A view from West Dunbartonshire & Inverclyde

My name is Brian Polding-Clyde, and I’m the Local Integration Lead for West Dunbartonshire and Inverclyde Health and Social Care Partnerships. I have worked in both areas for over four years and this has offered me the opportunity to work and influence across every sector of health and social care.

As a key Scottish Care partner, I was an invited to the Employee Recognition Awards for a colleague, Wendy Jack (Planning Improvement Manager, HSCP), who received a commendation under the Team Leader of the Year category. Wendy, along with Selina Ross (Chief Executive of CVS West Dunbartonshire), are instrumental members of a strategic partnership that helps to build ever closer links between the statutory, third, and independent care sectors. I was also invited to the Scottish Association of Social Workers (SASW) awards last week, where West Dunbartonshire’s HSCP’s Care at Home Team won the Special Award for ‘Best example of collaboration in an integrated setting’, recognising not only the worth of the team itself, but its impact as part of the wider integrated health and social care provision for adults and older people in area.

Wendy, Selina, and I, hosted a participation event in West Dunbartonshire which brought together Care at Home and statutory providers and commissioners. At the event, Chris McNeil, (Head of Health and Care) provided an overview of West Dunbartonshire’s present demographics and how the future may look. Chris was clear in noting the crucial role of the Independent sector in the ongoing delivery of care to the local population. Selina highlighted the role of the third sector and the ‘Link-Up’ programme, a single call telephone advice line run by well-trained local older volunteers, in helping to support people within their community. Link-Up, in addition to offering advice, also follows up on calls ensuring users are satisfied with the resolution. Lynne McKnight (Integrated Operations Manager for Care at Home) and I then gave a joint and integrated presentation on what we saw as the challenges and opportunities in delivering a Care at Home service. The room agreed that one of the key ways for us to move forward is to share resources and training. To be able to do this effectively will require the development of a Practice and Development Forum co-facilitated by the independent and statutory sectors.

In Inverclyde, we recently made a successful bid to have Care at Home and Housing Support Services become part of the Care Inspectorate’s ‘Care About Physical Activity Programme’. With partners in the third, statutory and independent sector we are developing awareness and interest in the programme, which will allow the Care Inspectorate to recruit fully committed participants.

Also in Inverclyde, we’re close to publishing ‘Come On In’, a resource developed to enhance the experience of visiting a care home. The publication has grown organically from the shared experiences of visiting family and friends, nursing staff, and reflections from Heather Edwards (Care Inspectorate), and myself.

Over the four years I have been working in West Dunbartonshire and Inverclyde, it has become apparent that the success of the work we’re involved in is dependent on closer partnership working and a commitment to joint leadership across all sectors. This will give us a better understanding of the complexity of the landscape we work in and the role we can play in enhancing the care of the people for whom we work.

‘Human rights do not have a use by date’: Scottish Care CEO calls for protection of older people’s rights

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 Sherlock but 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?

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.

Ageism as a concept was first coined in 1969, and describes a context where there is discrimination against, contempt for, abuse, stereotyping, and avoidance of older people.

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 in the last few months of their life that we allocate the sum of £3.85 an hour to provide 24/7 intensive nursing care home support? That’s less than the cost of a packet of 10 cigarettes!

Many of us feel that Scotland needs to address the challenges of the silent, pervasive and systemic age discrimination which impacts on the lives of countless of our fellow citizens. We are not alone. Last September the United Nation’s Expert on Older Age, Rosa Kornfeld-Matte, stated that current international provisions are not sufficient to fully protect older people’s rights, and she called on states to consider a new convention. A few weeks later I chaired initial discussions with interested parties to explore whether Scotland needs its own Convention of the Rights of Older Persons and/or an Older Persons Commissioner as Wales and Northern Ireland have.

The creation of a convention for older people in Scotland would not add new laws and rights but would go a long way to ensure equal treatment for older citizens, not least by demanding adequate financial provision for that group of the population.

Equally an Older Person’s Commissioner would be a champion and advocate for the human rights and equal treatment of older persons. Older Scots should not be the victims of discrimination in employment, in accessing public services, in social care or in hospital treatment.

The time has come for us in Scotland to join the campaign to create a framework of rights which recognises the distinctive discriminatory experience, both at societal and personal levels, which all too many older Scots endure and experience.

