Social care is social justice.

Next Thursday is the United Nation’s annual World Social Justice Day 2025. A quick look at official calendars shows that there will be lots of events around the country and across the UK on issues of gender, migration, poverty and inclusion.  But at least for me the day asks some uncomfortable questions. In Scotland we often pride ourselves on being a nation built on fairness, dignity, and equality – the very bread and butter of social justice. We are after all the nation of ‘A Man’s a man for all that.’ Yet, when it comes to social care the sector that should be at the very heart of our social justice efforts – we continue to neglect, undervalue, and overlook it.

Social care is not just about helping people live their lives with dignity; it is a profound expression of our shared humanity. It embodies the very principles of social justice: equity, human rights, and the belief that everyone, regardless of age, ability, or background, deserves to participate fully in society. Indeed, as I have said on more than one occasion the distinctive nature of social care as understood by Scottish legislation makes explicit the social justice dimension of social care. And yet, despite all the fine words and policy commitments, social care in Scotland remains on the margins, rather than at the centre, of our social justice agenda.

For me it could not be more plain social care IS social justice and social justice without social care is empty and vacuous.

Too often, social justice is discussed in abstract terms – poverty, inequality, exclusion – without recognising that social care is where these issues play out most starkly. Social care supports older people, individuals with disability, and those living with mental health conditions. It ensures that people are not trapped in their homes, isolated from their communities, or living in fear of not having their most basic needs met. It is the safety net that allows people to thrive, not just survive.

Good social care is the difference between an individual being able to choose how they live their life and having that choice stripped away. It ensures that human rights are not just a theoretical construct but a lived reality. A society that fails to invest in social care is a society that perpetuates inequality, particularly for women, disabled people, and those in poverty, who are disproportionately affected by the gaps in the system.

So why, I ask myself, despite its fundamental role in achieving social justice, does social care continue to be underfunded, undervalued, and underappreciated – at least in Scotland? Why is it that this week we have discovered again that the economic value of adult social care to the Scottish economy is £5.2 billion; that for every £1 spent there are £2 worth of additional socio-economic benefits. Social care is not a drain but a massive driver and contributor to our economy yet it hardly ever appears in any official economic strategy as such.

I suspect the primary reason for this neglect – yet the one that most would not confess to or admit – is the uncomfortable truth that social care is still seen as ‘women’s work,’ as an extension of informal family caregiving rather than a critical professional service. The chronic undervaluation of care work – both paid and unpaid – is a stark reflection of gender inequality in our society. You can also add to this the insidious ageism which pervades attitudes to social care – only this week we have witnessed the casual stereotyping of older age and the dismissal of contribution from the elderly by some political figures including a UK Minister who had been working around adult social care!

It is also not helped by the failure to accept the critical preventative role of social care but instead to continually focus on social care as a reactive response. Instead of recognising social care as a public good, policymakers and political leaders continue to treat it as an emergency response, something to be patched up rather than properly invested in. This short-termism ensures that the system lurches from one crisis to another, rather than addressing the structural inequalities that create the need for care in the first place.

At the heart of social justice is economic justice yet whilst we often speak of fair work, of paying a real living wage, of tackling in-work poverty, we refuse to see that the low pay and poor conditions in social care are an economic justice issue. Until we properly fund social care services, we will continue to condemn thousands of care workers – predominantly women – to pay that does not reflect their professionalism, insecurity, and burnout.

And over all these the classic failure to see social care as an issue of social justice is the fact that social care has become a political football rather than a political priority. Social care in Scotland has been at the centre of political debates, particularly with the proposed National Care Service. But rather than being framed as a fundamental issue of rights and justice, it has too often been reduced to a question of bureaucratic restructuring. We need to ask: will any of these reforms (even the most recent) truly shift power into the hands of those receiving care and those providing it? Or will we continue to have a system where people feel unheard, unseen, and unvalued?

If we are serious about social justice in Scotland, then social care must be our starting point. We cannot claim to be a nation committed to fairness and equality while we continue to fail those who rely on and provide care.

On World Social Justice Day, let us move beyond rhetoric. Let us commit to:

  • Fair pay, conditions, and recognition for care workers rather than self-congratulation about the Living Wage and promises tomorrow.
  • A human rights-based approach to care that prioritises choice, dignity, and participation and has legislative bite with a new Human Rights Act and clear implementation of social care choice not the kind that is limited by budgets.
  • A shift from crisis-driven social care that is there to rescue and patch up the NHS to preventative, community-based support

Social justice is not an abstract ideal. It is something we build through action, through policy, through investment. And it starts with ensuring that no one – whether they are receiving care or providing it – is treated as disposable.

Social care is social justice. It’s time we acted like it.

I leave you with some of the poetry of the contemporary American poet Jane Hirshfield whose works are enthused with a sideways look at the essence of justice. Her poem ‘For What Binds Us’ reflects on the various forces “both physical and emotional” that connect individuals and the resilience that emerges from shared experiences and healing.

For What Binds Us

By Jane Hirshfield

There are names for what binds us:

strong forces, weak forces.

Look around, you can see them:

the skin that forms in a half-empty cup,

nails rusting into the places they join,

joints dovetailed on their own weight.

The way things stay so solidly

wherever they’ve been set down—

and gravity, scientists say, is weak.

And see how the flesh grows back

across a wound, with a great vehemence,

more strong

than the simple, untested surface before.

There’s a name for it on horses,

when it comes back darker and raised: proud flesh,

as all flesh,

is proud of its wounds, wears them

as honors given out after battle,

small triumphs pinned to the chest—

And when two people have loved each other

see how it is like a

scar between their bodies,

stronger, darker, and proud;

how the black cord makes of them a single fabric

that nothing can tear or mend.

Copyright Credit: Jane Hirshfield, “For What Binds Us” from Of Gravity & Angels. Copyright © 1988 by Jane Hirshfield and reprinted by permission of Wesleyan University Press. Source: Of Gravity & Angels (Wesleyan University Press, 1988)

This poem is available on the Poetry Foundation’s website: For What Binds Us | The Poetry Foundation

Donald Macaskill

Photo by Ian Schneider on Unsplash

Too good to be true? Digital access and safety for older Scots.

