The following is based on an opening address given a couple of weeks ago at the Westminster Policy Conference.
We meet in autumn. The air is a lot sharper. The green has given away to the gold. We are between the light and the dark, between summer and winter.
And that is exactly where social care in Scotland is today – in-between. Between aspiration and exhaustion. Between rhetoric and reality. Between what is, and what could be.
So, I want to begin not with statistics, nor even with strategy, but with a story.
A few weeks ago, I sat with a woman in the northwest of Scotland. She is 87. She told me, with tears in her eyes, that her greatest wish is to remain in her croft – the home where her children grew up, where her husband died, where her garden still bursts with colour every spring and Highland summer. But she fears she will not be able to, because she cannot get the hours of support she needs.
Her words and her eyes have stayed with me: “I do not want to be a burden. I want to be myself. I want to live my life, not someone else’s.”
And in that single sentence lies the heart of social care in Scotland. It is not about structures, or even services. It is about life, dignity, being able to live as oneself.
Let’s be honest: the system is groaning under pressure. I hear daily from providers who tell me they do not know if they can last the year. I hear from staff who love their jobs but are leaving because love does not pay the mortgage.
I remember a care worker in Fife who said to me, “Donald, I have two jobs. I leave the care home after a 12-hour shift and go to clean offices, because otherwise I cannot keep up with my bills.”
What does it say about us as a nation when someone who does the most human, the most intimate of tasks – helping someone dress, helping them eat, holding their hand in the night when they are afraid – must then scrub toilets in order to survive?
These are not isolated stories. They are Scotland in 2025. I have this past week travelled top Aberdeen, Dundee, Edinburgh and Glasgow and I am hearing the same thing everywhere.
Providers tell me they may not survive. Half are financially insecure. Staff are weary; families are breaking.
Add to this the ending of the adult social care visa route in July. In Skye, in Barrhead, in Lanarkshire, managers have told me they rely on workers from the Philippines, from Ghana, from India – people who have become neighbours, friends, part of the fabric of our communities. Removing that route is like pulling out a thread from a tapestry – and the whole pattern begins to unravel.
And it is unravelling before our eyes. I spoke to a care home manager a couple of weeks ago who has 80% of her staff on international visas – and she is now beginning the process of having to tell too many of them that their visas will not be continued.
What is happening in that remote community? It’s not just the loss of a worker but the prospect of losing a care home in the midst of community; the prospect of the care workers’s children who’ve kept the local village school abundant in life having to leave and her husband too – yet again another skilled individual lost to a remote community.
And all the time decisions are made in distant detached realities deaf to the heartbeat of community in Scotland.
Realism tells us that social care is at breaking point.
But despite my virtual daily phone calls with somebody at the other end in tears at the collapsing of social care in Scotland – I hold onto hopeful realism, because alongside the exhaustion I also meet extraordinary resilience.
In a care home in Ayr, I saw a young care assistant sitting beside a man with dementia, singing quietly to him a tàladh – a Gaelic lullaby – the lullaby her grandmother used to sing. His agitation eased, his eyes softened. There was connection, comfort, love. Hope broke in.
That is the hope we must build upon.
When politicians speak of reform, they often use the language of systems and structures. They talk of Bills and frameworks, of services and silos. Of consultations and advisory boards.
And yes, those things matter. But reform is not simply about moving the pieces of the jigsaw. It is about painting a new picture altogether.
I remember a young man with a learning disability in Glasgow when I ran a project there a couple of decades ago. He told me he wanted to work with computers. Instead, he was offered a place at a day centre where he could do jigsaws. “It’s not that I don’t like jigsaws,” he said, “but I want to do more than pass time. I want to live a life.”
That, for me, is what reform must be about – moving from passing time to living life; moving from a maintenance approach to social care which keeps people as they are safe yet contained, a fulfilling our statutory duty approach – to enabling people to flourish and thrive not just exist; to empower people to be citizens so that they’re belonging interrupts and disrupts all our lives in a positive way.
Reform must not mean rearranging the furniture. It must mean a new way of living.
Reform means:
- Rights lived, not rights listed. Not a human rights logo on a government website, but the daily reality of autonomy, dignity, participation. Not saying to someone that because it costs more to support you to be independent in your own home that you have no choice but to go into residential care.