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 and both a Convention and Commissioner for Older Persons would be positive steps to take. Human rights do not have a use by date – they do not diminish with age.

 

Dr Donald Macaskill

Chief Executive, Scottish Care

 

The caring side of data: latest blog from our CEO

The caring side of data

I have become a victim of data or at least I have succumbed to the world of fitness data. Last year I was given a Fitbit and started using it in the autumn. I wasn’t aware of the massive advertising campaigns behind the Fitbit which is basically a cloud-based fitness-tracking device. But according to the advertisements this small device – with a little help from myself in the form of walking and sleeping more (though not together) – will enable significant life-quality changes. I will leave for others to decide the truthfullness of that statement viz-a-viz my waistline. But what I have been astonished by is the sheer amount of data that I am sent every week from this small device which sits on my left wrist everything from my average heart rate, my calories burning, my steps walked etc.

There has been an obvious shift in the data available to us about our own health in the last few years. I remember the early devices which enabled you to track your blood pressure or heart rate but what we now have is an empowerment of the individual, what some specialists have called the ‘democratisation of self-care.’ My device can now be used to adjust, alter and direct my behaviour – I have control and choice in its applicability and use. There is therefore huge potential in the realm of preventative health and self-care.

 The accumulation of statistical data indicates a shift of legitimacy and power from the medical expert to the individual.

 Many of you will be familiar with the concept of Big Data – defined as:

 extremely large data sets that may be analysed computationally to reveal patterns, trends, and associations, especially relating to human behaviour and interactions.

 But it is not the size so much as its applicability to determine trends, behaviours and patterns for whole populations that has become significant for social scientists and planners. This has especially become the case in the world of health. In some senses the data information I get and which is produced by my Fitbit gives me ‘Small Data’ –

 data in a volume and format that makes it accessible, informative and actionable. … Small data connects people with timely, meaningful insights, organized and packaged – often visually – to be accessible, understandable, and actionable for everyday tasks.

So what is the place of such Data, Big or Small, in social care?

One of the issues facing those of us who work in social care is that we need to take a greater degree of ownership of the data and the debate about data – we cannot leave this to technicians and data analysts alone but must increasingly work in partnership to enable a shared determination of what data can do to enable better outcomes for individuals who use and seek to access services. Data has a tremendous potential to advance care and improve health but it is one which has to be managed and to some extent controlled.

So much of our world is being increasingly defined by an analysis of numbers, statistics and data. Are we making the right decisions from that data? Is the picture of our health and wellbeing which is painted, a true one? Just as we get suggested reading from an Amazon account or Tesco might determine what it offers us in our shopping trolley from what we have bought before – are we sufficiently aware of the streamlining of choice as a result of someone else’s analysis of our data? That may be an issue for my shopping but it becomes a critical one if data becomes a key determinant of health and social care choice.

There is therefore an important ethical debate to continually be held about the use of both Big and Small data which necessitates an awareness of the ethics behind not just the use of technology which has been much articulated but the ethics of the use of health and social care data both individually, at community levels and wider society.

Other fields are much further ahead in exploring the use of Big Data in transforming the way we do things, especially education. There is clear potential but we have to guard against a whole-scale adoption of approaches that will serve to unhelpfully alter our care landscape.

Next month sees the first ever conference to be held in Scotland which will explore some of the ethical and social science questions behind the use of data in Scottish society.  This Edinburgh Data Summit is part of DataFest17 and will hear from international thinkers. But its debates and the messages which come from the conference will doubtless shape our response to data. Those of us involved in policy development, in preventative care, in empowering choice and control over health and care; those of us working or caring in care homes and in communities need to be alive to and aware of these debates.

 

Donald Macaskill (Dr)

 

 

 

 

 

My job lets me meet amazing people who do outstanding work to help others

My name is Heather and I’m the Local Integration Lead for the North Ayrshire Health and Social Care Partnership. My role is one I find both rewarding and challenging and it has given me the chance to meet some truly amazing people who do outstanding work to help others in their communities.

The partnership works very well in the North and I believe that myself and colleagues in the NHS, the council, third and independent sectors have a great understanding of integration and a commitment to partnership working. A major part of my work this year has revolved around the New Models of Care work, specifically focusing on the work stream and older adults with complex needs, which is being led by the North Partnership on a pan-Ayrshire basis. The providers have been offered various opportunities to be involved and their input has been well received by our partners.