It will be the annual Safer Internet Day on Tuesday next, the 11th of February, with celebrations and learning based around the theme ‘Too good to be true? Protecting yourself and others from scams online

Safer Internet Day is the largest event of its kind in the UK. It is a day primarily directed to younger people and keeping them safe online – and yet whilst that is clearly critical, the victims of online scams and harm are increasingly coming from the ranks of older individuals. There has been a disturbing rise in the issue of financial extortion and scamming of older people at a time when the drive to putting so many public services and access to diverse products has gone digital, when it is increasingly hard to live without being online for anyone at any age.

It is in the midst of this drive to digital that I frequently hear and see a silent crisis unfolding. The reality of digital poverty and exclusion for older Scots has never been as great as it is now. Its existence is not only one of concern in terms of financial harm and the need for societal safeguarding, but it is also a reality that challenges and undermines the human rights of older Scots.

I saw this recently when in the one day I witnessed an older person turned away from a café because it no longer took cash, and a few hours later another older person in a shop that demanded orders be placed using a keypad but which the older person with what I suspected was rheumatoid arthritis simply could not use. There are countless other instances where older people are increasingly unable to live the connected, independent lives they would want to. Even when someone has access to digital and online tools, there are so many instances of exclusion.

Digital exclusion is not merely a matter of lacking access to technology; it is a multifaceted issue encompassing affordability, skills, confidence, and motivation. It is also an issue to do with the fundamental inaccessibility of so many digital tools and devices for those with any sort of impairment, never mind those which worsen with age and frailty.

Audit Scotland’s recent report highlights that approximately one in six adults in Scotland lack the digital skills necessary for everyday life, with 9% of households devoid of internet access. This exclusion disproportionately affects those already facing disadvantage, including older individuals and those living in poverty. And yet the exclusion of such individuals is almost assumed to be a cost worth making.

The consequences are severe. Without digital access, many older adults find it challenging to engage with public services, maintain social connections, and manage their health and financial well-being. This isolation not only diminishes their quality of life but also places their fundamental human rights at risk.

The shift towards digital-first public services, while efficient, often overlooks the needs of those without digital access. This oversight can lead to the erosion of essential human rights, including the right to social security, education, and protection from discrimination. For instance, individuals unable to manage online benefit applications may face sanctions or delays, directly impacting their right to social security.

Moreover, the lack of accessible alternatives to digital services can result in older adults being unable to exercise their rights fully, leading to increased risk not least given the fact that many non-online points of access are hard to reach for individuals with issues of mobility and frailty.

We are, given this set of circumstances, not however without options for action and change.

We could as a society invest more in infrastructure – to really put some gas behind the claim that we want a digitally empowered citizenship. Heating and lighting are fundamental but so too is the ability to access the internet and use online resources. Yet recent budgets evidence a reduction in overall spend on technology and digital. We could give greater focus to ensuring affordable and reliable internet access, particularly in rural areas where connectivity is often limited and give enhanced cost reductions and savings to older Scots. We could by design build in and maintain non-digital options for essential services to ensure inclusivity. Indeed, when many of us lost our power and connectivity during the recent travails of Storm Eowyn we were reminded that not all of life and response should be dependent upon connectivity and Wi-Fi.

The Scottish Government’s Connecting Scotland initiative, launched during the COVID-19 pandemic, aimed to address some of the issues of digital exclusion by providing devices, internet connectivity, and skills support to vulnerable groups, including older adults. An evaluation of the programme revealed that lack of digital skills and experience was a prevalent barrier among participants, nearly half of whom were over 60. Specifically, 41% of respondents reported that they could not use, or would need help to use, the internet, while an additional 22% could use it with some difficulty. I would be very surprised if this were not the situation three years on, if not indeed a worsening trend.

What we also often forget is that as we age what might have been possible in our 50s and 60s becomes much harder due to issues of dexterity or memory loss when we reach our 70s and 80s and beyond. In other words, we should not assume that those who today in their 60s are digitally safe and knowledgeable will be equally the same in their 80s and 90s. Little research has been undertaken on how digital and internet use changes with older age and how we need to change and re-design products to take account of that.

Indeed, it is one of the issues I continually come across – a desire to be technically connected amongst older individuals – but an exclusion caused by issues of visual and aural impairment because the tech has not kept pace with ageing.

Designers and developers worldwide are actively addressing accessibility challenges to enhance technology use for older adults with visual, hearing, and dexterity impairments. These efforts are particularly significant in social care and health sectors, where accessible technology can greatly improve quality of life. It would be tremendous if Scotland – with its ageing population – was able to lead the way in some of these advances whether that might be in further developing voice controlled virtual assistants and devices, developing real-time text captioning, or most importantly developing alternative input devices to take account of the issues caused by dexterity change and frailty.

Technology has so much potential to enable and further enhance inclusion and independence, for all ages, not least older Scots. But we need to invest in tech and digital options that are not just the shiny new toys, but the workmanlike solutions to exclusion and inaccessibility. If we do not enable greater confidence and skill to grow amongst those who are excluded not least the older generation, then they will be at risk of even greater technological and internet harm.

Of course, for many grappling with modern technology, such as tablets and digital devices, is not always easy as an excerpt from ‘The Tablet’ by the British poet U A Fanthrope beautifully reminds us:

*”I am learning to use my tablet.

It is not easy.

The icons are small, my fingers are large,

And the screen is a slippery slope.

But I am determined.

I will not be defeated by a piece of glass.”*

 

Donald Macaskill

 

Photo by Glenn Carstens-Peters on Unsplash

What does it mean to care at home? A reflection.

There has been a great deal of talk this past week about how important it is that we support and care for individuals as close to their home as possible, including yet again an emphasis on hospital at home – as well as an increased commitment to focussing on prevention and healthcare at home from the First Minister. Yet what is often missed in the political rhetoric and proclamation is a proper understanding of what it means to support and care for someone in their own home or in a homely setting.

