It isn’t often that there is a happenstance coming together of events – on the 2^nd to the 8^th December next week we will mark National Grief Awareness Week and then it will be UNESCO World Futures Day on the 2^nd December. The latter is a day which is a global event inviting countries to embrace the future and develop their capabilities in terms of foresight and readiness, ‘and proactive policy-making to ensure sustainable development for future generations.’

I am struck by this juxtaposition because of conversations I have been having recently about the nature of bereavement and grief especially as it relates to the emerging concept of synthetic resurrection.

Synthetic resurrection can be described as the use of advanced technologies, particularly AI, digital media and holography to recreate aspects of deceased individuals. This can include generating digital avatars, voice replicas, and interactive personas that simulate the presence and behaviour of a deceased person These are now astonishingly life-like and wholly believable and are only going to get better.

One of my recent discussions mentioned the work being done by the organisation Deep Fusion Films to create a podcast series called ‘Virtually Parkinson’ which features an Ai-generated version of the late Sir Michael Parkinson. In the publicity and discussion around the announcement of the project in late October, Deep Fusion made it clear that they were not trying to deceive anyone and would make it very clear that this was Ai-generated, the result of analysing over 2,000 interviews. But with the aid of a generated synthetic voice these will be new and unscripted interviews with contemporary celebrities.

Undertaken with the consent of his son and family, these interviews will no doubt bring the idea and reality of synthetic resurrection right before the public when they are aired.

It is perhaps stating the blindingly obvious that synthetic resurrection raises complex ethical, human rights and moral considerations. But it is also stating the obvious to say that these cannot be ignored and that the growth of such techniques and approaches is here to stay. How we manage the ethical questions they raise and how we adjust our societal and individual expectations is what will determine whether new approaches will bring individual and societal benefit or not. Wishing the science had not been invented will not make the reality of existence go away.

I want to explore what the future use of such approaches might augur in terms of both positive and negative aspects.

First some ethical and human rights considerations:

The most obvious issue is the extent to which a deceased person has control over consenting to the replication of their image or personality. Who actually owns the digital likeness of a deceased person and the whole issue of digital legacy is at the moment an area fraught with contradictory views and the legality is as yet unresolved.

However, we still retain certain though not full rights of privacy posthumously. The use of personal data including voice recordings, texts, videos or photographs both of the deceased or anyone else they may interact with including family could be a breach of the fundamental right to privacy.

Then who decides that such synthetic modelling should happen. It is one thing if it is the deceased in an informed and consensual manner it is another if it is other family members or even strangers. And even if one member of a family agrees to synthetic resurrection, what about the risk of disputes or family breakdown?

There is also the risk as technology develops and the possibility of commercialising avatars and associated models becomes commonplace that grieving individuals might be emotionally vulnerable and susceptible to exploitation from those who offer synthetic resurrection services. Such services could make an individual dependent upon them – perhaps for fiscal benefit.

It is a natural stage of grieving to work through the pain of loss and to learn to live without the deceased and to re-orientate your living. What if you started to use a synthetic resurrection service which prevented such a critical part of mourning and grieving? What emotional and psychological harm could result in such ‘avoidance’ of grief? Is a grief delayed, and a resolution started something which could result in greater psychological and physical harm? What would be the risk of psychological harm as a result of such over-dependency and the inability to move on in life?

Because these technologies are so new there is limited research available about their impact on an individual or upon their grieving. Is there a risk that such synthetic resurrection might pathologise ‘normal’ grief and foster an unhealthy attachment where a person could not ‘let go’ and indeed where the very finality of death was ignored?

Death and grief are culturally sensitive and rooted experiences, not least in terms of many religious and belief traditions. What does synthetic resurrection say to the Christian understanding of resurrection? There are other cultural traditions and humanistic philosophies which emphasise the finality of death as part of the human experience. Is there a danger that the very sacredness of life could be turned into a programmable phenomena? Synthetic resurrection might conflict with these views and result in a changing of moral norms.. Nothing wrong with that in principle but it is often desired such change occurs through popular and common consent.

