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Time for respect: the critical importance of valuing social care nursing.

One of the first tasks I undertook when I started in my role as CEO of Scottish Care nearly 6 years ago was to go around the country and take part in a research project which involved me interviewing a number of frontline nurses in care homes. It was an amazing, humbling, and inspiring experience. Along with colleagues what came out of those conversations was developed into a report called ‘Voices from the Nursing Frontline.’ It told the first-hand experience and stories of nurses who had chosen to work in social care and care homes in particular. It was raw and honest, but also celebratory in valuing the exceptional importance and distinctiveness of care home nursing.

I have re-read the report and the words of these nurses in the last few days, sparked off in part by the publication of a survey from the Royal College of Nursing in Scotland, but also by comments from nursing colleagues in the sector. The RCN survey indicated that as many as 60% of nurses are actively considering leaving the profession. In what follows I want to share some thoughts on the current status of care home nursing in Scotland and why I believe it to be in very real crisis and in need of specific and targeted attention.

The Voices report articulated the breadth and extent of the role which care home nurses undertook. If I had not known before, I certainly knew after these conversations that the job entails an astonishing array of skills and requires real depth of expertise and knowledge.

Nurses in care homes are often the only nurse on a shift and as such a great deal is placed on their shoulders not least as the acuity and clinical needs of residents has risen so sharply in the last few years. They are frequently individuals who occupy leadership roles in our care homes whether as senior staff or often as managers responsible for the smooth running of the home not just exercising a clinical oversight role. Added to this they are the effective leaders of and support for social care staff. These are highly skilled professional leaders dealing with a whole range of clinical needs in residents including dementia, neurological conditions, delirium, palliative and end of life care, pharmaceutical interventions, frailty, rehabilitation, late-stage cancers and so much more. The care home nurse is a specialist in a considerable number of areas and not a generalist. They do so much often without the peer support that is available in an acute setting.

After being involved in the Voices report, along with others, I argued that both nursing regulatory bodies and nursing academic schools needed to create and value social care nursing as a distinct specialism in the same way as is done for paediatric, learning disability or mental health nursing. I hope one day that will be undertaken in earnest because in a very real sense all nurses need to develop the skills a care home nurse is required to evidence and display.

Yet having just noted the advanced clinical and social care skills required I cannot but reflect on an undercurrent in the Voices report which has become not only more pronounced but has grown in recent times in Scotland. That is the issue of value, respect and professional regard. One nurse stated in 2016 that:

“In hospitals, nursing homes were considered second class establishments. Our skills are undermined by the NHS due to us not using IV drips! The complex nature of communicating with those with dementia is not recognised.”

I well remember a nurse saying to me that her NHS colleagues thought she would become de-skilled, was taking an easy route out and that the care home sector was a dead end for anyone interested in career progression. She told me that the disdain from her former acute sector colleagues was palpable, as someone told her, ”It’s not real nursing is it?”

Now you might say that any one person’s experience is not always reflective of the whole. That is undoubtedly true were it not for the fact that for the last few years and especially in this last year I have continually heard from frontline care home nurses their growing dismay at their sense that others in the health and care system disrespected their professionalism, expertise and skill base.

Over the last few days there has been a lively social media debate about care home nursing, and you cannot read some of the comments and not conclude that these women and men have been made to feel less valued, de-skilled and dis-respected even more than other nursing colleagues in other services.

One experienced nurse stated:

@andreawyllie : When I first started out on my nursing journey, older people & mental health nursing were considered “Cinderella” services. CH nursing wasn’t even included in that category. Not much has changed in attitudes in 25yrs. It’s not just the nursing it’s how we as a society value people

Others commented:

@Justacarehomeg1 : The impact on social care staff at all levels has been largely ignored. Working front line with covid, with restrictions which cause moral dilemmas to staff day in and day out.

@andreawyllie: Just discussing this very thing with this morning and what the lasting impact may be for social care as we add in the lack of respect and value given to social care staff and the blame culture that has also had to be managed through the pandemic

@YvonneSManson : All these new NHS based oversight groups that got set up only further compound that stigma of NHS is better. Imagine setting up teams to oversee, make decisions on care homes with people who didn’t work, live or visit care homes can you imagine that happening the other way around!

I would encourage you to read the debate because it is inescapably blunt in its analysis that we are failing care home and social care nursing in Scotland.

The pandemic has been crippling and hard for frontline care staff, nurses perhaps especially so because of their leadership roles. Many have shared with me a sense of abandonment, the stress and emotion of dealing with loss and death, the fear of whether they would carry the virus into the care home or back to their own homes; the constant struggle to balance the need for restrictions with their desire to help residents enjoy their life; the continual requirement to be strong for colleagues; to be always up to date with the avalanche of new Guidance arriving just at the point of exhaustion; the disproportionate scrutiny from those who know not what they were talking about; the demands of reduced staffing; and their own inner questions about the level of care possible in situations such as forced isolation and separation from families with which so many disagreed.

Many have shared their real pain at the constant barrage of criticism and blame directed at care home nurses and managers not least from sections of our political and media worlds. And add to this, and uniquely in Scotland, the nature of constant investigation from Operation Koper where every single Covid death up to this day is investigated in care homes, thus putting immense pressure and stress on nurse leaders – a process consciously and subconsciously constantly demanding they ‘prove’ they did not make any errors or at least one which instils fear, guilt and anxiety. They have felt as if they were fighting a battle against a virus with one hand tied behind their back. Can you even begin to contemplate the outcry if this process of continual investigation and scrutiny and limiting of professional integrity was happening to nursing staff in an NHS ward?

The specific and personal observations quoted above and there are a lot more on Twitter and other social media are also clearly evident in the report on oversight and inspection published by Scottish Care two months ago and around which thankfully there has commenced some shared work to address the issues highlighted. That report stated quite clearly that we were seriously getting things wrong in the way we are allegedly supporting the care home, and specifically, the nursing care home sector.

I would contend that the comments expressed online this week and in the report are not accidental but rather are reflective of a damaging failure at senior health leadership level in Scotland both politically and operationally to value the professional integrity of and to seek to appreciate the role specialism of care home nurses most especially during the pandemic. Interventions might have been ‘well-intentioned’ and designed to ‘support’ but they have backfired and only served to compounded the problem and sense of disrespect, not least because of the lack of real engagement with, involvement of, and partnership with care home nursing professionals and the sector. No other professional group I know in social care or medicine would tolerate what is now happening in care home nursing.

The RCN report stated baldly the risk of us haemorrhaging real talent from the nursing profession in the NHS – I would go as far as to say that that worrying analysis can be multiplied ten-fold when one considers the social care nursing workforce. There is an urgent need for attention and action, but that must start with the development of trust and respect for the individuals who work as care home nurses. That respect seems singularly absent.

The Voices report some 6 years ago made 12 recommendations. It is an indictment on all of us involved in health and social care leadership that each and every single one of them remain unaddressed in large part to this day. We have not progressed matters with any positivity, rather in the last 22 months we have made matters significantly worse. The twelve were:

  • Identify what are the core skills mix for nursing in social care
  • Develop a career pathway with NHS nursing
  • Develop nursing in social care as a positive career choice
  • Address the inequalities in terms and conditions
  • Rebalance the level of scrutiny and inspection
  • Resource development in nursing specialisms in social care nursing e.g., dementia, neurology, geriatrics, mental health, palliative care etc.
  • Develop and promote a positive image of nursing in care homes
  • Work with HEIs to promote nursing in a care home setting as a positive career choice
  • Positively address workforce issues such as emotional fatigue, mental wellbeing, stress and distress
  • Address the issues of nurse recruitment and use of agencies.

If we start to work together, around a table of mutuality, from a position of professional regard rather than sector and clinical superiority, then we just might manage to prevent a crisis from becoming a collapse. Most importantly we will begin to give the amazing frontline care home nurses a sense of value, autonomy, respect and regard.

Donald Macaskill

 

 

 

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Teaching with care: a reflection for the International Day of Education.