Last week, the Ayrshire Branch of Scottish Care organised an extremely successful engagement event with providers from across the  three Ayrshire branches.  Our Chief Executive, Donald Macaskill,  set the context of this changing landscape and offered providers the chance to start thinking about what support might look like in the future, given the varied local demographics and workforce challenges.  At the event, we also introduced the providers to “simulation modelling”: a programme designed to take a whole-system approach and test out scenarios and changes within the system to see what impact they would have on other parts of the system. This will help to inform the direction of travel and what savings may be made to reinvest in providing care within community settings.

One of the main outcomes for me is to help our partners and the wider community understand the commitment of staff and the amazing person-centred support care homes are providing for their residents. I was therefore really pleased to be invited to sit on the planning committee for the Partnership Staff Awards to recognise the great work of all our partners. We have just completed our shortlist and I’m delighted that the sector nominated their staff for going beyond our expectations within their roles.

The landscape of health and social care in Scotland is changing. Independent providers are a crucial part of this  new landscape, which we hope will contribute to transformational change. Exciting times are ahead!

New blog from our CEO: Challenging the sexual taboo

Challenging the Sex Taboo:

One of the privileges – and challenges – of doing my job – is being invited to speak at a range of events and conferences. Yesterday I was taking part in a seminar in East Dunbartonshire Health and Social Care Partnership on ‘Capacity,
Sex & Relationships.’
I was asked to reflect on the issue of older people’s sexuality in care settings.

My preparation for the seminar highlighted for me the relative dearth of literature and academic study on what is one of the most fundamental parts of what constitutes our identity and what it means to be human. There are some good pieces of work not least from Alzheimer Scotland, the Terence Higgins Trust etc. but not a lot.

This might be because there are still massive social taboos around the issue of older people and sexual expression. Its almost as if older people and sex is for our age ‘the love that dare not speak its name.’ But people are living longer and healthier lives and why should sexual expression end when we reach a particular age, almost as if our sexual selves have a use-by date attached.

But pervasive negative attitudes serve to consolidate the taboo. People consciously and unconsciously suggest that sex is unimportant to older individuals; that it is somehow abnormal for older people to be interested in sex; that older people have no desire for intimacy; that older persons are not physically attractive and are not desirable. And of course the endemic cultural presumption is that sex is for the young and fit.

Nevertheless for many individuals sexual expression remains an important part of their quality of life. According to a 2013 Saga survey, 71 per cent of over 50s reported having a healthy sex life. Such expression is a basic human right.

Some 18 months ago Taylor-Jane Flynn and Alan Gow, professor of psychology at Heriot-Watt University in Edinburgh, carried out research on sexuality and older Scots which was published in the journal Age and Ageing. They interviewed and spoke to 133 Scottish adults aged 65 and over. Half of these lived with a spouse or partner.

What they discovered was that between 75 and 89 percent said they’d engaged in kissing, hugging and holding hands or touching. Men and women scored about the same for frequency and importance of sexual behaviours overall, and for quality of life.

Participants reporting more frequent sexual behaviour rated their social relationships as higher quality, while people who found sexual activity to be important had higher scores for psychological quality of life.

Critically they found that older adults who value sexual activity and engage in it have better social lives and psychological well-being.

So if that is a given there are clear challenges and implications for providers of care and support and for those who work in supporting older individuals.

So how important is sexual expression within the care sector?

There are obvious challenges not least with individuals with declining and reduced capacity and physical abilities in ensuring that there is a balance between protection and safety on the one hand, and enabling expression on the other. But beyond this – and there are good guides already available to help staff work with individuals who might have dementia and portray disinhibited behaviour or language – beyond that are we doing enough?
Are we able in care homes, for instance, to create places and spaces for people to be intimate and private?

Do we manage well those situations where the wishes of family members might not be the wishes of an individual resident who desires to form a new relationship?

Do we train and resource our workforce in such a way that they have confidence in dealing with what can be a challenging issue and to do so in a manner which is non-discriminatory and respectful of individual rights?

Is the regulatory framework and work of scrutiny too restrictive in this area?