There are also a whole host of considerations behind the nature of the interactions with synthetic resurrection services. We have referred above to the risks within the bereavement journey, but they also surely raise issues relating to the authenticity of human relationships and dialogue per se. What is the meaning of a relationship which one fosters with a piece of technology, it is after all not the ‘real’ person, even if a sense of response may become so sophisticated that it could portray masked reciprocity? What impact might the use of such technologies have on the exercise of authentic human memory when true physical interactions are masked with inauthentic constructions of the moment? Is there a risk that such interactions become uni-dynamic and are not shared with others? Are there not also questions around the potential misuse of such technologies to create misleading content or a risk of the exploitation of the likeness of the deceased?

So far, I have detailed ethical and human rights concerns and objections, but there are strong advocates of the use of such synthetic resurrection approaches who state that there are clear benefits.

It is argued that they could offer comfort, and potentially closure in situations where death and loss was traumatic and sudden, where the person was not enabled to resolve issues, and where that lack of resolution is preventing them from moving on in life.

Others have suggested that the use of such approaches enables a family to preserve the legacy and share the memories of those who have died not least with generations, perhaps a child who was unborn to a deceased parent, and that such sharing and creating of memory can bring real benefit.

One could also see the way in which the use of such avatars and synthetic models of famous individuals and personalities could enhance the continuation of history within educational and learning environments.

It is further stated that if properly used with clear ethical boundaries they could be tools that helped an individual create self-healing personal and individual experiences that benefitted them, and that with appropriate ethical and human rights standards that there is no reason why such services could not be safely utilised. This might especially be the case in the support and care of those living with neurological conditions such as dementia.

At the moment it is likely that synthetic resurrection approaches will only be available to those who are wealthy – but that will soon change, and it is therefore really important that as a whole community and society we develop appropriate ethical and human rights frameworks that assist the bereavement and grief journey whilst being sensitive to the realities of technology that is here to stay.

In this coming National Grief Awareness Week, we are already faced with the challenges of World Futures Day and of a future of grief and loss unlike anything we could have imagined a decade ago.

Synthetic resurrection offers profound opportunities for grieving and psychological support, yet its ethical, human rights, and moral implications demand thoughtful consideration, regulation and ultimately respect for the sacredness of the human experience.

Donald Macaskill

Well winter has well and truly arrived in the past week. Chatting to care providers in parts of Scotland they have been reflecting to me the struggles of staff getting through snow and ice to work in local care homes or to deliver care and support in the homes of their fellow citizens. Every year I am reminded of the astonishing professional dedication and no little sacrifice of those who in all weathers epitomise the essence of caring compassion and who get through to their place of work despite all the seasons throw at them.

As the first frosts of November glisten on the grass, there is also a sense of our communities moving into the quiet, reflective rhythm of winter as we hunker on down from cold and ice and today as I sit and write this also as we batten down the hatches from the gales and stormy blasts which seem to take up residence at this time of year.

All this meteorological change is resonant of years gone by and is uppermost in my mind as I reflect that tomorrow is Stir Up Sunday, the day traditionally set aside for preparing the Christmas pudding. The tradition dates back to Victorian times when the family would gather five weeks before Christmas to stir the Christmas pudding and, on a Sunday, church congregations uttered the prayer ‘Stir up, we beseech thee, O Lord, the wills of thy faithful people; that they, plenteously bringing forth the fruit of good works…’

Maybe not so much now but in the past families would gather, sleeves rolled up, each person taking their turn to stir the mix, add a wish, and fold in the ingredients that will mature into something rich and sustaining for the festive season. Nowadays I suspect with the pressure of time we simply have to get the job done or there will be no pudding or cake on the main day.

But if you allow me this week, I want to use Stir Up Sunday as a metaphor to share some reflections on social care in Scotland – a sector and community in urgent need of collective action, vision, and hope. Much like a pudding, the care system relies on a delicate balance of ingredients, each essential, each contributing to the whole. But as frost signals the arrival of winter, the cracks in the system remind us that some key elements are missing, and time is running out to prepare for the challenges ahead.