Miss Duncan, Miss Allan, Mrs Randall and Mr Hollywood. Names etched on my memory – they were four of my primary school teachers. There are others too especially in secondary school who if I close my eyes, I can still see them and hear their voices. I know I was lucky. I loved my school experience – well most of it. It opened a world to me of learning and imagination, of escape and possibility. The people who took me on that journey were individuals who through their professionalism and dedication sowed in me a hunger and desire to know and to discover. I have always had the fullest admiration for those who teach. A good teacher opens a door of possibility and lets you enter a world of potential. Rolled up in one person, a good teacher is an inspirer, dramatist, communicator, creator, listener, carer and so much more. But it was only later in life as I began to teach and train adults that I really appreciated just how hard the work of a teacher is. So, I am always so proud of the fact that my eldest daughter is a primary school teacher – I can think of few roles more rewarding and fulfilling yet challenging at the same time.

I’ve been reflecting on education and teaching a lot in the last week partly because I have been involved in discussions on learning and training but also because this coming Monday we will be celebrating the International Day of Education, which is a celebration of the role of education across the world.

It is a day which amongst other things, is a reminder of how critical education is in tackling so many of the injustices and needs of our world. As the United Nations has stated:

‘Today, 258 million children and youth still do not attend school; 617 million children and adolescents cannot read and do basic math; less than 40% of girls in sub-Saharan Africa complete lower secondary school and some four million children and youth refugees are out of school. Their right to education is being violated and it is unacceptable.’

Education and learning are critical for the future of society, and that includes for the future of social care in Scotland. This past week we have seen in an Audit Scotland report some substantial critique of the lack of leadership and focus on social care and its necessary skills. Given that social care is a major contributor to the whole Scottish economy, if we are not getting training and learning right for this sector, then we are impacting the whole of our economy. But even more important than that we need to continually make sure that in our learning cultures around social care that we are reflective of the changing realities of care around us.

Two things have struck me this week.

The first is that having spent the last few weeks highlighting the very real challenges that the social care workforce has been facing because of Omicron someone asked me, ‘Then why do the work of care?’. Now before I get accused of rose-tinted glass wearing, I am not denying and would strongly argue that we need to substantially improve the reward and remuneration, the terms and conditions of those who work in social care. We are slowly getting there although at times I think our national and governmental response has been more focussed on headlines than addressing the baseline issues of sustainability, structure and process which affect the social care system in Scotland. We cannot have fair work conditions, a workforce valued and respected, professional and recognised, if we have systems in place which make their organisations and employment unsustainable, forced to sacrifice quality on the basis of cost, and to continually be treated as outsiders in partnership and collaboration.  There is no point in having a better paid carer if the organisation that employs them has gone to the wall. The social care system in Scotland is in a perilous state and will only be changed by the sort of radical transformation which requires partnership, mutual respect and collaboration. The best teachers inspire not by instruction but invitation, by authenticity rather than acting, by offering possibility rather than predictability. Such change is not just systemic – for instance creating a National Care Service – it is profoundly attitudinal and cultural. Have we in Scotland the ground in which to sow a change that involves and includes, that respects diversity and difference, nurtures choice and capacity? I sometimes fear we do not because too often I witness partisanship and defensiveness, a desire to keep things as they are, to hold onto power-base and predicability.

The way we support and care for others is changing all the time, I very much hope that when we talk of skills in relation to social care in the months and years ahead, that firstly we will value the existing professionalism of those working in care, and secondly that we will give equal attention to the softer skills of affectiveness and compassion, communication and relationship, as we often do to functional and transactional activities and abilities.

We also need to ensure that the potential of a career in social care is talked up. And that change has to start early – we need to start inspiring the children now at primary school to consider care as a career of choice and as of huge societal value. That is up to all of us who are adults to be the enablers of that inspiration. My answer to the question I was asked is what I have heard so often – that there are few jobs in life, despite the challenges, that enable you to support someone else to change their life, to achieve their potential, and to live to their fullest until the end of their days. For many it is the best job in the world and surely that is worthy of all focus and attention, of our value as a society and respect as a community?

As we seek to inspire the young with the attractiveness of social care, can I suggest you look at sharing with the children you know the fantastic ‘ When I grow Up I want to be a Carer.’ written by Jenni Mack. It is superb!

The second main reflection about teachers and education that I have had this week is personal and that is that I probably am learning more now than at any other stage in my life. In other words education and learning, knowledge and insight did not stop when I left school or university – it just took on a different form. Now I hope that that is stating the obvious, but I suspect as a society it probably is not. There is a terrible presumption about older age in particular which suggests that learning and teaching have sell by dates. What nonsense – and I am thankful that increasingly I read of people in their eighties and nineties graduating with degrees or going back to school to learn a new subject or discover a new skill. We learn until we die and it is a fundamental part of our society that we should enable such learning into later age, and value the contribution that the gaining of such knowledge offers to our society. Education is too important and liberating for it to be the preserve of children and the youthful.

I conclude with one of my favourite children’s writers, Allan Ahlberg who write the poem ‘The Supply Teacher’. I said at the start that I enjoyed most of my school experience except perhaps one supply teacher who put the fear of the divine into me every day she appeared. If nothing else she made me appreciate the brilliance of those who had become my routine, and for me all teachers in school, care home and community, open our hearts to the essence of what it means to be in relationship with one another, in care and compassion. The best teachers, wherever they are, and whatever job they do, help us to reach our potential and flourish.

The Supply Teacher

Here’s the rule for what to do
If ever your teacher has the flu
Or for some other reason takes to her bed
And a different teacher comes instead

When the visiting teacher hangs up her hat
Writes the date on the board, does this or that
Always remember, you have to say this,
OUR teacher never does that, Miss!

When you want to change places or wander about
Or feel like getting the guinea pig out
Never forget, the message is this,
OUR teacher always lets us, Miss!

Then, when your teacher returns next day
And complains about the paint or clay
Remember these words, you just say this:
That OTHER teacher told us to, Miss!

 

 

Donald Macaskill

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Coronavirus and social care: what does ‘learning to live’ and the ‘endemic’ stage really mean?

It has been another significant week in the Covid pandemic. I will leave it to others to comment on the shameful goings on at Number 10 Downing Street, but alongside these events and the commentary attached to it, one of the announcements that I took note off with a degree of regret was the news that the English Deputy Chief Medical Officer, Prof Jonathan van Tam will soon depart to return to his substantive post at Nottingham University.

I cannot have been the only one that liked van Tam’s metaphorical turn of phrase, not least his footballing analogies, as he attempted to convey the meaning behind complex information, science and data. One of his best moments, for me, was when he said:

“It is a bit like being 3-0 up in a game and thinking we can’t possibly lose this now. But how many times have you seen the other side take it 4-3? Do not wreck this now. It is too early to relax.”

Having been ‘that fan’ at too many Scottish lower division games I know precisely what he meant! It has, therefore, intrigued – and I will be honest irritated me a bit – that this last week so much of the discussion has been about ‘learning to live’ with the virus and moving from a pandemic to an endemic stage. I accept the hopeful prospect of both, but these are phrases which it is self-evident mean so many different things to many people, and I cannot but feel at times that we are in danger of scoring a few own goals. Indeed, the irritation I mention is that for tens of thousands of social care staff right now work and life is about surviving exhaustion and fatigue as they spend themselves in supporting those who use services in the greatest crisis anyone can remember, and not just since the start of Covid19.

It is also important to acknowledge that yesterday we passed the horrendous toll of 10,000 of our fellow Scots who have died because of this Covid virus. Talk of ‘moving on’, of ‘learning to live’ and the ‘end stage’ has to be wholly sensitive to the grief and pain, hurt and abandonment so many feel today. For so many the rawness of reality does not make us feel that life now is any easier than it has been, quite the reverse.

In this blog, therefore,  I want to reflect a little bit about these concepts of ‘living with the virus’ and the endemic phase and specifically what they may potentially mean for social care services and those who use social care support.

