Dear Mr MacKay I appreciate that in the run up to the Scottish Budget that you will have lots of reports to read and voices to hear, but I wonder if I can take a moment of your time and suggest that your budget needs to prioritise the social care sector in Scotland. It’s often said, sometimes even by politicians, that social care is an expense and drain on society and that it’s holding back investment in other areas. That’s a lazy pitch because I’d like to suggest that by investing more in social care that the economic benefits – never mind the societal ones – are even greater than might first be imagined. I say that for several reasons but probably the most important is the argument that social care enables the rest of society to function well and be economically active. That was the conclusion of an independent report published a few months ago which showed that social care is a net contributor to the Scottish economy of around £3.6 billion. The arguments and figures are there in black and white. Might I suggest your budget is a great opportunity for Scotland to become a champion of putting social care at the heart of our nation. I could draw up a long list of how you can spend your money – and I wouldn’t be the first I suspect. But we are facing real challenges in social care made event worse by the uncertainty over Brexit. We have 9 out of 10 care providers struggling to fill jobs, nearly a fifth of nursing posts in care homes are vacant, we have people now being supported in care homes who would have been in hospital five years ago. Homecare providers are struggling to pay the Scottish Living Wage and remain sustainable. Costs and prices are soaring. I could add a lot more to that list but the reports and the facts and the figures are all out there. What I want to say is that we need a priority and targeted resource – I have argued for over £200 million – to make adult care a priority for all Scotland. It was Human Rights Day on Monday and with others I was at Parliament celebrating the successes of the last decade. We have a great opportunity to build a nation which puts human rights at the heart of our communities. You can continue that process by a human rights based budget which puts the interests of the vulnerable, the old and young, those living with mental distress or at the end of their lives at the centre of your financing of our futures. That’s what social care does it gives hope and healing but it needs resourcing. Social care makes us into the country we are and want to be. Thanks for reading Donald Macaskill @DrDMacaskill

On the 10^th December which is the annual Human Rights Day there is reason for multiple celebration. That date is the 70^th anniversary of the Universal Declaration of Human Rights, as well as the 10^th anniversary of the creation of the Scottish Human Rights Commission. As part of attempts to raise awareness of the significance of these events and the priority of human rights have in Scottish society a social media campaign has been launched with the hashtag – #AllOurRights10.  Starting today (30 November) the Scottish Human Rights Commission will be releasing one short digital film per day, sharing ten different stories of people working to protect and promote human rights in their own community or context. They are all about highlighting the value and relevance of human rights in people’s lives. Today is Carers Rights Day. See https://www.carersuk.org/news-and-campaigns/carers-rights-day/carers-rights-day-resources . It is also St Andrews Day, so a day of celebration of national identity and affirmation of our sense of belonging one to the other. It is therefore very appropriate that it is a day when we consider the importance of human rights to both paid and unpaid care and the role that care for others can have in creating a society in Scotland which values all, has care at its centre, and creates potential for everyone to be treated with dignity and respect. A couple of weeks ago I had the immense privilege of speaking to the Coalition of Carers conference in Edinburgh. The room was full of dedicated individuals who were involved in either supporting family carers or who were individuals who cared for a family member. I spoke to the group about how important it was for us to see the rights of family carers as basic human rights. We reflected on the way in which over the last ten years and more since the Scottish Parliament was formed that human rights have become embedded in political and policy discourse, and how so many pieces of our social care legislation have human rights at their core. However, I also shared my belief, and it is not inappropriate to reflect upon this today as we start to consider the approach to the 10^th December, that the journey towards  the realisation of human rights cannot conclude with the passing of innovative and good legislation. The real journey towards embedding rights for unpaid and family carers and for those who work in social care has to be in the robust implementation of all this good human rights based social care legislation. In that analysis, I believe, we still have a considerable distance to go on the journey. Sadly we know all too often and for far too many, especially older Scots, that the promise is unfulfilled. There are too many citizens today across Scotland who are not being able to fulfil their rights to the provisions of e.g., the Self-directed Support legislation. There are too many instances where we are playing at the system change and power transfer which some of our social care legislation predicates. There are too many who are not being properly assessed for their social care outcomes but for whom basic needs are only being addressed; too many who are not being told what budget they have to spend and are being denied information to enable them to exercise informed choice; too many who are having even their already basic packages of care diminished and reduced. We stand or fall in human rights terms not by what we promise and speak of, not by what we legislate and declare, but by what we enact, do and fulfil. In those terms we have some way to go before we have the ability to say that social care in Scotland has truly embedded human rights principles and is realising the human rights of our citizens. Implementation of rights is as critical as the articulation of those rights. Robust monitoring and inclusive evaluation is fundamental to ensuring people are not being led up to the top of the hill of promise and then let to slide backwards into disappointment. Every day 6,000 people across the UK become carers but often it’s not something they have prepared or planned for. This year’s Carers Rights Day is focusing on supporting people to prepare for the future through the theme Caring for Your Future.  It has three main focus areas:

1. Making carers aware of their rights.
2. Letting carers know where to get help and support.
3. Raising awareness of the needs of carers.

Carers Rights Day raises awareness of the needs of carers with the wider public, decision makers and professionals. Its aim is to realise the vision of a society that respects, values and supports carers. Too often in the past the voices of paid care organisations and family carers have been seen in opposition or discord, but the truth is that care unites us around a joint desire to ensure that the human rights of those cared for are upheld, that the abilities of unpaid and paid carers are valued and resourced, and that together we work to create a society where those who require support achieve and receive adequate care which enables them to continue to be the full citizens of our shared community, entitled to full rights and to be treated with full dignity. That journey starts with good legislation for carers and social care, it progresses with robust implementation of it, and it reaches its end with a society that truly gives value, affirms and welcomes the contribution and presence of all. That, I would suggest, was the energy and passion which inspired those who sat and signed the UN Declaration nearly 70 years ago. It should be our shared task on this Carers Rights Day and every day. Dr Donald Macaskill @DrDMacaskill

On Sunday the world seemed to stop and rest for a moment in remembrance of the millions who gave their lives in the First World War and in memory of all those since who have died after the war to end all wars. Remembrance Sunday was a day full of words and music, poetry and prose, pageant and solemnity. It was also, I suspect, for many a day when more personal stories and memories were brought to mind and shared with family and friends. For me it was a day when I remembered my own grandfather who left his Skye village as a boy and returned years later a man who whilst he carried a medal for his bravery also brought back the scars of encounters and experiences that would fragment his living and ache his heart until he died. Remembrance is many things to many people. It is both an act of literally ‘re-membering’, of putting back together the stories of a broken past but it is also about a resolve and a conviction that the lessons of that painful past need to be so real and so vital that the journey into darkness can never be repeated. In a few days’ time many of us will be gathering in Glasgow for the annual Scottish Care conference which is this year called, ‘A Caring Place.’ In thinking about it I could not stop recollecting the first person I ever met in a care home on a visit as a child. I forget his name but I remember his face etched with lines of laughter and fun, and the fact that he was introduced to us children as an old soldier of the First World War. Characters like him are long since gone from our communities and our care homes, but Friday in its own way at the conference is about remembering, putting together stories and developing resolve to learn from the lessons of the past. Scottish Care’s policy and research manager, Becca Gatherum will be publishing her latest report. This report is an exploration of the role of care homes, past, present and into an uncertain future. It is a remembering of the role of care homes through good and ill, it is a challenge to the casual myths and stereotypes which still dominate the public perception of care homes, and it is an articulation of what the future needs to be if we are to continue to celebrate the best of care. Care homes are very much ‘caring places’. Places where those with memories fragmented by the awful disease which is dementia are able to find assurance, comfort and a degree of purpose; where those who are living with palliative and end of life conditions are able to live to their fullest until the moment of their end; where those who have grown into frailness find the support and strength to still contribute, be valued and have purpose. Care homes are marvellous places of care … But there are still too many times when care homes are painted as places of negativity, of emptiness and abandonment. But there are still too many colleagues in health and social care who do not value the work of those whose skill we will be celebrating at our Care Awards on Friday evening, who do not see the professionalism and recognise the excellence happening in care homes up and down Scotland every moment of every day of the year. But there are still too many in places of policy development and decision-making who have an image of those who reside in care homes and what care homes do which is dangerously out of date and unappreciative of the reality of complex compassionate care. But there are still too many who decide upon resource allocation and strategic priority who dismiss the ‘homely setting of our ‘caring places’ as spaces beyond our contemporary need and purpose without realising the tremendous untapped potential of care homes in the modern era. Remembering the past can become a dangerous illusion if we remain in the memory but can be the most enormous strength if we use the energy that it gives to change the world around us and find new purpose and direction. The Scottish Care conference on Friday is both a reflection on the contribution of care homes in the past but much more importantly it is a looking forward to how these places can become the heart of our compassionate communities, how they can become oasis of belonging for the thousands who live in loneliness in our villages and towns, how they can be at the forefront of innovation, person-led dignity and rights based choice and control for all. Come and join us at ‘A Caring Place.’ Dr Donald Macaskill  