Some of that reality was portrayed in research which was undertaken by Scottish Care, Care Forum Wales and the Homecare Association in conjunction with Sky News and which was published this past week. It made for distressing and worrying reading and made me personally question whether we have become blinded to the need for humanity in our national response to the current social care crisis.

Entitled ‘It feels like we don’t exist’ the Sky News item explored the human cost of the social care cuts happening across the country and not least in Scotland. I’ve mentioned these cuts to care more than a few times over the last few months, but they have – unless you receive care and support or work in the sector – gone largely unnoticed and under the radar of the mainstream media. What they mean is that effectively most Health and Social Care Partnerships – the bodies who oversee and pay for the majority of care home and homecare delivery in Scotland – are having to make savage cuts of tens of millions of pounds in order to make their books balance this year and certainly into the next fiscal year. What that means – is not that there are queues outside our hospitals for our politicians and media to see – but that there are invisible impacts which mean thousands of people are having their care and support cut, or are not being assessed at all and that less and less is being spent on the support and care of some of our most valuable citizens. This is a process of cuts to life which is going largely unseen.

The Scottish Care research painted a sad and depressing insight into the reality of the current social care crisis in Scotland. Specific results from Scottish Care membership said that:

  • Over 80% of respondents stated that councils have reduced the number of care packages that would previously have been awarded.
  • 90% stated that councils have reduced the overall number of hours commissioned within care packages.
  • Over 90% stated that councils have asked providers’ to complete care tasks that are unrealistic within the commissioned time.

Such reductions place untold stress on the sustainability of vital care providers across Scotland and diminish access to an adequate level of person-led care. As commissioning and procurement bodies cut packages beyond the true cost of adequate care for our communities, care providers are struggling to stay afloat.

A provider told me of the increasing pressure to do tick box care. One spoke of the request from a Council to support someone up out of their bed, to help them to have breakfast, to make sure they had a wash for the day and to do all this in 15 minutes! This is obscene and inhumane. Another provider spoke of the fact that their care organisation had been fined on numerous occasions because the carer had made a cup of tea or had taken out the rubbish for a supported person – all because it wasn’t in the ‘care plan’. All of this smacks of a system where money talks and compassion walks, where we have turned care and support into a functional set of tasks rather than what it should be – a relationship of dignified humanity which enables a person to flourish and thrive. Behind the rhetoric of more and more money being given to social care is the perverse truth and reality of a system of social care that should shame every Scottish citizen.

I am writing all this being very aware that when care is cut this impacts on not only the person themselves, on the workers but also the wider family who depend so much on a functioning social care system.

Tuesday next, 4th February, is the annual World Cancer Day when we are asked to focus on the lives of those living with cancer and how we can improve health, and social care supports to enable people to live better with cancer. So often in these discussions the experience of older Scots living with cancer, and in large part supported in their own homes, goes missing from our focus.

With our ageing population more and more of those who live into older age are being diagnosed with cancer as well as the reality that positively those diagnosed younger are living longer with cancer. We often ignore the fact that older patients often present unique concerns, such as decreased tolerance to certain treatments, multiple co-existing medical conditions, and the functional challenges in daily activities which often come with age. These factors all necessitate a tailored approach to cancer care for the older citizen but in a system where we are struggling to do the basics humanely such focus and personalisation seems impossible. But it is urgent that we develop such cancer specific supports.

We know from recent research on cancer care that the role of homecare and social care is absolutely vital. Studies have shown that the benefits of home-based supportive care for advanced cancer patients is enormous. We need to resource social care to deliver more effective high quality cancer care.

What we have instead is the comments I hear from so many living with cancer, which is about rushed workers, staff constantly having to look at their watches, always on the move, and yet despite the care by the clock they are requested to make they still continue to show compassion, professionalism and care.

All our citizens, regardless of age deserve the best possible care and support in their own home or in a homely setting. This will not be achieved by ignoring the disintegration of social care across Scotland. We have to wake up to that reality and ignore the saccharine statements of assurance of a system that is working. We have to really accept that to care for someone in their own home, whether they are living with cancer or not, in a manner which affirms their rights and dignity – cannot and should never be done with a stopwatch in your hands.

Donald Macaskill

Photo by Pinakeen Bhatt on Unsplash

 

Blog – The Great ‘Doughnut Fallacy’ of social care in Scotland 

The Great ‘Doughnut Fallacy’ of social care in Scotland 

Minister for Social Care Marie Todd last week announced changes to the proposed National Care Service (NCS) Bill. The most significant of which is the removal of Part 1 of the bill, which focused on the structural reform of integrated social care and community health. This means the bill will now proceed with only Parts 2 and 3. I can’t help but note the passing of the ‘Welfare of Dogs’ Act in the same week and reflect upon what that means for how we value our citizens. What is crucial now is that we do not wait for the Bill to reform social care. A briefing was sent to all Scottish Care members with more detail, but here’s what we know: 

First, it’s important to acknowledge that the plan for a complete overhaul of the social care system, through the structural reforms in Part 1 of the National Care Service (NCS) Bill, has been dropped. This is where the system arguing with itself about who should run things got in the way of making a difference for people. It’s the great doughnut fallacy of social care. 

During the pandemic we experienced a health takeover of social care. They brought with them outdated ideals of person-centred social care. Whilst this was a positive initiative of its time, over 2 decades ago social care switched to person-led care and support. Person-centred was a way of reinforcing the need of the system to connect with itself with the individual citizen at the centre. However all too often what would happen is that the individual in the centre would find themselves in a vacuum surrounded by a system determining their needs, often to the detriment of the individual. This regression to person-centred caused a culture change which ripped a hole in the heart of the independent review of adult social care and delayed the implementation of meaningful change.  

With the structural reform proving too difficult, I am however reassured by the clear language shift to person-led in the Ministers speech reinforcing the need to remember why we are doing this. Put simply, for people not power. 

So what remains in the bill? 