Language, as van Tam powerfully illustrated, is always important and there has been a sense in the past week that in the rush back to ‘normality’ that the  careful use of language and appreciation of its subtlety has gone out the window.

Take for instance the commentary that we should stop talking about the Covid pandemic and start talking about a Covid endemic stage. As Wikipedia puts it:

‘In epidemiology, an infection is said to be endemic in a population when that infection is constantly maintained at a baseline level in a geographic area without external inputs. For example, chickenpox is endemic in the United Kingdom, but malaria is not.’

There are lots of viruses and infections which are endemic, but it is not true to say that those infections are harmless or not dangerous. Smallpox is endemic but it can and will kill. So being in an endemic stage does not mean there are no risks, does not mean there is no need for measures to protect or precautions which are required for safety to ensue.

Across Europe there has in the last seven days been much chatter about us moving into the endemic phase of coronavirus. This started off last Sunday with the English Education Secretary Nadhim Zahawi, who talked about the transition from a pandemic to Covid being treated as “endemic”. After his remarks news outlets began to reflect on what living with the virus and being in the endemic stage actually means.

Alongside this the Spanish Prime Minister declared a shift in policy away from counting cases and quarantining, towards a model of managing outbreaks of diseases like influenza that seeks to protect the most vulnerable. Others countries such as France and Switzerland have followed that lead in seeking to ‘manage and diminish restrictions’ because they believe the disease is entering an endemic phase.  However, in a word of caution the World Health Organisation stated on Tuesday that it was too early to believe we were entering an endemic stage as it warned that more than half of people in Europe would catch the disease over the next two months.

Covid is undoubtedly here to stay and we will over time have to learn to balance the risk from the virus with the requirement to live our lives. It will become less threatening and hopefully more like the ‘common cold’ as the vaccine discoverer Dame Sarah Gilbert, recently told a seminar.

But of course, life is not as simple as any politician going on air and declaring their belief that we are moving into the endemic phase, as Prof Christina Pagel, from University College London and member of Independent Sage, indicated on Sky News, the endemic stage will mean that Covid is :

“present, but you don’t get exponential rises in the absence of other measures”… We’ve literally just had a month of exponential rises of Omicron in our population – so we’re not at endemic stage… You can’t just say we’re moving from pandemic to endemic. That’s the virus’ timescale. It’s not ours.”

Of course, she and others are also right in asserting that it is a naïve presumption to assume that the progress of any virus, never mind one like Covid19, is inevitably along a trajectory of ever-decreasing threat. Our ability to reduce mortality during Delta as compared with the original Wuhan strain was because of the brilliance of vaccines not the fact that Delta was less severe. Virus threat fluctuates and just like that oft heard warning– they can go up as much as can come down. In Van Tam’s metaphor – the time you are most likely to lose a goal; is when you take your eye of defence.

So what does all this mean for social care?

This last week has been a really worrying one for many who use services and supports, especially those in their own homes. Last weekend’s Sunday Times carried a story suggesting that there would be an end to freely available Lateral Flow Tests (though of course they are not free as we pay for them in our taxes.) Although subsequently denied by Westminster ministers it has left many who are clinically vulnerable in our communities concerned that one of the key protections and mitigations may be removed from the Covid defence armoury especially as nothing was said in the ‘leak’ or ‘briefing’ about social care staff and service users in the community.

Then we had the announcement of a reduction of social isolation in England to five days with two clear LFTs. Whilst this may be acceptable it is argued for the majority population on ‘economic grounds’  (though personally the reality that over a third still remain positive and potentially infective after that time questions the morality of that assessment), the lack of robust safeguards for those who receive care and support in the community, or who have anyone from electrician to friend, come across their front-door, risks imprisoning a whole sector of the population into a perpetual isolation.

The balancing of the harms caused by lockdown and other restrictions cannot be at the cost of those who for whatever reason live with vulnerabilities and who need protection from harm. They deserve equality of citizenship and attention to their basic rights as anyone else.

Why is it that we believe that returning to ‘normal’ is inevitable? What is it in the presumption that ‘progress’ is always a continuum into the future? Perhaps progress is an acceptance that things can never be as they were, that difference is part of our tomorrow, and that maturity is living with that new reality? This time last year we were speaking about a ‘new normal’ of a way of living and being in community with one another that accepted that there may be some elements of behaviour and mitigation which will need to become part and parcel of our being with one another in society. Whether that is mask wearing or testing in defined circumstances and  environments I do not know but I strongly suspect that it will mean a continued period of awareness and support for those in our care homes and those who receive social care supports in their own homes. We will need to re-think social care support.

Living with the virus needs to become a state of being responsible in relation to others not an abandonment of the knowledge we have gained in the last twenty-one months. If the science is to continue to give insight, we cannot pick and chose the bits we like and ignore the evidence of challenge.

Living with the virus will for those working in social care undoubtedly mean an awareness that we have a workforce which is exhausted and drained, many of whom today as they fight the threats of Omicron are desperate for a rest, and many of whom might well be considering can they possibly go through this again.

Living with the virus will mean a necessary requirement to adequately resource the social care sector not solely as the appendage of the acute NHS sector, or even as the enabler of independent living and individual citizenship, but as a sector and workforce that equips the whole community to continue to remain healthy and which fosters the wellbeing of those who are at particular risk. The likely demand of continuing testing, IPC measures and other mitigations and precautions requires focussed planning and strategic attention now.

Living with the virus will mean that we have to acknowledge the massive extent of unmet social care need, the drained and diminished ability of family and non-paid carers to give any more, and their desperate need for real support and practical assistance.

Living with the virus should mean that we have especial regard for those who are at most risk, a characteristic of behaviour and priority because of the priority of those individuals regardless of age, disability or circumstance who are as vital a part of our place as we are, whose creativity and contribution need to be fostered and enabled as much as yours, whose rights and dignity require to be enhanced as anyone else’s in any day.

Living with the virus requires a re-orientation of all our lives, not just the lives of the few. It is one which can only be made together, in partnership and collaboration, in engagement and consent, and cannot be achieved by a rush to the exit door of caution and precaution. We are 3-0 up let us not lose the game.

 

Donald Macaskill

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Writing a new story in the Year of Stories: a reflection.

I discovered this week whilst listening to the radio that our national tourism agency Visit Scotland had launched the Year of Stories 2022 – a year which they describe as one where we celebrate stories inspired by, written, or created in Scotland. They go on to say that ‘stories are a vital part of Scotland’s culture, and every community has a different tale to tell. Shared stories, whether spoken, written, sung or filmed are what give a sense of place, history and belonging.’

As part of the Year of Stories there are already being organised hundreds of events across the country in museums, cinemas, community centres and visitor attractions which will focus on storytelling and the art of story. All of this in an attempt to capture the imagination, to entertain and inspire.  You can find out more on their website and by following the hashtag #TalesOfScotland.

I have written a few times about the power and importance of story and storytelling, not least in social care and in palliative and end of life care. I have reflected that stories are not just about a source of entertainment and escape, but rather that the real power of story is as a force for change and a tool to make a difference to our lives and communities.

But as I heard about the Year of Stories there were two stories which that day were uppermost in my mind, firstly Omicron and also the experience of living with dementia.

As I sat there I could not but reflect on the stories which I have been hearing and am still being told; these have been stories of this aching pandemic and of the response of the social care workforce and organisations to the Omicron virus. They have been stories of people separated again from loved ones in care homes struggling with outbreaks, of people in the community frightened of being supported lest someone brings the virus in to them, of family carers with nothing left to give such is their exhaustion.

This past week has been one of the hardest ever for anyone running a social care organisation or working in frontline care delivery. The levels of staff absence because of Covid have been crippling with some care organisations running with 25% absences, whilst the majority are experiencing absence rates of between 10-15%. What this means is not just a stretched service but an exhausted one especially the women and men who are now working double and sometimes triple shifts. They are drained to the bone of energy and yet they keep coming back to the frontline because they care and because they do not want to see those being supported whether in care home or community abandoned.

