Posted on

Blog: Madonna as a champion of age

Our CEO Dr Donald Macaskill was pleased to take part in Scotland’s first Festival of Age which was held in Glasgow on Thursday 23rd May.

Before the event he wrote the following blog to challenge some of the stereotypes and negative attitudes which still exist around age. Madonna – The champion of age.  Over the years the controversial singer Madonna has spoken about the flak that she had to take because of “using sexuality as part of my creativity” and with being labelled a “sexual provocateur” amongst the politest of critiques. She is now facing a new battle and in an interview in British Voguepublished on 10th May has argued that she is now fighting ageism in the music industry and that she is “being punished” for hitting 60. She told Voguemagazine: “People have always been trying to silence me for one reason or another, whether it’s that I’m not pretty enough, I don’t sing well enough, I’m not talented enough, I’m not married enough, and now it’s that I’m not young enough. All too many people will share Madonna’s angst about ageism and I for one look forward to her battling against it. Ageism is so endemic that it has become part and parcel of the wallpaper of our realities – so subtle, so pervasive that it is not even noticed; it is just accepted as a given, as a state of unalterable being. It’s almost the same position that racism was in the 1950s and early 1960s – so unconsciously accepted as a social norm in the UK that it went unnoticed – except by its victims. It is in the language we use, the stereotypes we accept, the rhetoric we hear. What do a ticking time bomb, a silver tsunami and a population apocalypse all have in common? No, they aren’t the latest plotline from an episode of Line of Dutybut rather they are phrases used to describe the fact that we are living longer. They are highly negative descriptions of a reality that most of us would or should want to celebrate – we are dying older and healthier than at any time in Scottish history. So why the negativity? Why is it that so much of our cultural and political discourse about old age paints such a dark and depressing picture of decline? Old age is something which should be valued, but alarmist attitudes fail to recognise the benefits and potential of older age and feed into the myth that getting old is about losing something rather than gaining something new and potentially positive. Old age is seen as a challenge rather than an opportunity. Everywhere you look there are negative stereotypes which perpetuate the myth that older people are incapable and dependent, have nothing to contribute but rather are a burden and a drain on society. We see this in many of the current debates about social care and health which count up the costs an ageing population results in but fail to recognise that over 90% of care delivered in this country comes from the hands of people who are themselves old thus saving the taxpayer countless millions. In Scotland I am sure we would like to believe that we treat all peoples as equal, regardless of colour, creed, disability, sexual orientation and we have indeed made great strides in addressing discrimination and hate. But have we made the same progress against negative stereotyping and discrimination which is based on age? I think not – why is it that a child in receipt of residential care will have nearly double the amount of public resource allocated to their care than an older person of 90 in a care home? Why is it that countless individuals talk about not even getting the chance of an interview if they are over 60 and are seeking employment? Why is it that at the age of 65 people who are accessing social care support move from being an adult onto being an ‘older person’ and in some areas such as mental health services they tell us they suddenly find the level of their support diminishes? Do we feel it is adequate that for thousands of older people seeking social care support that you can only now be eligible if your need is ‘critical’, that our social care services are critically under-funded? We need to take off the heather-tinted glasses and face up to the reality that Scotland is as ageist a nation as many others in the world but rather than just recognise this we need to act . Yes, the Scottish Government has just published a great summative strategy, but … Scotland has a real opportunity to do things much better. Embedding human rights at the heart of economic, social and political systems is a start. However, regardless of good policy intention and political priorities unless we address the pervasive cult of youth in our society, we will continue to acquiesce with ageist discrimination. So, with Madonna I will continue to fight against the ageist discrimination that fails to value contribution, for me that means fighting for Scotland to have an Older People’s Commissioner and for a Convention of the Rights of Age. What does it mean for you? How can we together create a country which is the best place in which to grow old and in which value and contribution is recognised regardless of chronology?   In the words of Madonna:

“I have a dream But dreams are not for free We all need to change Or just repeat history.”

