The turning of the year always invites reflection and an opportunity to consider both personal and societal priorities and ambitions. It offers us an opportunity to reflect not only on what lies ahead but on what binds us together as a community and for me the ties that bind us are often seen best and most clearly at times of loss and grief. Bereavement is not a private shadow; it is a communal experience that shapes the health and wellbeing of our society. As we step into January, I am thoughtful of the extent to which as a society and as communities in Scotland we do or do not support every single person who is living with loss and experiencing grief in our midst at this time.

Bereavement is not merely a health service concern; it is a public health issue. Research shows that unresolved grief increases risks of mental illness, physical health decline, and economic strain through lost productivity and higher healthcare costs. I became very well aware of this whilst serving as a Commissioner on the UK Bereavement Commission and listening to the stories of hundreds of individuals whose lives were so damaged by grief. Poor bereavement support both costs lives and cripples our economic wellbeing. A very convincing article in The Lancet some eighteen months ago reminds us that failure to integrate bereavement care into public health systems leaves families vulnerable to illness and isolation, exacerbating the societal toll of loss. It forcefully argues what I believe personally to be truthful and that is that investing in bereavement care and support is a public health priority.

This past week those individuals and organisations involved in Scotland’s National Charter on Bereavement for Adults and Children, which was launched in 2020, published their Manifesto for the upcoming Scottish Parliamentary elections.

The manifesto calls for:

• A National Bereavement Lead within government to coordinate policy and ensure bereavement does not fall between departmental cracks.
• Investment in Bereavement Charter Marks for workplaces, schools, and other locations such as prisons and ordinary businesses thus creating cultures of compassion where grief is acknowledged and supported.
• Community Partnerships that embed bereavement support in local networks, from hospices to voluntary groups.

The Manifesto uses a number of case scenarios to show the sort of success that has been achieved to date, all of which evidence compassion in practice and the positive impact that good bereavement support can bring to communities as well as individuals.

It tells the story of ten Scottish schools who have embraced the Bereavement Charter Mark, integrating grief literacy into education and partnering with local hospices. Teachers report that this work “takes a village” building resilience and empathy among pupils and staff alike. The Manifesto shows how employers adopting bereavement-friendly policies have seen improved staff wellbeing and retention. As one case study notes, “a single act of kindness kept me afloat”—a reminder that organisational culture can transform grief into belonging.

Strong bereavement support is not charity; it is social infrastructure. A 2023 study by Marie Curie and Warwick University found that equitable access to bereavement care reduces health inequalities and fosters community cohesion, particularly for marginalised groups. When grief is met with understanding, people return to work sooner, families avoid crisis, and communities grow stronger.

The Charter Group is making simple asks of our new parliamentarians and whoever it is that will form the next Scottish Government. These practical steps are to:

1. Fund the Vision: Allocate resources for Bereavement Charter initiatives – especially by resourcing the process with £250K over three years which is a modest investment for systemic change.
2. Appoint a National Bereavement Lead: The next Government needs to create a dedicated role within Scottish Government to coordinate bereavement policy and practice across departments.
3. Develop a National Bereavement Strategy: The lack of a national strategy is a real gap in Scottish public policy. We need to co-produce a national strategy for bereavement support, building on the Charter and addressing gaps in the current palliative care strategy
4. Embed Bereavement in Public Health strategies: We need to integrate grief support into mental health and wellbeing plans, ensuring timely, culturally competent care. This can be achieved by more groups adopting the Charter Mark, but that work needs to be resourced.
5. Mobilise Communities: We need to encourage local employers, schools, and voluntary groups to adopt Charter principles and collaborate with bereavement organisations, and lastly
6. Prioritise Succession Rights in the Housing Bill: We need to implement actions to protect the housing rights of terminally ill people and bereaved families.

As someone who has walked alongside countless individuals and families in the aftermath of loss, I know that bereavement is not an event rather it is a landscape. It shapes how we live, work, and belong. Policy matters because it signals what we value as a society. When we invest in bereavement support, we invest in humanity. When we consider bereavement support as a matter of societal and economic priority then we shape our communities into places where all are welcome, where none are excluded even in the rawness of grief and the pain of absence. Bereavement support opens the door to belonging.