Today is the International Day for the Eradication of Poverty. Since the first Day in 1992, it has become a day during which we are invited to give some thought to the grinding reality of poverty across the world. When our television screens are full of the faces of starving children in Africa or India it is probably easier for us to recognise the reality of poverty. It is probably less easy to see that reality in the lone parent struggling to make ends meet, in the child without the material possessions its peers take for granted or in the hidden life of an older neighbour too afraid to put the heating on in winter for fear of spending savings they no longer have. Poverty in our midst and in our community is often less visible and more hidden unless it is quite literally enshrined in a body sleeping rough and destitute on a doorstep. The United Nations has declared Fighting Poverty to be one of the key aims of their Millennium Development Goals. It is a recognition that poverty only grows unless direct action is taken both to address and eradicate it. The impact and effects of poverty are increasingly recognised and known not least in terms of attainment, education, life quality and importantly upon personal health. As a society we are much more in tune today than in the past with the need to address poverty especially as it impacts itself upon children and young people, recognising as we do the detrimental results this can have on the whole of their lives. One area we are less aware of or even open to discussing is the reality of poverty amongst older people. Indeed there is a growing public mantra which suggests that today’s older person has never had it so good and that those who follow will never ever enjoy the same benefits and wealth. At a factual level it is undoubtedly true that there has, especially in Scotland, been a sharp decline in what is often termed ‘pensioner poverty.’ That has to be acknowledged but the starting point of the improvement were the shockingly high levels of pensioner poverty a couple of decades ago. Acknowledging improvement also risks ignoring the reality of acute poverty, emptiness and detrimental health outcomes for a sizeable minority of older people in Scotland today. According to Scottish Government statistics:

• In 2014-17, before housing costs are accounted for, 19% of children, 16% of working age adults and 17% of pensioners in Scotland were living in relative poverty.
• After housing costs, 24% of children, 19% of working age adults and 13% of pensioners in Scotland were living in relative poverty.

