The frost clings to the windows of a care home. Inside, a carer hums a carol, her voice soft against the hum of an oxygen machine. A resident stares at the tree lights, wondering if her family will come. Across town, an unpaid carer sets down her shopping bags and begins the evening routine of lifting, washing, soothing, all the while as the kettle boils in a kitchen that feels both sanctuary and prison. In another village, a homecare worker drives through sleet to reach an older man who waits for help with his supper.

This is the paradox of Christmas in social care: joy and fragility intertwined. For Scotland’s care homes, homecare services, and unpaid carers, this season arrives amid deep uncertainty, the reality of staffing shortages, savage cuts because of Government under-funding, loneliness that lingers like winter fog. We long for certainty, for answers that will fix the cracks. But what if certainty is not the gift we need? What if hope, fragile yet fierce, is the light that can guide us?

The Scottish social care sector stands at a critical place as we come to the end of this year. Reports speak of workforce crises, rising costs, and the emotional toll on carers stretched beyond measure. Families worry about quality and continuity; providers wrestle with sustainability and even survival itself. Homecare services struggle to recruit and retain staff, lack of commissioned care means many older people are waiting for visits that never come. Unpaid carers, often family members, carry invisible burdens, sacrificing careers, health, and rest to keep loved ones safe.

In such a climate, the instinct is to seek certainty, and to do so through rigid policies, technological fixes, or predictive models. But life, especially life at its twilight, resists such neatness. Prognoses shift, needs evolve, emotions defy algorithms. Whether in a care home, a living room, or a carer’s kitchen, uncertainty is the constant companion.

Last month I was privileged to take part in a workshop and to attend a session delivered by Dr. Ariel Dempsey. It was during the always wonderful Scottish Partnership for Palliative Care Conference and this past week I was fortunate to meet up again with Ariel when I was in Oxford.

Ariel’s doctoral work at Oxford reframes uncertainty not as a problem to be solved but as an experience to be palliated – soothed, softened, and held with care. In her thesis, Palliating Uncertainty: Tools from the Pragmatism of William James, she argues that uncertainty causes suffering akin to physical symptoms and therefore deserves the same compassionate attention as pain or breathlessness. Traditional responses – over-investigation, over-medicalisation – often amplify distress rather than relieve it. Instead, Dempsey proposes an approach grounded in the ethos of palliative care: acknowledge uncertainty, orient toward meaningful action, and cultivate relational support.

Drawing on William James’ pragmatism, Dempsey frames uncertainty as an invitation to act rather than a barrier to truth. James wrote of “the will to believe”; the idea that when evidence cannot decide, hope becomes a genuine option. For Dempsey, this means clinicians (and by extension, carers) must act with humility and courage when certainty fails. We cannot eliminate uncertainty, but we can meet it with grace.

Her practical steps include managing expectations: naming uncertainty openly rather than masking it. It also means turning attention to action: asking, “What matters most now?” instead of “What will happen next?” And most importantly it means relational holding: building communities of care where uncertainty is shared, not borne alone.

This is not abstract philosophy. It is deeply relevant to social care. For homecare workers, it means entering each home with openness, knowing that plans may change and emotions may surge. For unpaid carers, it means finding strength in the ordinary, in the ordinary acts of making tea, sharing stories, all the time while living with questions that have no easy answers.

Liz Lochhead captures this time of yearning and longing in her winter verse from Festive Poems:

“These are the shortened days
and the endless nights.
So wish for the moon
and long for the light.”

In care homes, in kitchens, in cars parked outside rural cottages, these shortened days are literal and metaphorical. Yet the act of wishing – the audacity of hope- is itself a form of resistance against despair.

Hope, in this frame, is not naïve optimism. It is active, relational, embodied. It is the quiet courage to believe that even in the shadowed places, light can still break through. In social care, hope takes shape in small acts: a carer learning a resident’s favourite song; a homecare worker pausing to share a laugh; an unpaid carer finding respite through a neighbour’s kindness.

William James reminds us that hope is a moral choice when certainty fails. To hope is to act as if goodness is possible, even when the evidence wavers. For Scotland’s care homes, homecare services, and unpaid carers, this means investing not only in infrastructure but in relationships. It means training carers in presence, not just procedure; designing systems that honour the mystery of life, not just its metrics.