  • It includes “Anne’s Law”, which appears to strengthen visiting rights in care homes although in practice the role of Public Health still has a power to overrule any decisions, making this legislation have no greater impact that what already exists. 
  • It aims to improve information sharing between health and social care services. Many of you will know data is one of the pedestals I like to climb upon, but that is because it is a real area of opportunity. Especially with the adoption of ethical AI. However, it will only work if it meets a vision to reduce bureaucracy and improve the user experience. I wrote about this with Dr Tara French some years ago now in Seeing the Diamond in Social Care Data, but the principles remain the same. Alongside this, there is a need to embrace digital to augment the care experience, offering people more autonomy and freeing up care workers to get back to delivering care. 
  • There’s also a plan to establish a national care service advisory board. This is meant to be an independent body, including people with lived experience, that will help to improve the quality of care across the country. It will provide advice on national programs to support improvements and will monitor and report on local frameworks. However, it’s not statutory, so it may not be as powerful as it could be. What is important here is how the board can ensure transparency and influence over poor practice in all parts of the system. This will be supported by work on  
  • Ethical commissioning and procurement which remains in the bill. This is where real change towards person-led sustainable and quality care can be made, but only if it is enforceable. Financial constraints and the persistent underfunding of social care and support for a decade has led to a time and task takeover meaning that providers are not commissioned to deliver the care and support that people really need to live well. In addition, delays in payments to care providers are putting them at further risk of collapse because they cannot meet cash flow demands. Providers are closing. Staff are exhausted and undermined. There is additional pressure on families, and worst of all, people are being failed. In response to the statement that Scottish Government has increased funding for social care by 25%, two years earlier than planned. I wonder how much of this has been used to meet public sector pay increases or simply to meet inflationary rises. Funding remains a concern and transparency, and good governance is still needed for system change to embed. 

So there we have a list of what should perhaps be the items for the agenda of the first National Care Service Advisory Board. Whatever happens next, it is critical that changes are person-led and focus on the needs of individuals, ensure care workers are properly supported, care providers experience full economic cost recovery, and that the system is accountable, flexible and efficient. Without these critical foundations, the changes to the NCS bill will not deliver the required improvements of the Independent Review of Adult Social Care and the doughnut fallacy will remain strong. However, if we collaborate with intent, we can have our cake and eat it. 

 

Karen Hedge
Deputy CEO, Scottish Care

Media Statement: “It Feels Like We Don’t Exist’ – Scottish Care Calls for Urgent Action

“It Feels Like We Don’t Exist”: Scottish Care Reiterates Call for Urgent Action Following Sky News Report  

Scottish Care is deeply concerned with the findings of Sky News’ recent report into the experiences of homecare and housing support providers delivering commissioned care packages, summarised within our Briefing Report.

Specific results from Scottish Care membership are as follows:

  • Over 80% stated that councils have reduced the number of care packages that would previously have been awarded.
  • 90% stated that councils have reduced the overall number of hours commissioned within care packages.
  • Over 90% stated that councils have asked providers’ to complete care tasks that are unrealistic within the commissioned time.

Such reductions place untold stress on the sustainability of vital care providers across Scotland and diminishes access to an adequate level of person-led care. As commissioning and procurement bodies cut packages beyond the true cost of adequate care for our communities, care providers are struggling to stay afloat amongst increasing operational costs:

“For the first time in 27 years I am genuinely scared for our future.” 

Reversing this reduction in service availability is vital, with funding for care providers that is commensurate to the true cost and value of the vital work they do.

Sky News’ report reaffirms the inadequacy of time and task models of commissioning homecare and housing support, typified by 15-minute visits and the lack of person-led care on offer:

“How are carers supposed to provide high quality care if they only have 5 minutes! This is not enough time to take off your jacket let alone assess the persons wellbeing.” 

As opposed to tailored packages that meet the individual needs of service users, carers must complete multiple complex tasks within this narrow timeframe (personal care, medication administration and meal preparation). Increasingly, basic needs cannot be met. Moreover, by removing the vital human element of care, individual citizens feel rushed and undignified.

The results also highlight a breakdown in partnership working between commissioning bodies, providers and service users when making significant decisions regarding the future of a care package:

“We seem to be in a situation where there is no transparency or honesty”. 

The whole adult social care sector must commit to greater communication with providers on any decisions that affect service delivery.

Scottish Care’s recent response to the Scottish Budget describes a “budget that kills”. Sky News report exemplifies this very real risk without sufficient support at all levels of government.

We must address the #SocialCareCrisis in Scotland. This begins with a truly ethical approach to commissioning and procurement that respects the true cost of care, communicates openly with service users and their care providers, and works collaboratively to advance the much needed change away from time and task models of care. These steps are vital to safeguarding a care system that prioritises dignity and delivers high-quality, person-led care.

-Ends-

Time to tell the story of social care

One of the joys of living in Ayrshire is the continual presence of the poetry of Robert Burns. I have to confess that I have not always loved the works of the Bard but the more I have got to know his poetry and his life the greater my appreciation.

So tonight, with others I will be partaking of that Scottish ‘tradition’ of haggis, neeps and tatties and no doubt will attempt – probably badly – to recite a few Burns’ words in the presence of friends and family. I am also well aware that today and tonight across not just Scotland but across the globe there will be gatherings bringing together families and friends to eat, drink and recite Burns on this his birthday. Despite the tides of modernity and social media influences Rabbie seems not to be going out of fashion – quite the reverse!

In one of those literary happenstance moments today also marks the beginning of National Storytelling Week. Story is as I have often written in this blog a powerful vehicle to communicate truth, to inspire, to challenge and to change. There is something almost timeless about the power of stories to change our world – the energy of tales to shape our understanding of our lives and connect us to one another.

Burns epitomises for many the ability to communicate truth, to tell a story, in verse and in poetry. The ploughman poet understood the enduring truth of storytelling. His verses captured the humanity of his time: the struggles, the joys, the resilience of ordinary folk. Through his words, the voiceless were given voice, and their stories, their truths, became immortal. He was able to speak uncomfortable truth to power and to seek to change and redirect the society in which he found himself – all through the power of story and words.

And that I believe is the urgent necessity and challenge for those of us who work and live in the world of social care. Rather than remaining silent, whispering to the interested few, the stories of social care – the unsung experiences of carers, the resilience and passion of those who receive care and support, the lives that are turned upside down and changed for the better, and the challenges faced by care organisations – all need to be told, shared, and celebrated. And the best way of influencing and changing minds is through the power of story.