So, what are the ingredients we must urgently focus on to ensure the resilience and future of social care in Scotland?

Workforce: the flour that holds it all together.

No pudding rises without flour, and no care system thrives without its workforce. Across Scotland, dedicated care staff are the backbone of our communities, and evidence that dedication as I said, in all weathers and conditions. Yet they are overworked, underpaid, and often undervalued. This winter, we are faced with the bizarre situation that we risk losing some highly skilled individuals because we are not recognising and rewarding them sufficiently. How can we with any sense of achievement declare that paying the Living Wage is the pinnacle of our ambition? We should and could value social care and its workforce by paying so much more, and that inevitably means that as most social care is bought by the public purse that the Scottish Budget needs to recognise this with adequate funding for local authorities.

Scottish Care is soon to publish a statement on the Scottish Budget which will be presented to the Scottish Parliament on the 4^th December and I hope at the heart of that Budget will not just be an agreement to fund the Living Wage but to seek to go much further and truly embed Fair Work commitments.

We also need the UK Government to urgently address the failing immigration system which is preventing people from being attracted to work in social care in Scotland. It appears to me that the current Labour administration at Westminster is just repeating and carrying on the failures of their Conservative predecessors – just doing it more quietly and subtly and all to the demerit of Scotland in particular.

We must stir with urgency to address fair pay, improved conditions, and recognition for the critical role care workers play.

We need more than words of gratitude. We need investment that reflects the true value of care, creating a sector where workers are supported, respected, and empowered. Without this fundamental ingredient, the structure collapses, and the system crumbles.

A sustainable sector: the sweetness of inclusion

The dried fruit in our pudding brings sweetness and depth, much like a human rights-based approach brings dignity and fairness to social care. As we work towards embedding the principles of Scotland’s National Care Service, we must remember that all parts of the sector need to have a voice at the table around which decisions will be made about its future.

The recent debates around the National Care Service have been fractious and territorial and one thing I am clear on is that reform is urgently required and that cannot be the continuation of a status quo where control and power are vested in the interests of local government. There needs to be a power-shift towards those who use and work and deliver care and support and not those who contract and commission, and control in their own vested interest.

There needs even more immediately to be a recognition that the charities and private organisations that deliver the majority of social care in Scotland, must be heard when we say that we are simply not sustainable. Urgent attention to the National Insurance issue both in terms of Westminster mitigations but also in terms of the Scottish Budget is an imperative. The media has rightly picked up our concerns about the care home and hospice sector, but it is even more fundamental that we address the fact that without intervention large parts of our homecare sector will simply collapse.

If a care home dedicates around 75-80% of its running costs to staffing that figure is closer to 90-95% for most homecare organisations. If you are as they are then faced with a 30% increase in staffing costs because of the UK Labour Government Budget including NI then the sums simply don’t compute and there is only one answer and its closure. If care at home organisations close in large numbers in Scotland, people who require support in their own homes will have to be admitted to hospital and those in hospital will not be able to return home. The scenario is nightmarish in proportion.

Integration and collaboration: stirring together for strength.

A pudding’s ingredients only become cohesive when stirred together with care and intention. Similarly, social care cannot operate in isolation. The urgent need for true integration between health and social care must be prioritised – not as an afterthought but as a foundational principle. We are light years away from such integrated, cross sectoral working and it dismays me that work in this area is the first to be cut when budgets are stretched.

Stirring collaboration means breaking down silos, aligning policies, and ensuring that care is seamless across every stage of life. From hospital discharge to home care, the journey should feel like a single, supported path. Winter reveals the weaknesses of disjointed systems; we must mix and work together for strength. If we are not all working together, we are working apart.

Community and solidarity: the binding spirit.

Finally, no pudding is complete without the touch of brandy, whisky or spirit to bind it all together. In social care, that spirit is community – our shared responsibility to care for one another. This is not about maintaining people as they are but working to enable them to live their life to the fullest in care home and own home.  As the frost deepens, the cost-of-living crisis bites harder, as people really begin to experience the devastating and potentially deadly effects of the withdrawal of the Winter Fuel Allowance as a universal benefit in Scotland, and vulnerable individuals face greater challenges, the power of community becomes even more vital.