Another Scottish poet Josephine Neill’s A Christmas Poem offers a vision of hospitality that mirrors the heart of care:

“Step ower the straw
Draw ben tae the fire
Afore the day daw.”

This is what care should feel like: an invitation to warmth, a shelter against the cold. In a world obsessed with efficiency, such gestures are revolutionary.

Christmas itself is a story born in uncertainty: a child in a manger, a family far from home, a future unwritten. And yet, hope arrived not as certainty, but as promise. This is the hope we need in social care: not the brittle assurance that all will be well, but the resilient trust that love can flourish even in fragile places.

The true gift of Christmas is presence. For those who live and work in care homes, for homecare workers driving through winter nights, for unpaid carers who give without measure, that gift is you – the carers, the families, the communities who choose to love in the face of the unknown.

As we look to renew our communities and social care and support, let us not seek perfect answers but better questions. Let us shape care, whether in homes or residential homes, into sanctuaries of meaning, where uncertainty is met with grace and hope is practiced daily. Let us remember that policy and funding matter but so do poetry and presence, song and silence, firelight and friendship.

This Christmas, may we embrace the dance of uncertainty. May we choose hope not as sentiment, but as strategy, not as illusion, but as moral courage. For in that choice lies the future of care.

In the hush of winter’s breath,
Where questions linger, answers flee,
Hope is not a fortress strong;
It is a candle, trembling free.

It does not banish all the dark,
Nor silence every fear we keep,
But in its glow, we find the strength
To love, to listen, and to weep.

Donald Macaskill

Photo by Leni on Unsplash

 

Social care in Scotland stands at a critical juncture. Rising demand, workforce shortages, and financial pressures have created a system under strain.

For years, reform efforts have focused on structural fixes, the introduction of integrated boards, new governance models, and performance targets. We even came up with the ill-fated National Care Service. Yet, the lived experience of many remains fragmented. Why? Because we have been trying to manage complexity with tools designed for simplicity.

Occasionally there are times when certain parts of your life and worlds come into creative engagement. I recently had such a moment when I listened to a superb speech being delivered by Professor Toby Lowe and recognised the synchronicity of his words with my role as Chair of NDTI who are continually trying to promote and develop creative ways of addressing broken systems in their work, not least the failures to deliver citizen-led and controlled social care and support.

Professor Toby Lowe’s work on Human Learning Systems (HLS) offers a radical alternative to a lot of traditional and normative social care reform approaches. It begins with a simple but profound truth: outcomes can not delivered – they emerge from complex systems of relationships. This insight challenges the dominant logic of control and invites us to design systems that learn, adapt, and serve human flourishing.

Traditional public service management, shaped by New Public Management philosophy and practice (beloved of civil servants and Prince 2 learning systems) assumes that outcomes can be specified, measured, and purchased through contracts. In reality, social care outcomes which are after all wellbeing, independence, or dignity, are created by hundreds of interacting factors: family support, housing, community networks, health services, and personal resilience. Holding providers accountable for outcomes they cannot control leads to gaming, stress, and worse results.

It turns professionals into bureaucrats and people into cases. Scotland’s experience with integration shows this clearly: structural change without cultural change achieves little.

Lowe’s Human Learning System approach rests on three principles:

• it is Human – see people as unique, not data points. Design bespoke responses that start with individual strengths and aspirations.
• it is Learning – make learning the engine of improvement. Use cycles of inquiry and adaptation, not rigid plans and targets.
• it is about Systems – nurture healthy systems: trust, collaboration, diversity, and shared stewardship across organisational boundaries.

Instead of asking, “How do we deliver outcomes?” HLS asks, “How do we create the conditions for good lives to emerge?”

In his talk Toby Lowe cited the innovative work being undertaken in Leeds. There Leeds City Council have embraced a strengths-based approach that aligns beautifully with HLS thinking. This has led to a liberation of social work and social care. They have moved from care management to relationship-based practice. Social workers became “travel companions, not travel agents.” It has as a result reduced bureaucracy, by cutting assessments from 52 pages to two conversational pages. It has led to real community investment through small grants for local initiatives that build resilience and belonging. And critically it has been rooted in system stewardship with senior leaders giving a clear mandate: “Do no harm. Don’t break the rules. Don’t break the budget. Otherwise, go for it.” This created psychological safety for innovation.