I’ve said before that social care exists in the background of society, quietly supporting lives, enabling independence, and nurturing community. It is the thriving energy of our community. But that constancy of presence often means that people do not properly value, notice or understand the importance of the sector. For lots of reasons it is a sector too often overlooked, undervalued, and misunderstood. Stories can change that.

The challenge is that those of us who seek to advocate for social care and its importance to society as a whole have to get better at getting our message across – less about numbers and trends, data and detail, more about heart and humanness, passion and the poetry of care. Through storytelling, we can humanise statistics, breathe life into policies, and remind the public, the media, and policymakers of the essential humanity at the heart of care.

I know at the present time there are very real challenges facing social care as a sector but I feel we too often miss the point if all we do (and it is important to do this) is to continually complain and paint a negative picture; to talk about numbers and statistics, to describe crisis and disintegration, to talk about organisations and structures (even about new plans for a National Care Service!) – to do all that and not to tell the truth of the human lives that are touched by social care and which at its best can be changed, renewed and revitalised by good quality care and support.

These are the stories of so many people I have met over the years. The young man who defied diagnosis and retreated into an inner world of silence yet learned to communicate and verbalise his emotions and thoughts because of the professionalism and care and support he was given by one single dedicated carer. The story of the woman whose whole life had been in her own words always ‘lived in the corner’, the victim of an abusive marriage and a neglectful family and yet who when she entered a care facility discovered her voice, her purpose and learned to live out her dreaming – all because she felt safe for the first time, was made to feel at home, and sensed a community of compassion cradling her in hope and kindness. The story of the carer who literally at the end of her shift goes the extra mile to bring comfort to a dying individual in their own home, of a person rediscovering their independence through compassionate support that helps them to take risks and find courage, or of a care home that becomes a true community where children and adults live as one community with shared hopes, dreams, distress and tears.

These are the narratives that can inspire change, challenge ignorance and the casual stereotype which suggests that social care is there just for the ‘vulnerable’ and those ‘whose lives are over.’ Social care has stories about children, adults, older people that are today, this moment, changing not only their own individual worlds but changing the communities and society around them. Social care is a place of revolutionary and relational change and disruption – if only we had ears to hear, and eyes to see.

Just as Burns captured the universal truths of his time, so too must we capture the truths of social care in ours. We must hear the voices of those receiving care, whose lived experiences too often go untold. We must amplify the stories of the care workforce, whose quiet dedication deserves loud recognition. And we must share the challenges faced by care providers, whose work is made harder by outdated perceptions and inadequate support.

By telling these stories, we can create a tapestry of care that reflects the dignity, complexity, and richness of human life. We can challenge ignorance, foster empathy, and inspire collective action.

So as we raise our glasses to Burns tonight, let us commit to listening to the stories of social care and sharing them with the world. Stories, like Burns’ verses, which have the power to move hearts, challenge minds, and spark change.

I leave you with a poem that captures the spirit of storytelling and its enduring power, words that remind us that stories are not just told but that they are lived, felt, and carried forward.

It is ‘The Storyteller’ by Mark Strand (1934–2014) who was an acclaimed Canadian-American poet, whose spare, elegant words should challenge us to tell the story of social care. Because these stories matter. They always have, and they always will.

“The Storyteller”

 

We are all caught in a story,

each one of us a narrative thread

interwoven into a vast, endless tapestry.

Our voices blend with the hum of the loom,

spinning dreams, fears, truths, and lies.

 

The storyteller knows this

and so shapes the tales,

crafting bridges with words,

turning time back upon itself,

making strangers kin.

 

For in the heart of a story

is the secret we all crave:

to be heard, to be seen,

to belong to the human chorus

of what has been and will be.

 

Donald Macaskill

 

Photo by Etienne Girardet on Unsplash

 

 

Weight of the Nation: Obesity and its impact on older Scots and social care.

The media this past week has been filed with stories around obesity,  from debate about the impact and costs of new drugs such as Wegovy on a dedicated BBC Panorama programme to ongoing discussions about the impact of obesity on the costs of the NHS as a whole. Maybe not surprising as it was National Obesity Awareness Week from the 10th to the 16th January.

One of the reports this week referred to major research published in the Lancet which suggests that there needs to be “a more accurate” and “nuanced” definition with doctors suggesting that the overall health of patients with excess fat, rather than just measuring their body mass index (BMI), should be the starting point. The Lancet experts then suggest that those with chronic illnesses caused by their weight should be diagnosed with “clinical obesity” – but those with no health problems should be diagnosed with “pre-clinical obesity”.

More than a billion people are estimated to be living with obesity worldwide and there are particular challenges for those of us in Scotland.

It is not by any means an exaggeration to state that Scotland as a country is facing one of its greatest health challenges of the modern era in terms of obesity. For the worlds of social care and in particular older persons care and support there are especial challenges which I would like in this blog to briefly explore.

For many of us, ageing is associated with frailty, undernourishment, or the loss of physical health. The popular image is not one that imagines weight to be an issue in older age – nothing could be further from the truth. Among Scots aged 65 and over, a significant and growing proportion are classified as overweight or obese. This is no longer an issue confined to the young or middle-aged; it is a challenge that increasingly shapes the experience of older adults and those who care for them.

Obesity in later life brings with it a host of complications: reduced mobility, increased risk of type 2 diabetes and cardiovascular disease, and a greater likelihood of needing personal care. These health conditions exacerbate the complexity of care delivery, placing additional demands on a social care sector already under pressure.

Recent data from an important study by Obesity Action Scotland highlights that overweight and obesity are more prevalent issues than underweight among older people in Scotland, emphasizing the need for targeted interventions. Their report indicates that obesity rates among older age groups in Scotland are substantial and sadly growing. In 2023, 32% of adults were living with obesity, the highest level recorded and an increase from 24% in 2003. In 2020, among those aged 65-74, 77% of men and 70% of women were classified as overweight or obese and for individuals aged 75 and over, 73% of men and 62% of women fell into these categories. These are scary statistics which tell us an uncomfortable truth but not the whole story.