Do we commission in such a way which would enable the provision of facilities to enable couples to live together or someone to initiate or form a relationship whilst in a care setting?

Do our services have sexuality policies whether in the community or in a residential location?

Do we properly understand issues of consent and capacity in the sexual relationships of the old?

Are we aware of the growing issue of sexually transmitted diseases amongst our older population, in and out of care environments?

 

All of us who support and work with those who are older need to not only start challenging the conspiracy of silence which surrounds this issue but proactively to start working to address some of the challenges I have just outlined.

 

Donald Macaskill

@DrDMacaskill

 

 

 

Carespotting

In recognition of today’s release of T2 Trainspotting, the Scottish Care National Team decided to embrace the hype with our own version of the famous monologue, “Choose Life”.

Instead of “Trainspotting”, we present to you “Carespotting”.

 

‘CARE SPOTTING’

Choose life.

 

  Choose meaningful partnership.

 Choose human rights.

  Choose difficult conversations.

  Choose inclusion. 

Choose learning.

  Choose a rewarding career.

Choose achieving things you never thought you could.

  Choose innovation.

 Choose to be brave. 

Choose to value the things that matter most, like people and relationships.

Choose living well.

 Choose dying well. 

Choose positive ageing. 

Choose improvement.

  Choose an extended family that never leaves you.  

Choose quality.

  Choose a sustainable system, that’s there for you when you’re old and your kids after that.  

 Choose where you want to be, and who you want to be with.

 Choose living to the full, right to the end.

 

Choose your future.

Choose life.

Sweating the small stuff

Well here it goes – my first ever blog! I’m Julie Hodges and I have been working with Scottish Care as a Development Officer based in Highland since July 2015.  My experiences so far have covered all ranges of emotions – great joy, sadness, and frustration. That said, the most overwhelming feeling I get and witness is one of hope and a commitment to continually improve the way we all support our older people to live the best life possible. One that is inclusive and person-centred and recognises the importance of all involved in the care home service – residents, families, and staff.

To support people to live a meaningful and fulfilling life can be difficult in trying times – but the desire to do so always seems to be there. I am delighted my role allows me to be supportive to providers (and residents/families) who are experiencing both good and more complicated situations.

Highland is further down the road with integration than other partnership areas. Because of this, I could write about numerous interesting collaborative pieces of work that are taking place on a regular basis; Highland Business Stream, the ‘Echo’ project, the 10-second pause tool, NHSH finance surgeries, NHSH & SSE contingency workshops, day-care review short term working group, complex care STWG. However, the one I have chosen to focus on is ‘Culture of Care & the impact of you’ workshops.

The workshops take place over two days and are open to anyone wishing to attend – our aim is to include residents and relatives in the future. Each group has a cross section of staff and is delivered locally were possible. The participants are introduced to some of the My Home Life tools and philosophies and reflect on their own roles in creating and supporting a positive and quality experience for anyone living, visiting, working, and dying in a care home or care setting. Workshop content is influenced by feedback from residents, staff, and relatives. The workshops are currently being delivered by the NHSH along with colleagues from all sectors who have undertaken the MHL program.

The plan is for those colleagues to present the workshops within their own services and locations to ensure a spread and share of experience and knowledge. Following on from the workshops we have created a support network for people working in care homes and care at home services. This is a supportive group of providers, managers and senior staff who are committed to sharing resources and offering help, as and when is needed, by other services and colleagues. This includes helping to identify effective paperwork/systems assistance following a care inspection or even just a ‘fresh pair of eyes’.

There is a lot to celebrate in care home life and it’s lovely to see this first hand – committed owners, thoughtful managers, hardworking knowledgeable staff, and residents who blossom with the support they have. There is also a lot of work behind the scenes – difficult negotiations and challenging conversations, and I see my role as supporting people through these in a positive way.

I’ve met some amazing people along the way and something which I notice all the time is that small things matter – the way we speak to each other, the care taken to get to know each other and to care. To care about doing a job well, whatever it is. Unlike the title of a popular book, my experience so far is that sweating the small stuff matters and many people are doing it daily. I love being part of this.

New blog from our CEO: Lessons from a boiler breakdown

Its that time of the year when things start to decide to break down. I’ve been having quite a few problems with my household boiler – not ideal at any time and especially during a winter, however mild. In the process of several visits I have been having chats with the plumber and been looking online about how a boiler system works – now fear not I shall not be visiting a boiler near you anytime soon!