Belonging is not a feeling we manufacture; it is a practice we share. It looks like a school that teaches grief literacy and a workplace that keeps the door open when someone returns. It looks like a local café that knows how to hold a silence, and a parish that lights a candle with a name. It looks like government appointing a Bereavement Lead and resourcing Charter Marks so compassion becomes ordinary and everywhere. It looks like the neighbour who brings bread, the nurse who calls back, the friend who sits and says nothing at all. If we want a Scotland where everyone has a place, then we must keep making places where grief is met, supported, and held. When we invest in bereavement support, we invest in community. When we stand with the grieving, we stand with ourselves.

The UK Commission on Bereavement captured this truth with clarity:

“Bereavement is everyone’s business. It is not a niche concern but a universal experience that demands a collective response.”

Starting the year with compassion means making this more than a slogan. It means embedding bereavement care and support into the architecture of our communities and the heart of our governance. As we’ve set out in the Charter and its Manifesto, these are simple, fundable acts that make compassion part of the everyday. Let us make 2026 the year we turn manifesto into movement.

I am mindful of one of my favourite poems from a favourite poet, Jackie Kay, who offers us a tender, communal vision of how those who have died  “are still here holding our hands,”

Darling

You might forget the exact sound of her voice
or how her face looked when sleeping.
You might forget the sound of her quiet weeping
curled into the shape of a half moon,

when smaller than her self, she seemed already to be leaving
before she left, when the blossom was on the trees
and the sun was out, and all seemed good in the world.
I held her hand and sang a song from when I was a girl –

Heel y’ho boys, let her go boys –
and when I stopped singing she had slipped away,
already a slip of a girl again, skipping off,
her heart light, her face almost smiling.

And what I didn’t know or couldn’t say then
was that she hadn’t really gone.
The dead don’t go till you do, loved ones.
The dead are still here holding our hands.

Darling by Jackie Kay – Scottish Poetry Library

 

Donald Macaskill

Photo by Priscilla Du Preez 🇨🇦 on Unsplash.

As the calendar turns and we stand at the threshold of a new year, I find myself drawn to reflection not least on what I consider to have been the significant changes and developments in social care in the last year, and what this new one might bring. That for me has undoubtedly been in the arena of Ai in social care. I am reflective of the journey so far, the companions who have shaped my thinking, and the ethical crossroads that lie ahead for social care in Scotland.

The rapid advance of artificial intelligence in our sector is not just a technical story; it is, at its heart, a human one. And as we look forward, I believe it is essential to ground our ambitions in the enduring values of dignity, autonomy, and justice. I offer this extended thought piece as a contribution to that ambition.

My first instinct is gratitude. The conversations and collaborations of the past year, especially with the Institute for Ethics in Ai at Oxford, the Digital Care Hub, and Casson Consulting, have given our sector a shared language for what ‘responsible’ Ai should mean in social care. Their Summit and White paper gave us a shared language for dignity, autonomy and equality in the age of automation. I am equally grateful for the practical clarity offered by the AI & Digital Regulations Service (AIDRS), which brings together NICE, MHRA, CQC and HRA in England to help health and social care organisations navigate regulation. And I acknowledge UN human‑rights experts who have insisted, I think quite rightly, that the procurement and deployment of AI must be grounded in robust human‑rights due diligence.

All this work has served to remind me that human rights and ethics is not an afterthought, but the very foundation of innovation.

Why a human‑rights approach to AI in social care is non‑negotiable

Ai is already here in adult social care. We see systems that transcribe and draft notes and care assessments, support language translation, monitor movement to reduce falls, and triage requests for support. These tools hold promise, but they also reach into the most intimate spaces of life, our homes, our relationships, our routines. That depth of reach demands a depth of ethics. Oxford’s work in our field is clear: responsible use means Ai must support and never undermine human rights, independence, choice and control, dignity, equality and wellbeing. UN guidance adds the necessary governance spine: carry out human‑rights due diligence across the Ai lifecycle, engage those most affected, and ensure access to remedy.