For care homes and home care providers, the implications are far-reaching. Obesity is not just a medical issue – it’s a practical one, affecting how care is delivered day-to-day from design to staffing.

For instance, many care homes were not built with an increasingly obese population in mind. From the width of doorways to the strength of hoists, providers often need to make substantial investments in adapting their environments and this is only going to increase in what is an ageing built estate in all sectors. In addition, obesity often comes with a range of comorbidities, requiring enhanced medical oversight. Social care teams both in homecare and in residential care need to work closely with healthcare providers to manage these complex needs effectively. As a result, there is a direct impact on staffing and training.

Supporting someone with obesity can be physically demanding for staff. Proper training in manual handling and the use of specialised equipment is essential to prevent injuries and ensure dignity in care. And inevitably all this boils down to the adequacy or the inadequacy of resources and prioritising expenditure. Obesity-related conditions are likely to increase the time and resources required for individual care, from personal hygiene to mobility assistance, placing additional strain on already stretched teams and care budgets.

As in so much the problem is that we often start to address issues of concern too late in the day. We have a brief window of opportunity to try to address the issues of obesity before they completely overwhelm us. We have to look upstream to address the root causes of obesity in older age. Prevention should not stop at retirement. Encouraging healthier lifestyles through community programmes, targeted interventions, and national health campaigns is critical.

Addressing obesity in later life is not just the responsibility of care providers – it is a challenge for society as a whole. It requires partnership: between individuals, families, communities, and the care sector. Most of us celebrate the truth that we are living longer as Scots, but what we all need to be striving for is healthier ageing and that critically includes addressing the obesity epidemic which we are currently enduring.

Part of that challenge is addressing issues of stigma and stereotype which often prevent older individuals from addressing the impact of obesity and being overweight. I came across this anonymous poem on the web recently – it is entitled ‘The Weight of Us’ and for me it captures the real ache at the heart of obesity for all ages and a call for all of us not least those who work in social care to share that burden and load.

“The Weight of Us”

We carry it, silent, unseen,

The weight of what has been and what will be.

Not just the heft of bodies shaped by time,

But the burden of whispers, the unkind rhyme.

A mirror reflects, but does not forgive,

The years we’ve eaten to feel we live.

Comfort wrapped in layers tight,

Hunger quieted in the dark of night.

The world stares, but rarely knows,

The stories tucked beneath the clothes.

A lifetime of battles, silent, profound,

In each heavy step, a muted sound.

For age adds years and pounds alike,

A slower pace, a harder hike.

Joints creak, breath fades, yet hearts still yearn,

For acceptance given, not made to earn.

This is not just a number, not just a size,

But a measure of pain behind weary eyes.

Let us see more than scales and charts,

Let us weigh the truth in human hearts.

For in every body, a story resides,

Of how we stumble, where love collides.

So let us carry each other with care,

A lighter world when kindness is shared.

Donald Macaskill

Photo by Angelo Pantazis on Unsplash

Let’s stop talking about the NHS: social care needs to be prioritised.

I have just spent the last couple of days in London and have held various conversations with colleagues in the social care world in England. It has been a busy few weeks – what with the ongoing disastrous intervention of the Chancellor and the uplift in National Insurance payments which still threatens to devastate the social care sector in Scotland, and plans for a Commission on Social Care in England being announced just last week.  It is the latter which I would want to focus on in this week’s blog.

Despite all the previous reports and commissions, research papers and independent analyses, the new Labour Government has decided to establish an independent commission to develop sustainable, long-term solutions for the adult social care system. Chaired by Baroness Louise Casey, the commission’s primary objectives include:

  • Assessing current challenges by evaluating the existing social care framework to identify critical gaps and inefficiencies.
  • Engaging stakeholders by collaborating with care providers, service users, and industry experts to gather diverse perspectives and insights.
  • Proposing reforms by recommending actionable reforms to enhance the quality, accessibility, and affordability of social care services, and lastly if not critically,
  • Ensuring sustainability by means of developing strategies to ensure the financial and operational sustainability of the social care system.

The Commission will operate in two phases with medium-term recommendations to be reported by mid-2026, focusing on addressing immediate challenges within the social care sector. Then there will be long-term solutions with full and final recommendations to be delivered by 2028, outlining comprehensive plans for the future of adult social care in England.

At the heart of all this according to Wes Streeting, the Health and Social Care Secretary is the desire to fulfil a manifesto commitment and to create a “National Care Service” to meet the needs of people and better integrates social care with the state-funded National Health Service.

A sense of déjà vu comes to mind. Indeed, my colleagues in England whilst welcoming the Commission have bemoaned the length of time it will take to get to any sense of final recommendations, and I cannot help but reflect of a social care ball being well and truly kicked into the long-grass of forgetfulness.

But what has intrigued me more than the mechanics and aspirations behind the new Commission is the way in which both politician and pundit, policy maker and social commentators, by in large have viewed the Commission. Specifically, the debate and discussion evidence yet again a myopic fascination with seeing the world of health and social care through an NHS lens. Indeed, this reflects a lot of similar discussion in Scotland – social care only ever seems to get a mention when the NHS is in crisis, or the extent to which it is seen as being able to support the priorities of the NHS.

I’ve often reflected on the tendency to see social care as the understudy to the NHS – a supporting act rather than a leading role in its own right. This perspective, however well-intentioned, is profoundly flawed and ultimately diminishes the critical contribution social care makes to individuals, families, and communities.

Even social care practitioners – me included – have at times sought to enhance and sell the value of social care to a uniformed audience – by using its role in assisting the NHS as the vehicle for that conviction. We are so wrong to do so – and that’s why I am increasingly convinced that we have to stop talking continuously about the NHS and to start selfishly, consistently advocating for social care absolutely in its own right.

Social care is not – and cannot be – simply a handmaiden to the NHS. It is its own sector, with its own identity, purpose, and values. And yet, we persist in framing social care primarily as a means to ease pressure on hospitals, to prevent delayed discharges, or to free up beds. This narrative is not just reductive; it is dangerous.

