The Scottish Budget was passed by the Scottish Parliament yesterday evening. So that’s it over for another year. The chance of smaller political parties to get their pound of flesh from a minority administration has passed over the yard arm.

And what’s it done for social care in Scotland? Well pathetically little.

Admittedly we got our £66million, which is amongst other things supposed to cover the increase in the Scottish Living Wage, the effect of changes on sleepovers, Free Personal Care increases and the start of the Carers Act. Mind you last year we had £100 million allocated for the Scottish Living Wage which had then just gone up by 20p- but it’s amazing what £66million is going to stretch to given it’s a 30p increase this year! That’ll be one to watch!

But I don’t want to just dwell on the Budget because no doubt I’ll be back talking about the back of a fag packet economics of it all at a date in the not too distant future. What I want to talk about is that I’m scunnered and getting really quite angry at the whole charade.

I’m scunnered at what feels like standing in the middle of the public square with a begging bowl each year calling for extra funding for some of our most vulnerable watching out for a passing MSP who might hear the need for serious investment in care.

I’m scunnered at saying we need a dramatic serious investment – I called for a third of a billion in December and we got £66million and at the time I was made to feel as if I was dreaming of Utopia rather than the socially just and human-rights based country that I thought I was a citizen of.

I’m scunnered that there seems to be no real debate despite political rhetoric that admits that the sums are simply just not adding up – and that’s a lesson in the arithmetic of austerity that people who are today grabbing 15 mins of rushed care rather than being treated with respect and dignity have learnt only too well.

But I’m also angry…

I’m angry at the wasted opportunity of having a grown up non-partisan political debate about what is the real and not the affordable cost of rights-based dignified social care and not the system we have at the moment where eligibility makes social care the preserve of the few and not the requirement of those who need it.

I’m angry that a week after the Kings Fund published a major report offering a range of proposals for the funding of public social care in England, no political party north of the Wall seems prepared to look beyond the next ballot box to think seriously about how we are going to pay for care into the future, what system will fit us and how we are to create equity rather than accidental access.

I’m angry that we seem to spend so much of our time hiding behind data to show that what we are doing is making an apparent difference to the health and care experience of our fellow Scots, and that we engage in a self-congratulatory back-slapping of what’s going well. Let us hear the good news stories but let’s not pretend everything in the garden is blooming!

And I’m angry that despite the rhetoric of prevention and self-management we are still dominated by the sacred cow of the NHS against whom no critique should be offered and are thus failing to address the fact that we need to transfer resources from the privileged few in that system to the majority in communities who experience inadequate social care provision.

So yes, the Budget may be over for another year but for goodness sake let’s not be here next year arguing over scraps for a crumbling social care system where the word ‘crisis’ is already beginning to sound empty and hollow. Let’s start to work together to transform the woefully inadequate funding and priority given to social care. And that means we all of us have to take charge and control and start talking up the critical importance of social care.

Social care should not just be for an election debate or a budget negotiation – it should be the central characteristic of the society we wish Scotland to be.

 

Dr Donald Macaskill

@DrDMacaskill

 

Love is all around…

The 14th February has become synonymous with love and depending upon your perspective it is either a day for the purchase of over-priced red roses or a day of true romance.
It’s a little known fact that some of the relics of the famous St Valentine, whose day it is, lie in a church in the City of Love. Paris? Rome? Venice? I hear you suggest but No – Glasgow. St Valentine is (at least in part) resting in the unlikeliest of places – in the Church of the Blessed Duns Scotus – in the Gorbals, a part of the city once synonymous with gang violence and searing poverty.

Just like any relationship, expecting the unexpected and challenging stereotype are probably two useful characteristics for this St Valentine’s Day. In that light three stories struck me in the last week that have relevance and challenge for the care sector. They are each about relationship and value, about human contact and dignity.

The first was the news of the growing challenge of loneliness facing our population.

In a world which presupposes relationship as being intrinsic to well-being it was noticeable that last week saw the launch in Glasgow of research by the National Campaign to End Loneliness which found that of the 15,000 older people in the city, it is estimated that 10% can go days or weeks without having any contact with anyone. It is stated that loneliness and its impact can have such negative health determinants that it is the equivalent of smoking fifteen cigarettes a day.

With over 1.4 million in the United Kingdom reported as being lonely, the issue has not surprisingly become one of great significance with both a Scottish Government Strategy and a UK Minister with responsibility for loneliness to name but two political responses.

With around 7.7 million people living on their own, of whom around 2.2 million people are over 75, the issue of loneliness is likely to become of even greater prominence.

