Home: a place of shielding and freedom: our CEO’s weekly blog.

I’m writing these words from the Isle of Skye where I arrived yesterday to visit family for the weekend. Every time I come to Skye I have a sense of coming home.

As the child of two Skye parents my life-story is punctuated by journeys ‘home’ to Skye; not least the activity of packing and going on the seemingly never-ending journey north from Glasgow. Decades ago, it did indeed feel like an intrepid adventure taking as it did an inordinate 12 hours for one large family to travel by buses and taxi and arrive at the place which for generations my family had called theirs. I possess memories of ridiculously hot summers spent with grandparents who seemed to me already ancient beyond years; I resurrected my Gaelic by listening in on the latest gossip; I gained insight into the strong cultural dialects of church and tradition, of music and poetry; I have memories of the rituals of crofting as my eldest son father took his part in shearing sheep, repairing byres and erecting fences.

As I grew up I recognised that deep within me was an inner truth that I sensed a wholeness of self only when I was in that space of open glens and brooding mountains, breathing in a beauty so raw it’s reality caught your breath, witnessing the vibrant power of nature in daytime storm and evening calmness. I also sensed a need to be away, to be distant, to be free and far. I now know that this was a sense of ‘home’ which despite all efforts I did not have away from this space.

To return home restores and renews, it re-invigorates, and it gives balance. I know acutely that this is not true for all and I am not blind to the brokenness of my own story. Home is not always a place of happiness but can be a harbour of hurt and a painful prison. But I also know from years of conversations with those who have never found a space to be themselves, and to feel secure and safe, that there remains a yearning and a desire to find that space which we often call ‘home.’

In this last week I have been reflecting with many others about the value of home.

I am especially mindful today of those who have spent months shielding themselves from Covid and who are being ‘allowed out.’ That is the phrase used by someone who wrote to me this past week. Fiona is receiving treatment for cancer and has been unable to go and see her father in a care home not just because the care home has been closed but because she has been shielding herself in her own home. She reflected in her letter the way in which she feels safe and secure, protected from harm and the unknown of this virus behind her windows and doors. She reflected that she was concerned about how she would cope with being away from that place of protection; a place where in her own words she has ‘cocooned herself from harm’.

Our home is a place of memory and belonging. It is not just a construction of brick and mortar, of stone and wood, though the physicality is part of what makes a place special. Home is a place and space which enables us to be authentically who we are as a person. It should be a place that we feel protected, able to be who we are without mask or pretence, able to be at ease inside our own skin.

But I also recognise that the best homes are places which enable you to have a sense of confidence and freedom to go out into the world to be changed and to grow, to fail and to flourish, and in both to be able to return with the confidence of acceptance, welcome and warmth.

So, I am thinking of those who are making that journey out today for the first time from the place of shielding to encounter and engagement with others. It is one which will no doubt be faltering at first but which I hope the rest of society will support not least by adhering to the safe practices which will keep us all safe from this virus.

But I am also thinking today about what home has felt like for those who have been caring for a loved one in their own homes. Many of them lost the packages of support which they had before the pandemic and these are only slowly getting back. Others chose to cancel care packages because they feared that workers would bring in the virus and these have still in most instances not been renewed. I am very aware from conversations this week that family and ‘informal’ carers across Scotland are exhausted and at the stage of really needing immediate support. The task of caring for a loved one is draining and depleting even of the energies of loving. Yet day centres remain closed and many sources of traditional respite are shut off to carers, including many care homes. There are older Scots at home who today are anxious about getting access to their GPs, unsure about when the podiatrist or community physiotherapist will next see them, who know that their own health has been affected by lockdown whether as an individual or as a carer or as someone who has been technically shielding.

Lastly when I reflect about ‘home’ today I am thinking of all those who I have spoken to and been in communication with in the last week about the place which their mother or father, wife or husband, grandparent has called home – their care home.

Yet another week has passed, and we still have not had an announcement about what date residents will be able to be visited inside their care home. I have said before and I fully acknowledge the need to carefully balance the risk of the virus getting into our care homes with the desire and urgent imperative to restore the rights of family and residents to be re-united. I am not naïve to the hardness of these decisions, but I am increasingly concerned that our scientists and others are not aware of the damage and effects of separation.  There are thousands who have not seen a family member for 21 weeks. Their care home is their home, a place of security and safety, a place which they have been protected in despite the ravages of this disease. There is a growing sense of anger and frustration that as the rest of society prioritises children going back to school and as snooker halls and bingo, funfairs and casinos are given dates for opening, we still do not have a date to restore life to our care homes, to allow indoor visiting, to inch closer to making our care homes back into real ‘homes.’

Home is a space and place,  a feeling and sense of being at ease and secure, of being able to become who you are and be what you dream of. Home is a place of memory and dreaming, of creating and growing. But home does not just happen – it is a work of heart and soul, of sinew and sacrifice.

Today we need to work with even greater energy to ensure that family homes are spaces where the old and ill, those shielded and in need of extra protection, feel they have the level of support and care, guidance and assurance that they need. Today we have to renew our efforts to ensure that our care homes do not become antiseptic units of infection management devoid of presence and humanity but are restored to being places of encounter and life. We need to get family back to start re-creating home not least for those whose time is in days and weeks, not months and years.

Home is the labour of those who feel the need to root their loving and compassion into a place and space, to create a cradle of belonging for family and friend, stranger and guest . When I close my senses there is only one place which webs me together. In that I am lucky. For at least a couple of days I am ‘home’ but with the conviction that we must restore and affirm that sense of home to and for all.

“In the distance day was dawning,
Comes to me the early morning,
Something tells me that I’m going home

The brand new sun shining bright
From the darkness fields of light
Something tells me that I’m going home

Going home
When the summer’s coming in
And the moonlight on the river
Shows me where I’ve been

Soft the rain is gently falling
Lightly cross the city morning
I get the feeling that I’m going home

Across the moorlands, past the mountains,
O’er the rivers, beside the new streams,
Something tells me that I’m going home

Going home
When the summer’s coming in
And the moonlight on the river
Shows me where I’ve been

As the train is rolling nearer
Ah, the feeling just to be there,
Something tells me that I’m going home

Now the skylines reach my eyes
The ridge stands out in highland skies
I just can’t believe I’m going home.”

(Lyrics of ‘Going Home’ by Runrig)

 

Donald Macaskill 

 

New nursing blog for July from our Transforming Workforce Lead

Nursing a career for life, past, present and future.

Nursing has always been viewed as a job for life, a vocation that spans over 40 years that gives you the ability to grow, to diversify and offers the opportunities to have a flexible worthwhile career, where there is real potential to make a difference. This can be on an individual, national or international level. The possibilities are endless.

Back in the day when I was a student nurse, nursing was all about matrons and procedure manuals. Often feeling like an extra pair of hands, following doctors around, and rarely questioning anything that was said. Thankfully nursing has moved on from the medicalised model, not only nurses but student nurses are now empowered and leaders in their own right. It’s hard to believe that back then we had no access to internet or social media, all which without question has today catapulted nurse education and the profession as a whole.