Dr Donald Macaskill CEO, Scottish Care

Posted on

Latest blog from our CEO – Redressing the balance: the potential of homecare

In just over a week Scottish Care will be hosting our annual Care at Home Conference, Exhibition and Awards. It is shaping up to be a great day of debate, a very full exhibition and a real opportunity to celebrate the best of homecare across Scotland in the evening. The title of the event as a whole is ‘Redressing the balance: the potential of homecare.’ To some extent it is a bit disquieting and disappointing that we are still talking about re-dressing the balance of care in Scotland. After all we have had a policy direction of enabling independent living and support in our communities and homely settings for over two decades – and yet we are still talking about re-dressing the balance from acute to community, from health and clinical dominated concepts to social care practice, from time and task commissioning to relationship, trust-based approaches. To redress the balance means to achieve ‘an even distribution of weight to ensure equilibrium within a system.’ It is that care equilibrium that is significantly missing from our current approaches to health and social care in Scotland. That’s what we are after in social care – namely the gain of truly integrated services and supports which we are meant to achieve. At the heart of the debate and all the policy and political priorities in terms of re-dressing the balance is the need to move the focus from reactive response to need on to one which is truly preventative in nature. This is the massive and largely untapped potential of homecare within the whole health and social care system and economy. For what we are seeing in practice on the ground across Scotland is yet more sophisticated approaches to reacting after the horse has bolted. Our eligibility criteria which determine the level at which social care supports and services can be accessed have now reached critical in most parts of the country; and resources for innovation and new models of care are depleted and drained as we seek to keep the ship of care from grounding on the rocks of reality. As a sector with some of the best independent care and support, providers and frontline workers alike are straining under the stress of ever-growing demands being met from ever-tightening funding. It is the care economics of insanity not to recognise that we need to prevent people from accessing the expensive and unhealthy acute system in the first place rather than to seek to respond to their needs once they have been in it. Let us stop people from going to hospital after their latest bout of mental distress and illness; let us prevent unplanned admissions as a result of an unnecessary fall or incident; let us ensure that malnutrition and poor diet, unaddressed lifestyle factors and loneliness are not the vehicles for the inevitable journey into the acute system. But to achieve all that we have to change not just the rhetoric but the reality to properly resource our social care sector in order to enable real prevention to happen. It is not rocket science so why decades after policy initiatives are we still talking and not doing? There is a real opportunity for us to be brave and dynamic, innovative and creative in working together at local level, commissioners, planners and providers in developing models of preventative care which are up to the mark. We can do so much better than we are at present in developing models and approaches which prevent an individual from either early or unnecessary access to enhanced care, hospitalisation or sharper personal physical decline and deterioration. We can do so much better in working together to re-balance care so that we focus on approaches which enable independent living for a longer period of time and which focus on maintaining a higher quality of life and wellbeing. Our obsessive functionalist approach to social care is not only degrading and demeaning of worker and recipient alike, it is a public health hazard and threat. Let us work together to re-balance care by achieving the potential of care at home and housing support, by maximising autonomy and control. Join us on 17th May and get involved in the debate! Dr Donald Macaskill, CEO Scottish Care @DrDMacaskill

Posted on

Latest Scottish Care blog: National Director, Karen Hedge

Putting human rights into the commissioning cycle

  This has been a period of uncertainty and deadlines. It seems every other headline covers Brexit, but for the care sector there is a real and significant effect of negotiation at various levels. When 19 care homes closed last year, and 9 out of 10 of our care at home providers told us that they may not survive until the end of the financial year, it confirmed that we are in worrying times indeed. The Freedom of Information request by Robert Kilgour on the cost of statutory care home provision highlighted that the cost for the Local Authority to run a care home is double that of what they pay the independent sector. We know that for care at home providers the proportionality is similar. But it is not simply about cost. The care sector is exactly that, a sector which cares. Choice and control is critical to the Self Directed Support Act and the independent care sector is sufficiently diverse to meet that; made up of charitable, voluntary and private providers; and they range from small, single, family-owned businesses through to large corporates. It is a vibrant sector, grounded in Human Rights and the National Health and Social Care Standards which enable person-led care and support in a flexible way. We know this from our conferences and awards ceremonies; held to facilitate innovation at the forefront of the sector, and to celebrate the dedicated but often overlooked staff with whom it is an honour to work. I am fortunate to have had a varied career in health and social care and have experienced the sector from many different perspectives. The intent of the system is to have the person at the centre, yet, there are glaring gaps and confusion. All too often commissioning (the delicate balance of facilitation and planning to ensure the right services are provided at the right time) is confused with procurement (the purchasing of services). With only one major purchaser – integrated authorities, the concept of competition in the sector is a false one, and the push to drive down costs has led to a focus on the wrong things. We measure the amount of time that we spend with a person, not what difference we made for that person during that time. This competition also limits opportunity for the collaboration needed to maximise the full potential of the sector and is worsened by the tendency to consider only one part of the system and not the totality as intended by the Public Bodies (Joint Working) Act on integration. Back when I was a Local Authority commissioner, the Commissioning Cycle was my guide as remains true for commissioners today; Plan, Do, Analyse, Review (repeat). But I came into that role with the experience of having been a carer, social worker, researcher and citizen. I knew that bringing those components and more to the table would change the nature of the process. So we changed the make up of the Board. It was, I now realise ‘integrated’; it consisted of 50% citizens and 50% professionals comprising of health, social care, commissioners, providers and procurement managers. This was over 10 years ago now and at the time it was not considered revolutionary, it was merely a step on the road to getting it right. Together, we could map a realistic picture of a complicated landscape, and create the conditions to share resources, maximising the potential of the totality of our assets, but most importantly, we could sense check this approach with those who matter. It took time and courage, but we created a safe space to try out new ideas, quickly focussing on successes, continually improving as we went, always coming back to the person. It is this realistic and person focussed embracement of the commissioning process which meant that the changes we made were meaningful and had impact; increasing the number of people who could access care and support by 110% at no extra cost, and with every one of them saying that the service had made a positive difference to them. The current frustrating focus on measuring outputs limits our possibilities, as do the invisible and enduring barriers of silo-working. But change takes bravery. We had to put in systems to support those involved in decision making to enable them to equally and fully participate in the process. At Scottish Care we do something similar for the independent sector through our Branch structure and Partners for Integration Team, representing our members, creating trusting relationships with our partners to enable collaboration. We have some great examples where working together has led to people getting the right support in the right place at the right time; implementing an enablement approach, supporting people to move back into the community, reducing falls and pressure ulcers to prevent admission to hospital, and targeting medicine waste to make tens of thousands of pounds worth of savings per month in just one area of Scotland. For all of these to work, they had to be approached with courage, and from the perspective of the person accessing care and support. Without this they would have failed. Planning and Review is all good and well, but what is clear in the current landscape of diminished budgets and increased need is that that we need to change our approach across Scotland. It is time to put human rights into the Commissioning Cycle.   Karen Hedge National Director, Scottish Care @hegeit  