If the UK Government Commission becomes dominated by the political concern (and the public one) for the NHS, then we will take two steps backward into the past.

It is unashamedly time to robustly advocate for social care even if that means talking less about the NHS.

The heart of social care is relational, not transactional. It is about enabling people to live meaningful, independent lives. It is about dignity, choice, and human rights. Social care supports people not just when they are unwell, but throughout their lives, whether they are living with disability, managing long-term conditions, or simply seeking support to thrive in older age. It is not as so many English commentators have said in recent days – about the vulnerable – because that categorises and diminishes – it is rather about our most valuable citizens, of all ages and characteristics, of all needs and none, and what enables them to flourish and thrive in life and citizenship.

Unlike the NHS, which often intervenes in moments of acute crisis, social care is rooted in the rhythms of everyday life. It is about helping someone to get out of bed, to share a meal, to reconnect with a loved one. It is about companionship as much as care, empowerment as much as treatment. This is why it cannot and should not be judged purely in terms of how it serves the NHS’s objectives.

When we view social care solely through a medical lens, we risk losing sight of its wider purpose. We reduce people to patients and care to a clinical function. We forget that social care is about living – not just surviving.

This medicalisation of social care (which I moaned about a lot during the pandemic) also fuels structural inequalities. Funding decisions, workforce strategies, and political attention become skewed in favour of acute and secondary healthcare. Meanwhile, social care – despite employing more people than the NHS and supporting just as many lives – remains underfunded, undervalued, and misunderstood.

We have seen this imbalance starkly in recent years. While billions have been rightly poured into strengthening the NHS, social care has struggled with chronic underinvestment, rising demand, and a workforce crisis. The pandemic exposed the fragility of the sector, but instead of learning lessons, we have often reverted to seeing social care as an adjunct to the NHS rather than a pillar of society in its own right.

This lack of recognition has real-world consequences. It perpetuates low pay, poor conditions, and limited career pathways for the social care workforce. It fosters stigma and misunderstanding about what social care does and who it supports. And it weakens the case for long-term reform, leaving the sector stuck in cycles of crisis management and yet another damn Commission.

Most worryingly, it marginalises the people who rely on social care – those whose voices are too often drowned out in debates about targets, efficiency, and systems integration.

We need to shift the narrative. Social care must be recognised as a sector of equal value, complementary to but distinct from the NHS. It must be funded and supported in ways that reflect its transformative role – not just in keeping people out of hospital, but in enabling them to live the lives they choose.

All this requires the same things I have been talking about for aeons – a human rights-based approach where care is seen not as a commodity but as a fundamental part of a just society. It requires fair funding and an end to the chronic underinvestment in social care by Government providing long-term funding settlements that match the scale of need. An end to the cap in hand approach of social care providers and users to gather the leftovers from a bare fiscal table. It shouts out for the need to recognise the workforce and to treat social care staff as skilled professionals, with fair pay, proper training, and clear career pathways. And lastly and critically and at the heart of this piece it needs a mature public understanding where we shift public perceptions through education and advocacy, challenging outdated views that reduce care to charity or dependency.

The NHS will always be vital. But so too is social care. They are partners, not hierarchies. The more we invest in social care – not as a crisis response but as a foundation for well-being – the more we build a society where everyone is supported to live with dignity and purpose.

Social care doesn’t just save hospital beds; it saves lives in their fullness – their hopes, connections, and possibilities. That is why it deserves recognition, investment, and respect. It’s time we stopped viewing social care through the lens of the NHS and started seeing it for what it truly is: the beating heart of our communities.

Let’s value it. Let’s protect it. And let’s give it the future it deserves.

Donald Macaskill

Photo by Jason Leung on Unsplash

Menopause Matters Webinar – 6 February

Scottish Care & alsico – Menopause Matters Webinar 

Exploring Menopause Support in Care Homes (6 February)
1 in 5 care workers say menopause symptoms affect their job performance, and 1 in 10 consider leaving their jobs because of it.

To address this critical issue, Scottish Care is hosting a webinar in collaboration with leading uniform supplier alsico. Building on the success of alsico’s Menopause Matters event at the Care Show last year (learn more here), which brought together some of the UK’s largest care providers—this webinar will focus on practical ways to support staff navigating menopause.

Date: Thursday 6 February
Time: 2pm – 3pm
Location: Teams Webinar

Speakers include:

  • Caroline Deane – Scottish Care
  • Sara Catanzaro – Alsico
  • Flora Neville – Citation
  • Pauline Ritchie – Oakminster Healthcare
  • Alyson Vale – Abbotsford Care
  • Rachel Payne – Bandrum Nursing Home

Topics will cover:

  • Misconceptions about menopause and how to address them
  • The importance of uniform considerations in care homes
  • Exploring practical menopause policies
  • Insights from care home providers implementing menopause-friendly practices

This webinar will share resources, explore ideas, and foster collaboration within Scotland’s care sector to create more supportive workplaces.

Register here

Join us to continue the vital work of improving menopause awareness and support for care workers across Scotland.

Caring for the self within social care: a January reflection.

Well, that’s another year started and with the predictability of a well-worn tradition we are getting the adverts for our summer holidays appearing in all our usual media alongside those irresistible offers to join our local gym, start a class, and start the year as we mean to live it, with fitness and vigour – and of course sobriety, for Dry January.

In the UK January driven not least by New Year resolutions, is typically the month in which most people chose to take out a gym membership – yet the initial surge usually means that at least half of the new intake will have quit within the first six months, and of the remaining only 6% will attend more than once a week.

Now the gym sector has done a lot of work on why so many drop out including unmet expectations, waning motivation and a growing lack of time – all of which should be insights for other sectors, but what interests me in this week’s blog is the health and wellbeing of the greatest asset social care employers and organisations possess and that is its workforce. In the coming weeks and months this space will no doubt reflect on what I personally consider to be the most challenging period for social care in Scotland that I have ever known, but at the heart of all those considerations will be the health and wellbeing of the over 200,000 Scots who work in social care organisations to say nothing of the tens of thousands of unpaid carers.

In what follows I want to suggest that despite or perhaps more because of all the challenges facing social care frontline workers and managers that attending to self-care and personal wellbeing has never been more important for those who work or deliver paid or unpaid care and support.