By any calculation those are shameful statistics for a society as developed and relatively wealthy as ours. Behind every statistic is a story of personal pain. Thankfully there are no shortage of programmes and projects – and indeed Government focus – to address child and adult poverty and the mental health distress that results. But what is there for the 17% of older people living in relative poverty? Sadly and comparatively not as much as there needs to be or could be. Undoubtedly measures like free prescriptions, support with fuel, free bus travel and elements of free personal care have and are making a difference .. but… more could and needs to be done to address the issues of poverty, older person’s mental health distress, loneliness and isolation affecting too many older Scots. We are rightly appreciative that life expectancy has increased for both men and women. However, the length of time spent in ill health is also rising as the incidence of health problems increases with age. There is an inextricable link to living less and being unhealthy and the poverty an older person experiences. The lower a person’s social status, the more likely they are to enter older age in poor health and die younger than people from higher social classes. This is especially evident when we see the impact of the social patterning of chronic diseases such as heart disease, stroke and cancer. It is quite right that attention is given to child and adult poverty for that will significantly impact on older person health but it is dangerous – I would suggest – to ignore the factual reality of the impact of poverty upon some older Scots today and to primarily focus on poverty and older age as a future challenge. I met Joan a few months ago. She was born to a family which looked after the pounds as she put it. She was brought up with a canny Scottish appreciation of what she had and a desire never to be beholden to another. She worked hard as a secretary and saved the small amount of extra she was left with. She never married and although she had nieces and nephews they have moved away and become strangers. Joan is now in her nineties, lives in a small flat which she has rented for years, and she struggles every day. She laments the fact she can’t look after herself better, doesn’t go out as her friends have all ‘passed’ and doesn’t receive any services or support. Joan is poor but she would never ever use that word and would be affronted if she knew anyone used it to describe her. But Joan eats one small meal a day usually uncooked which in her own words gets smaller as she gets close to pension day; she massively relies on her fuel allowance but it still isn’t enough to keep the cold away in winter; she never sees anyone as she no longer can manage to go to church; she doesn’t watch television since her old set broke and she can’t remember when she last bought herself some clothes. Yet Joan proudly declares she has enough to bury herself – although no one has had the heart to say that what she has saved will never be enough. There are too many folks like Joan living as our neighbours, the quiet forgotten ones in our midst, their silence speaking to the heart of our vibrant communities. They are not included, rarely noticed, and not missed. They do not show their poverty, yet its truthfulness is as real as that we see in those more visible. Joan is poor. Her poverty is not just of material belonging but of connection, contribution and value. Today’s Day for the Eradication of Poverty should encourage us all to continue the struggle to recognise the poverty of older age, which is so easy to ignore and which all too often remains hidden. Dr Donald Macaskill CEO Scottish Care @DrDMacaskill