Posted on

Latest blog from our CEO: Towards an age-valued Scotland

On Wednesday 3rd April the Scottish Government published ‘A Fairer Scotland for Older People: framework for action.’ Over a year after the creation of the first ever ministerial portfolio for Older People, the document is an important contribution to addressing the challenges facing Scotland’s older population. Sadly, despite what I would consider to be an excellent starting point this Framework report has received only a minimum amount of media coverage. You could say, of course, that Brexit and its shambles dominates the media. However, even without Brexit the absence of any significant media comment is perhaps itself illustrative of the challenges in addressing age apathy within our contemporary society. The Framework is a starting point. In her Ministerial Foreword Christina McKelvie MSP states that: ‘I am also aware that older people can be marginalised. Maybe that is because we fear ageing and the impacts it can have on our lives through deteriorating health or because, quite simply, ageing is something most of us don’t want to think about. ‘It is time to remove barriers, tackle inequalities and allow people to flourish and be themselves. That is why I am publishing this framework. It affirms our responsibility to ensuring equality for everyone as they age and outlines the clear steps, we will take to deliver improvement.’ She goes on to state: ‘Importantly, the framework provides a platform from which we can reframe our thinking about older people, to move from what can be a negative, problem-focused perspective to a positive and cohesive recognition of older people as a vital part of Scotland’s potential for success and improvement in the 21st century. ‘We recognise that change will not occur overnight and will require years of sustained effort and a change in thinking…Scotland’s older people today and those older people of tomorrow are depending on us to deliver.’ I would encourage you to read the document as it brings together in one place actions and priorities around older age and also indicates areas where there needs to be more work and where we need to start addressing the barriers that prevent older people from becoming full citizens. So why is this important? Well on a simple level – if we are to create a fair society then that society needs to be inclusive of all and enabling of all citizens to achieve to their fullest potential. Sadly, this is not always the case for older people especially given the definition of older person in the framework as anyone from age 50. There are too many cases of age discrimination whether that be in the workplace or in accessing services and resources. Scotland has an ageing population, and this is surely something to celebrate although all too often it is the subject of negativity or simple stereotype. The population is ageing at a faster rate in Scotland than the rest of the UK. Median age (the age at which half the population is older and half younger) in Scotland is 42.0 years from the mid-2017 population estimates, around two years higher than in the UK as a whole and is projected to rise to 45.4 years by 2041, compared to 43.5 years for the UK. There is also considerable geographical variation in the ageing of the population within Scotland. In general, it is lowest in the cities and higher in more rural areas. Between 2016 and 2026, all council areas in Scotland are projected to experience an increase in their population aged 75 and over. Clackmannanshire (+48.0%) and West Lothian (+46.0%) are projected to experience the largest increases, while Dundee City (+9.6%) and Glasgow City (+2.9%) have the smallest increases. Therefore we have a particular challenge in Scotland but that also gives us a real opportunity to ensure that Scotland is ‘the best place in the world to grow older.’ Age matters to all of us and most especially to those organisations who work in the care and support of older people in Scotland. Indeed, the Framework addresses some of the very real issues which the social care sector is currently facing in contemporary Scotland. It highlights the importance of social care in enabling older people to remain parts of their community, and to be active and contributing citizens. It addresses some of the challenges in ensuring that a career in care is viewed as a positive choice and that the standards and quality of care and support continue to improve. It requires the voice of older Scots to be at the heart of the decisions around the reform and future of social care and health. Yet the Framework also shows the distance we have to go. It challenges the discriminatory behaviours and attitudes which treat older age persons as less than those of other ages. It calls out behaviours which dismiss the contribution of those whose communication is changing and those who face frailty and ill health. Scottish Care has long argued that there is a profound discrimination at the heart of the way in which older people are treated within society. At a simple level discrimination is when one treats another on whatever basis in a less favourable manner than you would treat someone else. That discrimination happens to older Scots far too often up and down Scotland every day of the week. It is often so subtle and unconscious that it is almost impossible to recognise or name – but discrimination it is nevertheless. The Framework is an excellent starting point in the journey towards achieving the ability of older people in Scotland to exercise and enjoy their full rights and entitlements as citizens. It is a summative work describing existing commitments and future aspirations. The challenge is to ensure that it does not simply remain a summary of good intention but becomes the description of action-led response. There are still today too many instances in the social care of older persons where we are daily witnessing systemic discrimination in Scotland. Why are so few older people in Scotland actively and fully participating in the range of choices which are offered under the Self-directed Support Act? Why do I still hear social work assessors say ‘SDS is not for older people’? Why are there so few of the 33,000 people whose home is a care home who have been given an outcomes focussed assessment to determine their needs and wishes, who have been allocated a personal budget and given real choice rather than the fiction they are offered, all of which is their entitlement under the SDS Act? In terms of revenue and resource why does the social care sector have to fight a continual battle to maintain already inadequate resource allocation for vital services and supports? Despite being a major contributor to the Scottish economy why does the social care of older people in Scotland continually get described as a cost and a drain on our society? Why do those who live with dementia effectively pay twice for that care and support whereas those with other conditions do not? There are many instances where we have some distance to go to create a fair Scotland where everyone is enabled to exercise their human rights regardless of age. The Framework makes a helpful start. I for one – not least as I am well into the decade of older age – want to ensure we support its actions and its aspirations. It is up to each one of us to work with some speed to creating that Fairer Scotland which values age.   Dr Donald Macaskill CEO, Scottish Care