Social care is not just about services; it’s about people, relationships, and connection. We must weave solidarity into every decision, ensuring that no one is left behind, whether they are a unpaid family carer, a supported person, or a family member navigating the complexities of the system.

As Stir Up Sunday approaches, let us each take a turn to stir the mix for social care in Scotland. The ingredients are before us: workforce investment, a sustainable and funded system, integration and whole system working, and community. But it will take collective effort, political will, and a shared vision to create something that truly nourishes and sustains us through the challenges ahead.

The frost may be appearing, but winter is not a time to despair. It is a time to prepare, to strengthen, and to stir hope into our efforts. Together, we can ensure that social care in Scotland rises to meet the needs of its people – rich, robust, and full of promise.

I leave you with some of the words of the Scottish poet Gerry Cambridge who captures the interplay between winter’s harshness and the promise of renewal in his poem “Processional at the Winter Solstice.” The poem portrays the desolate end of the year, with imagery of darkness and frost symbolising death and stillness. However, it also hints at the return of light and the rebirth of the sun, reflecting a sense of hope and the cyclical nature of seasons.

Now, let us roll up our sleeves. The pudding won’t stir itself.

Processional at the Winter Solstice.

He has gone down into darkness at the wrecked end of the year
And is lying, gaberlunzie, in the needled nest of frost.
The arctic thrushes call for him although he cannot hear,

And the worm too understands him in the chilled grip of its dark,
And the ptarmigan in blizzards where no thought is worth a crumb,
And treecreepers in shivering puffs in Wellingtonias’ bark.

Shop windows glint in city lights like ice and sky, but still
No tinsel gifts can touch him, freed to silence like a stone’s;
His face is white as paper’s white in miles-high midnight chill.

He lies as plain as frost-dust where those starving thrushes call,
And his lime and ray-struck armoury could hardly be less small
On the anvil of beginnings in the sun’s gate on the wall.

Gerry Cambridge

from Notes for Lighting a Fire (Glenrothes: HappenStance, 2012)

Processional at the Winter Solstice by Gerry Cambridge – Scottish Poetry Library

Photo by Bruna Branco on Unsplash

Donald Macaskill

There is never a dull moment in the world of social care in Scotland. In the past week we have ongoing debate about the National Care Service culminating in the decision of the Scottish Government to pause the Bill Stage 2 process and to return to the matter in 2025. This decision has been met by some who think it means the end of the Bill and by others who wish it did, and yet others who are both confused and disappointed.

I mention all this because yesterday was the Scottish Care Care Home conference. This annual event brought together care home providers, managers and workers, together with other stakeholders and partners from across the country. It was also an opportunity to hear from some of our political leaders, including the Cabinet Secretary Neil Gray, about their position on a whole range of issues, not least the National Care Service.

However, for most of those there the number one issue was not the future shape of social care (however critical that is) but whether they would be around to see it. Yesterday Scottish Care published a summary of some of our latest consultation with our members about the implications of the Westminster Labour Government’s intention to increase the National Insurance threshold and rates. Our research indicated that of those who responded to a survey in the past week, nearly half (48%) of care home and homecare organisations noted the very real possibility of service closure as a result of this increase.

In our media statement I said that:

“These additional pressures on social care providers created by the UK Budget announcement are unworkable in the current climate and a solution, either through exemption or funding, must be found in order for the social care sector to be sustained. Scottish Care is incredibly alarmed at the figures presented in our survey, not least around service closures, with many providers indicating that this may very well be the straw that breaks the camel’s back. It is no exaggeration to say we will lose swathes of social care provision in Scotland unless urgent, practical and resource-based solutions are progressed for the sector. If not, the impact on individuals, communities and public services will be catastrophic.”