As a student nurse you work alongside many nurses within a variety of different specialisms and you soon determine those who are role models. Despite having trained in the 1980s I can still remember those nurses who inspired me and as importantly those who did not. This often helps reaffirm the areas you wish to work after completion of your training.

The natural progression for the majority of student nurses is to go straight to a post within the NHS, however it is imperative that we expand the opportunities for newly qualified nurses to come straight into the social care sector. The sector offers a real potential to grow and develop your professional autonomy, clinical development and management.

Recent months have saw an influx of student nurses into the independent sector who previously wouldn’t have been placed within a care home, with this exposure being viewed by many as positive and insightful. I am delighted to say this has resulted in some third-year students due to take up their first staff nurse post within the independent sector. Despite these numbers being low in comparison to NHS placements there will be a concerted effort to extend student placements within care homes as we commence the new pre-registration nurse training.

Nursing without question made me who I am today. I grew up quickly, had never witnessed death or dying or what it truly felt like to be needed, respected and the pride you feel when people share their vulnerability and inner most fears. I do hope that every nursing student still experience these feelings, as I believe this is the foundation to being a professional nurse.

Being prepared to make the transition is something that many students worry about especially in today’s climate when everything appears to be under the microscopic. Preceptorship has never been more important and needs to be robust to ensure newly qualified staff have adequate clinical supervision, especially in the first 6 months after qualifying.

For many staff qualifying is a reality check and unfortunately staff continue to leave post registration within the first few years of qualifying. Recent figures in 2018 suggested almost half of all nurse who leave are under 40 years old.

As nurses we often hear the phrase ‘I couldn’t do your job’, the fact is it is probably true. I don’t believe anyone can be a nurse , it’s not a job that anyone can do if it’s not intrinsically part of you, in your heart to care, the desire to make change happen, ensuring improvement and keeping people safe. Unfortunately these qualities alone are not enough to cope with some pressures that are currently placed on staff. This is also apparent in the numbers of students who do not complete their training. According to figures released last year by the Nursing Standard, the attrition rate was around 24 per cent.

Looking back and I can’t believe where the years have gone. I never imagined when I completed my training the different roles I would’ve undertaken and that many of those I trained and work alongside continue to be in nursing today, as clinicians, nurse educators and senior managers, although I must mention approaching retirement fast.

Sadly, despite the satisfaction nursing offers it has unfortunately gone through many years of being an undervalued profession despite pre-registered nurses now trained to graduate and master’s level. We were seeing a reduction of nurses ahead, due to upcoming retirements, an increase in nurses choosing to take early retirement, and the exiting of EU nurses post Brexit. In addition we also had a workforce that was struggling with high level of staff absence due to mental health related absences,  often cited as a result of short staffing, and too many priority areas being placed on staff .This had undoubtably placed massive pressures on the existing workforce.

This makes an urgency to impress on staff the importance of being empowered and how promoting leadership with the sector will ensure better job satisfaction and peer support. I often come across articles where newly qualified staff express how overwhelmed they feel and question whether they can deal with the daily pressures. Nurses work at the coal face of a fast-paced health and social care system that can often feel dysfunctional, which is exhausting. It can often feel like you are on a rollercoaster as one thing is resolved something else comes behind to continue the pressure.

My response would be that nursing has always been challenging and this will never change and the reason its challenging is because it’s a job that really matters and is reliant on the right people to influence change, which can improve outcomes for people we care for, all the reasons for becoming  a nurse in the first place. Being part of a great team and peer support is crucial to ensuring you develop the coping mechanisms to grow strong.

In 2017, the 2030 vision was published. The aim of this document was about showcasing the work nurses do, to raise the profile, define competences and ability to develop in an evolving health and social care world. In this the ‘Year of the Nurse’ we have certainly highlighted the role of nurses, their ability to rise to challenges, be solution focused and be skilled to undertake a level of practice required to ensure patient safety during a time of the greatest uncertainty, and risk to their own personal health.

In recent months we have witnessed the dedication of nurses who responded to join the emergency register as well and the redeployment of nurses alongside other healthcare professional, none less than the high numbers of student nurses who came forward to be part of this dynamic professional workforce. In addition, we saw an increase in the nurse register as a result, however we must continue to see this now and into the future. As we approach the highest levels of staff retirements within the next 5 years it is imperative that we recruit and retain staff more than ever to be able to provide a sustainable health and social care workforce.

We have increased student placements and funding for students to assist in getting more people into the profession and post covid19 most universities have reached their admission targets with many over prescribed. However we must be mindful of the changes to the curriculum, and the extension of online training may result in higher dropout rates over the next few years, alongside the uncertainties that have been presented with this pandemic to staff welfare.

Staff burnout was already at an all-time high therefore it is paramount that staff receive appropriate support to ensure they are fit to practice, and part of this is to ensure their physical and mental wellbeing. Nurses often view stress as normal therefore if we genuinely care about our staff, we must look to ensure we hold onto them and avoid the risks of putting additional pressures on those staff who are left on the ground.

We must reflect that for many staff who made the decision to leave that this was not necessarily because they really wanted to let their registration lapse, but that they felt defeated or that they were no longer doing a job in the way that they wanted to , were not valued or understood and most importantly not listened to. It’s important to note that this is rarely a reflection on ability but more likely to be due to professional frustration. Nurses need to know this is not the end and in nursing we all can face difficult situations that can push us to the edge. I challenge any nurse to say they haven’t had a period in their career that they didn’t want to throw in the towel.

In a career that could and should be for life, we need to change thinking to be inclusive of all aspects and sectors and ensure there is a real determination to work together to prevent boundaries and assist staff wishing to work across these sectors. There is a real benefit to working in collaboration having shared national approaches and systems across NHS and the independent sector, not as a joint entity but as a respectful partnership which is mutually supportive.

Recent months have without question pushed the transforming nursing roles agenda by identifying the current roles being undertaken by nurses and how these can evolve to improve practice, data collection and ultimately job satisfaction to improve staff recruitment and retention.

Each sector offers the potential for each individual nurse to work to the top of their license and the social care sector ensures gerontology nursing is given the credibility it has not always been given in the past. The access to future funded post registration educational programmes within the sector will ensure this.

This specialism is going to evolve rapidly in light of the increasing ageing population and the fragility of our older people. This will require significant knowledge and skills to care for people who have debilitating long term conditions and therefore the workforce development will require significant focus and centralised investment. Rehabilitation and recovery will play a significant part moving forward post covid19, ensuring those people requiring 24 hour care are not excluded from the right care at the right time by the right person.

Every role needs to have scope to grow and the more exposure to the independent sector by student nurses, NHS boards and higher education institutes the more we will work inclusively which will without question ensure student nurses will have a more rounded experience and career trajectory, and we will hopefully see more newly qualified nurses coming straight to social care nursing, or considering this as a prospect at some point in their career. Personally, I believe rotational peripatetic posts and taking up posts across all sectors throughout your career can significantly enhance knowledge and skills and empower staff to think more strategically.