But it did get me thinking because the way in which a boiler works is quite fascinating. Basically when I want to heat the house, I switch on the boiler with an electric switch or timer which for many of us today is now wireless. ‘A valve opens, gas enters a sealed combustion chamber in the boiler through lots of small jets, and an electric ignition system sets them alight. The gas jets play onto a heat exchanger connected to a pipe carrying cold water. The heat exchanger takes the heat energy from the gas jets and heats the water to something like 60°C (140°F).’ – and clearly I needed help to work that out!

I am not going to become a heating engineer but what a household boiler is illustrative of is the way in which so much we take for granted in our living is in effect made up of a series of systems which relate to each other in order to achieve a particular outcome. As I heard someone say recently when I get into the car in the morning and turn the ignition I don’t think of the 30,000 plus individual parts and hundreds of systems which make it work – I think about whether the car is working or not and by extension whether I will get to my destination or not.

One of the problems with my boiler has been that the fault has been hard to detect – sound familiar? This has meant repairing or replacing different elements of the system in order for the whole to work. But that comes with a price and introduces a weakness to the whole system. Dealing with part of the problem, even replacing a part or changing it, affects the whole system often in subtle and undetectable ways. Yet that is how we have often gone about not just repairing a heating system but addressing the problems in human service systems. Traditional technical approaches have addressed problems in individual parts without necessarily considering the impact on the whole machine. This has been a problem with designing new systems as much as it has been with repairing broken ones, so Amory Lovins wrote: 

“Designing a window without the building, a light without the room, or a motor without the machine it drives works as badly as designing a pelican without the fish. Optimizing components in isolation tends to pessimize the whole system—and hence the bottom line. You can actually make a system less efficient while making each of its parts more efficient, simply by not properly linking up those components. If they’re not designed to work with one another, they’ll tend to work against one another.”

What we need is whole-system thinking which shows and maximises the connections between parts.

 I’ve been reflecting on what these insights might mean for a whole systems approach to health and social care in Scotland. Indeed there is a growing literature on these ideas.

 Just before Christmas the Scottish Government published its Health and Social Care Delivery Plan. In some senses there was not a great deal which was new in this work but it has helpfully brought together a whole range of policy initiatives and Governmental strategies and priorities.  Indeed if you read between the lines you can get a sense of a system which is lurching towards a whole system approach if not by design then by inevitability.

 The health and social care system is a multiplicity of systems which if dealt with in isolation might benefit the part but will not succeed in changing and fostering positive outcomes which enable the whole system to work. 

Perhaps this has been most apparent in some of the media over the last few weeks which has addressed itself to what has been happening south of the border in relation to health and social care. Slowly, inexorably, and almost at a snail’s pace, the linkage between health and social care has started to dawn on our popular media. Put simply dealing with a crisis in A and E without addressing the underfunding of social care whereby people have no provider to help them get home or to move into a care home is a fragmented effort doomed to failure. In a Scottish context targets around delayed discharge and unnecessary hospital admission have to have social care providers  at the heart of the design of solutions to the challenges.

 With integration in Scotland there is a real potential to make whole system thinking and approaches a reality. But it will not come easy because the constituent parts of the ‘machine’ are so diverse and often instead of working collaboratively are designed or made to work against each other.

This is very much the case with the way parts of the system relate to the  independent sector. We know that in some Integrated Joint Board areas in Scotland there has been and continues to be significant progress in achieving positive outcomes for people. Where this is happening the culture of partnership, collective decision making, shared risk, and consensual leadership is being fostered and nourished. Where things are not working so well, it is where the ‘them and us’ mentality, professional separateness, role defensiveness, lack of a trustful, transparent and respectful engagement are all too apparent. For instance, where the independent sector is at the table as a partner on IJB Boards then there are positive shared outcomes – where we are not present then a critical part of the machinery of care is left to rust on the side.

We can no longer tolerate an approach to health and social care which tries to deal with the distinctive parts on their own. The interconnectedness is self-evident. We have real potential to enable the whole health and social care system to work. This can be achieved only by whole system approaches; in planning for our shared workforce, in adequately resourcing social care, in developing reciprocal relationships between the NHS and social care, e.g in relation to nursing, in giving value to the contribution of social care staff and in so many other ways.