I have never before heard reports of such stress as those I have heard in the last week. And one of the things that is making it really hard for all involved is the constant drip drip of commentary that suggests that Omicron is a mild virus, ‘like the common cold.’ Now apart from the fact that we have been warned this week by experts such as the World Health Organisation that such comment is dangerous, the severity of Omicron does not really change the fact that because it is so infectious thousands of health and care staff are off ill or isolating and that those left are on their knees. A system can collapse through a mild disease just as quickly as through a severe one. In many of the conversations that I have shared this past week folks are despairing of the reality that as they are struggling ‘in the trenches’ the rest of the world has become dismissive and blasé believing that the pandemic is over, that we just have to ‘ride it out’, rather than taking the threat to our health and social care systems as seriously as they should. And that threat should absolutely worry us – any of us – who might sometime in the next few weeks want to call an ambulance, experience an emergency health incident, be worried about the health of a sick child or relative. If we do not take actions to protect others in this crisis then they will not be there to take action to protect us in our crisis.

As I reflect on storytelling in a week such as this I cannot help but remind myself that stories are not always works of fiction and make-belief, tall tales of impossibility and miracle. Stories are the happenings of our moments, the actions of our heart, the fruit of our relationships. We are not passive actors on a stage which we cannot control and using a dialogue we have no influence over. We are not the playthings of a writer beyond our ken, but rather we are the agents able to influence the outcome. In other words the real power of story is that the page is still unwritten and we have the ability to determine what is the ending to our most important stories. We have control in this Year of Stories of the story of our time, and that at this moment in this year is still the story of Covid. We can determine whether with the aid of reflection at the end of this year we look back and read of the folly of forgetfulness and the narcissism of self-interest, or we can read of collective solidarity and support, where once again we rolled up our sleeves and were present for others.

So as well as Omicron, as I sat listening to the plans for the Year of Stories, I could not but also think of the fact that it was my parent’s birthday that day. As a child it was a great benefit to have your parents’ birthday on the same day! Now that they are no longer alive inevitably it is now a day of reflection and remembrance. But it was also this year a day where – albeit on the margins of media stories covered that day – new research was published on dementia, the disease which took my mother from life and with which we had as a family lived with for years. The Global Burden of Disease report was the first international study of its kind and it was reported as stating that:

‘The number of adults living with dementia worldwide is on course to nearly triple to 153 million by 2050… Experts described the data as shocking and said it was clear that dementia presented “a major and rapidly growing threat to future health and social care systems” in every community, country and continent.”

It went on to state the substantial evidence indicating ways in which health and lifestyle could be improved and changed in order to prevent dementia which for the majority is not ‘inevitable.’ It also argued quite clearly that there was a need for major investment and research to ‘find a cure’ for a disease which will outstrip all as a threat to humanity and the quality of life.

To some extent this research tells us nothing those of us involved in the world of dementia did not know or at least fear. Its robustness and rigour is what is terrifying. But it also shows the way forward and the prospect of change offered to us.

I cannot be the only person who has marvelled at the way in which the global pharmaceutical and research community has come together and within an astonishing period of time has managed to find vaccines of such effectiveness and safety that we have prevented the Coronavirus pandemic from being even more disastrous than it has been, The vaccine discoveries have been an astonishing result of science and collaboration. Equally I cannot have been the only person, not least those whose lives are shortening as they live with dementia and those who love someone with dementia, who has not asked the question, ‘If they can do this for Covid, why cannot they do it for dementia.’

I am the last person to demean or diminish the dedication and energy of those over the years who have been involved in researching dementia and a potential ‘cure’, but I will be the first to question the moral priority of societies which continue to fail to invest and prioritise such research. I will be the first to call out the reality that when push comes to shove a disease that predominantly affects the old (but by no means exclusively) is deemed and viewed by society as less significant because of an inherent cultural and global ageism. That simply has to change. We must get serious and with the same international and national focus which brought us the Covid vaccines turn our attention to dementia.

In this Year of Stories, we need to be reminded that within us all is the ability to write a new page, to create a new ending which is of hope and change, restoration and light. In the dark winter days where in a care sector stress and exhaustion run rampant, we need to know that every change worthy of its name has been brought about by ordinary women and men deciding to change the story of their living. The power of story lies within each one of us to become a narrative which changes lives and improves community.

In this Year of Stories I hope we can use our words and actions for the betterment of all and not just the entertainment of a few. Because stories at their best, I believe, can change the world, re-orientate direction and motivate lethargy and tiredness.

Let us all therefore write a new story for this year and every year.

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On the lip of tomorrow: a new year dawns.

It was just under a year ago that I first became, along with many others I suspect, aware of the amazing poetry and insights of Amanda Gorman who you might remember delivering a breath-taking poem at the inauguration of President Biden. She has recently produced a book of poetry ‘Call Us What We Carry’ offering the same insightfulness and beauty. One of my favourites is ‘Ship’s Manifest’ which you can read and hear her recite in the New Yorker magazine.

It starts with these words:

Allegedly the worst is behind us.
Still, we crouch before the lip of tomorrow,
Halting like a headless hant in our own house,
Waiting to remember exactly
What it is we’re supposed to be doing…

To be accountable we must render an account:
Not what was said, but what was meant.
Not the fact, but what was felt.
What was known, even while unnamed.
Our greatest test will be
Our testimony.

2021 has been an immensely challenging and hard year for so many both at an individual and societal level. That is perhaps especially true of those who use social care services, both care homes and homecare, unpaid carers, families, friends and the amazing health and care workforce.

Today as we start another year in the midst of a pandemic we are in Gorman’s words on the lip of tomorrow, and I am sure we all of us hope that as we move into 2022 it will be a year of restoration and renewal rather than retreat and yet more restriction. The challenge especially at the moment with Omicron is how we get from where we are to where we want and need to be. I am sure that I cannot be the only one who recognises that the months and year ahead has to be one that witnesses real change and difference. It is a year which proffers the possibility of sea change and reformation in the way we deliver social care in Scotland, and yet which also carries the risk of our dreams and aspirations running aground.

We will all have a different view of what is important in the coming months and year. For me I hope 2022 is a year of fairness. There are many definitions of what fairness means but I don’t think we need to depart far from the dictionary which describes fairness as ‘impartial and just treatment or behaviour without favouritism or discrimination.’

Fairness means that we treat all without discrimination. In 2022 we need to work for a social care system which recognises the needs of all and adequately prioritises all regardless of favouritism or discrimination. In truth I feel that has not always been the case and that social care much as with the rest of Scottish society is rife with age discrimination. I see the signs that we are still a society which considers value and contribution, capacity, and ability to have use-by dates. Any holistic community or equal and fair society must not only enable the voice of all to be heard but empower that voice to lead to change and creativity. I hope 2022 will see a deliberate challenge to the age discrimination we witness so frequently and seem to accept so casually.

Fairness means that you recognise the needs of all regardless of condition. In this regard I hope in 2022 we finally begin to challenge the discrimination, which means that should someone be unfortunate to be diagnosed with dementia then they will receive unequal treatment through the failure to recognise their condition and the required support as healthcare and not social care needs. For too long people living with dementia and their families have been the object of societal and fiscal discrimination compared to so many others. We must end the dementia scandal in 2022.

Fairness means that we will really enact what we all know to be fair work practices. Everyone I know talks the talk of fairness in the workplace. We all know that if we are serious about valuing the work and role of care in our society that we need to properly reward and recognise our frontline workers. This involves not just increasing baseline salaries but ensuring that other terms and conditions are adequate and fair. So, for instance, I really doubt anyone using the scales of fairness would say that the continued practice of electronically monitoring frontline homecare staff is anything but iniquitous and unfair.