This is the ideal time for many who may have left to return. As previously highlighted nurses leave for many reasons and perhaps this is something that the NMC as the registering body should consider recording as a means of anticipating the potential to offer an alternative to coming off the register as often this is due to a negative set of circumstances and can often be a reactive response. Within the independent sector we may have staff who decided to let their registration lapse and work as in a care role rather than a nurse and may now wish to return to practice.

There are two new return to practice programmes being offered in Scotland later this year and at the beginning of 2021 which will support staff to return to the practice by taking into account their experience and placing them ideally within future staff nurse roles, assisting the issues we currently have in unfilled vacancies. This is something I encourage providers within the sector to consider supporting the current recruitment processes.

There is no question the future has some uncertainty, but we have the real potential to have a workforce which will be skilled and fit to cope with the challenges ahead and beyond. Staff have always shown significant resilience, but this has been none more evident than over the last few months, with those student nurses who took up the paid placements being testimony to this.

It is every single nurse’s responsibility to do everything in their power to encourage, support, mentor and make others understand the importance of being a nurse and recognise what the new workforce must look like.

In this the year of the nurse the profession has without question been tested , despite our staff having given their all ,within a political climate that has been less than supportive and at times downright derogatory to our nurses we will end this year stronger .

This is our year to be strong, be a collective and demonstrate what a privilege it is to be a nurse and the crucial role we play and will continue to play as the backbone of our health and social care sector.

Jacqui Neil

Transforming Workforce Lead

Dying of a broken heart: the pain of care home deaths. A personal reflection.

I interrupted one of my many Zoom meetings this week to go outside briefly and stand with others as the hearse carrying the remains of a neighbour left his home for the last time accompanied by the small family group able to attend his funeral. I was saying goodbye to a man of quiet dignity and constant smile who had left his home for the last time just before the pandemic as his dementia worsened to the extent that he needed to enter a care home.

As I stood there clapping with others in memory and thanks I could not get out of my mind the words his now widow had spoken to me a few days earlier. I had met her and as I expressed my condolences she told me of how she had been unable to see him for four months until his last few hours. She had nothing but praise for the care home staff but she was deeply upset about restrictions that prevented them from being in contact as they had for virtually every day of their married lives. I parted with her words ringing in my ears. “Donald you have to sort it. His death certificate said he died of his dementia, but I wanted them to write in it that he died of a broken heart, but they wouldn’t. He died of a broken heart. I just know it.”

As the weeks have gone on fewer and fewer people thankfully have died from Covid19 in our care homes and this past week we have seen the lowest level since the start of the pandemic. But sadly, in the rhythm of time there are still people dying in our care homes as there always has been and always will be. Care homes as I have said elsewhere are increasingly hospices in the heart of our communities; places of living in fullness and love until the end; places which give solace, comfort and care as folks come to the end of their days. So, there is nothing new about death and dying in our care homes. Indeed, over the years the ability to get to know residents as individuals, especially those wracked with dementia and its horrific hold, have made care homes places capable of giving people as personal and as appropriate an end as possible.

During Covid19 the natural humanity of caring has been interrupted. Part of the rhythm of a death which is expected is the necessary and essential presence of family and friends, to give assurance, offer comfort and to simply be present. Being with the dying is our greatest gift to a human life; surrounding a life with love and memory, holding one another in our first steps of grieving are intrinsic to good bereavement. The times I have been privileged to be with someone as they have died will forever be etched in my soul, without diminishing the aching sadness and emptiness that those moments brought. I have learned more about life in the presence of death than from any textbook or any teacher.

“He died of a broken heart.” Living is not just the intaking of breath into the frame of a physical body of flesh and bone; living is not just the occupying of space and earth; living is not just being there. Living is about relatedness,  knowing that you are part of a story, being assured that you matter, that your voice is heard and your personhood upheld. What is the point of simply continuing to be here when all that is of worth and meaning, of value and heart, is absent and held back from you. The number of our days are as nothing without a quality within those days.

So it is that I do indeed believe that there are many others just like my neighbour who have died and are dying in our care homes not because of the vicious virulence of a virus but because of the measures put in place to protect and save their lives.  I am definitely not saying that actions taken to protect are misplaced or wrong, certainly not in the earliest days of this virus. But now we have entered the 20th week of lockdown in our care homes and with regretfully no immediate move to visiting indoors, I have to with all honesty and I hope with integrity and sincerity, question whether we are now doing more harm than anything else.

I cannot imagine what it is like to have been in love with someone for decades, to have so become inter-twinned with another, that your steps are as one, your memories wrapped up in an alongsideness so intimate that there is nothing to separate them – and then to be separated, kept distant, only able to touch through glass, or speak through a machine. I cannot conceive the agony that it has been and still is for so many hundreds of not being able to touch and hold and be with those you love. I dare not imagine what it is like not to be with those I love.

There are loads of attempts to find a vaccine for this virus. But what I want – in the sad awareness that this virus will be around for many many years to come and that a vaccine may not work for all – is that we put equal effort into finding ways in which we can  better balance protection and presence; that we can devise ways in which families can be with their loved ones so that the scar of separation is removed from our care homes.

I have seen it before, and I know deep inside myself the truth that my neighbour spoke. It is possible to die of a broken heart; to turn your face to the wall because the voice that gives you confidence is not heard; the hand that strokes you in assurance is not felt; the smile that lightens your soul is not present. There is no science for such an assertion only the evidence of experience and the truth of knowing.

In the weeks and months ahead, we have to get better systems of Infection prevention and control for our care homes which are appropriate to their nature as a home first and foremost and not simply adopt measures and approaches from an acute hospital setting. In the coming weeks we have to give very serious consideration as testing techniques develop to appointing at least one relative for each resident to enable the continuation of contact and human presence throughout any future outbreak. Over the next few weeks we have to really start to hear and listen to the voices of those who have autonomy and rights. We have to stop doing to and for and start listening to the voice of resident and family.

We cannot mend a heart which is broken; we cannot bring back a life which is lost or fill the emptiness of the days which hundreds have experienced, but moving forward we all, I believe, need to commit to responding better and doing differently in the future of this pandemic.

There are few poems about loss and dying more beautiful than Maya Angelou’s ‘When Great Trees Fall.’ I end this piece with the last stanza of her poem because it reminds us that when anyone dies they leave not just a memory but a call to action based on their living. The hundreds who have died in care homes in the last few months, my neighbour amongst them, need action not memorials, they deserve change so that no more hearts may break, and to that I for one will commit.

‘And when great souls die,


after a period peace blooms,


slowly and always


irregularly. Spaces fill


with a kind of


soothing electric vibration.


Our senses, restored, never


to be the same, whisper to us.


They existed. They existed.


We can be. Be and be


better. For they existed.’

 

Donald Macaskill 

The essence of hope: the dangers of Covid19 optimism.

 

Hope is not optimism,

which expects things

to turn out well,

but something rooted

in the conviction

that there is good

worth working for.

 

– Seamus Heaney

 

Hope is one of these intangible commodities. If we lack or lose it we diminish our abilities both individually and collectively to achieve and to continue. It is an emotion which has been very present in a lot of the conversations and exchanges which I have had this week.