Regulatory currents are shifting underneath us. The EU’s Artificial Intelligence Act is now law, with staged obligations and a risk‑based structure that bans certain “unacceptable‑risk” practices (for example, systems that exploit vulnerabilities or enable unlawful mass surveillance), sets transparency duties for limited‑risk systems, and imposes stringent requirements on high‑risk uses. Even for Scottish providers, this matters: EU rules apply whenever AIisystems or their outputs are placed on the EU market or used in the EU which is an extraterritorial pull that many supply chains and software subscriptions already trigger.

In the UK, there is as yet no single Ai Act. Instead, a regulator‑led approach asks sector regulators to enforce five core principles (safety, transparency, fairness, accountability, redress) under existing law. For health and social care, AIDRS and NHS information‑governance guidance have become the de facto playbooks: proportionate assurance, safe evidence, clear data rights, and ethical oversight. In short: the EU sets a high, codified floor; the UK expects context‑based governance through existing duties. Scotland must live comfortably with both. I would particularly commend here the blog written by John Warchus which unpacks some of this hinterland.

PANEL: how I turn “rights” into decisions

In a previous article I argued that this is an ethical and rights space that benefits from the implementation of the well-recognised PANEL human rights framework. Nothing that is happening now has changed that perspective and personally I would commend the continued use of the PANEL principles: Participation, Accountability, Non‑discrimination, Empowerment, Legality, to move from slogans to practice. Let me illustrate some of this:

Participation

People who draw on care, unpaid carers and frontline staff should shape Ai before it arrives. Participation is not a survey at the end; it is co‑design at the start and dialogue throughout. The Oxford collaboration modelled this: bringing people with lived experience into the room, defining “responsible” in the language of care, not merely in the grammar of compliance. In my view, participation must include real choices about trade‑offs, say, between night‑time safety and the sanctity of the home, because these are moral choices, not merely technical settings.

Mrs M lives with frailty and prefers to sleep with her door ajar. Her care home trials a thermal‑imaging night monitor to reduce falls. In a participation session, residents and families ask: Can we disable the device in private moments? Where is the data processed? Who can review it? The home agrees to local (on‑premise) processing, automatic masking of faces, visible “privacy on” indicators, and a resident‑controlled off‑switch. The result is not the absence of technology; it is what Jenna Joseph calls consented technology.

Accountability

We need an accountability map for every deployment: who is the provider/deployer and who is the vendor/importer; who signs off risks; who investigates incidents; how can residents and staff escalate concerns; what goes into the public learning log? The EU AI Act gives practical scaffolding, namely roles, risk management, post‑market monitoring, all of which I would contend Scottish providers can adopt to make accountability legible even in a UK regime that leans on existing law.

A local authority pilots an LLM that drafts care assessments from worker dictation. After several weeks, managers notice the model confidently inserts “no risk of self neglect” where the worker had simply paused. An incident is logged; the authority’s accountability map lets a resident, a worker and the vendor meet to replay the transcript and model output. The authority introduces a “yellow banner” policy: any AI generated statement about risk must be explicitly confirmed by the social worker, or it is struck out. This example builds on some of the excellent ethical considerations espoused by Rees and Edmonson.

Non‑discrimination

Bias audits must be routine. Predictive models trained on skewed data can channel more surveillance toward some groups than others, or depress service offers without anyone intending harm. NHS ethics work emphasises countering inequalities; UN guidance insists on HRDD with those most at risk. In social care, we should publish fairness metrics, not hide them in procurement files.

A homecare provider uses an Ai scheduler. Complaints rise from women working school‑hours who get fewer paid visits. A fairness audit shows the model equates “availability” with a 12‑hour window and penalises constrained patterns. The provider resets the objective function to value continuity of relationship and paid breaks, not only distance and minutes. Complaints fall; retention rises.

Empowerment

Human rights require capability. We must make explanations understandable, options visible, and opting‑out feasible. Generative tools should lower barriers for those who do not speak English as a first language, or who want draft letters in accessible formats, without locking people into systems they cannot question. UK information‑governance guidance is clear: professionals remain decision‑makers, and individuals retain rights over their data.

Amira, recently arrived in Scotland, struggles to draft a support request. A co‑produced LLM assistant helps her write in Arabic and produces a plain‑English summary for her key worker. The service’s policy, shaped with users, states that the assistant never submits letters; Amira reads, edits and approves every word. Empowerment is the difference between a tool that writes for me and one that lets me say what I want to say.