Fairness means that we adequately resource the delivery of care and support to those who need it. I hope against hope that 2022 will see the dramatic increase in financial allocation which is required to give Scotland a human rights-based, person-led and dignity-infused delivery of both homecare and care home services. The home care sector is on its knees and so many organisations providing excellent care are likely to go out of business in the next year not because what they deliver is poor but because the Government fails to adequately resource contracts that value the care they deliver. This in no small way is a crunch year for home care and also our care homes. After years of dispute and disagreement the much-lauded National Care Home Contract which indicates what the State is prepared to pay for care home provision, (and in very real detail) is in the last chance saloon. Negotiations around this are currently taking place but when all is said and done, they are about fairness. At the heart of these discussions is how much does central (and not just local) value those who receive residential and nursing home care and support and those who care for them? In this regard I should not need to remark that fairness means not just paying the carer adequately but ensuring that they have the resources, facilities and sustainable services which enable them to deliver that care and support.

Fairness means everything in social care. But perhaps it especially means a recognition of the distinctive and unique contribution which social care makes. Good social care, which is well-resourced, recognised and valued, enables individual citizens to flourish and thrive, to grow into and celebrate their identity and belonging in community.  So I hope 2022 will see the acceptance of care as a national priority and as a National Outcome. Social care has to be seen not as an appendage to a health care system but as a distinct set of professions, services and supports which are deserving of equal respect and value.

On the lip of 2022 we have the prospect of walking the talk and turning rhetoric into reality. In a year that will see the start of the Covid Public Inquiry, new legislation to establish a National Care Service and potentially a new Human Rights Act, doubtless yet more challenge posed by Covid, and sadly I suspect an increasingly strained and drained social care workforce and provider body, then the year has no few challenges ahead of itself. But in meeting those challenges I have absolutely no doubt that seeking fairness in all we do should be at the heart of a social care response to 2022. Fair treatment, fair resourcing, fair work and fair contracting all together and not apart deliver fair care. 2022 needs to be the year of Fair Care.

Though we are undoubtedly all tired as we stand on the lip of tomorrow I hope we can be awake, alive and strong enough to welcome a new way of being and doing social care, a new morning for a new day, a new start for a new year. As the poet invites us to be open ourselves to the light and brilliance of a new morning:

Morning sunrise.

‘It creeps towards the day

like a teenager

returning home from a night out,

trying not to wake a house

asleep in its dreaming;

but clumsy with the unfamiliar dark

stumbling drunkenly through the door.

 

It slips through the curtain crack

like an inquisitive puppy

sneaking round the corners of a room,

searching for that smell of strange newness;

seeking unexplored place,

sniffing out new danger and adventure.

 

It caresses the sky

like a lover

discovering the joy of being safe,

relishing the moment of a place

where words are not needed;

when touch is enough to share

all that is warm and wanted.

 

It splinters the tired night

like a spring of water

crashing down a summer hillside,

renewing the parched and cracked earth,

gushing into familiar patterns,

with a fresh vigour and cleansing air.

 

Dawn,

unheralded in the midst of

a dark and slumbering night;

creeping into the day,

slipping into the hour.

caressing the moment,

renewing the tired;

 

welcome

and this day

sparkle our sameness with purpose,

lighten our familiarity with newness,

surprise our conformity with revolution,

renew our tiredness with morning light.’

 

Donald Macaskill

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Waiting for hope: a Christmas reflection

I am sitting here in the semi darkness tapping these words into a laptop trying not to wake a house of children and family, a house in waiting. There is something tangible and at yet at the same time tender about the expectation of a Christmas morning. All those days of counting down and growing clamour, all those conversations about possibility caught up and held in the advent time between night and morning. Yet waiting does not come easy – we are so often impatient for the lights to go on and the wonder to start, the glasses to be filled and the food to be served. But waiting does not just enhance the experience it changes it. Taking a moment to recollect, to remember and renew for me at least is an essential pre-requisite for this unique day amongst days.

I sit and wait.

I sit and wait and remember all those years down to the days of my own childhood when in different places with different people I have waited for the dawn to sparkle into cold welcome for this day of birth and celebration. I have always loved Christmas perhaps because in my own childhood it was not always a time of ease or enjoyment as I witnessed my mother struggling to make this a day made different by its fullness and fun rather than one marked by the mundanity of ordinariness and emptiness. So, I know that for many this day will be one of feeling that they have not managed to give to those they love what their heart would have wanted and so along with the smiles and happiness there will be mingled disappointment and upset.

I sit and wait.

I sit and wait and like so many around the country will think of those who are not here this year to sit around a table of tale-telling, to share laughter and fullness. There is something painfully hard about being in the midst of celebration when your heart is fractured and grieving. And in the darkness as I wait I cannot forget all the folks in this last year who I have spoken to and who have been cut off from the love that made them who they were, not just those who have lost loved ones to Covid but all who mourn in these times of detached consolation and distanced comfort. For so many, today is a day of empty remembrance, of a voice not heard, a smile not seen, a touch not felt.

I sit and wait.

I sit and wait and recollect the week that has just passed. The conversations I have had with carers, managers and providers in care home and homecare which have been so emotional and upsetting. People are exhausted into emptiness – they have so little left to give because they have been on the frontline for so long in this Covid battle. The thought of getting up again, walking into a non-man’s land of uncertainty and infectivity, of meeting the onslaught of yet another wave, of not knowing what to expect but fearing the absence of so many colleagues, of yet more tiredness and fatigue, of yet more assault and loss, for so many all this seems just far too much. And I think of the tears shed this last week and the fear that I saw in eyes frozen and empty as they wait for the next few weeks to unfold.

I sit and wait

I sit and wait along with everyone I know who desperately wants the best gift of all, the gift of normality, the predictability of the past, the familiar and the safe to become our life companions once again.  There are so many just weary with headline and comment, with statistics and models, tired of scientists and strategists. We want the spark of optimism and possibility to replace the deadening weight of restriction and retreat.

I sit and wait

I sit and wait but know that authentic waiting can never be passive if it is to bring the dawn rather than deepen the darkness. And so I sit and wait and believe that there is a strength which comes from knowing that as the sun rises on this Christmas morning that it will do so again tomorrow and that the hurt of the moment will give way ultimately to the healing of hope.

I sit and wait

I sit and wait and know that what has brought me and so many to this day and what makes this day special is not the meaning of merchandise but the truth of loving, the comfort of community and the energy of togetherness.

I sit and wait

I sit and wait and hope – but not a hope in fantasy and fairy tale, in faux surprise and mock enjoyment, but a hope grounded in the assurance that what makes the difference every moment of every day is the giving of ourselves to others, the creating of community, the being in solidarity one with the other. I know that in the weeks and days ahead even to their own cost there will be women and men who will find an energy deep in their marrow to continue to give and spend on others the compassion which courses through their veins; that they will be there to hold a hand frozen by the fear of tomorrow because they have lost the touch of today’s memory; that they will be a presence of peace to those who walk into the final path of living with steps faltering and anxious; that they will not be silent in the midst of the noise of fear and anxiety, but will whisper against it by their love and care a word of assurance and hope.

I sit and wait.

I sit and wait and hope – with optimism that the emerging news about Omicron and its severity will indeed work out to be a positivity which will pull us onwards to a spring which witnesses growth and renewal, new beginning and restoration. But at the same time rooting that hope in a reality which appreciates the tremendous pressure care and health systems and workers are currently under and knowing that it is only by collective action and support for necessary cautious protective measures that hope will come to flourishment.

I sit and wait

I sit and wait but know too the truth that waiting must lead to action. Even as we sit still, we are continually in our mind and body preparing for the movement, the next breath, the new beginning. Hope does not just happen it has to be worked for and it must be welcomed in. So, I open the door to hope, so it can sit at my table in Christmas celebration, and fill those present with a belief that this indeed is a day unlike all others. The sounds and smells, the conversations and commitments, all point and call to the day after fear which is the dawning of hope. For me that is the real soul of Christmas that our world can be changed, can be renewed and can become one of possibility through the fragility of vulnerability.

The house is beginning to stir. There is now a different waiting, a waiting for hope and its smell and taste fills the air.