Hope was there when with others I attended the NHS Mobilisation meeting chaired by the Cabinet Secretary. It was a hope that through deliberate and focussed action we could begin to restore NHS and social care services to where they had previously been, learning lessons from the pandemic response and ensuring that we are as prepared as possible for the coming winter. It is a hope not based on day-dreaming but solid hard work which through a cautious ending of lockdown and opening up of society means that we will meet the current and future challenges of Covid19 with as much preparedness as possible.

Hope was there when I spoke to a manager who had to deal with the family of a co-worker who had died as a result of Covid19. It was there when I spoke to the family themselves. It was a hope that tomorrow would be better, that they would slowly be able to put back together the shattered pieces of their lives and find a new way of living without the strong presence of their loved one. It was a hope which they desperately needed to pull them through into their future  because right now they are drowning in the emptiness of loss and the pain of grieving.

Hope was there when I read a beautiful pain full letter from a mother unable to hug and hold her adult daughter because she lives in a residential home and is subject to the current restrictions on visiting, including the wearing of PPE and social distancing. The mother’s poignancy was the hope that the time would come soon when they could be properly together as once they had been in an intimacy of touch and belonging.

Hope was there when with so many others I was moved by the hundreds of stories which flooded Twitter and Facebook on Wednesday during Care Home Day as folks took time to share stories of amazing compassion and care; as they reminded us all that care homes are places of life and vibrancy, places where individuals are enabled to life to their fullest and when the time comes to end their days surrounded by dignity and solace. There was a real sense on Wednesday of a hope that sometime soon we will return to something like normal and that sounds of laughter and song, of banter and memory will fill the silence that has enveloped so many care homes. But in doing so without forgetting the pain and sadness of the last few months and with a desire to hold in fragile memory those who have been lost.

Hope is an essential requirement to enable all of us to find the energy to deal with challenge, whether professional or personal. I recognise that there are countless thousands who need to believe that there is hope. I know that too many have lost their jobs and their sense of self and personal worth as a result of this pandemic. I know that too many have been deeply scarred by the effects of lockdown on their mental health and wellbeing. I know that there are countless families who will never be the same because they have lost someone to the virus. I know too that there are thousands who fear for the future because they run a business or work for an organisation and are uncertain about how or when they can get back to ‘business as usual.’

So, hope is an essential commodity to enable life to flourish and for purpose to have direction.  

But and it is a big but – that hope has to be grounded in some degree of reality. Hope has to be rooted in truth and grounded in carefulness. As the poet Heaney says it is a hope that has to be worked for. So, it was with a sense of real despair I heard yesterday some of the words of Boris Johnson, the Prime Minister. I am deeply concerned that by suggesting that ‘It will all be over by Christmas’ that he is in danger of echoing the mistakes of those of a previous generation who thought that resolution and restoration would result with a quick victory over an enemy in 1914 and that all would be well by Christmas.

Covid19 will not be over by Christmas. We will live with it for many years to come. We will have to live with its pernicious ability to destroy lives and shatter love. But with discovery and ingenuity we will discover how to control and lessen its harm and how to heal those whom it hurts. But we are not there.

A false hope is a dangerous illusion because it prevents caution and fosters reckless action. Anyone who has lived through the hell of these last few months in the care home sector, who is still not able to freely see and be with loved ones, will know the huge sacrifices that have been made by so many. We risk throwing all that away, we risk the escalation of danger, should we be deluded into thinking that things are about to be sorted and solved. Hope has to be rooted in sense rather than expediency, lives matter more than anything and we cannot use them as the vehicle for populism. Hope has to be worked for.

So, I end the week with hope. It is a hope grounded in the knowledge that by safe and slow steps we are edging forward as communities and as a nation. It is a hope that we will support one another through the days ahead in a way that affirms our humanity, recognises the pain of others and upholds those who are most in need of support. It is a hope that by collective support and cautious planning rather than naïve rhetoric we will meet the challenges of the autumn and winter ahead.

For one thing I am sure of is that Covid19 has changed us all in ways which are unimaginable.

“The world is indeed full of peril, and in it there are many dark places; but still there is much that is fair, and though in all lands love is now mingled with grief, it grows perhaps the greater.” 

― J.R.R. Tolkien, The Fellowship of the Ring

Care Home Day blog from our Workforce Lead

Constantly Adapting – The Changing Nature of Care Homes

Care homes have, for many years now, been changing how they operate, and this has been well documented throughout these years although it was still not widely known among the general populace.  Covid-19 has started to highlight this work to a far greater degree, and it has also created a time of rapid change within these care homes to adapt again to the ‘new normal’ that we are currently experiencing.

At the heart of these care homes are the workforce, social care nurses, care and support workers, care managers, kitchen staff and domestic workers.  Today on Scottish Care’s Care Home Day we are looking to thank these workers and take time to really reflect on the work that they do and most importantly the work they have done in the last few months since Covid-19 arrived.

Thankfully now we have the platform of social media to really highlight the kind of dedication, commitment, and compassion that the social care workforce has embedded in their nature and in their practice when delivering care services.  This has shone through in the actions of those workers who have for example stayed for periods of time in their care homes with residents to reduce the risk of the virus being brought into the care home.  There was the ‘Dedicated Dozen’ made up of 12 care workers who made the decision to move into their care home for a #32dayshift to protect their residents and the wonderful stories that came from their experience.  Other care homes had staff make the same commitment and the overwhelming theme of their stories was the increased closeness of relationships they had built during those times with each other in their staff teams and with the residents.

These examples and others show the huge dedication of social care staff who continually make personal sacrifices, not seeing their own family members and being away from home to deliver that care and to best protect those most vulnerable at time they greatly need it.  In general care home staff have worked tirelessly coordinating shifts and ensuring that the amount of footfall within care homes has been reduced as much as possible.

Staff have continued to adapt to the necessary confines of the guidance that has been produced to ensure peoples safety.  This has been extremely difficult for care staff who have had to make sure that residents stay in their rooms to comply with social isolating.  Given that most of these residents are extremely fragile with various comorbidities and often complex dementia this has been a hugely emotional time for both staff and residents and care staff have remained the staunchest of defenders of those they support.  Care Home staff have continued to highlight that the importance of a good quality of life, of meaningful relationships and human contact for older people remains the same as for everyone else and that the removal of this contact has had such a significant impact on individuals who live in care homes.

This is another reason that Care Home Day is so vitally important to recognise this work and to offer reassurances to people that care homes remain safe and dedicated to the importance of inclusion and good quality of life for everyone.  Those currently supported in care homes and their families have seen firsthand and can attest to the dedication of these staff.  Care workers who have stepped up and taken further that role of providing comfort, support and care when needed and when families have been unable to be there particularly for those at the end of their lives.

This same energised approach is now being used to plan and set up visiting with family members desperate to see their loved ones after so long.  Gazebos have been purchased and risk assessments carried out, another great deal of work undergone to ensure residents can be supported to safely make contact again with the outside world.  Dealing with additional problems of wind and rain and those gazebos being chased down streets, the care sector somehow always manages to laugh at their challenges along the way.  Once again I cannot express how much of a fight care homes have put up to ensure equality as much as possible for their residents and have highlighted the unfairness and disparity of approach against those simply because of the setting in which they live.