I hope 2017 despite the clear challenges ahead of us will continue to embed a culture which addresses the cracks of the whole rather than the fragments of those who attract the most attention.  Whole system approaches result in whole system responses.

And lest we forget the outcomes we all want are not about getting a machine to work, but that every woman, man and child at the point of their need receives health and care supports when they require them, where they are and which serve to foster their wellbeing and wholeness.

And … I wish you all a working boiler and a ‘warm’ and healthy 2017.

Donald Macaskill

@DrDMacaskill

New Blog from Ivan Cornford Local Integration Lead, Angus

Collaboration – Cooperation or Fraternizing?

Collaboration – noun

  1. The action of working with someone to produce something – cooperation
  2. Traitorous cooperation with an enemy -fraternizing

Collaboration is a word that that is used frequently in these times of partnership working. Talking to colleagues across Scotland both meanings of the word seem to be in play across Partnerships where some have embraced the notion of working cooperatively whereas others seem to have a notion that working with the independent sector is a form of fraternization. Within independent sector organisations a similar dichotomy is at play with some people willing to work together whilst others will not share ideas and good practice with similar organisations.

Luckily for me I work in an area – Angus – where cooperation has the upper hand over fraternization, it is uneven but spaces are opening up for cooperation between people at different levels in different organisations to bring about service innovation and change. This became clear at a recent meeting of one of our locality care home improvement groups. Sitting round the table were Care Home Managers -Corporate and Independent, a GP, Practice Managers, Pharmacist, Health Service Manager, Care Manager. During this time participants agreed to setting up two tests of change relating to improving medication systems across Care Homes, Health Practices and Community Pharmacy. Discussions were positive and people were listening to each other as they discovered the systems and limitations of how people work in different parts of the Partnership. People left the meeting commenting on how it had been useful and helpful to their own work. I then caught myself thinking back to previous meetings of the same group where attendance had been low and I was having to sell the idea of positive collaboration to various people. It has not been an easy process and I am sure that the progress of the group will be uneven but I am hoping that the positivity of this last meeting will continue and people will realise that collaborative working is good for all of us and the people who use our services.

 

 

Festive Blog from Scottish Care CEO, Dr Donald Macaskill

Twelve Christmas words and wishes

The Christmas and New Year period mean different things to different folk. For me it’s an annual opportunity to engage in an ever failing effort to try to beat the quizzes in our newspapers. My competitive instinct comes to the fore when I convince myself (wrongly) that I really do know the name of Cruz Beckham’s first solo or the winning baker in the Great British Bake Off.

But it’s also a time of reflection, recollection and reconsideration.

2016 has been a busy and ‘interesting’ year. For me personally it’s seen the start of my role as CEO of Scottish Care and the start of these blogs on our new website. Looking back on them they have covered a wide range of topics. That is itself descriptive of the amazing scope of the independent care sector. But in the spirit of the season here are my Twelve Christmas words and wishes:

Nursing

Scottish Care has produced two nursing reports in the last two months. https://www.scottishcare.org/nursing/ . I am grateful they have been so well received and that we are seeing progress on their recommendations. I was privileged to conduct one of the interviews in the Voices report and that conversation has left a deep impression on me. It was with a dedicated nurse who was growing tired of workload pressures and the lack of value accorded to her role in caring for older people. She felt that others viewed her as ‘just a care home nurse’. So my Christmas wish would be for a society that values nurses who care for our older citizens wherever they work whether care home or an acute hospital ward.

Palliative Care.

I’ve personally spent a lot of time with people at the end of their life. There is a transparent truthfulness and honesty at such times and in such conversations. But the discussions I have had this year with frontline care staff show me that we aren’t giving enough time to paid carers to be with those who need simply to talk, to sit and be still, to have someone bandage up their fears as much as to attend to their physical pain. So my Christmas wish would be for a society that values those who sit and hold the hands of the dying by adequately resourcing their work.