Legality

We must separate lawful bases for direct care from those for training or improving systems. We need Data Protection Impact Assessments (DPIAs), contracts that say what data can (or cannot) be used for, and documentation that shows how we manage risk. For high‑risk uses, the EU AI Act expects a full risk‑management system and technical documentation; UK guidance expects the same good governance, anchored in GDPR and equality law.

A supplier proposes to “improve accuracy” by training on de‑identified care plans. The provider’s DPIA flags re‑identification risk for small island communities. The contract is amended: no secondary use without explicit, revocable permission from the individual; only synthetic or federated approaches may be used for model refinement; independent re‑identification testing is required before release.

 The human rights we must actively protect (and how AI touches each)

When I talk about a human‑rights approach, I mean specific rights not vague goodwill.

• Dignity: The first test is always whether the person’s sense of self is enhanced or eroded. Ambient sensors and “smart” cameras risk reducing people to data points, especially older adults. Dignity is preserved when surveillance is not the default; when there are off‑switches; when people choose how technology shows up in their home.
• Privacy: Home should remain a sanctuary. Data minimisation, local processing, strict retention limits and audit trails are the ethics that make sanctuary possible. The EU AI Act’s bans and transparency duties give guardrails, but we must reach for the higher standard of trustworthiness experienced by the person.
• Autonomy and Informed Consent: Consent for direct care is not consent for model training. People should be able to say “yes” to one and “no” to the other. Explanations must be understandable, and meaningful alternatives must exist. UK IG guidance is explicit about these distinctions in care contexts.
• Equality and Non‑discrimination: Age, disability, race, language and socio‑economic status can interact with AI in harmful ways. UN experts call for HRDD with at‑risk groups; NHS programmes focus on countering inequalities. Make fairness testing public and fix disparities quickly.
• Participation and Voice: People affected by Ai must have a say. Co‑production is a right, not a courtesy. Oxford’s co‑produced guidance shows how to do this well in social care.
• Accountability and Remedy: Grievance routes should be accessible and non‑retaliatory, with independent escalation. Document AI incidents (privacy breach, discriminatory output, harm to autonomy/dignity) and publish learning. AIDRS provides pathways for when regulatory notification is required.
• Workforce right and professional judgement: AI must augment care and support work, not deskill workers or micro‑surveil them. Scheduling and productivity analytics need limits and worker voice. Oxford’s governance work and sector commentary both underline this.

Scotland’s digital and policy context: making rights operational

Scotland’s Data Strategy for Health and Social Care emphasises data ethics, interoperability and “better use of data” in preventative care, with work underway toward an Ai policy framework. This is precisely where PANEL and HRDD must be baked in, not as an afterthought, but as the organising principle for design, procurement and evaluation. The Scottish AI Alliance has moved the public sector toward greater AI transparency, and that same ambition should explicitly extend to adult social care.

Scotland’s continuing debate on social care reform and international human rights incorporation is a reminder that law matters when resources are thin and systems are stressed. As the Health and Social Care Alliance have  clearly articulated Ai  must never become a technical shortcut for structural under‑investment. Efficiency that erodes relationships or displaces human judgement is not progress; it is a re‑statement of the very problems we claim to solve.

On a Hebridean island, a care provider is offered a “smart home” package: video monitoring, voice analysis, predictive alerts. The team ask residents to join a design circle. The answer that emerges is: “No, unless it is privacy‑first, entirely local, and unless our crofts feel like crofts, not clinics.” The vendor re‑engineers the solution: devices process on‑device; cameras are replaced by door sensors and pressure mats; and a human call‑back is guaranteed within 10 minutes of any alert. Rights shape the technology, not the other way round.

 

How EU and UK legislation will impact social care in Scotland

Let me put this plainly and practically.

EU AI Act: what Scottish providers must understand accepting the comment above about best practice and legal requirement given our non-membership of the EU at present.