Care home activity coordinators have been working hard to come up with new ideas of entertaining residents and providing much needed stimulation within the restrictions of social distancing and all with the use of extra PPE such as face masks.  Technology is being increasingly explored to see how it can be used to its fullest and the workforce has responded with enthusiasm for the task ahead, introducing innovative ideas and approaches to working with people.  White boards have been used by residents to write messages on and then shared through social media and tech devices such as ipad’s.  This has helped with staying in touch and connecting to family and friends and has also reminded the world that the residents in care homes are still thriving.  The sentiment has definitely been that keeping distance from each other is not ideal but there are still plenty of laughs and fun to be had.

Care Managers especially should be shown heartfelt gratitude and appreciation for the manner in which they have held everything together and during a time when they were experiencing their own high levels of anxiety while giving much needed reassurance to their staff teams.  Care home managers have shouldered the bulk of the responsibility, making tough decisions on a daily basis and putting into place the strict measures needed to keep residents and staff safe using guidance that was constantly changing.  These managers should receive awards not scrutiny for how they have risen to the many challenges and have kept the morale of staff, and those they care for, going through this complicated and frightening experience.

In light of all this, it is my request that the same dedication, compassion, and support is given to these workers.  Staff who are hitting a point of exhaustion, who need to talk through their experiences and make sense of what they have been through and have witnessed.  The health and wellbeing of these workers is of paramount importance and there is stark evidence to show the ongoing impact of the pandemic on the workforce if these supports are not made readily available when needed.

Thankfully, there is a great deal of work going on in the space of staff wellbeing and Scottish Care will continue to actively participate in these conversations and to fight for support and appropriate resources for the social care workforce.  We aim to show how much regard and respect we hold for care workers, care managers, social care nurses and other members of the care home workforce who truly epitomise the meaning of the word care.

Caroline Deane

Workforce Policy and Practice Lead

Care Home Day blog from our CEO

Care home as community.

If you look up the dictionary you get loads of definitions for what a community is. Its described variously as a unified body of individuals who have common interests living in a particular area; or its defined as the geographical area itself or pictured as a body of persons of shared and professional interests scattered through a larger society, and so on.

But actually, when I think of the word community it combines all that sense of space and place, of people and belonging. When I picture community, I see faces and folks, a sense of togetherness and attachment; a sense of arrival and coming home rather than travelling to a destination. For me a care home is a superb living example of what a community is all about.

Today is Care Home Day and I am very pleased to be able to write a few thoughts on what a care home community is all about.

In the last few months we have seen witnessed in our care homes a story which has shown the absence of the characteristics which make up a normal care home. These are places of interaction and engagement, full of banter and gossip; spaces where people come and go, of busyness and belonging. If you want to seek solitariness and silence your average care home is probably the last place you should go.

In the last few months, however, as the pernicious Covid19 virus began to impact upon the whole world, care homes have become places of quiet; of curtailed activity and limited engagement; locations which have sought to isolate individuals in a desire to protect and keep them safe. Far from being places of busyness they have become withdrawn, far from being places which reach out and pull the wider community in, they of necessity have had to shut their doors and seek to keep out family and friend, young and old alike.

That is one story of the last few months. It is a hard story whose lessons we must learn and whose pain we must feel. But care homes even in these hard times have still been places of community. They have seen and heard words of love, care and compassion; they have witnessed the gentle presence of comfort in the midst of fear; solace at times of sadness and reassurance in moments of anxiety.  The staff in our care homes have gone beyond calculation in their dedication to those they support and residents themselves have sought to support one another in these challenging days.

A community is not just a physical place or even the gathering together of people with shared interest. A community is a place where you can be wholly who you are without pretence or mask, where your humanity can be honest, and you can be comfortable in your own skin. I have lost count of the folks who have said to me that moving into a care home was the best thing that they had done in their life. From loneliness they have found company, from isolation they discovered a sense of togetherness, from mental distress they gained restoration. That is the real sense of community in care homes in ordinary times.

It is hard to think of normal times when we are still in these strange days but despite all attempts of Covid-19, there is a beating heart within a care home which is pulling us back to those better times. There is a rhythm of comfort and care which despite challenge reminds us that care homes are communities where the best of what it means to be human is on display every day. Care homes will again become places where song and togetherness, exercise and competition, encounter and memory sit together and ruminate over time. They are places where people dream not solely of the past but of what tomorrow might hold. They are places where there is such brilliant original artistic and literary creativity. They are places where the young learn the lessons of age and where those old in age are enabled to become young in heart. This is the real story of community in our care homes.

So today as we recognise Care Home Day, we thank all involved in the last few months, we remember the sadness , loss and the hurt, but we also promise to work together in all our local communities to place our care homes in the heart of not just our concerns but of our daily living. Let us wrap round our care homes and let them find a place in the centre of all our communities.

Dr Donald Macaskill.

Autonomy and choice in pandemic times: the importance of empowerment in care decisions.

Recently I happened to be discussing being a parent with someone who had become a father for the first time. One of the comments I made to him was that parenting was a process of discovering that true knowledge is learning what you do not know. For despite all the books and videos you can read or watch nothing can prepare you for the real experience. It is a journey of self-discovery; a process of un-learning all the suppositions and thoughts you initially felt were true and allowing yourself to be changed for ever. There is a real truth in the sense that the best parents are those who have been willing to be taught by their children. From the first moment when you return from the hospital into the fearful state of total responsibility for a fragile life all the way through to the faltering first steps, through toddler tantrums and on to teenage expressiveness parenting is something that not only leaves an indelible mark but changes you forever. It is full of ebbs and flows, shallow pools and torrid currents.

As any parent will probably attest one of the hardest lessons you learn is the art of letting go. From the desire to protect and guard with suffocating love you have to learn to let go, trust, and empower individuality. Whether it is allowing a toddler to climb beyond your own risk analysis or allowing someone to miscalculate in fledgling relationships – it seems a constant balance between the desire to intervene and protect and the realisation that autonomy and individuality can never flourish in the shadow of a dominant parent.

Autonomy is a concept that has been much in my thought in the last week. I recognise that autonomy is critically important in the nurturing of a child through its early life. The skill of enabling a child to develop so that it is able to make its own decisions, develop its own moral and ethical framework for action, and to do so with an emotional maturity is perhaps the greatest gift of parenting. Without it we would create a society devoid of creativity, ingenuity, expressiveness and soul.

The autonomous child learns to understand that they that they have control over themselves and the choices that they make. That their actions and interactions have consequence and purpose, effect and outcome. Autonomy is developing the abilities to think for yourself rather than merely replicate the views, opinions and thoughts of others, especially your parents! It is the sense of control, agency and responsibility critical to making us into human beings capable of being truly who we are and in relationship with others.

Sadly, there are a whole host of factors that can limit autonomy and prevent the development of the essential characteristics of self-worth, self-regard and self-love. The things that limit our personal autonomy can be the barriers that society places in front of us in terms of our socio-economic status, its disabalism or racism or classism. But equally our autonomy can be restricted by impairments of body or mind that may constrain us.