But I for one have become increasingly uneasy with some of the loneliness narrative. It is certainly important that as individuals and communities we should try to include, involve, engage and enable participation and contact. But we also have to be careful that we don’t develop some reverse morality when faced with such loneliness data.

Being on your own is not intrinsically negative and much of the recent debate has ignored the benefits of solitude. There is a world of difference between social isolation and forced loneliness over which you have no control and which you do not desire, and the reality for many which is a decision to be single and alone. Have we lost the capacity and ability to be alone? There has been an automatic presumption of the negativity of aloneness in much of the consideration of these issues. What we need rather is a serious debate about what loneliness is and what interventions are needed, which will be beneficial for both the individual citizen and society as large. I am not convinced our sometimes guilt-ridden knee-jerk reactions have developed such maturity.

The second insight from last week’s media came from a disturbing report from the Leonard Cheshire charity. This research is not unrelated to the issue of isolation and loneliness we have just considered. The research undertaken as a result of a Freedom of Information (FOI) request has shown that a third of Scottish councils commissioned 15 minute visits for the provision of personal care in 2016/17. This has meant that over 5,000 Scots were being subjected to the degrading practice of flying visits. At least 5,182 people received personal care visits of 15 minutes or less for support with intimate care, based on data from councils that responded to the FOI request.

Freedom of Information responses from councils in Scotland found that one in three – 31% – were commissioning 15 minute visits for the provision of personal care in 2016/17.

For many individuals receiving support at home, 15-minute personal care visits barely allow for tasks to be completed, let alone to develop a positive relationship between the individual and their carer.

Given that in January, the Scottish Government’s Minister for Social Security Jeanne Freeman launched a consultation and draft strategy on isolation and loneliness, highlighting the link between loneliness, poor physical and mental health, one might ask what benefit such short, task-oriented visits are making. They do little for effective mental well-being but then given the Mental Health Strategy hardly mentions older people its maybe not a surprise that there is a priority on loneliness but not on some of the causes of it.

Leonard Cheshire’s Director for Scotland, Stuart Robertson said:

“These damning figures show that many vulnerable people are being failed by the social care system… We have to urgently address this scandal and ensure people receive the person-centred care they deserve. No one should have to choose between going to the toilet or having a cup of tea, and this practice must come to an end.”

I couldn’t agree more with Stuart Robertson and Scottish Care has called over a long period of time for an end to the shame of short time and task oriented visits which leave no room for dialogue and dignity, never mind conversation and relationship. It is really sad that on a day we are celebrating love and relationship, for so many their only opportunity for exchange and interaction is reduced to a fragment of time.

The third media story I remember from last week was the report that the well-known and formerly respected broadcaster Jeremy Paxman, told an audience last week that he is in favour of removing the vote from anyone over the age of 65. This is somewhat ironic in the week we celebrated the 100th anniversary of woman’s suffrage.

Paxman’s easy dismissal of the contribution and role of the over 65s is indicative of the acceptable ageism that is all too prevalent today. Paxman states that the elderly have done very well out of life and that they are now using their voting power to ensure that they, rather than young people, are getting the best out of the state.

On St Valentine’s Day love has surely to be for more than a Hallmark day. A society where loneliness becomes a political policy priority, but not where the same political system is prepared to allocate resource to address the issue is less than it should be; a community where contact is reduced by the arithmetic of affordability does not in any sense value those who it should care for; and a place where older age is considered to be beyond contribution – such a society needs to rediscover the essence of a love and regard for others, which can’t just be for one day.

Donald Macaskill
@DrDMacaskill

2017 saw Angus Health and Social Care Partnership provide funding for care home staff to attend a series of learning and development days. Staff were able to hear speakers on a variety of subjects including – UTI Prevention; Well Being in Dementia Care; Adult Protection; Maintenance of Hearing Aids and Management of Chronic Pain. Events were held locally and care homes sent staff within their own locality. Having secured funded places I felt sure that this would be of interest to all care homes in Angus and the majority of care homes took up this offer. Sessions involved presentations from a range of services. Interestingly, those people who previously had had little contact with care homes would remark on the enthusiasm and knowledge of care home staff.

After the sessions, homes developed action plans for change and then reported back to session presenters as to how they had got on. Many of the homes came up with well thought out plans but for me one home stood out.

The staff of a small home in Carnoustie rose to the challenge and the range of actions was inspiring – from developing posters for families on over use of antibiotics to starting up a “relax shack” for supporting people with chronic pain. Time and again they would come to follow up sessions with their new ideas and brimming with enthusiasm for further knowledge which they would then use to improve the lives of the people in their care.