At the heart of the social care sector in Scotland there is a systemic discrimination that is often not named or called out for what it is – it is a discrimination based on sex or gender. Over a year ago in its exploration of the Gender Pay Gap, the Economy and Fair Work Committee of the Scottish Parliament in its important report ‘No Small Change’  identified that gender segregation was a real phenomenon within the care sector in Scotland. Indeed, the evidence submission from Scottish Care to that Inquiry argued that gender discrimination was at the root of a great deal of the issues facing the sector. Yet more than a year later has anything changed? – absolutely nothing other than a wider dialogue and acceptance of the challenges of gender discrimination in care and all that entails. Indeed part of this wider valuing of social care has seen the same Parliamentary Committee’s acceptance of the important economic contribution of social care to the overall economy of Scotland. (See Scotland’s Economic Performance) So at the risk of simplification what do I mean by discrimination and why is it an issue? Put simply discrimination is when you treat one group or sector in society in a manner which is less favourable than the way you would treat another person or group. We can easily recognise the racism which considers one group as being less than another because of their county of origin or the colour of their skin. We have become increasingly aware and critical of the way someone who might define their sexual orientation as lesbian, gay, or bisexual might be the victim of homophobia and hate crime. But I would contend that we have become almost blase, dismissive or immune to gender and sex discrimination? Maybe we shouldn’t be surprised. The great strides of the feminist movement in the 1960s have passed into history. There are increasingly very few folks around who remember the fact that a woman employed by a public authority when she returned to work having had a child was often demoted had she been in a management post. Such occurrences seem the stuff of history text books and yet they were happening less than 50 years ago. We have come a long way in some areas and yet in others we have stood still or even gone into reverse. One such area is the way as a society we think about care as a personal responsibility and care as a professional role. We still think of care as primarily a female activity, almost as if the male of the species has not been endowed with the biological attributes to care for someone other than their own self; as if the skills of empathy, compassion and affectiveness were solely female genetic constructs. I would suggest in the face of this that we need to develop a response to this sex and gender discrimination – a response fit for the new age we find ourselves in. Such a response, I would contend, has numerous strands to it but at least must include the following: • A re-designed early years and child support system that enables real participation of all in the workplace. There has long been widespread recognition that a critical enabler of female and male participation in the workplace is a coherent, high quality and affordable child care and early years system that gives parents confidence to go out into the workplace. Despite improvements we are some distance from achieving this in Scotland. Childcare is still ridiculously expensive and for many the thought of working in the care sector when they have young children is simply unaffordable. Our Government could significantly incentivise investment in social care by giving special credit status to enable care workers to benefit from reduced or even free child care. • An increased emphasis in challenging stereotype and gender segregation in primary and secondary education. We know that many children have consolidated their sense of occupational identity and thus role segregation by mid way through primary school. We must give children opportunities to understand that care is without gender and is both a responsibility of and opportunity for all. The increased emphasis on inter-generational working and shared facilities is serving to put a spotlight on what can be achieved in changing attitudes to older age and frailty. Significant investment from central Government and making this a key cultural and economic priority would consolidate these early foundations. • A real focus on workforce in social care – and that is a whole system and a root and branch reformation of practice. On the one hand there is a growing recognition that social care is an enabler of economic performance and community wellbeing but on the other the way we reward and remunerate those who care suggests a low societal esteem and community value. Undoubtedly the Scottish Living Wage sought to be a step-change but it’s patchy implementation has brought even greater fragility to the care sector. Pay on its own won’t address the challenges of fair work though failing to adequately resource a decent wage will remain damaging of future development. But more needs to be done. This includes addressing the reality that in the medium to short term most of our workforce will be older. As a result we need to address one of the major barriers presented by those who return to or enter the care sector later in life. That is, alongside low rates of pay, the costs of retraining and qualifications. The work of Scottish Care in its recent report ‘The Experience of the Experienced’ has helped to focus upon the unique and distinctive contribution of the mature workforce. It has also highlighted that we need to re-frame and re-design our current learning and qualification frameworks to enable greater appreciation of prior-learning and skills than that which currently occurs. But re-framing conditions has to also be inclusive of the principles of fair work. Is it fair that in social care we effectively electronically tag our frontline workforce? Can we expect fairness in work practice when the way we commission care fosters a lack of trust, embeds low value in the worker and creates employment practices which are less than they could be? • We need a re-gendering of the whole care sector. The inescapable reality of our history is that because the care of our most vulnerable has been seen as women’s work then we have accepted it as a task constituting low skill and worthy of lower financial remuneration. We have not done the same for equivalent male dominated areas of work at a similar skill level. There should be an immense shame in the fact that despite nearly 50 years of equal pay legislation we still have women paid less than men for equivalent jobs. Indeed why is it that men undertaking manual jobs are paid so much more? – well the answer is probably pretty obvious – the financial and political decision making not least in both local and national government have been for long dominated by men. We need a dramatic challenge to the gendering of the role and task of care – better paid workers with fairer conditions employed by providers who operate under realistic and properly resourced contracts. We need a re-conception of care which is evident across the whole of society from children’s books to the latest soap opera. This has to be broader than social care commentators. It entails a cultural and societal multi-media strategy. The American Pulitzer Prize winning journalist Susan Faludi famously wrote in 1991 a book called ‘Backlash: The Undeclared War Against American Women.’ In it she argued that the 1980s saw a backlash against feminism, especially due to the spread of negative stereotypes against career-minded women. Her work has become a classic text of gender and sociology and warns women of every generation that the gains of feminism should not be taken for granted but that re-defining and valuing contribution is a continual challenge. With some glorious exceptions, such as the #metoo social movement, I suspect she has been largely prescient. The care sector in Scotland has huge potential to contribute yet more to the Scottish economy, to re-frame our communities as places that welcome older age and frailty, that recognise care is the responsibility of all regardless of gender. We have the potential of creating a dynamic, valued and skilled social care workforce. But it will involve a dramatic shift in cultural thinking and current social norms – re-defining care so that it becomes gender inclusive means that that task becomes all our concern and not just a woman’s work. Donald Macaskill @DrDMacaskill   The Scottish Care workshop ‘Kaleidoscope of Care’ on Friday 28th September explores many of the themes covered in this blog.