The result was social workers reporting feeling empowered, and citizens experiencing care as something co-created, not imposed. For those who were around at the start of Self-directed Support in Scotland, this is what we dreamt of and we can only yearn for such achievements.

I mentioned my work with NDTI and it is through their work that some of these principles are becoming more rooted in parts of Scotland. The National Development Team for Inclusion (NDTi) has helped spread these ideas through its Community Led Support (CLS) programme. CLS creates local hubs where people can have “good conversations” about what matters to them, reducing bureaucracy and connecting them to community resources.

In Scotland, CLS has been implemented in East Renfrewshire, South Ayrshire, Scottish Borders, Fife, and South Lanarkshire, with measurable impacts. Waiting lists have been reduced (e.g., Scottish Borders saw a 37% drop). There was evidence of improved staff morale and reduced bureaucracy; of better outcomes for people as a result of quicker access and more community-based solutions. And CLS also demonstrates cost-effectiveness by preventing crises and reducing reliance on statutory services bringing clear economic benefits.

These changes echo HLS principles of trust, learning, and human-centred design.

I think Lowe’s approach has clear potential for Scotland as we struggle with complexity by too often delivering simplistic responses. Applying these lessons means:

1. Commission for learning, not control – fund organisations to adapt with people, not hit arbitrary targets.
2. Invest in relationships and communities – strengthen local capacity and trust, because outcomes emerge from networks, not contracts.
3. Create connected learning systems – link insights from frontline practice to policy, so reform grows from lived experience rather than top-down design. And stop obsessing with the mistruth that the only people with ‘lived experience’ are those who are currently using care and support. Cast the net wider to the users of tomorrow, to the workers of today and the employers of the moment. They all have invaluable lived experience to teach a failing system.

This is not about importing a model wholesale. It’s about embracing principles that honour complexity and human dignity. Leeds and CLS show that when you trust professionals, invest in communities, and make learning the core of improvement, transformation happens.

Imagine a future where a district nurse, a social care worker, and a community volunteer co-design support around a person’s life. Where local teams share learning openly, shaping policy through lived experience. Where success is measured not by throughput or cost per case, but by stories of flourishing.

This is not utopian. It is already happening – in Leeds, in many other places in England as well as in Scotland. The question is whether we have the courage to scale it.

As Toby Lowe reminds us: stop pretending the world is simple. Embrace complexity. Learn together. Build systems that serve human freedom and flourishing not that feed the gods of performance and the cult of system outcomes.

Donald Macaskill

 

Photo by Armand Khoury on Unsplash

On Human Rights Day 2025, which will take place this coming Wednesday on the 10^th we are called to remember not only the rights enshrined in law but the relationships that make those rights real. In the realm of social care, this is not a theoretical exercise but rather it is a daily, lived reality.

On reflecting upon this I was reminded of a great speech I heard whilst in Boston for the Global Ageing conference a few weeks ago. It was given by the essayist and journalist David Brooks. Several times during his contribution he used the word ‘beholden.’ It sent me searching the dictionary for its origin and meaning.

I discovered that beholden comes from Middle English, originally the past participle of behold. It was a word which did not mean simply to see rather it meant to hold, to keep, to be bound to another. To be beholden is to live in obligation, not as a burden, but as a bond. It is to recognise that our lives are entangled, that our dignity is shared, and that our rights are sustained not only by law but by love.

In an age that prizes autonomy and self-sufficiency, beholden sounds uncomfortable. In our age of individualism, beholden sounds archaic. We prefer autonomy, independence, self-sufficiency. Yet in the realm of social care, and indeed in the moral ecology of our communities, perhaps it is a word we most need at the present time. Because care is not a transaction but rather it is a covenant. Care is profoundly about relationship not task.

Reading a bit more about his writing I have discovered that David Brooks, in his work on the Weave Project and in The Second Mountain, as he did in his speech, speaks of a society fraying at the edges. One that is lonely, tribal, spiritually hollow. His response is not technocratic but relational. He calls for a “relationalist” ethic, one that sees people not as consumers or clients, but as neighbours, as kin.

Brooks writes of “radical mutuality,” of lives built not on independence but on interdependence.