Those who work in social care know that the essence of good care is enabling an individual to exercise the fullest possible autonomy. It is the realisation that regardless of any cognitive or physical impairments that every human individual has the right to exercise choice, control and autonomy to the best of their abilities and capacity. Good care is about removing or limiting the barriers that prevent human autonomy and control.  It is about enabling an individual to be as independent as possible, it is about reducing dependency rather than fostering it.

That is why our legislation in Scotland recognises that whilst there are indeed some who may have limits on their mental capacity there can be no automatic presumption of incapacity rather there is always a presumption of capacity. I have the right to make decisions about my own person, body and life unless under very strict criteria it is deemed I no longer possess the mental capacity to do so. But even then there is an awareness that capacity can fluctuate and be episodic so there is a duty on those who care for me to continually seek to enable me to exercise autonomy, choice and control.

Without a sense of autonomy, we would feel continually under the control and agency of others; we would not be able to make decisions about what matters to us in our lives. So, in social care the fostering of autonomy is central and critical.

As a whole society we have an obligation to respect the autonomy of other persons, which put simply is to respect the decisions made by other people concerning their own lives. This is what lies at the heart of human dignity, the ability to allow others to grow  into the fullest expression of their own humanity and individuality, without us forcing them to be someone they are not, to do something they do not want to do. All of which is boundaried by the laws and obligations of the whole community and society.

That last point is important because of course no one of us is wholly autonomous. We cannot just do what we want without appreciation that we live in relationship one with the other in a society. When we make decisions and act on those decisions, our decisions and actions are at least partly autonomous.

In social care and health care it has become one of the core ethical standards that an individual must be involved in decisions about their own health and wellbeing.

Autonomy is regarded as a fundamental ethical principle. Put simply it is the acknowledgment that patients who have decision-making capacity have the right to make decisions regarding their care, even when their decisions contradict their clinicians’ recommendations. Autonomy is the principle which underlies the requirement to seek the consent or informed agreement of a patient before any investigation or treatment takes place.

So, what about autonomy in the time of a pandemic?

It is because we are part of a wider community, society or nation that during a period of national emergency that as autonomous individuals we are willing to accept the instruction and laws of our Government in order to protect both ourselves and others. We have seen this in the remarkably high level of compliance during lockdown and in the initial stages of removing ourselves from lockdown.  Managing public behaviours and expectations has been critical. A citizenship without a sense of consensual autonomy would never have supported the restrictive measures which we have all had to live under in the last few months.

But the reason behind me thinking about autonomy this week is the number of people who have written and spoken to me about the extent to which, perhaps especially as we come out of lockdown, we have failed to give adequate respect and cognisance to the autonomy and rights of older people.

Jane wrote to me to say, “I have the right to make decisions over my own life.”  She is in her 90s and in a care home which has been affected by Covid19 and because of that even outdoor visiting is not happening because of the requirement to be virus free for 28 days.  Jane has mild dementia and is in a residential not a nursing home. She is there because of issues to do with mobility and frailty. She has full cognitive ability and mental capacity, yet she feels that she has no control, diminished rights and no autonomy. She feels in her own words “as if I am being treated like a child.”

Her letter was heart-felt and I have to be honest in saying I find it hard to answer her because I think she is right. I do think that we have now reached a state in our pandemic response where we are in danger of limiting the human rights and personal autonomy of individuals ‘solely’ on the basis of where they happen to live or on the basis of their age.

The loss of autonomy and individual agency brings about profound psychological impacts on an individual. This sense of not having control and choice robs us of our identity and purposeless, our individuality and freedom.

Atul Gawande in his brilliant book ‘Being Mortal’ argued that this lack of respect for older people and their exercising of individual autonomy can ultimately mean that as a society we can conclude that prolonging longevity is more important than quality of life. We are so preoccupied with minimising risks in the way our elderly are cared for that we strip them of their autonomy  and control (even with reduced capacity) by treating them like infants unable to make decisions and take actions for their lives.  

Studies across the world are recognising the emotional and psychological toll which lockdown has brought to care home residents, including the loss of interaction with family members. I am increasingly convinced that we need to urgently look at the way in which we have approached the need to balance infection control and prevention and the quality of life of those in our care homes. This in essence has to do with autonomy.

When someone enters a care home regardless of whether or not they have a life-limiting condition such as dementia they do not lose autonomy, they have not left their rights to choice, control and individual agency at the front door. Yes, we have as a whole society  consented to restrict ourselves as part of our belonging to that society, but now that we are removing these restrictions we cannot treat one group less favourably than others simply in the name of infection prevention. This is a subtle and hard balance, but I am not sure we are getting it right.

Moving forward it will be critical that as a whole society and as a care system that we find better ways of ensuring that individuals in care homes and indeed individuals who are dependent upon support and care in our communities have a better mechanism and means to influence decisions taken on their behalf. Part of autonomy is the right to exercise voice and influence, the need to be heard and have your distinct needs addressed.

Any future ‘lockdowns’ will risk a failure of compliance if there is not a greater sense of engagement with and involvement of those affected by measures ostensibly designed to protect but which by default rather than design may actually lead to greater harm. We need to empower people to exercise their autonomy in decisions made about their care most especially when the extent of restrictions have such a dramatic impact on their health, well-being, and autonomy as human beings. We have to stop treating care home residents as children and restore their adult autonomy.

“A few conclusions become clear when we understand this: that our most cruel failure in how we treat the sick and the aged is the failure to recognize that they have priorities beyond merely being safe and living longer; that the chance to shape one’s story is essential to sustaining meaning in life; that we have the opportunity to refashion our institutions, our culture, and our conversations in ways that transform the possibilities for the last chapters of everyone’s lives.” 

Atul Gawande, Being Mortal: Medicine and What Matters in the End

 

Donald Macaskill

We need a National Day of Mourning and Remembrance – a personal reflection

Today is the 4th July and memories of a few years ago when I was in Boston where events changed the history of the United States of America live on in my mind. It is a special day for many citizens of the United States and later today I will no doubt chat to American family as they celebrate the 4th. Closer to home it is a day which in the past week has built in the public consciousness with a growing clamour in England around the opening of pubs! And that’s been hard for so many.

As I have mentioned over the last few months I receive a lot of correspondence from folks who have kept in touch with me during the pandemic. One of those wrote to me this week about how hard it has been reading the newspapers and seeing the news on TV in the build-up to what has become this self-styled ‘Independence Day’ and ‘Super Saturday.’ For her it is a day of real insensitivity because like countless thousands she is one of those who have lost her husband to Covid19, her husband being one of the people who died as a result of the virus in a care home.

She is not alone. Many have spoken, written or messaged me from their places of hurt. They have found it hard to reconcile a return to ‘normal’ with the loss and emptiness which is a constant ache in their waking moments and restless nights. They have spoken of the way in which they feel as if they have been put to the side in their grieving as the world rushes by in its race back to normality. They have spoken about becoming the invisible grieving, those whose story is an uncomfortable and constant reminder of the vicious pain and raw absence that this virus has and is causing.