But it would be massively disingenuous and hypocritical not to couch and premise that discussion on the reality which is that we have to recognise that one of the primary factors behind exhaustion, burnout, fatigue and mental ill health in social care and in unpaid care is because of the total and utter failure of successive governments and society at large to properly compensate people for the critical role of care and support which they deliver whether as professional workers or unpaid carers.

We now have a plethora of recent research showing just how critical pay is to the mental wellbeing of staff in social care.

For instance, a survey of over 5,000 social care workers last year in Wales revealed that while many feel valued in their roles, the main reason for job dissatisfaction and the primary contributor to people leaving the sector is inadequacy around pay.  I could add to the Welsh study others by the Universities of Surrey or the Manchester Metropolitan and several others where the link between job satisfaction, self-value and pay and reward are inextricable.

These research studies collectively underscore the truth that inadequate pay in the social care sector detrimentally affects worker well-being, job satisfaction, and retention. More than that they show that there is a direct and negative impact on the quality of the care and support experienced by the supported person, when staff are inadequately paid.  Addressing compensation issues is therefore essential for improving the mental health of social care workers and ensuring the delivery of high-quality care services.

So please do not read this blog and its focus on wellbeing as suggesting that if we only look after our own wellbeing as individuals that we are more able to ignore the lack of proper fiscal reward – nothing could be further from the truth. We must continue to expend all our energies in 2025 in campaigning for proper pay and reward for frontline social care workers in Scotland – and as I have often said to highlight just how inadequate the Scottish Living Wage is as a level for such aspirations to settle at.

So why a focus on self-care you might ask?

Well, there are many reasons why in January people begin to focus on their own self-care, and we should not lose the opportunity on building on these realities for the benefit of individual workers and carers. I have already referred to the cultural influence of resolutions, and then there is the psychological impact of starting a new year and wanting to plan to do things differently. But there are other motivating factors which should lead organisations and employers to build on personal influences to focus on self-care in this month.

These include the fact that people reflect a lot on their own choices and life during the holidays and often people are more likely to re-assess their personal and psychological health when they have had a break. If it is evident to them that there is little scope for wellbeing and self-care/development or indeed motivation in an organisation, then they are much more likely to look elsewhere for such a focus. It is also true that in a social media influenced era with influencers and commentators, that January has become even more so the ‘re-set’ month with clear programmes of targeted goals and challenges which once again organisations can tap into. But of course, whatever the motivation and reasoning what all such activities require is a supportive and affirmative environment and community which a good provider and employer can offer albeit that it is much harder for unpaid carers to access – though even that provides care organisations with an opportunity to nurture and build community.

The campaign for just pay can sit alongside the prioritising of self-care and wellbeing for carers and workers and assist not only personal health but also enhance the experience of those who are being supported. Again, there are numerous studies which show how engaging in regular self-care practices can lead to improved job satisfaction, better mental health, and enhanced resilience against work-related challenges.

Whilst acknowledging that achieving self-care for Scotland’s social care workforce in the context of poor funding and low pay requires creativity, collaboration, and systemic change, it can nevertheless be achieved. There are potential practical and sustainable approaches that organisations and leaders can adopt to support staff well-being.

For instance, the creation of Peer Support Networks perhaps within a care home or amongst community homecare teams help workers to share experiences, offer emotional support, and reduce feelings of isolation. It might work by allocating 30 minutes per week for reflective practice or group check-ins.

Introducing flexible working arrangements – which are already evidenced strongly across Scotland’s social care sector are a further support to self-care and wellbeing. Introducing flexible rotas or job-sharing options allow some staff to achieve better work-life balance, thus reducing stress and enabling people to achieve personal as well as professional responsibilities.

More recently I have come across many more employers who have introduced and developed Mental Health First Aid training into their organisations which has led to a core group of staff being trained to provide immediate peer support for those experiencing stress, anxiety, or burnout. Others have created Well-being Champions within teams to advocate for and coordinate self-care activities. Again, this promotes a culture of self-care and raises awareness about mental health resources. Champions can organise activities such as yoga, mindfulness sessions, or walking groups during breaks.

Further examples of organisational support for self-care and personal wellbeing include those organisations that have introduced low-cost perks and recognition schemes all of which helps to boost morale and makes staff feel valued despite financial limitations. Employers who work with partner organisations to offer reductions in areas such as reduced access to reflexology, meditation, yoga or more directed psychological and talking therapies; or discounted schemes for food and products – all are illustrating initiatives designed to make staff feel that their health and wellbeing is critical and central.

Investing in self-care, even in the face of funding constraints, is about fostering a culture where social care staff and those who are unpaid carers feel supported, valued, and empowered. By focusing on low-cost, high-impact strategies, organisations can help sustain the workforce, improve retention, and enhance the quality of care provided across Scotland. This approach also strengthens the call for systemic funding reforms to create a more sustainable sector for the future.

Unlike those who join the gym in January and forget how to access it within six months I earnestly hope that the focus on staff wellbeing and self-care which many organisations begin to explore this month becomes embedded as evidence of quality care and compassion.

Whatever techniques or tools, models or methods are used – self care is fundamental to the delivery and nurturing of all care and support; it is a lifelong process which nurtures of living and loving as much as our working and achieving, and yet as the Anglo-Irish poet David Whyte reminds us – it is not always easy:

Self Portrait

It doesn’t interest me if there is one God
Or many gods.
I want to know if you belong — or feel abandoned;
If you know despair
Or can see it in others.
I want to know
If you are prepared to live in the world
With its harsh need to change you;
If you can look back with firm eyes
Saying “this is where I stand.”
I want to know if you know how to melt
Into that fierce heat of living
Falling toward the center of your longing.
I want to know if you are willing
To live day by day
With the consequence of love
And the bitter unwanted passion
Of your sure defeat.
I have been told
In that fierce embrace
Even the gods
Speak of God.

David Whyte

Self Portrait: A Poem by David Whyte | High Road Artist

Donald Macaskill

Photo by Marc-Olivier Jodoin on Unsplash