In The Second Mountain, in particular, Brooks argues that the first mountain of life is about personal success, but the second is about moral joy found in commitment to others, in covenant, in community. To climb that second mountain is to become beholden – not in weakness, but in strength. It is to say: I am because we are.

This is not sentimentality. In this view, social care is not a service – it is a covenant.

This is not weakness. It is strength. It is a strength those who work in social care will easily recognise. It is the strength of carers who show up day after day, often unseen and underpaid. It is the strength of communities who hold their elders not as burdens but as bearers of wisdom. It is the strength of a society that says: I am because we are.

In Scotland, we are facing a crisis in social care. But it is not only a crisis of funding or infrastructure – it is a crisis of moral imagination. The centralisation of care contracts, the economic fragility of rural care homes, and the bureaucratisation of support have eroded the relational soil in which human rights grow.

As I’ve said before, “You would be, quite frankly, insane to waste your money building a private care home in any part of Scotland, unless you were guaranteed 100% of private income.” But the deeper insanity is imagining that care can flourish without community.

The National Care Home Contract has failed not only economically, but relationally. It does not reflect the reality of being beholden – to elders, to carers, to the land and its people.

In my writing on the local democratisation of social care, I have argued that we must move from a model of delivery to one of relationship. The Self-directed Support Act of 2013 was meant to empower individuals, but its implementation faltered because it did not embed itself in the moral soil of community.

We need a care system that is not just efficient, but beholden – to the values of dignity, inclusion, and human rights. We must move from a model of delivery to a model of relationship. From care as service to care as covenant. From rights as entitlements to rights as responsibilities held in common.

Ageism, as I’ve explored in recent speeches, is a symptom of a society that has forgotten what it means to be beholden. When older people are seen as burdens rather than bearers of wisdom, we lose not only their stories but our own moral compass. The rise in age-related hate crimes, the media’s portrayal of ageing as decline, and the economic marginalisation of older workers – all point to a rupture in our social fabric.

To repair it, we must reclaim the ethics of obligation. Not obligation as duty alone, but as relationship. To be beholden is to recognise that our lives are entangled, that care is not charity but reciprocity.

On this year’s Human Rights Day, I’d love us to reclaim beholden as a word of moral power. Let us say we are beholden to those who age, not as problems to be solved, but as people to be honoured. We are beholden to carers, whose labour is love and whose work is justice. We are beholden to communities, whose strength lies in their capacity to hold one another.

David Brooks reminds us that moral renewal begins not with systems, but with stories. And in Scotland, we have stories of care that stretch from croft to coast, from ceilidh to care home. They are stories of people who are beholden and proud to be so.

Let us write policy, yes. But let us also write poetry and story. Let us build care systems but let us also build kinship. Let us be beholden, not as a relic of the past, but as a radical vision for the future.

Human rights are not sustained by policy alone. They are sustained by people who are beholden to one another. By carers who show up. By neighbours who listen. By governments who remember that dignity is not delivered but that it is held.

Let us be beholden. Not as a relic of the past, but as a radical vision for the future of social care.

Because to be beholden is not to be bound – it is to be human.

In his poem The Poet’s Obligation the great Pablo Neruda shares a declaration of the poet’s moral duty to awaken others to the vitality of life. Neruda sees himself as beholden to those trapped in routine, pain, or isolation. His obligation is not merely artistic but rather it is human, spiritual, and communal. The sea becomes a metaphor for freedom, and the poet a conduit for its liberating force.

I leave you with his words as we approach Human Rights Day in the spirit of beholden.

 

The Poet’s Obligation

by Pablo Neruda

(Translated from Spanish)

 

To whoever is not listening to the sea this Friday morning,

to whoever is cooped up in house or office, factory or woman

or street or mine or harsh prison cell;

to him I come, and, without speaking or looking,

I arrive and open the door of his prison,

and a vibration starts up, vague and insistent,

a great fragment of thunder sets in motion the rumble of the planet

and the foam, the raucous rivers of the ocean flood,

the star vibrates swiftly in its corona,

and the sea is beating, dying and continuing.

So through me, freedom and the sea

will make their answer to the shuttered heart.

 

https://www.tnellen.com/cybereng/poetry/obligation.html

 

Donald Macaskill

Photo by Andrew Hall on Unsplash