Merry Christmas to you all.

I leave you with the words of the poem ‘Smell’:

the smell of a baby

just newly born,

pure and innocent,

without love forlorn

 

the smell of a promise,

lived to the full,

flowing and vibrant,

the truth of the soul

 

the smell of a day,

crisp to the touch,

of a cold winter’s frost

blanketing life’s hurt

 

the smell of a moment,

when love takes your hand

and breathes a kiss

into the heart of your palm

 

the smell of a flower

opening to the day,

yearning for fullness

with clear open air

 

the smell of the forest,

trees folding in a wood,

groaning in innocence

of naked ancient truth

 

the smell of tomorrow

beyond broken hurt

expectant with vision

of a world restoring hope.

 

Donald Macaskill

 

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The hospitality of welcome: the benefits of migration.

The BBC programme ‘Who Do You Think You Are?’ is one of my all-time personal favourites. For those of you who do not know it – it is a TV series now into its 18th season which in each episode shows a celebrity tracing their family tree. Who would have thought genealogy would have become such a hit? Indeed, away back in the first series the last ten minutes of each episode featured a genealogical researcher giving tips on tracing a family tree. I’ve always been fascinated by my family history not least as my late great aunt traced our family back for generations when she was in her nineties well before the era of internet search. The fascination is not because I think there are great swashbuckling heroes, princes or bishops to discover – very much a Scottish crofting family for generations – but because a sense of who you are and where you have come from has, for me at least, been a critical part of self-identity.

My interest in genealogy has also increased in me the awareness that countless generations of my family have been people who – largely because of poverty – have had to uproot themselves from the familiar, have had to leave the known and with real courage and self-sacrifice have had to move and start a new life in a new place amongst strangers. I am unashamedly the child of generations of migrants. And if you look at the demography of Scotland so are most of us – it’s just that in our increasingly static and settled lives we have lost the memory chord to our migrant past.

Why is this important? Well in one sense I am reflecting on migration because today is United Nations Migrants Day. It is a day whose theme this year is about ‘harnessing the potential of human mobility’ which highlights for us all the astonishing number of people who are migrants across the world, but more important than the numbers is the amazing contribution that migrants make to the societies in which they settle. It is hard to fathom that in 2020 – a year of real chaos and turmoil – that around 281 million people were designated as international migrants – nearly 3.6 per cent of the global population.

In the last year I have spoken at many virtual events and in meetings about the contribution and added value which folks who have come to Scotland to work in social care have brought to our sector and most importantly to our communities. They have brought knowledge and skills, insights and creativity, innovation and compassion. They have enriched our care and brought quality to our organisations.

But being a migrant has never been and is not easy. It requires a strength of character and resolve which few of us can show; it necessitates a flexibility and openness, a willingness to be changed and challenged.

Alongside these meetings I have taken part in numerous discussions with politicians and ministers, activists and campaigners around the effect that the new United Kingdom Government immigration restrictions have been having on social care over the last year. I wrote in a previous blog around this a couple of months ago. Sadly, with the arrival of Omicron the glaring gaps in our workforce capability and resilience are being shown for what they are. The post-Brexit immigration policy has a lot to answer for but part of that is the critical shortage of staff in social care which has seriously weakened the sector’s ability to meet the challenges of Omicron. It is not an exaggeration to say that the policies of the United Kingdom Government especially initiated during a global pandemic have seriously endangered lives and made us less likely to keep people safe.

In the light of all that reality it was therefore really positive to read this week of the recommendations of the UK Government’s own specialist Advisory team, the Migration Advisory Committee. In an extensive report published on Wednesday they are recommending to the Home Office that there are urgent changes made to the new immigration system to meet the needs of the social care sector. The Committee stated:

“Given the severe and increasing difficulties faced by the care sector, the report brings forward preliminary findings on adult social care. The MAC recommends the government make care workers immediately eligible for the health and care worker visa and place the occupation on the shortage occupation list.”

This is what we have been calling for throughout the last year. The experts have heard the pleas to support a care sector not least in Scotland which needs to continually attract new people into the care sector. And lest anyone retort this will pull wages down – there is absolutely no evidence of this in recent times in Scotland where frontline care salaries continue to rise.

Now we can only wait to see if political leaders at Westminster will accept data and fact before rhetoric and mantra. I earnestly hope the Home Secretary will accept the expert advice of her own Committee, if she fails to then 2022 will continue to see the decline of our communities and a reduction in our ability to deliver basic social care to meet citizen needs. The actions of the UK Government have already endangered the care sector they now have the ability and evidence to make change or continue to cause harm.

So as the nights start to draw in towards December 21st I hope as we turn into lengthening days of light in the next few weeks that we will see a light of realisation dawning in the Home Office. I hope we can begin to see and hear in that place less of the toxic intolerance of the migrant and more of the true character of Scotland and its people, of openness and welcome, valuing and affirmation. Migrants are a gift to our communities, and I say that as the son of the son of the son of the son of the son… of a migrant, and as each hand touches the next in an embrace of hands back into the mists of time … that is a family tree which really does tell me ‘Who I think I am’.

And on a day thinking of all who are migrants I’ll close with the beautiful poetry of Lory Bedikian. It is timeless in its rhythm of migrant truth and landless in the horizon of its insight.

Prayer for My Immigrant Relatives

While they wait in long lines, legs shifting,
fingers growing tired of holding handrails,
pages of paperwork, give them patience.
Help them to recall the cobalt Mediterranean
or the green valleys full of vineyards and sheep.
When peoples’ words resemble the buzz
of beehives, help them to hear the music
of home, sung from balconies overflowing
with woven rugs and bundled vegetables.
At night, when the worry beads are held
in one palm and a cigarette lit in the other,
give them the memory of their first step
onto solid land, after much ocean, air and clouds,
remind them of the phone call back home saying,
We arrived. Yes, thank God we made it, we are here.

Copyright © 2011 Lory Bedikian. This poem originally appeared in The Book of Lamenting (Anhinga Press, 2011) and is taken from https://poets.org/poem/prayer-my-immigrant-relatives .

Donald Macaskill

 

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Covid and the Selfish Gene: a reflection.

I have been spending a lot of time chatting to people in the last week, both virtually and in person. As I have travelled and met folks, held discussions and meetings, I have been aware of the conflicting emotions which have been evident in what – even in these times – has felt like an exceptional week.

It is a week which has witnessed a growing anger at what may or may not have happened in Christmas parties at 10 Downing Street. I am not going to comment on the politics of all this but having spoken to so many around the issue of bereavement and grief in the past week I do find it appalling that at a time when so many were unable to be with their loved ones, to say goodbye to a mum, dad or husband or wife in the latter stages of their life, when so many of us were experiencing Christmas at a distance from love and belonging, that some people thought it appropriate to party and ‘allegedly’ break the rules.

Alongside this we have witnessed England moving into Plan B in its Covid response but even this serious action which evidenced growing concern about the Omicron strain has been diminished by politicians complaining about loss of ‘freedom’ and the suggestion that we should learn to ‘live with the virus’ which is deemed as equivalent to doing nothing so as to protect various sectors of the economy – all against a backdrop of an increasingly partisan response which has shouted down the clinical and epidemiological arguments.

As I have travelled I have heard comment which suggests that society is over-reacting to Omicron and what is claimed to be a ‘mild-infection’; I have witnessed far too many people choosing deliberately to not wear a mask on public transport or to wear it in a manner which is purposeless.

Then towards the end of the week in Scotland yesterday we had a series of stark warnings from our First Minister and letters sent to the care sector requiring staff to increase their testing in order to protect both those resident in care homes and in the community. It feels for many like an anxious and worrying time. Regardless of the fear and exhaustion which is wholly justifiable it is important to underline that we all of us need to ensure that the access for family and friends to residents in care homes over the next weeks is as normal as possible whilst at the same time keeping people safe from such an infectious variant of the virus. It will be a balance that requires compassion and care, openness, and good communication.