• Risk‑based duties: The Act bans certain uses outright (e.g., systems exploiting vulnerabilities, certain emotion‑inference and untargeted biometric scraping), requires transparency for limited‑risk tools (like chatbots), and imposes heavy governance on high‑risk systems (risk management, data governance, technical documentation, post‑market monitoring). In social care, high‑risk categories often include systems that materially influence access to services or safety, or that manage workers in consequential ways.
• Who is on the hook? The Act distinguishes providers (those who develop or place a system on the market) from deployers (those who use it), as well as importers and distributors. A Scottish care organisation using a vendor’s tool is typically a deployer but may inherit provider‑like obligations when customising or substantially modifying a system. Contracts must make these roles explicit.
• Extraterritorial pull: If your system or its outputs are used in the EU – perhaps because you serve people funded from an EU jurisdiction, or your vendor markets the same configured product into the EU- you can be brought under the Act’s scope. Care technology is global; procurement must assume cross‑border obligations.

A Scottish care home adopts a falls‑prediction platform from a vendor whose product is also sold in the Netherlands. The vendor classifies the system as high‑risk under the EU Act and asks the home to contribute to real‑world performance monitoring. The home agrees on conditions: the vendor provides the conformity assessment and post‑market monitoring plan; the home captures outcome data only with resident consent and publishes a lay summary locally. The result: the home benefits from better safety while remaining on the right side of both EU and UK expectations.

UK approach: what anchors apply in Scotland

• Principles via existing law: The UK expects regulators to apply five core principles through current frameworks rather than creating a single AI statute. For social care, this means leaning on UK GDPR, equality law, and sector IG rules, plus clear, proportionate assurance. AIDRS acts as the navigational aid across NICE, MHRA, CQC and HRA.
• Health/social care specifics: NHS information‑governance guidance clarifies consent, data minimisation, and the continuing role of professionals as decision‑makers. The NHS AI Ethics initiatives and MHRA’s “AI Airlock” are developing practical safety and evidence expectations, useful anchors even when tools are used in social care rather than the NHS.
• So what for Scotland? Health and social care are as we know devolved, but UK regulators and guidance still shape market behaviour. Scottish providers should adopt the highest applicable standard: use EU AI Act role definitions and documentation discipline, follow UK IG rules on data and consent, and align with Scotland’s Data Strategy commitments on ethics and transparency. This “belt and braces” approach reduces risk, builds public trust, and future‑proofs practice.

Practice patterns I commend:

• Co‑produce from the outset: Assemble standing forums of people who draw on care, unpaid carers and staff to review proposals, test interfaces, and agree consent flows. Treat this as governance, not engagement.
• Publish an Ai register: What systems do we use? Why? What data do they process? What is the lawful basis? Who is accountable? How can people complain? (If you only have a procurement file, you do not have accountability.)
• Bias and equity routines: Run fairness tests at go‑live and on a schedule; commission independent audits for consequential systems; correct disparities and publish fixes.
• Privacy‑by‑default architecture: Prefer local processing; minimise retention; create human‑readable logs so that residents and families can see what happened and why.
• Explainability for humans: Build short, accessible explanations; train staff to challenge the model and to document overrides; avoid any fully automated adverse decision.
• Contracts that protect rights: Require vendors to disclose training data sources, known limitations, bias mitigations, and incident response plans; prohibit secondary use without explicit permission; align role allocations with EU AI Act definitions.
• Remedy pathways: Offer simple reporting for residents and staff; classify incidents (privacy, bias, harm to dignity/autonomy); share learning in public. Use AIDRS to judge when to notify regulators.
• Worker voice and wellbeing: Set boundaries on algorithmic monitoring; involve staff and unions in tool selection; invest in digital and ethical literacy; design for augmentation, not substitution.

Closing reflection: the humanness of care

I hope you have found the above useful as we start to navigate Ai in social care in 2026 from a human rights and ethical perspective. There is a lot more to say in this conversation. But essentially social care is a human practice and art before it is a service. Ai will be judged not by how clever it seems, but by whether it helps people live the lives they choose, surrounded by relationships that dignify and sustain them. The frameworks are now at hand, the Oxford values‑led guidance, the UN’s HRDD expectations, the EU Act’s structure, and the UK’s principle‑based oversight. Our task in Scotland is to make them lived reality: to ensure that, in our homes and communities, technology becomes a tool for care, not a technique of control.

