system- one that reflects the complexity, diversity, and potential of later life.

“We’ve added more life to our years, but we haven’t updated the map. We need a GPS for ageing that helps us navigate not just where we’re going, but who we want to be.”

This metaphor resonates deeply with our Scottish experience. In rural communities, where dùthchas anchors people to place and tradition, ageing is not a linear journey but rather it’s a landscape of memory, contribution, and identity. But even here, the terrain is shifting. The old waypoints and markers of retirement, dependency, institutional care, no longer suffice. We need new coordinates.

Coughlin’s GPS is not just about direction- it’s about agency. It’s about giving older adults the tools to chart their own course, to make choices, to remain connected.

“The future of ageing is not about finding a destination- it’s about designing the journey.”

This invites us to think of ageing not as a descent, but as a pilgrimage – a journey rich with possibility, shaped by relationships, values, and aspirations. In Scotland, we might say that the GPS of ageing must be calibrated to our cultural compass: one that values community, intergenerational solidarity, and the wisdom of lived experience.

Without a new GPS, we risk getting lost in outdated assumptions.

“Most of our institutions—from housing to healthcare to transportation—are still designed for a world where ageing meant withdrawal. But today’s older adults are mobile, connected, and ambitious.”

Are we designing services that help people move forward, or ones that simply manage decline? Are we offering pathways to purpose, or just places to wait?

Coughlin’s work also highlights the power of women in the longevity economy.

“Women outnumber men, control household spending and finances, and are leading the charge toward tomorrow’s creative new narrative of later life.”

This is a call to listen more deeply to the voices of older women in our communities, those who are often the backbone of informal care, community leadership, and intergenerational connection.

He also dismantles the myth of the “average senior.” Just as 25-year-olds differ widely, so do 65-year-olds.

“There’s no one-size-fits-all senior. Yet businesses often lump everyone over 60 into the same box, leading to poor products and outdated messaging.”

This insight is vital for our policy and practice in Scotland. We must design for diversity, not age. We must move beyond the dependency ratio and see older adults as contributors, creators, and citizens.

Coughlin is clear:

“Technology without empathy is just engineering.”

This is a warning and a guide. In our rush to digitise care, we must not lose sight of the human. Smart homes, wearables, and AI can enhance independence but only if they are designed with dignity, inclusion, and story in mind.

In Boston, I heard stories of older adults using tech to stay connected to grandchildren, of care homes becoming design labs, of intergenerational teams solving problems together. These are not just anecdotes- they are narrative shifts.

I return to Scotland with a renewed conviction: that the renewal of social care begins with the renewal of story. We must tell better ones. We must listen more deeply. We must design not just for longevity, but for legacy.

Let us build our own GPS for ageing. Let us honour dùthchas. Let us co-create a future where ageing is not the end of the story, but the beginning of a new chapter.

As Coughlin writes:

“The longevity economy is not just about living longer—it’s about living better, with direction, dignity, and design.”

Let us chart that course. Let us tell those stories. Let us navigate the future of ageing with courage, creativity, and care.

 

Donald Macaskill

 

The following is adapted from a speech given in Fort William on the 24th October at an event organised by Angus MacDonald MP whose primary focus was to explore his proposal to create four new 60 bed care homes in the Highlands. After reflecting on the nature of social care, its current challenging state in relation to sustainability and workforce pressures, I went on to suggest some actions which might make a difference.

So what can be done ?

Like many others we will continue to lobby for a new approach to immigration which is sensitive to demographic truth rather than political rhetoric – Scotland needs, wants and values our international colleagues, no more so than in social care – and with the pain of Brexit still felt so acutely we need the UK Government to restore a skilled workers route, or at the very least to allow Scotland to develop such a model.

It also goes without saying that we need a Budget both in Holyrood and in Westminster that properly values social care not as a nice to have but as a fundamental partner to NHS funding and provision.

But there are other things we can do which I think can help.

I want to suggest several actions:

1. A Highland Weighting Scheme.
2. Flexible models of care, including co-housing, intergenerational living, and community-led support.
3. A reformed understanding of what care home provision in remote communities needs to look like
4. Flexible regulatory and registration arrangements for workers and organisations.
5. Investment in co-ordinated digital infrastructure to support remote care delivery especially in homecare.

1.

One practical solution is the introduction of a Highland weighting– a regional pay supplement for social care workers in remote and rural areas.

Social care providers in the Highlands struggle to recruit and retain staff due to:

• Workforce availability
• Terms and conditions cf to other sectors
• Seasonal employment patterns
• Higher travel costs.

A Highland Weighting scheme would also recognise:

• The higher cost of living in rural Scotland.
• The complexity of delivering care across large distances.
• The lack of affordable social housing.

Such a scheme could be structured similarly to London’s, but tailored to rural realities:

There are some key components

• Base supplement for all care workers in designated Highland zones
• Tiered rates based on remoteness (e.g. mainland vs islands)
• Travel allowances for mobile care staff
• Housing support or relocation grants.

The London weighting scheme has shown that:

• Targeted pay supplements can improve recruitment and retention.
• Inconsistencies across sectors can cause inequality
• Transparent, annually updated models(like the Minimum Income Standard) help maintain fairness.

Applying these lessons to the Highlands would require:

• Clear criteria for eligibility
• Cross-sector coordination
• Annual review mechanisms

Other countries do this:

• Australia offers a range of financial incentives for health and social care workers in remote communities, particularly through the Remote Area Nurse Incentive Package and similar schemes for aged care and disability support.