There have been so many other things which have happened in the last week and some of it has evidenced the best of us and some of it certainly the worst of our humanity. I mean what is happening in our society when we have even reached the stage that yesterday (Friday) in response to an inept briefing from Downing Street which suggested that if you sing you do not need to wear a mask, that we have folks trying to enter some major supermarkets arguing that if they sing they are exempt from mask compliance? Stupid certainly and dangerous given the deadly seriousness of the times and indicative of what I would term a growing health narcissism and selfishness in response to Covid19.

Tomorrow is the UN Day which focusses on international and universal health coverage. To be honest it is a day which would normally pass me by but this year it has a somewhat chilling resonance as we face the threat of Omicron. Nearly a decade ago the United Nations General Assembly endorsed a resolution urging countries to accelerate progress toward universal health coverage (UHC) – the idea that everyone, everywhere should have access to quality, affordable health care – as an essential priority for international development. Tomorrow is about raising awareness of the need for strong and resilient health systems across the world.

The failure of the international community in the last year to meet the vaccination needs of developing countries is shameful. Despite much vaunted promises to donate 100 million vaccines to other countries the UK Government has donated only about a tenth of that total. The practical implications of failing to act in solidarity with the world is that new strains of the virus are enabled to develop and eventually come to threaten our own shores and communities. Omicron is the fruit of our failure to ensure that every person benefits from the human right to health and to make sure that no one’s health needs during a pandemic are unmet.

The Covid pandemic has drawn in the world around our table and hearth. We must develop a sense of awareness that pandemic planning is not just about looking after ourselves but recognising the global inter-connectiveness of our lives. Focussing on developing resilience locally and nationally should never be at the price of a withdrawal from international collaboration and cooperation. To do so is naïve and dangerous – we are all in this together. Looking after yourself alone, a health nationalism or narcissism is inherently dangerous and selfish.

When the ethnologist Richard Dawkins wrote ‘The Selfish Gene’ in 1976 he coined a phrase which would not only be influential in genetics but in wider society, not least when he introduced us to the idea of the ‘meme’. I am going nowhere near the technical and scientific debate around his arguments, but it is interesting the extent to which he sparked a debate and whole host of study about the nature of human selfishness. Are we hard wired for survival, to reproduce only those genes that aid our existence, and what is the nature of the ‘selfishness’ that can both preserve and damage living?

I have been reflecting about selfishness a lot this week not least as I have heard some horrendous personal accounts of what life has been like for so many during the pandemic. Are we a selfish society or do we care about others? Certainly, there was a sense at the start of the pandemic of collective solidarity and mutual support. As I sat on trains witnessing individuals who vocalised a refusal to wear a mask with the pride of narcissistic arrogance; as I watched arguments which suggested that the price of older people dying was worth paying for the ‘strong’ to get on with living; as I heard the syrupy justifications of political moral emptiness defend an unwillingness to take hard decisions – the concept of selfishness, of the cult of the self against all others, seemed to dominate my mind.

The next few weeks are clearly going to be immensely challenging. If we are to overcome them then collective compassion in a community which upholds one another strikes me as the only route out of the chaos of selfishness. Commentators are already warning that the public health message is being lost as people seek to restore themselves to the normality of pursuing personal priority. But surely that should encourage all of us, perhaps especially those of us who work in health and care, to point to a deeper truth of what human relatedness is and should be? That putting your ‘self’ second is not a genetic deficit but a humanitarian priority. And that perhaps all this involves us in adopting not a passive acceptance of the negative actions of others but a need to challenge them. In my journeyings in the past week I have witnessed what seem almost to be a desire to be defiant, to be protective of self and personal benefit, rather than an acknowledgement of any desire to protect others. Any society built on reciprocal co-responsibility needs to challenge and call out such behaviours rather than let them slide into acceptance.

I think too often we dance around the edge of politeness when what we need to do is call out inherent selfishness – a defensiveness of self which has become more and more dominant in society during these Covid times.

You probably know the poem of the Persian 14th century mystic Hafiz which although short and simple I think captures what the essence of selflessness is – it is such a selflessness and not a health or personal narcissism , which we need today in great measure to fight a virus that has and is claiming too many, destroying so much, and making far too many consider their self alone as worthy of attention:

The Sun Never Says

Even
After
All this time
The sun never says to the earth

“You owe me.”

Look
What happens
With a love like that,
It lights
The whole sky.

 

Donald Macaskill

 

 

 

 

 

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Supporting grief as a human right: an invitation to explore

These last four days I’ve taken some time off and as illustrative of what I am told is an inability to sit still I have been doing some badly needed tidying and catch-up jobs. As part of this I came across my daughter’s Child Record. As well as an exercise in reminiscence which every parent indulges in from time to time it reminded me of all the focus that I and others put into those critical first months and years of life. From pre-birth classes to birth planning to the nth degree, from health visitor visits and the excellent Baby Box there is so much attention, resource and focus on making sure that our wee ones enter their life as they should. That brought to mind a remark someone made to me about if only we could put the same degree of attention, resource and focus on the way we end our living and on the way we support those who are experiencing loss and bereavement.

The week from the 2nd to the 8th December is the annual National Grief Awareness Week. This is run under the auspices of the Good Grief organisation which is itself a body representing 800 bereavement support organisations. It’s aims are clear and include normalising grief so that we challenge the taboo around dying and getting the public to talk so that it’s easier to support those who are living with grief as part of their life. The week also highlights the need to end the postcode lottery of bereavement support and to focus upon the necessity for tailored support when it is required.

I’ll be taking part in Grief Awareness week by chairing a session for the UK Commission on Bereavement. I’ve mentioned the work of the Commission before and I’d encourage anyone reading this to take part in their survey and to share your thoughts if you have been bereaved in the last few years. See https://bereavementcommission.org.uk

A couple of days after the end of Grief Awareness week is the annual United Nations Human Rights Day on the 10th December.

Human rights have I believe a lot to contribute to the nature of bereavement support in Scotland.

In most instances however if you Google the connection then you will come up with comment and articles covering the importance of those who are bereaved being treated equitably. This has been the focus of an important legal case last year on ensuring cohabitees have protected legal rights.

But I think human rights have a lot more to contribute to bereavement support. Indeed, it is such a belief that led myself and others to become involved in the creation and promotion of A Bereavement Charter for Children and Adults in Scotland. The Charter is human rights based and explores what it means to support someone through their grieving.

So why human rights and grief? Well, I would reflect back on my earlier comments – put simply because the way we support those who grieve is as important as the way we support a child and new life into our world. If being born enshrines our human rights, then dying and bereavement do also.

Human rights are there in law and practice because they describe to us the way we should relate to one another and what a society that enshrines dignity as intrinsic to human identity should look like.

In technical terms we have within the International Covenant on Economic, Social and Cultural Rights the ‘right to health’. I have argued elsewhere that this right needs to be broadly interpreted both to encapsulate a right to social care and a right to palliative care. The ground for that reasoning is that the right to health is not solely a right to psychological health but that it has a holistic dimension including the right to psychological, emotional and mental integrity.

It is a fundamental part of personal identity and living in community with others that we all of us experience the death of those who are important to us at some stage or other should we live any length of years. The inter-relationship of human existence means that we all grieve. Grief is wrapped up in the bonds of connection we make and is the fruit of the depth of our loving.

Grief is always an individual journey but the taking of the steps towards a re-orientation of your life in the absence of the departed can for some become challenging beyond their own capacity and beyond their strength to achieve alone and without support. For most of us if we get stuck on our walk of grief others who know us will manage to lift us up, support us and put us on the right direction. But not for all. That is when professional and sometimes specialist bereavement support becomes necessary.

We have, I would contend, to see such as a human right for bereavement support as a core element of the right to health and indeed within other rights such as Article 8 of the European Convention of Human Rights and its emphasis on psychological integrity and family life. There are many more human rights which are engaged in the realisation of a human right for bereavement support. We should also see the requirement to provide such bereavement support as a duty indeed obligation upon the State and its actors. Bereavement support as a human right should be an intrinsic part of our ability to realise all our other human rights because it is for some an essential enabler of their ability to maintain psychological and physical health, to remain connected to others, to articulate their needs and requirements and so much more.