Donald Macaskill

Photo by Luke Jones on Unsplash

Four days before Hogmanay, Scotland feels like a country holding its breath. The streets glisten with frost after what feels like weeks of rain, a growing number of hills wear their winter shawls, and the air oozes with anticipation. The rush of Christmas has ebbed, leaving behind a quieter rhythm and a time for reflection, for counting what matters, for dreaming what might yet be.

Hogmanay is not just another New Year’s Eve. It is a threshold, a liminal space steeped in tradition. We sweep the hearth, we lay out coal and shortbread, we wait for the first-foot – that lucky soul who crosses the door after midnight, bearing gifts of warmth and sustenance. Bells will ring from church steeples and smartphones alike, whisky will pour amber into glasses, voices will rise in song.

But beneath the revelry lies something deeper: a belief in renewal, in the possibility of beginning again.

And so, as we stand on the cusp of 2026, we ask the question that Hogmanay demands: What will we carry forward? What will we leave behind?

This past year has been a hard one for social care. We have seen dedicated workers stretched thin, families navigating impossible choices, and communities stepping in where systems faltered. We have heard the language of crisis so often it has become a drumbeat. And yet amid the strain there were and are today sparks of light. Neighbours checking in. Volunteers delivering meals. Carers delivering compassion even in the fragments of commissioned time. Care homes finding creative ways to keep hope and joy alive. These moments remind us that social care is not a service to be rationed; it is the heartbeat of our humanity.

As Hogmanay approaches, we are invited to make resolutions. Too often, they are about waistlines and wallets, about doing more, being better. But what if this year, our resolutions were about something deeper? About the kind of Scotland we want to wake up to on January 1st – a Scotland where care is not a postcode lottery but a shared promise.

Here are three resolutions for a Scotland that cares:

1. Speak of care as infrastructure. Care is not an optional extra; it is the foundation of a good society. Let us resolve to talk about social care with the same urgency as roads and schools because without it, nothing else stands.
2. Invest in people, not just systems. Technology can help, but it cannot replace the human touch. Let us resolve to honour and reward those who care, the professionals and unpaid carers alike, and to do so with fair pay, respect, and recognition.
3. Make community our first footing. Hogmanay’s tradition of first-footing reminds us that the first person through the door brings luck for the year ahead. What if our first step in 2026 was towards deeper community? Towards knowing our neighbours, supporting local initiatives, and weaving networks of kindness?

Picture it: the bells ringing out across Edinburgh, their echoes tumbling down the closes and wynds. The clink of glasses in kitchens from Shetland to Stranraer. The hush before midnight, when the old year lingers like smoke and the new year waits like a promise. A lump of coal on the hearth, symbol of warmth and continuity. A dram of whisky passed from hand to hand, the colour of hope. Laughter spilling into the frosty night as doors open to welcome the first-foot, carrying gifts of bread and salt, symbols of sustenance and friendship.

This is Hogmanay: a ritual of connection, a declaration that we belong to one another. And if that is true in our homes, should it not also be true in our policies, our priorities, our politics?

For me, Hogmanay is never just about fireworks or whisky. It is about standing in the cold night air, listening for the bells, and asking: What kind of Scotland do I want to wake up to? My answer is simple: one where no one feels forgotten. Where social care is not a crisis but a covenant. Where the measure of success is not GDP but the dignity of every life.

Four days to Hogmanay. Four days to decide what matters. What will your resolutions be? And how will they help build a Scotland where social care is not just a service, but a shared value?

Hogmanay is a time for words as well as deeds. So I leave you with this:

New Year

No fireworks needed, no grand display,

just a quiet shift from night to day.

A message sent, a hand held near,

a whispered truth: We’re still here.

Forget the lists that fade by March,

the hollow vows, the rigid arch.

Begin instead with what is real,

a promise made, a wound to heal.

Not coal, but care to light the fire,

not luck, but love to lift us higher.

Bring voices strong, bring laughter clear,

bring hope enough to last the year.

The future waits – no distant star,

it starts with us, right where we are.

So open wide the door of now,

and let the new year teach us how.

Donald Macaskill

Photo by Chris Flexen on Unsplash

 

 

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