Posted on

Compassion – Guest blog from the Care Inspectorate

I am part of a group of people in the Care Inspectorate and the Scottish Social Services Council taking forward work to develop a resource exploring compassion, we are partnering with colleagues and stakeholders from many organisations across Scotland. We are currently putting out a call to gather stories of compassion and kindness from people experiencing care and from those working in social care. We hope to start a national conversation, to be inspired and moved, we want to show how compassion is more than often given without recognising it for what it is, but for those on the receiving end it is central to how they perceive their care. Over the coming months we will be sharing stories through social media which will contribute to a resource which will highlight the importance of compassionate care. We might also bust some of the myths around how we relate to people who experience care as well as how we care for ourselves and our colleagues.

Whenever I hear providers and the frontline workforce speak about the work they do and what brought them into social care in the first place I am often struck by the level of compassion they have without them necessarily realising this. Compassion often comes to life through the relationships we have with people around us.  When these relationships are based on empathy, respect and dignity, compassion is given and received.  The impact when we reach out to the people around us with compassion and kindness often goes further than we may ever be aware of.

Compassion can be given in the briefest of moments, with a smile or reassuring touch.  We want to explore why sometimes compassion has been missing, as well as some of the beliefs and myths that people have about the caring relationship.  Compassion may come easier when we have a natural connection to a person or situation that we find ourselves in, but what about when there is disagreement and tension?  This is when we are asked to show compassion and kindness unconditionally.

There is a place for compassion in every aspect of our lives, in the way we support and care for people, how we get along with our co-workers and most definitely if we manage people, how we do that. Importantly there is also the way in which we show compassion to ourselves, it can be difficult to be compassionate to those around us when we are running on empty ourselves.

The Health and Social Care Standards have compassion as one of the five underpinning principles and they described what should be expected by those experiencing care and support.

Compassion

  • I experience warm, compassionate and nurturing care and support.
  • My care is provided by people who understand and are sensitive to my needs and my wishes.