Scotland is on the point of seeking to incorporate the International Covenant into domestic law and a lot of work has been undertaken in this regard. I hope our legislators use this as an opportunity to encapsulate and enshrine the priority we should all give as a modern, progressive society top supporting those who need support in their grieving and bereavement. The extent to which we enable people to live through grief, the degree to which we are prepared to accompany our fellow citizens who require support is a mark of the humaneness of our society. I hope this Human Rights Day Scotland can begin to become first nation to start that process. If nothing else, we should start a serious debate on the extent to which supporting adequate bereavement support is a human right and all that that may mean.

Grieving is the letting go which takes part of our heart in the freeing; we should not only prepare for the parting, plan for the journey, but be supported if we need direction for our walking from where we lose the warmth of touch and the familiar, and as we learn to live and to love in a different way. The amazing American poet Mary Oliver says it all.

 

Look, the trees

are turning

their own bodies

into pillars

 

of light,

are giving off the rich

fragrance of cinnamon

and fulfillment,

 

the long tapers

of cattails

are bursting and floating away over

the blue shoulders

 

of the ponds,

and every pond,

no matter what its

name is, is

 

nameless now.

Every year

everything

I have ever learned

 

in my lifetime

leads back to this: the fires

and the black river of loss

whose other side

 

is salvation,

whose meaning

none of us will ever know.

To live in this world

 

you must be able

to do three things:

to love what is mortal;

to hold it

 

against your bones knowing

your own life depends on it;

and, when the time comes to let it

go,

to let it go.

 

Mary Oliver

In Blackwater Woods

http://www.phys.unm.edu/~tw/fas/yits/archive/oliver_inblackwaterwoods.html

 

Donald Macaskill

 

 

 

Posted on

The best leaders dream: a reflection

Leadership has been much in the news this past week perhaps not surprisingly because it has been International Leadership Week up until yesterday. There’s also been a bit of a debate about the Peppa Pig approach to political leadership!

I’m always somewhat reticent in writing or talking about leadership in part because there is such an industry built around it that I don’t want to be responsible for adding to. I haven’t had much choice but to reflect on the issues this week as along with others I was taking part in a Project Lift workshop on Thursday and have also been interviewed this week by a research project exploring leadership in social care.

At the workshop I shared two reflections on what leadership means for me.

The first is one I’ve written about in this blog before and relates to my time many years ago as a student on a maternity ward. It was there that I sensed a model of leadership which was distinctive and insightful, natural and humane. Maieutic leadership is one where the leader enables the other person or team to identify what needs to be achieved and provides the support and resource to enable them to achieve their outcome or objective. A midwife does not do the work of birthing but is there to support, to guide, to encourage, to address and answer fears and concerns. She is the bridge of birth that a mother must walk across but at her own pace and in her own way.

I also reflected on another leadership insight. Years ago, I spent some time in Crete and experienced quite a few community and cultural celebrations. What struck me about the many processions I saw weave their way through the village with an almost weekly occurrence was the fact that the leaders of the parade walked not at the front nor back but in the middle – amongst and within those who made up the community.

They also significantly didn’t just look backwards and forwards but continually were looking outwards to ensure all were walking and included because the destination could not be reached unless all were arriving. They were there to watch out for those who might struggle to have their voice heard, to be noticed or have their contribution valued. Inclusion was everything to them because without all the community could not be whole.

The topic of leadership is of course not just of theoretical importance but is of huge practical importance especially as any system or organisation seeks to reform and change itself. I believe leadership by example has to be focussed around what it means to be authentic, relational, vulnerable and dynamic. These four characteristics enable personal psychological integrity and wellbeing and should, I believe, form the core characteristics of any and all who seek to lead others regardless of context or situation. Such an approach has, I would suggest, much to teach those of us who work in health and social care.

For me leadership has first and foremost to be relational. You cannot hope to be successful in managing people and in leadership unless you are able to relate to others. Leaders do not sit in a room (especially behind a closed door) detached from the reality of experience, the necessity of relating, and the invitation to encounter others. But relationships in leading and managing are not always easy, not least because in so many professions we have become obsessed with ‘boundaries’ and distance. Relationship formation especially with those who are different from us is challenging and the danger of not focussing on its importance and priority is that organisations can develop to look like their leader which is rarely creative or positive. As in all of life leadership relationships require effort and work – they do not just happen – they require all to be open to the other, to adjust and be prepared for the novel and change, contradiction and surprise, they require us to walk alongside one another, rather than to expect similitude and compliance. Relationship is frequently about risk and leadership is often about adventure.

A core enabler of positive work or organisational leadership is the ability of everyone to develop, nurture and foster the gifts of listening and strong affective communication skills. In my experience when things become challenging or when resistance intensifies there is often in the midst of that situation someone who feels unheard, undervalued and unrecognised. The best leaders are those who are open to hearing what they might not want or expect to hear and recognise the necessity of creating space for people not just to talk and share but to be heard.

A second characteristic which is important for me is that leadership has to be authentic. Again, I have written before about how important it is that people are able to recognise someone who walks the talk in their leaders. But authenticity, that sense of being ‘hand-made’, genuine, transparent, and real, is something which allows space for contradictory unpredictability. At its best authenticity is allowing you to be the person you really are and being authentic helps you discover the person you want to be. Being authentic is not about playing at a role, it is living life as much as possible without wearing the mask of pretence. It is really costly to be authentic in a world which demands predictability and constancy – for being human is rarely a linear walk – for me – it is as much about the hills and valleys as the calm and settled plains.

Part of being authentic is my third characteristic of leadership. Being able to embrace your vulnerability is so important. I do not mean that we need to go around carrying a box of Kleenex with a faux emotionalism. What I mean is that we have to discover the strength to be open to challenge and change, open to being able to relate at a deeply affective level where we are willing and enabled to share the questions we have, the doubts we possess and the dreams we are still nurturing. We live in a society which too often denotes strength and ability with some ideal image of wholeness, whereas in my experience being able to show your woundedness, your limitation of knowledge and the unfinishedness of your ideas, gives space for others to flourish and be more fully themselves in relation to you and the world around them. Vulnerability is not a personal weakness it is the deepest strength of authentic being in relationship with others especially as a leader.

And lastly there has to be a recognition of dynamic in our leadership – life continually changes, and relationships alter always – a good leader or manager is open to the dynamics of change, constantly re-orientating and learning but solid in the predictability of being open, honest, straight, and transparent; enabling of others, allowing others to achieve their potential rather than being self-interested or self-serving. We should not be afraid that the person we are today is different from who we were yesterday, a year ago, a decade ago. This is why for me the best leaders rarely see themselves as leaders because they are still striving to improve, to discover better gifts of authenticity, and to dig deeper into their humanity.

It is why dreaming, and vision-capturing are so critical for the leadership of any organisation or system. My old grandmother used to say that dreams are wasted on the night. The best dreamers change their day and I think the best leaders are dreamers. These dreams are not the stuff of cloud cuckoo land, but the dreams which are cabled and grounded in the earth of experience, in the reality of revolution, as we continually seek to turn our communities into places of compassion, dignity, humanity and equality. Every single person has the capacity to dream in their day so that it changes their tomorrow, and the most gifted leaders enable you to dream your dreams.

The American poet and novelist Langston Hughes was part of the so-called Harlem Renaissance, and in his work, he brought to the fore black life in America from the twenties through to the sixties. One of his best-known short poems says it all for me about what leaders need to do to relate, be authentic, show vulnerability and thrive through change, they need to hold fast to dreams:

Dreams:

Hold fast to dreams

For if dreams die

Life is a broken-winged bird

That cannot fly.

 

Hold fast to dreams

For when dreams go

Life is a barren field

Frozen with snow.

 

Donald Macaskill