It was in the context of such a troubling background that together with my colleague, Scottish Care’s Deputy CEO, Karen Hedge we ended the conference by focussing on the Four V’s which lie at the heart of Scottish Care’s recent Strategy document. What follows is a summary of what we shared:

Visible​

Social Care that works for Scotland ​

In order to move forward you need to know who you are …

Scottish Care is essentially a membership organisation – we represent the greatest diversity and range of providers of social care in Scotland indeed probably in Europe – from care home to homecare, housing support to respite support. From small single operators to large corporate organisations; from rural to remote and urban to town.

We are an organisation driven by social values. We aim to ensure that social care in Scotland is not only sustainable but also exemplary, reflecting the high standards and compassionate care that our communities deserve.

The problem is that a lot of people do not know what social care is – we have got to the stage of it being seen as the release valve for the NHS on the one hand (not least around delayed discharge and avoidable admission) or as a set of services which is about maintenance and keeping people safe – it is so much more.

It is about flourishing and thriving – about citizenship and contribution, it is about challenging the discrimination of age and the limitation of conditions such as dementia.

social care is rather:

‘The enabling of those who require support or care to achieve their full citizenship as independent and autonomous individuals. It involves the fostering of contribution, the achievement of potential, the nurturing of belonging to enable the individual person to flourish.’

It is time for social care and care homes to be seen for what they are  – contributors and not costs, enablers of life and not limiters of freedom, places of thriving lives and not ante-rooms of the end days.

As a society we need to shout loudly about the brilliance of compassion and the dedication of our care homes staff and managers in the delivery of a society which values all.

We are here to build the possibility of a society that truly values care, and walks the talk of the rhetoric of priority.

Viable

Scottish Care also published yesterday our report on Ethical Commissioning which states clearly that we need to radically reconceive the way in which we commission and contract care services into a model which embeds human rights at its heart. It centres its focus on rights, respect and redistribution. People deserve high quality social care and support focussed upon human rights

Social Care is experiencing an increase in demand at the same time as a decrease in resource and it remains a net contributor to the economy. It is time to think differently and sustainably.

We need to start thinking about the potential for social care to be an economic and societal driver rather than using the language and mindset of cost and drain.  We need to focus on human rights – work collaboratively across the health and social care system in the preventative space and beyond, to make sure that people can live with autonomy for longer.

This all requires that we approach each other with mutual regard and transparency, creating trust in a system built upon robust cost of care modelling and funding this by reducing duplication and bureaucracy, bridging the implementation gap through a redistribution of funds.

We also need to support our amazing social care workforce through the implementation of Fair Work principles and sectoral bargaining, but we need to do this in a planned way with appropriate procurement measures. The implication and implementation of the Employee Rights Bill and the UK Budget have to be recognised both at Scottish and UK level. Almost half of our members responded to a survey on the budget saying that they may not be viable with the changes to National Insurance contributions alone, if these are not carried through into funding.

What we have stated before of net-zero is true still of commissioning:

“Many of the concerns circle back to the long-standing issue of insufficient funding available in the sector and the undervaluing of social care. Changing mindsets to focus on sustainability in the commissioning and procurement processes would be beneficial to implementing long-term change”

We no longer have a National Care Home Contract which is fit for purpose ands indeed the financial gap between true cost and public funding is between £4-500. Such a contract limits and the moral step away from funding the true cost of care cannot be excused.

​Valued​

At some point, everyone in Scotland is likely to experience care and support either directly themselves or indirectly for their loved ones.

It’s time to celebrate social care, a sector that makes a difference every day for the people of Scotland, whether you access, work in or provide it.

Despite the shelved human rights bill, we put human rights at the front and centre of our work, we know that value lies in people, not process but we need to do more to address discrimination in our society. Discrimination in our legislation which excludes older people living in care homes from access to self-directed support,  discrimination which has become so pervasive against older people we do not even notice it is there.

And societal discrimination in the form of microaggressions which for instance maintain that it’s women’s work, worthy only of a living wage, rather than a professional wage for professionally qualified and regulated individuals. That it’s women’s work, thinking which a recent study as part of IMPACT showed that deters men from considering a role in social care because they are too worried what their family might say thus perpetuating the myth.