I would like to say well done to the team at Braehill Lodge in Carnoustie – at a time of worry and concern over funding and the future of care homes they have taken advantage of opportunities offered.

For 2018 we are going to continue our development days but in a different format making full use of new technology in an effort to make the sessions more accessible across Angus. I suppose the message here is to take the opportunity and try to use it for improving the lives of people living in care.

 

Ivan Cornford,

Local Integration Lead, Angus

Since I started at Scottish Care I have noticed a change in the advertising feeds that show up on my computer. Clearly some algorithm has assumed that my interest in health and social care, and the human rights of older people is because I have aged significantly in the last 6 months (mind you, given what I have seen by way of pressures on the sector, there could indeed be some figurative truth there).

It has been an interesting experience to see aging through the eyes of an advertiser. Many of the photographs contain trendy looking silver haired ladies – ‘move over sage and beige, grey and black are where it’s at’. The women smile back at me with a confidence that I could only have dreamt of in my twenties. They have seen, and quite possibly, done it all.

But as the products move from beauty and adventure to assistive, there is a marked change in the photographs. The face vanishes to be replaced by hands. Oh so many wrinkly hands. Or backs, they are popular too.

The philosopher Levinas describes the face as “Living presence”, the Oxford Dictionary defines faceless as “remote and impersonal”. Whilst there is countless research into the reasons behind this de-personalisation, and campaigning to refocus the lens, the reality remains that the portrayal of older people in advertisements is often the opposite of presence. It is absence.

And whilst it may be a reaction associated with ignoring the stark reality that will affect us all, surely this is a point where we should afford ourselves some dignity.

Perhaps then it is of no surprise that theme of absence is what I also see the social care sector battling with.

In my final blog of 2017, I raised a thank you to our partner organisations for our invitation to the table, but this is still work in progress – the independent sector have representation at only 7 out of 32 IJB’s. I also asked our partners to listen. If presence is only notional, then there will be no useful impact. Without our voice, it is not possible to properly map and evidence the landscape of the health and social care sector as a whole. Without that map, it is not possible to commission or deliver effectively.

At yesterday’s Scottish Evidence Summit hosted by the Alliance for Useful Evidence and Iriss, everyone was asked to take away an action – mine is to tackle that disconnect between evidence and implementation. The health and social care sector as a whole needs to incorporate our evidence and make it real and applicable, and, have the bravery to follow through with necessary action.

So, let us stand up proud of our contribution to the sector – social care is so often the buffer for health care, it seems obvious that they need to be considered in totality.

And with that, let us stand up proud of aging – 2018 may be the year of the young person, but do not let that distract us from the bigger picture. Young people will get old too.

Greater presence and indeed prescience of aging and older people should bring greater presence and prescience of the sector, so let’s ban those faceless photos, and raise our voice in a manner that will be heard.

2018: The year of positivity or negativity?

So here we are… the second week of 2018 and I have already written a report about how strained the social care sector is and why partners need to start listening to us.

This particular report focuses on the sustainability or otherwise of the care at home sector, with survey data from members telling us that 2017 saw half of providers not tendering for Local Authority contracts and 40% handing work back to councils.

Looking ahead to 2018, home care services tell us they are concerned about their ability to continue operating this year.  In fact, only 14% feel confident about their provision this year and nearly a quarter have extreme concerns.

What a way to start to the year.

A noticeable trend over the past 12 months has been the extent to which Scottish Care’s research and statements have gained widespread media coverage in a way that didn’t happen before.  The publication of today’s report is no different, with STV and the Herald already covering it this morning.  Whilst this is a positive reflection on Scottish Care’s ability to reach and influence others, it is probably much more an indication of just how important the issues we raise really are, not only to the sector but to the whole of Scotland and to the health and social care infrastructure which as a whole seems so fragile.  Does it mean people are starting to listen?

This new report comes on the back of the 2017 reports I wrote, which included work to highlight the lack of support for care staff’s palliative and end of live provision (Trees that Bend in the Wind), the impact of the removal of preventative homecare (Bringing Home Care), the growing recruitment & retention crises (Care Home Workforce Data & Independent Sector Nursing Data) and the strain placed on care staff’s mental health (Fragile Foundations).

And coming up in the next few weeks will be the uncertainty around the future of the National Care Home Contract.

This all sounds extremely negative and in many ways it is, showing again and again just how undervalued and under-resourced the independent care sector is.  So is this negativity the theme of 2018?