- Person-led, not person-fitted. Too many of our services still require people to fit into their shape. Real reform turns that on its head. Real reform enables us to have a creativity which redesigns the present structures and models of care support into what people increasingly demand, want and deserve but which they cannot get because it’s existence is budgeted out of possibility.
- Co-production, not consultation. Sitting with people before the decision, not after. Let’s end the game of pretence which uses language like co-design to suggest participation – when the reality is a predetermined set of responses massaged into apparent engagement.
- Fair work. And here I want to be blunt: we are failing the predominantly female workforce of social care. Eight out of ten are women, yet their pay lags behind, their careers are undervalued, their pensions insecure. This is gender injustice written into the fabric of our system. In a week where the latest data from SSSC the workforce regulator shows that 1 in 12 working Scots is in social care – this is a lamentable state of affairs.
Reform must not only be structural — it must be moral.
As the poet Hugh MacDiarmid once cried:
“Scotland small? Our multiform, our infinite Scotland small?”
In the same way, I ask: will our vision of care and support be small, mean, and miserly? A reform and change limited by an imprisonment of affordability and reality rather than aspiration and reimagining.
Or will our reform be infinite – rooted in rights, generous in scope, brave in ambition?
I have sat in more strategy rooms than I can count. I have seen policy papers crafted with elegant words. I have listened to Ministers make soaring speeches. And yet I have also seen how easily these things falter when they meet the ground.
Implementation is not glamorous. It is hard work. It is messy. It requires compromise.
A few months ago, a small provider told me: “we have survived not because of government but despite it. We’ve survived because local people care, because staff go the extra mile, because families muck in.”
That is both inspiring and damning. Inspiring because of the resilience of communities. Damning because we cannot build a system on heroic endurance. Heroism is not a policy. Endurance is not a strategy
Implementation is where aspiration meets accountancy.
We need implementation that is resourced, supported, and intentional.
Implementation requires:
- Clarity of purpose – never losing sight of the why.
- Proper funding – not dreams without legs.
- Local flexibility – Shetland is not Glasgow and must not be treated as such.
- Leadership at every level – not just in Holyrood but in homes, communities, and among people who use services themselves.
Every act of care, every local innovation, every moment of dignity matters – but only if the system enables them.
Let me put it in five imperatives:
- Rights into reality. Every commissioning decision must be tested against human rights.
- Workforce justice. Pay parity, pensions, progression. Without staff, there is no system.
- Real co-production. Stop tokenism. Share power.
- Rebalancing spend. Move money from crisis health treatment into preventative care and community support. A billion shifted from the NHS budget is not theft – it is investment in sustainability.
- Changing the story. We must stop talking of social care as a cost. It is not a burden – it is a blessing, an asset, the foundation of citizenship.
I want to finish as I started with a story.
I was in a care home earlier this year. An elderly gentleman with advanced dementia was nearing the end of his life. His daughter sat by his bedside, holding his hand. She said to me quietly, “I know my father does not know me now. But I know him. And that is enough. What I need is the time, the space, and the support to sit with him, to be with him, to say goodbye well.”
That is what social care gives us – the possibility of a good life, and the possibility of a good death.
Or, as the Gaelic proverb has it: “Is e cairt nan daoine an saoghal” – “The world is carried on people.” Social care is that carrying.
Hopeful realism tells us that our system is near collapse – but also that collapse is not inevitable. If we choose differently, if we invest, if we reform, if we implement with urgency and with humanity, then we can still build a Scotland where every daughter can sit with her father without fear, where every older woman can stay in her home, where every young man with a disability can live the life he dreams of.
That is the Scotland I believe in. That is the Scotland we must fight for together.
But all that aspiration requires political leadership that does not just use words to hide inaction but governs with urgency and with focus. We are distinctly lacking such. After a summer of relative inactivity on the part of Scottish Government in the face of a social care crisis we are now into an autumn of silent inaction, where women and men are dying waiting for care as assessments now take months, as care home beds are cut and as care at home packages are being reduced and removed.
Social care does indeed carry people, but it urgently needs political and societal leadership to share the burden rather than walk away. And the need is urgent.
Donald Macaskill