Everyone in this room knows the worth of social care and support through the significant contribution it makes to society and our economy. Through the difference that it makes to our lives and in the measurement of humanity.

It’s time we broke through those barriers and set things right. It’s time for a care revolution to bring us social care that works for Scotland.

​Visionary​

All of us recognise that the seeds of change are rooted in the present moment, that the future is not an alien country but one we must all be citizens of. We can never stand still, we must always be re-imagining our today in a new direction.

So that is why Scottish Care is continually committed to asking the hard questions – what will a care home need to look like? How do we make services and support truly person-led with the citizen in charge and our services and staff there to enable them to direct their living?

That’s why technology and digital solutions and the emerging role of Ai are not a fad or a distraction but central and critical for the delivery of quality and rights-based care and support.

That’s why we will use design approaches to work with a range of stakeholders so that the people in this room and those who use services and support in care homes are at the forefront of coming up with a vision of tomorrow.

Whether through our work on data or research and policy we will continue to listen to the best the world of aged care has to offer in all corners of our globe, bring insights into this place and help to re-shape plans and possibilities into realities and revolution.

An American actor once said:

“Tomorrow is the most important thing in life. Comes into us at midnight very clean. It’s perfect when it arrives and puts itself in our hands.”

We all of us have the potential to create a vision of the possible for social care in Scotland, we can work together from all political standpoints to put aside short term self-interest and partisan positioning and identify what we can agree on and re-shape that tomorrow.

Tomorrow is fresh and full of possibility, if we dare to allow all that stops us from working together to be set aside.

Donald Macaskill

Karen Hedge

Photo from Joshua Sortino from Unsplash

In a previous blog I mentioned that I had had the privilege of visiting Australia where I had the opportunity to meet with and discuss the challenges of delivering aged care in that vast country. Part of these conversations related to how providers navigated the challenges of remote and rural care delivery.

In many ways the challenges faced by care providers in Scotland are not dissimilar – issues of workforce recruitment and retention, transport, cost of living, depopulation and lack of whole system thinking. I’ve previously written about what some of this means for the Highlands of Scotland and argued that at the very least we need to develop specific funding streams to address these issues, but in truth it is more than additional resource which is needed. The criticality of these issues is self-evident with growing numbers of care homes closing and public intervention required to avoid further social care withdrawal.

In this piece I want to suggest that there are some practical solutions which might aid us in the short term but also that if we are serious in addressing the challenges of depopulation then we need radical new (and old) approaches to our delivery of social care and health services. What follows is an attempt to describe some aspects of this in brief and to initiate a wider conversation.

Going back to move forward.

I have long been interested in the work of Eileen Younghusband. Eileen was a pioneering British social worker, educator, and researcher whose work significantly shaped social care practices, especially through her emphasis on community-based social work and a holistic, person-centred approach to care.

The Younghusband Report (1959) was a landmark document that analysed social services provision in the UK and made recommendations for integrating social work with health and community support. Her ideas laid a foundation for modern social care practices, particularly in settings where tailored, community-oriented approaches were essential.

In many senses she was the forerunner of our modern attempts at the integration of health and social care but critically her starting point was the local community and not national systems, and her focus was on the person living in community and primary care/social care and not on secondary and acute clinical care.

Younghusband’s work was grounded in the belief that social workers should operate within communities rather than distant institutions. She promoted integrated care models that involved close collaboration between social services, healthcare, and community organisations, enabling social workers to respond more effectively to local needs and provide tailored support. It all sounds remarkably prescient but sadly much of her report and recommendations remained on the shelf and unimplemented.

Her approach did however chime with many of those behind the development of the Social Work Scotland Act of 1968 not least in its emphasis upon a holistic approach to wellbeing rooted in universalist and communitarian principles.

Younghusband argued for a holistic model that viewed individuals within the context of their families, communities, and broader social environments. This approach encouraged social workers to address not just immediate social needs but also the underlying factors impacting an individual’s well-being, such as housing, employment, mental health, and social relationships.