We are keen to hear about compassion across all age ranges and service types and if you have a story of compassion to share with us please send it to [email protected]

 

Heather Edwards

Interim Head of Improvement Support Care Inspectorate

Posted on

The Inequity of Social Care – the latest blog from our CEO

The inequity of social care I’ve spent a lot of my professional life working in areas to challenge and address inequity and inequality. Indeed since I took over the role of CEO of Scottish Care a great deal of my focus has been on highlighting the challenges of unequal treatment in older people’s care and support. That has included the very real funding imbalance which has over time seen less and less proportionately allocated to resource older people care whether in the community or in care homes. But increasingly I believe that there is an overarching inequity at the heart of our health and social care policy and practice. At its centre is a critical question. Put simply what defines a support or service as social care and therefore currently chargeable and what defines a condition or illness as a health condition whose treatment and support is free at the point of delivery? I was reminded of this when I listened this week to a presentation from Alzheimer Scotland on their Fair Dementia Care campaign Alzheimer Scotland has recently published a report from the Fair Dementia Care Commission chaired by former First Minister Henry McLeish. At the heart of the report is a description of the life experience of thousands of our fellow Scots who live with or support someone living with advanced dementia. A number which is due to grow significantly in the coming years. As well as offering a definition of what is meant by advanced dementia the report highlights the confusing and complex maze of charging policies for social care services across Scotland’s local authorities which end up meaning that people with advanced dementia pay a staggering £50.9 million in care costs every year. The report does not call for the end of charging per se but for greater transparency, consistency and understanding. But I think one of its greatest services has been to shine a light on the inequity of social care and health in Scotland today. In the dictionary inequity is defined as ‘a lack of fairness or justice.’ Whilst the report from Alzheimer Scotland rightly highlights the inequity faced by people living with dementia I believe the inequity or lack of fairness goes even further. At root is it fair that if in life you are struck down with a life limiting cancer that you will receive your care and support free of charge but if you are someone living with dementia you will face charges for social care which might include disposing of your home and assets in order to pay for care home fees? Is it fair and right that many people living with neurological conditions are treated as having social care needs and not primarily health and clinical needs? I think not. We have too many individuals living with conditions such as Parkinson’s, Huntington’s, Multiple Sclerosis and so on who are paying for the essential support that enables them to continue to live and contribute as citizens in our communities. Is it fair that a person who suffers the ill health that arises from frailty and age and requires appropriate support for that should have to pay over and above their lifetime contributions to taxation for that care including nursing care? Just as Scotland is seeking to create a rights-based social security system I am convinced that we need to seriously start a debate about the inequity, the lack of fairness and justice that lies at the heart of social care charging for specific conditions such as advanced dementia. But I am equally convinced that we need to go much further and start the conversation to move us to enshrining the human right to social care, to have your care and support provided equitably regardless of the condition or illness or disease, regardless of the realities of age or decline, that life deals you. In the words of Bill Gates: “Humanity’s greatest advances are not in its discoveries but in how those discoveries are applied to reduce inequity.” Dr Donald Macaskill @DrDMacaskill

Posted on

The essence of social care – our CEO’s latest blog

It was encouraging to read over the weekend research which had been undertaken by Ipsos Mori. It was the latest ‘Ipsos Mori Issues Index – 2018 in review’, which gives a “snapshot” of the top ten major concerns across individual parts of the country. Brexit and its implications was not surprisingly revealed as the most important issue facing Britain, topping the list. However, what it also showed was that Scots worried about the ageing population and social care much more compared to concerns over immigration and crime than the rest of Britain. 16 per cent of people were concerned about social care compared with 11 per cent for the rest of the country. This is at least encouraging considering that ‘Scotland’s population is ageing at a faster rate compared with the rest of the UK, while the population is growing at a slower rate and fertility, life expectancy at birth and net in-migration are all lower.’ When I read the report I was encouraged by the prominence not least because the social care sector as well as facing huge demands in terms of capacity is eagerly awaiting a Scottish Budget that prioritises it rather than provides leftover crumbs from other fiscal concerns. But when people talk about social care what do they really mean? Indeed I am reminded of a senior public official who recently confessed that it isn’t at all clear what social care is and what it’s distinctive role is. There are many definitions, both legal and aspirational, as to what social care is and what it is not. For instance social care whilst it may contain services which are clinical or medical in nature is not primarily about one’s physiological health. For me the role of social care is:

‘The enabling of those who require support or care to achieve their full citizenship. The fostering of contribution, the achievement of potential and the nurturing of belonging.’