Key Features:

• Retention bonuses and relocation grants.
• Higher base salaries in remote zones.
• Accommodation subsidies and travel allowances.
• Often tied to return-of-service obligations.

Canada – in the Northwest Territories, care workers receive a tax-free northern allowance to offset living costs and attract staff to remote communities. A similar model in the Highlands could include tiered supplements and housing support.

South Africa introduced a rural/remote allowance for social workers and other social services professionals (SSPs) working in designated remote areas. The scheme was developed using a GIS-based remoteness index to scientifically identify eligible locations.

Key Features:

• Allowance covers costs related to transport, housing, schooling, and lack of amenities.
• Aims to equalise pay between urban and rural sectors.
• Targets vacancy hotspots where recruitment is most difficult.
• Approved by the Social Development MINMEC and supported by national funding.

There are further models in Japan and nearer home in Portugal and northern Spain.

2. Community led-models of homecare.

We must also look to community-led care. We must embrace new models of homecare tailored to rural realities.

For instance, in Rannoch and Dunkeld, local trusts are developing a care-at-home service governed by the community itself. It combines paid staff and volunteers, local governance, and flexible scheduling to meet individual needs.

Again, there are clear international lessons:

Canada has adopted an Integrated Rural Home Care model

The Canadian Home Care Association (CHCA) promotes integrated care models tailored to rural needs, emphasising safety, dignity, and quality of life. Innovations include mobile care units, community-based nursing, and partnerships with Indigenous communities for culturally appropriate care.

In the United States there are many ‘At Home’ Service Models. For instance the innovative PACE (Program of All-Inclusive Care for the Elderly) combines medical and social services to help seniors stay at home safely with an emphasis on rural and remote living support – from St. John’s United (Montana) and Missouri Slope (North Dakota).

In Australia amongst many rural responses there is the IMOC Program (Innovative Models of Care trialling multidisciplinary care models in remote towns, including in NSW. There is the PRIM-HS Model in Mareeba in Queensland which is a community-led and co-designed model integrating local government, clinicians, and volunteers and aged care providers focussing on sustainable, locally tailored primary and social care for rural populations.

3.

Care homes must also evolve.

Flexible models like co-housing, intergenerational living, and small-scale community homes are being trialled in rural areas across Europe and could be adapted for rural Scotland.

We have also to be prepared to build not what is wanted and needed now but what is going to be acceptable in 10 or 20 or 30 years – and all the signs are in the UK and internationally that when people do need to move into residential care they want small, purpose built residential settings within local communities – and which are embedded, adaptable, and supported by technology.

Research by Alzheimer Scotland last year advocated for what has become known as the ‘small supports’ model – which many in the sector are only too open to deliver but which at the moment is wholly unaffordable because of the low levels of funding through the NCHC.

Indeed, Scottish Care and other stakeholders have done work on costings for a 20-25 bed care home model rather than the current model of 50 plus. But whilst it might be desirable it is wholly unaffordable within the current fiscal envelope. So key to all this change for care homes is a radically revised Cost Model within the National Care Home Contract.

4.

Flexible regulatory and registration arrangements for workers and organisations.

I am aware of the work that Jaci Douglas from the Care and Learning Alliance has been leading on in terms of the Single Care Model in the Highlands. I was pleased to meet Jaci and hear of this innovative work and I shared with her that similar models had been and are being developed and delivered in rural Canada. There several provinces maintain professional registries for early childhood educators, often linked to broader care workforce strategies. These registries support career mobility and professional recognition across child and adult care sectors.

The work of the Highland consortium is exciting, and I hope will go from strength to strength –

‘It is about taking a holistic approach in rural communities, an opportunity for people to live and work in their communities in a way that is flexible, everything needed is met i.e. person has child care which allows [her – more often women] to go to work and to care for parents or other loved ones which otherwise wouldn’t be able to.

Many carer roles are part time in smaller communities, not enough hours, this combined role would allow more full-time opportunities, this can be the difference between working and not is it worth working when not enough hours.’

To succeed it needs regulatory change and flexibility.

Australia at this very moment is actively exploring a national registration scheme for care workers that spans aged care, disability, and early childhood sectors. The so-called ACRN Proposal (2025): advocates for a nationally mandated, harmonised, and legislated registration and education scheme for all care workers. This would allow for cross-sector mobility and ensure consistent standards across community and residential care settings. Note this is not just for rural communities but it is felt by stakeholders that these communities will especially benefit.

Effectively and put simply we need to adjust our registration frameworks to enable a more flexible approach to services across the age spectrum and across sectors; and secondly we need to enable a much more flexible approach to workforce so that we get away from siloed professionalism which is not only failing us but in truth is divorced from the realities most younger workers want to experience and live in.

5.

Investment in co-ordinated digital infrastructure

The Care Technologist Project in Baillieston and other models developed by Scottish Care and now being adopted at scale in England – equip older adults with smart lighting, voice-activated devices, and robotic pets. In rural areas, such tools can reduce isolation and support independent living.

These innovations show that rural home care can be responsive, personalised, and sustainable – that is if we invest in the right infrastructure and leadership.

Conclusion

We are at a turning point.

We can continue to patch a system that is fraying. Or we can build something better- something rooted in fairness, shaped by lived experience, and responsive to local needs.

Social care is not just about services. It is about relationships, dignity, and the right to live well.

I spoke at the beginning about the sense of belonging that people like my Skye grandmother have always spoken to me about. A sense of duchlas. It is about how we care for one another, especially those who are most valuable and in need of our support. I believe we can – if we are sufficiently adventurous honour that belonging through a social care system that is compassionate, innovative, and rooted in community.

Donald Macaskill