Dementia

For me dementia has been a personal and professional concern. My mothers’ own journey with the disease came to an end this past year. Dementia takes over your living when it comes into your family; its rhythm is one which echoes emptiness where once there had been shared memory and story. But I also want to celebrate the capacity and contribution of those who live with dementia rather than, as some do, seeing people with dementia as a problem to be addressed. So my Christmas wish is that people will stop talking about dementia ‘sufferers’ and start celebrating dementia lives.

Human Rights

The beating heart of any society is the degree to which it speaks for the voiceless and recognises those on the margins. Human rights provide the language for such an articulation; they are the vocabulary that enables people to be treated and dealt with not out of sympathy or charity but as equal citizens of a community. So my wish for Christmas is that in Scotland we continue to challenge instances where the rights of our older citizens are minimised, ignored or suppressed. There is no use-by-date on one’s rights.

Living Wage

My first public words in my new role as Scottish Care CEO were a positive recognition of the decision to pay frontline care staff the Scottish Living Wage. Yes, it has been hard and at times a challenge to implement – but the positivity of giving people a wage by which their work of care is valued cannot be downplayed. So my Christmas wish is not only that we are able to build on what we have started and to improve the terms and conditions of carers, but that we work to create a society where those who care are accorded the greatest possible societal value and are awarded appropriate financial reward.

Care Home Reform

33,000 people live in our care homes and this year has reminded me of the astonishing brilliance of the care which is received by so many. But that care comes at a cost. The reform process which has occupied Scottish Care and our partners in the last few months, is seeking to build on existing best practice so that we create a care home sector fit for the future. So my Christmas wish is that Scotland has the courage to adequately fund the care of some of our most vulnerable citizens.

Fullness

The negative, limiting image of people living in residential care or in their own homes and receiving support is often wholly wrong. I have met countless individuals who aren’t simply waiting for their end to visit them but are striding out to own their futures, living with enthusiasm and energy in the face of illness and long-term conditions. Too often society constructs isolation and fosters loneliness by doing things that fail to include, engage and involve our older citizens. The lives of those in care homes and in their own homes are rich to overflowing with dreams still to be realised and contribution lying untapped. So my Christmas wish is that as a society we stay silent for just a second to ask and listen to what older people want from the Scotland that is their home and their future, and to learn what older people can give to the rest of us both now and tomorrow.

Age

Perhaps more than anything in the work I do I have become increasingly aware that we treat people differently based on an artificial number – usually 65, sometimes 70,

sometimes 80. I have written this year that the time is right to stop using language such as demographic ‘time bomb’, to stop subconsciously regretting longevity, and instead to seize the opportunities given by longer and healthier living. But I know that real discrimination happens daily for many of our older citizens, so my Christmas wish is that in 2017 civic society in Scotland will come together and work towards creating a legal framework that adequately protects the rights of older Scots.

Struggle

2016 has been a year of struggle for many of the providers who offer care services across Scotland. I have had too many conversations with individuals who have felt that the pressures of viability and unsustainability have become overwhelming. I have personally despaired of the system of competitive tendering of social care, especially in care at home services, which makes a mockery of dignity and is as far away from person centred care as the heavens are from the sea. So my Christmas wish is that collectively we find a way in which social care can be arranged which will banish forever the obscenity of 15 minute visits and enable small, often family run businesses not only survive but thrive in the giving of care.

Partnership

Partnership working, co-production and collaboration have almost become the buzzwords of the age. They speak to the potential of finding common cause, working together for the benefit of the person needing support and focusing on outcomes rather than systems. Where I have seen partnership work it has fostered remarkable innovation, enabled shared risk-taking and created mutual respect. But independent social care providers have struggled with being heard and represented not least in our Integrated Joint Boards where only 7 out of 31 have representation. So my Christmas wish is that in the reshaping of social care in Scotland we don’t just talk the talk but walk the walk of partnership and realise that partnership without presence is meaningless.

Celebrate

And my last word and wish is that over the next few months and year we all of us, whether we commission care, work in direct support, receive care, or simply talk about care – that we all of us work together to daily celebrate the good rather than talk up the negative; that we give space to hear stories of compassion and care beyond cost; that we influence our media to tell our nation of the thousands of individual acts which every day go unnoticed, unmentioned and unheralded – because that is in essence what happens across Scotland today and everyday.

This Christmas I for one want to thank the 98,000 workers who are the life-blood not only of the independent care sector but also of our communities.

Merry Christmas

Donald Macaskill