That may all sound a bit nebulous but in essence social care is about enabling the fullness of life for every citizen who needs support whether on the grounds of age, disability, infirmity or health. Social care is holistic in that it seeks to support the whole person and it is about attending to the individual’s wellbeing. It is about removing the barriers that limit and hold back and fostering conditions so that individuality can grow and an individual can flourish. Social care is not about performing certain functions and tasks alone for it is primarily about relationship; the being with another that fosters individual growth, restoration and personal discovery. It is about enabling independence and reducing control, encouraging self-assurance and removing restriction, maximising choice and building community. Therefore as many of us have sought to illustrate over the last few years, social care is profoundly about human rights. It is about giving the citizen control and choice, voice and agency, decision and empowerment. All of the above is why social care is critical to Scotland’s future. That is why we need a social care workforce which is valued, well-rewarded and appropriately resourced. That is why we need to undertake necessary reforms and critically that is why we need to properly resource a sector that is a major contributor to Scotland’s economic and national progress. Social care is not the handmaiden of the NHS- there as an adjunct department to clinician care and medical intervention . This why we cannot treat the two as if they were the same. Whilst inextricably linked the healthcare we deliver is vastly different from the social care we should rightly demand. One of the fundamental areas of difference has to do with choice. If I have a medical emergency then personally I want the best clinical care and don’t really want to have much say in who delivers that care as long as they are trained, suitably qualified and supervised. A short term stay in a hospital is very different from the place and people with whom I spend my life. For if I am living with a lifelong condition or need support in any way because of life circumstances or age then I most certainly do want to have more choice and control both over who is in my life as a carer and what the nature of that support and care might be. The critical importance of legislation like Self-directed Support is all about embedding that control and choice, building those rights with the citizen. We are absolutely right to value social care as intrinsic to the fabric of our society and as a marker of the maturity of our commitment to support and uphold one another in community. In the weeks ahead social care will continue to face fiscal and workforce challenge but in those times it will remain critically important that we defend the intrinsic role and distinctiveness of social care rather than acquiesce in attempts to limit choice, control outcomes and thereby restrict individual rights. It is to be celebrated that Scots care about social care and the ageing population and it is incumbent upon all of us to ensure that social care is advanced and protected in the years ahead. Donald Macaskill @DrDMacaskill

Posted on

New Scottish Care Blog: Robert Telfer

Sharing is Good for You

I have always felt it is good to share whether that be specific knowledge or just general life experiences. Before joining Scottish Care I worked for a number of years in nursing in both NHS and Independent Care settings where there was always some degree of sharing of knowledge between care professionals. I can remember the Clinical Team meetings from early in my nursing career with input from various members of staff being sought, these then seemed to expand into Multi -Disciplinary Team meetings with, as the name suggests, input from a wider range of health care professionals. No matter what title you called the group it all came down to sharing knowledge, experience, views and opinions.

Since joining Scottish Care in 2012 initially as a Development Officer, under the Reshaping Care for Older People Project, then as Integration Lead, I discovered that the sharing of experience and knowledge continued to be a recurring theme. At the various meetings different views from the various departments and groups would be heard and discussed before plans and decisions were made. Since Integration this sharing of experience, views and opinions still continues although perhaps not at as a high and consistent level that some of us in the Independent Sector would like. The sharing of good practice was something that the Scottish Government’s Cabinet Secretary for Health and Sport mentioned in her speech at the recent Scottish Care Annual Care Home Conference.

I would like to briefly describe what I consider to be a good practical example of sharing. This is not something that happened at a high strategical level but at a more basic level.

One of the two geographical areas I cover is Renfrewshire and in 2018 my Scottish Care colleague who works in East Renfrewshire and I decided we would facilitate a joint Care Inspectorate Quality Improvement event for both areas. This event would be not only for Independent Care providers but also for Partnership commissioning staff, care home staff and other interested persons. Invitations were duly sent out and one day in late August approximately 40 people from a variety of professional backgrounds turned up at Eastwood House near Rouken Glen for the event. We had representatives from both Renfrewshire and East Renfrewshire, staff from Independent Care Homes, from Independent Care at Home providers. From the Health and Social Care Partnerships we had commissioning staff, care home staff and care at home staff.  Members of the Care Inspectorate not directly involved in any of the day’s presentations also came along to participate.

The day comprised of 9 sessions which I will not go into in any detail, but covered topics such as the “History of Quality Improvement”, “What is an Improvement Collaborative Approach” plus ample time for group discussions. A recurring theme right from the icebreaker session through the day was that processes and improvements are better and more easily achieved by joint working, sharing knowledge and experiences. For me, and judging by the feedback from those attending, one of the main benefits of the event was the variety of different working backgrounds and experiences shared throughout the day.

Sharing good practice does not need to be complicated or difficult. I will share the words of one of the slides from the day regarding Collaborative Principles:

  • Everybody teaches
  • Everybody learns
  • Share generously (transparency)
  • Steal shamelessly
  • Acknowledge graciously

With regards to that last point of acknowledge graciously I would like to thank Aiden from the Care Inspectorate for all his work prior to and on the day and sharing his knowledge with us all.