Well, not entirely.  All these reports also highlighted how many examples of compassionate, innovative care take place in spite of the vast array of challenges. Even today’s report highlights that care services are trying their utmost to continue delivering high quality care and won’t allow their values to be continually undermined by poor contract terms.

A planning meeting that we held last week within Scottish Care highlighted how many exciting projects and initiatives aimed at supporting reform will be undertaken in 2018.  These include work with the Glasgow School of Art on reforming home care and many other proposals in the pipeline which we’ll share through our blogs in the coming weeks and months.

What’s more, there are so many good news stories to be told about care.  Just this week, I’ve been made aware of a relative of a care home resident who wants to recognise the amazing care they received over the 14 years up to and including their death.  I also heard of another service who realised that across 7 of their staff, they had a combined sector experience of 130 years (an average of over 18 years each), so there are still many people who pursue care as a career and love it.

So is 2018 a year of positivity or negativity?  I would contend that it is partly both, but more importantly it needs to be the year of listening, and of acting.

The challenges won’t be solved overnight, not by a long shot.  And the positive work will continue in terms of everyday good care and the learning and sharing of new ways of working.  Both of those things are a given.

What will really make the difference (and determine whether we have a sector to survey next year on their sustainability), is what partners, policy makers and practice influencers do with the messages we continue to give to them – of the real challenges and the real difference our services make.

As we say in the new report:

“We can no longer tinker around the edges of social care – the challenge needs to be grasped with both hands and driven forward by a political will to ensure there are a range of high quality, sustainable services.”

2018 needs to be the year we move past a flurry of media coverage, a wringing of hands and then a return to the status quo.  It simply can’t happen anymore if we want there to be a social care sector.

Scottish Care doesn’t want to be the constant bearer of bad news.  We want to be a positive partner in finding practical and meaningful solutions so that everyone who requires social care can receive the best.  So this year I ask that you listen to us, and act with us, to ensure the positivity outweighs the negativity in social care.

Becca Gatherum

Policy and Research Manager, Scottish Care

 

Happy New Year and Welcome to 2018.

Within the context of New Year’s Resolutions, and the focus on caring for and creating the ‘better you’ peddled within any one of the many self-help books promoted at this time of year, I see a shift from a focus on having less, to a focus on having more. To be health-‘ful’ by limiting what you give your body, to have more time by limiting how you use your time, to be richer by limiting how, where and when you spend your money: they all require a fine balance so close to being contradictory, and in complete contrast to the holiday feasting.

It’s an analogy which I see, in this time of austerity, being applied across the health and social care sector. Not to focus on cuts, but to focus on what we have and what we can do within that context. And whilst this appears to be a laudible approach, I have not yet found an ‘off-the-shelf’ self-help book on the health and social care sector.

This is because missing from the discussion is the reality that we have been working at this for over eight years now. At what point can we say that we have applied all of the efficiencies possible? Not to say that there is no place for review, but that a focus on what can be saved now leaves the sector exposed to the real risks associated with a failure to future proof.

Last  month I had the privilege to hear Professor Gillian Ruch speak at the Social Work Summit. She spoke about relationship-based approaches to service delivery, and raised the concept of austerity as an ideological choice about making budgets balance, not about looking at the needs of the population.

Often when we plan for our sector, we think about celebrating our aging population who may use health and social care services. But what we need to be aware of is that we also need to celebrate and value our aging workforce without whom the sector as a whole risks folding. Consideration then must also be given to the necessary interaction with and effect of this on the rest of the population, especially given the economic contribution of a sector which employs 1 in 13 Scots. But this has to happen not just in relation to workforce planning, but to all of the aspects of health and social care. To plan for the sector as a whole, we must to consider the needs of the population as a whole.

If carefully and thoughtfully planned, implemented and resourced, there are currently many opportunities for the sector; the reform of many of our partners, the new health and social care standards, self-directed support, integration, and so on. But my concern is that the pre-requisite context is not a given, and the current impact of winter on an already under-resourced and under-valued sector, means that change will come too late.

At the time of writing, we await the response of the Health and Sport Committee to the evidence given in relation to the ‘Save Our Bield’ campaign. Whilst I support the call to create an independent commission to review the crisis in the Scottish care home sector, I am wary that to consider the outcomes of this in isolation from the sector as a whole – from care at home through to acute provision – would be limiting and wasteful. What happens in one part of the sector will inevitably affect another, inevitably affecting the citizens of Scotland. And so the pressure is on to consider our vision for the future of care as a whole; a vision which values our population as a whole, the sector as a whole, and the contribution that it makes to the population of Scotland as a whole.

#careaboutcare