Mourning is an essential part of the rhythm of life – it’s moves are individual and it’s actions are determined by our own character. For some there is a desire to be busy and active, using routine and familiarity to contain our lostness;  for others a need to withdraw and hold pain close; for yet others there is consolation and comfort in the presence of family and friends. But the problem has been that we have been prevented or blocked in so much of the ways in which we traditionally mourn and grieve. Mourning has become unnatural and painfully hard during the pandemic with all the restrictions on funerals, on being together, or on simply being free to wander in our hurt.

As things begin to ease through lockdown then it will undoubtedly become easier for people to reconnect and nurture their own grieving. But I think we all of us have to recognise that those who have lost someone to Covid19 need to be supported and upheld by the wider community. There is something painfully distinctive about losing someone in and to the pandemic and we need to acknowledge that and take action to address these issues. This in part has started already through the resourcing of more focussed grief and bereavement support. But increasingly I feel that this support and recognition needs to be broader and wider.

The messages I have been getting are from people who feel as if society is in danger of creating a stigma around Covid19 and especially around dying from Covid19. We saw a similar trend after the Spanish Flu in the 1920s. They speak of the bereaved unable or unwilling to say to others that their relative has died from the virus. I very much hope that those are a minority, but I also fear that we need to recognise better  the reality of these feelings than we are doing.

Whether you have been bereaved because of Covid19 or someone has died during the lockdown period I believe that there needs to be not solely a restoration of personal grieving support but that we now need to do something at a community and national level. My concern is that if we do not do so there will be far too many with unresolved and blocked grieving which will only serve to cause hurt and harbour pain into the future.

So today I am calling for a National Day of Mourning and Remembrance  for all those impacted by Covid19 in Scotland. I am asking all Members of the Scottish Parliament to agree in principle to the idea of such a day.

  • A day to mourn all those who have died in care homes, in hospital and in community
  • A day to mourn all those who have died during Lockdown for whom we have been unable to grieve and remember as we might have done
  • A day to remember all those who have worked tirelessly in the care of others sharing compassion, giving professionalism and sacrificial service.
  • A day to remember all those who have had their lives changed and turned upside down by this virus.

I am not naming a day, but I think we need to as a community identify the need to have such a day in the future when we can be together to focus on those we need to remember. We need to create a point in the horizon ahead to which those who are lost in their grief can find the energy to pull themselves toward in the hope that society will hear their story, will listen to their loss and will be silent in remembrance.

We need to have a day when in silence and in action, in country and in city, in streets and in homes people have the opportunity to pause and reflect for from such comes healing and renewal both individually and as a community.

Above the din and noise of rushing back to a normal future we must give space and place for people to remember, to picture their loved ones and to cradle a moment in time which is theirs to grieve. We owe them no less.

After the silence of loss, the memories come, the tears fall, the sadness echoes and  mourning and remembrance sounds.

Donald Macaskill

Who cares for the carers? – new nursing blog for June

Who cares for the carers?

This is a term we have heard mentioned often over the years, but what is the answer?

Back in 2010, we saw the Caring Together Carers Strategy published, promising support and recognition for the role unpaid carers provide, building on the recommendations made within the early Care 21 report: The Future of Unpaid Care in Scotland.

Most recently in 2019 NICE (National Institute of Clinical Excellence) published new draft guidance which aims to improve the wellbeing of adults who provide unpaid care for people over 16 years old. The recommendations made tasked the local authorities and health and social care partnerships (HSCP) to identify how they provide support to carers. In the main, this was to assure that they would direct people to the appropriate financial, social and emotional resources that are available.

This month saw Carers’ Week celebrated and at no other time was this more poignant.

New figures show that 392,000 became unpaid carers in Scotland in a matter of weeks, caring for older, disabled or seriously ill relatives or friends during the pandemic.

This is on top of the 729,000 unpaid carers in Scotland who were already caring before the outbreak, bringing the total to 1.1 million.

Throughout the pandemic, we have celebrated the contributions of all health and social care staff but sadly there was not the same celebration provided for informal carers, with many having had to continue to manage with the limited supports available during the lockdown, but at what cost?

Being an informal carer may sometimes be a choice and can be very rewarding, but for many, it simply is a result of circumstance where people are left feeling duty-bound to step up and take care of their loved one. Some people may feel emotionally pressured whilst others simply do not wish to involve others. It is therefore important that we advocate where possible for those who feel powerless, who feel that they have no voice and that their concerns are not being heard. Despite recommendations, many continue to feel they are not listened to, which may make some reluctant to ask for help.

This undertaking is difficult enough when you are supported in this role but for a significant number of people, they simply are trying their best in an extremely difficult situation and often at a huge detriment to themselves emotionally, physically, financially and psychologically.

As the age of our population increases so does the age of those finding themselves in a caring role. We recognise that promoting healthier lives and living longer increases the possibility of caring duties.

Older people, some even retired themselves may have to look after their parents, who will be living to significant old age, as well as their own partners and perhaps even caring for grandchildren.

As time goes on, if no services are involved in supporting the care needs, the carers can often experience burnout which can result in finally asking for some help or for some making the difficult decision not to carry on.

Sadly sometimes the first that services realise someone is in a caring role is when either the carer or one they are caring for becomes unwell and appears at hospital.

Unfortunately, this was something I witnessed far too often over the years as a nurse and as a social work manager within the hospital, a sharp reminder that we are continuing to fail the most vulnerable people within our communities when you see an elderly man has lost his life and his wife that he cared for having to be placed in care. There are too many invisible vulnerable people within our neighbourhoods. We must promote the need to ensure people’s wishes are adhered to and facilitate the use of the power of attorney and welfare and financial guardianship to avoid the sad indignity that results when these protective measures have not been addressed. Having a relative sit for months in a hospital bed because they have no capacity and no legal rights to place someone in a homely setting is a real injustice.

As we move on from the impact of the pandemic this may be the case for many, as we have noted the traumatic effects of being confined as a carer during the lockdown, highlighting the responsibilities in caring for someone you love with limited resources and lack of social interaction.

We know that respite for some allows that time out, to recharge batteries to continue, however respite is not accessed by all for a number of reasons, with some feeling they are failing the person they care for, or that the person being cared for would become distressed at the thought of it.

This highlights the importance of firstly to offer this resource and secondly to ensure that the respite experience is one that gives benefit to both the carer and the person requiring care.

Respite care in Scotland has thankfully now changed and does not now necessarily mean the person has to leave their home, which provides greater flexibility. I can recall a young father who had a degenerative condition who simply wanted to allow his wife and sons a break but to have respite in his own home. Unfortunately, bureaucracy prevented this at that time and that sense of failure stays with you. Everyone should have the right to have care around the personal outcomes, especially with a life-limiting condition.

Older carers who are looking after someone with dementia can also find it difficult to cope with the changes in the personality of their loved one. People with dementia can become easily frustrated, aggressive, and suspicious of other people. This can be extremely damaging to the carer’s emotional wellbeing. We can all think of someone who has experienced this distress.