Robert Telfer

Independent Sector Lead, West Lothian & Renfrewshire

Posted on

Re-discovering Compassion: a new blog from our CEO

The start of a year is always an opportunity to look forward, to resolve to do things differently, to relate in a different way and to change direction. It is therefore a risky time. The desire for the new can risk sweeping away the best of the old; the energy to innovate can risk draining sense from what is commonplace; the urgency for change can risk the loss of the safe and familiar. The necessity of action can risk the way we relate to others. The first few days of 2019 have filled me personally with a growing sense of dismay and on occasion real concern about the cohesiveness of society. There seems to me to be a growing sense of dis-ease and a lack of compassion and care in politics, in many of our communities and in the wider media. This personal unease was articulated by the Queen in her Christmas Message when she said: “Even with the most deeply held differences, treating the other person with respect and as a fellow human being is always a good first step towards greater understanding.” These words were immediately seized upon and considered to be a veiled reference to Brexit. Be that as it may I would suggest they have a wider resonance at the start of this year. Compassion is central to all good and meaningful social care. Indeed compassion is one of the five principles which underpin our Health and Care Standards in Scotland. Sadly what seems to be lacking in recent days is a sense of compassion beyond the context of social care and health. Admittedly compassion can be a bit of a nebulous word but it has some essential elements. Compassion conveys a sense of sympathy, fellow feeling, empathy, understanding, and tolerance. It is not surprising therefore that the concept of compassion is central to good care. We recognise that the best of care in care homes and of care in an individual’s own home requires staff who are empathic, sensitive and able to relate and get alongside others – even when personal feelings may make that relationship challenging. Care involves developing the art of being professionally compassionate. The scenes of angry crowds shouting down politicians outside Westminster in recent days, the vitriol and violence expressed on social media and the horror of several murders in open and public spaces in the last two weeks seem to paint a picture of a society which has lost the capacity to be compassionate. Now I immediately accept that this analysis on its own is too simplistic not least because the tens of thousands of staff in care homes, homecare and in doing jobs in the NHS and elsewhere are daily illustrations of compassion in action. But… I suspect we need to recognise that civil society and cohesive communities do not just happen but that they need to be striven for and built. I suspect that the ability to dialogue with difference and to discover reconciliation and compromise is something that has to be developed and worked at. I suspect that the resolution of the massive political and economic challenges we face in the next weeks and months can only be achieved by shared collective resolve and mutual respect. Compassion needs to become the energy not just of professional carers but all who would seek to lead us politically and economically. If we are to move forward on so many issues whether Brexit or a Scottish Budget, whether reform of social care or education, then I suspect we need to rediscover the spirit and power of compassion in civic and political discourse. I believe it is perfectly possible to hold strongly held political and philosophical beliefs without that requiring the disminishing and devaluing of the views and values of others. I believe that it is absolutely right that anger and passion can be utilised in a way which is righteous and convincing. However when anger becomes dismissive and denigrating of the other then it is destructive and dangerous. The philosopher Arthur Schopenhauer wrote ‘Compassion is the basis of morality.’ It is such a political morality we need to urgently discover. The year that lies in front of us will bring undoubted challenge and in the world of social care as elsewhere the necessity to make hard and sometimes painful decisions – I very much hope that it will also bring a discovery of the power of compassion. Dr D Macaskill @DrDMacaskill