This week I gave evidence at the Health and Sport Committee on the proposed Health and Care Staffing Bill, specifically in relation to Part 3 of the Bill relating to social care. Last week, colleagues from the NHS presented their perspective. Whilst the intention of the Bill may be well-founded, the unintended consequences of introducing it could have significant limiting effects for the sector. Social Care in Scotland has come a long way to begin to create the conditions required for improvement and innovation; you can see this in our policy such as the Health and Social Care Standards introduced earlier this year, our legislation such as the Self Directed Support (Scotland) Act, and in our practice such as the new methods of inspection implemented by the Care Inspectorate. I am proud to represent an ever-evolving sector which retains at its heart an asset-based individualised approach to providing care that is grounded in Human Rights. As human beings, and as a society, our wants, needs and wishes change, and this means that to be able to meet the needs of our older citizens, and others who access care and support, we must be flexible to those demands. On top of this, the market itself is ever-changing as we are living longer and in times of austerity, we need to be able to think differently about how care and support is delivered. The biggest concern that I have is that the purpose of legislation is to freeze its components and the proposal to enshrine the use of a tool in statute puts at risk several things:

• It does not allow for professional flexibility, or for a multi-disciplinary approach, or the development of the new models of care and workforce development that the sector so desperately needs to be sustainable.
• It does not consider significant parties to the process such as commissioners who would need to respond to the potential increased demand in resource, or, social workers, who would need to be available to assess those who access care and support in order to provide the data for the staffing tool.
• There is a real risk of the legislation directing resource, meaning that limited funding may be directed towards meeting staffing requirements, or towards meeting the potential additional administrative burden upon a sector who already have to report both to the Care Inspectorate and to their commissioners.
• Most significantly however is the potentially devastating impact upon the recruitment and retention crisis that the sector currently faces. The SSSC workforce data report published last month shows a Stability index of 77.1% that means almost a quarter of staff are changing roles or leaving. Our own data shows that more people leave than enter the sector within their first 6 months of employment, and that the nursing vacancy rate is currently at 32%. This cannot continue, as evidenced by last weeks headline news that 19 care homes closed because they cannot recruit nurses. We must too bear in mind that last year some of our providers were paying £1200 per night for an agency nurse, and that whilst the number of nursing agencies has increased by 18% in the last year, there is no greater pool to draw from. Creating legislation does not in itself create nurses.

The whole issue that the Bill has been created to address needs a solution that is co-produced from across the health and social care landscape, offering opportunity and flexibility to free up systems and allow the optimisation of the workforce through a multi-disciplinary approach, with career pathways which value our staff and enable them to progress, and to allow for the use of technology and other solutions which the National Workforce Planning Group may already be exploring or which may not even exist yet. A care home is not a clinical setting, it its by its very definition, a home. People who live there are surrounded by their own possessions and sometimes their furniture and décor. And as is also the case for our care at home workforce, they build relationships with those who both live and work there. We need to enable our skilled workforce across the sector to exercise their expertise and professional judgement and allow them time to just ‘Be’ with the people they support. Fundamentally, the Bill in its current format puts that at risk. Our evidence is in, next week the regulatory bodies will be presenting, and thereafter the committee will make their decision on how to proceed. Every single vote will count. #careaboutcare You can watch live or pre-recorded on SPTV  and you can see our submission here Karen Hedge National Director, Scottish Care