In 2015, an estimated 47 million people were living with dementia throughout the world, with this number expected to triple by 2050. Several studies have highlighted respite support is an unmet need for people caring for someone with dementia, this may be due to limited specialist places who offer respite, alongside the difficulties around this being communicated to the carer, and at times the carer’s inability to seek this information out. In addition, as mentioned earlier respite may not cause further distress and behavioural upset.

During the pandemic, this may have been compounded by a reduction in social work assessments, alongside some councils making the decision to change the criteria for access to care, which left many without additional support and only limited new care packages, with families requiring to step. Closure of daycare facilities has been viewed as a particular hit for many carers who have previously relied on the respite these services provides.

Scots who have started caring since the outbreak may have been able to simply because they were shielding or furloughed. We know many were new to this but some are also juggling paid work alongside their caring responsibilities, highlighting the need for working carers to be supported as they return to work. Estimates show that the care provided by friends and family members to ill, frail or disabled relatives is equivalent to £119 billion every year.

It is without question that services could not manage the demand if informal carers did not exist.

The six charities supporting Carers Week – Carers Scotland, Age UK, Carers Trust Scotland, Motor Neurone Disease Association, Oxfam GB and Rethink Mental Illness – promoted the need for further reform to happen which recognises and raises awareness of the role unpaid carers are playing during the pandemic and ensure they are supported through it, and beyond.

One success, however, was the recognition of unpaid carers as key workers with the right to access testing.

As reported by The Princess Royal Trust for Carers 65% of older carers have long term health problems or a disability themselves, with 69% saying that being a carer has had an adverse effect on their mental health. Older carers also report that their role makes it hard to find time for social life and isolates them from friends. We must also acknowledge that illness and disability in old age can create a large financial burden for some people. Carers may have to find the additional money to pay for specialist care or necessary equipment.

Over the next 30 years, the number of carers will require to increase by 3.4 million (around 60%).  Much has been spoken about this over the years but as carers become older themselves the ability to cope is likely to decrease significantly and result in crisis situations. Contingency planning and the need for more investment in community capacity building must be at the forefront of social reform.

As we acknowledge the fact that services will need to look different moving forward it is fundamental that we ensure that we don’t forget those within our communities who have undoubtedly been affected by the pressures of COVID and lockdown.

We need to move away from crisis management to avoid the unnecessary and distressing results that bring for carers and their families. People should continue to have choice and control and remain within their own homes for as long as possible even if they have 24 hr care needs.

The whole criteria of assessment of need, needs to be reviewed to ensure clarity and intrinsically have a preventative measure to avoid further failures in the future.

We must ensure greater recognition of the responsibilities carers are under ensuring their health, wellbeing and personal protection, especially as there is a significant potential risk of a second wave, bringing with it an additional loss of lives, as we move into the flu season.

We must advocate for reform and ensure personalisation, equality, respite and support that has a direct benefit to carers health and well -being or we are undoubtedly failing this country’s unsung heroes.

Jacqui Neil

Transforming Workforce Lead for Nursing

Let care flourish… reflections on primary and social care

I read probably more than my fair share of reports and official research and if truth be told I often struggle to get beyond the Executive Summary for most of them and probably hold very few in my memory. There are exceptions and one was ‘Let Glasgow Flourish’ a report in 2006 describing the health inequalities of the city of Glasgow and what was needed to address these. Written by Prof Phil Hanlon and colleagues it was an articulate, impassioned, reasoned and convincing argument of what needed to be done to address that city’s health and social care woes. Sadly, a lot of what was called for is still resonating as an echo.

As a former citizen of Glasgow, I have always treasured the motto of the city ‘Let Glasgow flourish ….’ The idea of flourishing resonates with the sense of springing into life, of growth and renewal, of resurgence and success. Its organic positivity is at the heart of all human health and care. Clinical and social care have a shared desire to see the individual grow and develop, become whole and achieve potential; in other words, to flourish to the fullness of their humanity. Something of this is captured by the idea of thriving which I know is now much beloved by public health thinkers. But there is something about flourishing that appeals to this west coaster!

The concept of flourishing may seem a strange one to reflect upon as we are struggling to still deal with a pandemic which has destroyed so much in its wake, and has brought havoc and despair, loss and death to tens of thousands. But I think it is important in the days, weeks and months ahead to start reflecting on what it is that will help individuals, communities and organisations start to flourish again.

This week we received the thankful news that slowly and safety we will see the start of care homes enabling family members to visit their relatives. The abnormal exclusion of contact and presence is coming to an end boundaried by the need to protect and keep safe. But alongside this is the urgent requirement to support residents and staff to start to flourish again. Work is ongoing and has a new urgency to address the very real deterioration and decline that has occurred as a result of measures designed to protect, through self-isolation and social distancing during lockdown. This will not be easy either on a personal level or for organisations, but we must give as much energy to coming out of lockdown as we have to protecting it. The role of our Allied Health professionals, physiotherapists, podiatrists, nutritionists, speech and language therapists, optometrists and so many more will be critical and central as we seek to let care and people flourish again. I have often heard folks say that people got a new lease of life when they went into a care home and were cared for, met others and felt as if they belonged. We all have a lot of work to do to restore that sense of joy at the heart of our care homes and to let them flourish once again.

But care also needs to flourish by restoring the well-being of nursing and care staff who are understandably spent and exhausted by the struggles and demands of the days and weeks which have passed. Without the traditional routes for relaxation and renewal offered by a flight to the sun, we will need all of us to support staff and frontline nurses and carers to be able to deal with the emotional and physical challenges of the last months.

On a wider front we have a real opportunity to let care flourish. Yesterday I took part in a webinar with hundreds of primary care colleagues which was both a reflection of the lessons learned during the pandemic and the real positive work that has been underway. I have written elsewhere that over time we have fragmented the critical interface of how primary care and social care relates. If there is one thing we need to do better after Covid it is to ensure that we get this right. Part of that is the painful acceptance that we did not get it right all the time, in every place and in every way,  at the start of the pandemic to the extent to which social care staff have voiced a sense of abandonment. There is little point dwelling on this – but we have to learn from it and need to move forward to recognise that where we got it right it was of immense benefit to resident and professional alike. The tremendous examples of GPs, palliative and end of life practitioners, pharmacy colleagues, community nurses working alongside social care nurses and social care staff should be the ultimate memory that changes things in the future.

I believe we need to develop a real partnership of mutual respect, professional understanding and reciprocal awareness that wraps primary and secondary care around our care homes and our homecare services. In some parts of Scotland, the pandemic has helped us to walk in each other’s shoes for the first time and has helped to create real mutuality and respect. We need to build on this systemically, strategically and with sensitivity. These conversations and pieces of mutual work will be essential to enable care to flourish.

To flourish is to have a sense of positive renewal. Now is the time not just to open the gardens of care homes to visitors but for the community to take care homes into their centre; for us to create a system where all citizens, regardless of need or location, of residence or age, of disease or condition, receive equal treatment and care which is built around the needs of the person, enhances the humanity of the individual, and enables them to flourish, and our society to become renewed. We will do that by binding secondary, primary and social care together not so tightly that the distinctiveness of each is diminished, but in a way that each has voice, contribution and creative ability to grow and change.

So, let care flourish.

Donald Macaskill