Posted on

The state of care in Scotland: new blog from Dr Donald Macaskill

The State of Care in Scotland

Over the next few days our newspapers and magazines will be full of reviews of 2018 and the expression of hopes and resolutions for 2019. It would seem churlish not to add to that volume. So here are some social care hopes and reflections for Scotland. Worker pay and conditions: ‘A fair days wage for a fair day’s work’. The adage is very familiar and describes the desire to pay staff according to the skills they evidence. The nature of social care has changed dramatically over the years. Social care is a major part of the Scottish economy with 1 in 13 Scots employed and delivering multi-skilled and professional care and support. Yet we have consistently failed to adequately reward and remunerate them at an appropriate level. Even an initiative such as introducing the Scottish Living Wage for frontline carers has failed to make the step-change that was desired because put simply it has been only partially funded at National Government level and poorly implemented by local authorities. The ongoing effects of underfunding are being seen right across the country as care home and home care organisations struggle to recruit people for the fundamental job of care. If we are serious about care in 2019 we not only need to establish a Pay Commission to set proper targets for worker terms and conditions but we need to stop deluding ourselves into thinking that paying the minimum is enough and start attempting to pay with respect for a job well done. Workforce retention and recruitment The survey published today by Scottish Care is the last in a long line of research we have produced in 2018 and illustrates that we are way beyond the point of crisis in terms of recruitment and retention in Scotland’s social care sector. It’s all too easy to read figures which state for instance that we have 9 out of 10 organisations who simply can’t find staff, that we have a nursing vacancy rate of 20% equivalent to having no NHS nurses at all in the whole of the Western Isles, Shetland and Orkney put together, that we are losing nearly 2/3rds of care staff within the first six months of their employment. These are the statistics but behind them is a story of staff struggling to cover shifts, working far too many hours to fill in the gaps, and being quite frankly exhausted by their care. Behind them is a story of younger staff deciding enough is enough and walking away with their skills and abilities. Behind them is the truth that unless we start to sort out the crisis of the social care workforce in 2019 then we will begin to see closed signs over care homes up and down the country and more people stuck in hospital because there are no social care staff to care for them in the community. The statistics are easy to read but the stories of people at risk should challenge us all to do something urgently. Brexit and migration It is impossible to reflect on the year that has passed or the year to come without mentioning Brexit. The social care sector in Scotland is significantly dependent upon and grateful for the skilled and dedicated staff – some 12% in care homes – who have come to care for Scotland over the last few years. Brexit is not going to happen in March because it is already happening up and down Scotland today as individuals and families are making hard decisions on whether or not to stay and contribute or to leave. Employers are already reporting to us the loss of dozens of staff in the last few weeks who feel that their future lies elsewhere. The depth of uncertainty, the lack of political will and what sometimes appears to us as a failure to appreciate that decisions being made or not being made are for many a matter of life and death is having a profound impact on the social care sector in Scotland. We urgently need a sense of certainty. What we are getting however is a set of proposals around immigration that shamefully describe social care staff as low-skilled and set levels of pay expectation that will make it impossible for us to plug the gaps in our already critical workforce shortage. How dare politicians and policy makers describe the intensive skills of palliative care, neurological support, behaviour management and compassionate care which is being delivered in our care homes and home care organisations as being ‘low-skilled’.  2018 has already seen a massive drop in recruitment from Europe. 2019 has to see the development of a model of immigration that really takes people seriously rather than playing to the crowd. Scottish Budget The Finance Secretary is busily trying to build a political consensus around his initial budget proposals. Our colleagues in Cosla and elsewhere have expressed alarm about the extent to which the current offer will fail to meet the needs of local government. This is the primary route for funding social care in Scotland. Scottish Care has called and continues to call for an investment in social care  in 2019 of £200million. It is not our role to say where that resource has to come from or how we pay for it. It is absolutely our task to flag up the insufficiency of funding which is frankly putting lives at risk. Yes we need to reform how we are doing things and we are working robustly with others to achieve this. Yes we need to ensure that individuals are able to better self-manage and remain independent for as long as possible. Yes we need to ensure that we have services which are adequately resourced from cradle to grave … but. We cannot continue to collude in a system which purchases care on the cheap and sets levels of eligibility so high that you have to be in some instances at death’s door before you get social care support. We cannot continue to collude with a system that purchases care by the minute and considers that care is about tasks rather than being with people .Let’s stop expecting social care to pick up the fiscal crumbs leftover on the plate – let us together change the size of the cake!   Commission for Social Care Scottish Care has called for the creation of a Commission on the Funding of Social Care in Scotland.  England and Wales are shortly to be presented with a White Paper on how they will fund social care., There are lots of ideas floating around – in Scotland we have not even started to have these debates. There is a real urgency faced with the increasing demands on social care, faced with workforce challenges, and the reality of financial uncertai8nty for us all to plan for our personal future. We are expected to do that at a personal level so it is incumbent upon those who call themselves our political leadership to work together in order to arrive at proposals for how we are going to as a society pay for our care in the years to come. Care is too important to be used as a political football. We need to get around the table and start talking.   Integration In the last few weeks of the year we have seen published a report on the Integration of Health and Social Care from Audit Scotland. It made uncomfortable reading and has highlighted clear points for improvement. What we need to do in 2019 is to build on what is working and to once and for all make it clear that integrating health and social care is first and foremost about making life better for our fellow citizens. Integration is not about health and social care professionals learning to work together and talk to each other, though it is in part, it is trying to create a system where the individual citizen has greater control and choice, and the ability to direct their care and support. That is an aspiration which we should surely all work towards achieving.   A future that cares The mark of any society which might want to describe itself as civilized, rights-based and mature is the degree to which it cares for those who are in greatest need and most vulnerable. There is such an amount of excellent care and support being delivered every minute of every day across Scotland. We are fortunate to have tens of thousands of staff who offer amazing care and astonishing love. There is so much to herald as positive and inspiring. But there are still challenges of resourcing, of workforce and of structure. Scotland has a proud heritage of putting people at the centre, of listening to those who have no voice, of creating space for those who feel threatened so they can feel secure, of giving welcome to those who are strangers. We have the capacity to direct our future into one that cares. But this future will not just happen rather it has to be moulded and built, nurtured and nourished, resourced and struggled for. As we finish a year and stand at the door of another we have the prospect of creating a nation that truly cares or one that walks by. Dr Donald Macaskill @DrDMacaskill