Critically for our context today she also focussed on the importance of preventive measures in social care, including early intervention, education, and ongoing support to help individuals maintain independence and prevent crises. She also argued for the need for flexibility around the scope of roles and activities within professional groups, being critical of role protectionism and an unwillingness to work beyond scope and registration. I would suggest her work has much to teach us today around rural and remote health and care delivery.

Alongside this philosophical UK grounding of a communitarian primary and social care model it is worth reflecting on the Australian context which I came across.

Australia is actively working to improve access to and the quality of aged care services, particularly for those in rural and remote areas and from diverse cultural backgrounds. It is doing so by utilising several distinctive programmes including:

The Multi-Purpose Services (MPS) Program which has a primary aim to deliver integrated health and aged care services in rural and remote communities that cannot support standalone facilities. As a result, older people can remain in their communities, closer to family and friends, while accessing necessary care. The program encompasses a range of services including residential and home care, acute and subacute care, emergency, allied health, and primary health services. It is all funded jointly by the Australian Government and state and territory governments, with funding shared between them.

The National Aboriginal and Torres Strait Islander Flexible Aged Care Program aims to fund culturally appropriate aged care services for older Aboriginal and Torres Strait Islander peoples, primarily in rural and remote areas. It does so by recognising the importance of cultural safety in aged care, ensuring services respect and support unique cultural identities and needs. A key element of its success is that it emphasises worker registration and regulatory flexibility, cultural appropriateness, and accessibility, thus empowering communities to tailor services to their needs rather than expect people to fit into pre-existent structures and models.

Lastly the General Practice in Aged Care Incentive seeks to encourage continuous and quality primary care for older people residing in aged care homes by their regular GP and practice. Financial incentives are provided to GPs and practices registered with Incentive for providing regular visits and care planning. This has already resulted in improved continuity of care and a reduction in avoidable hospitalisations.

There are certain key themes in all these programmes including a stress on ensuring equitable access to quality aged care services for all Australians, regardless of location or cultural background. They seek to promote models that integrate various health and aged care services to provide holistic care and improve outcomes. And being very aware of issues of fiscal and demographic/geographic sustainability they directly address the challenges related to funding, workforce, and infrastructure to ensure the long-term viability of aged care services.

What does all this mean?

In rural and remote areas of Scotland, where communities are dispersed, resources are limited, and access to healthcare and social services can be challenging, Younghusband’s approach combined with some Australian insight offers, I would suggest, a potentially valuable framework for effective social care and health delivery. I would suggest four key aspects.

There needs to be a greater flexibility in the registration of services. The introduction of one registration requirement for any and all social care services would enable providers to exercise greater flex in the delivery of services. So, a residential care provider could also work in the community delivering care at home and day care/community supports. Whilst this is technically possible at the moment the process of dual registration and all that comes with it is cumbersome and stymies creativity and investment. Australia is rich in examples of the benefits of such a flexible approach to registration.

Clearly one of the major challenges is attracting and retaining a workforce. Again, Australia evidences what can be achieved when it is the person who is registered to work across multiple settings rather than limited in their scope and practice to one service or model of care and support. This serves to attract new workers because there is a clear appeal in working across environments, in the variety this offers a practitioner and in the positive ability of a worker supporting an individual across settings, transitioning from community through respite provision into permanent residential or advanced care.

Part of Younghusband’s work was her eagerness that such flexible approaches to professional role would become commonplace in integrated environments. We are not seeing this in Scotland, and I think this offers a direct challenge but also opportunity to nursing and social care colleagues. Many of us still remember the early models of district or community nursing which had a critical component of ‘social care’ and preventative approaches within them. Even if they were not always explicit, they existed in practice. These have largely been lost, but I would contend that in our rural and remote communities there is a real opportunity to re-envisage the role of community nursing in partnership with social care practitioners. Some lessons might be learnt from what is increasingly happening in our care homes in the relationship between senior carers and nursing staff. Faced with demographic challenges and a lack of available staff we need to be creative and positive about re-designing roles to fit population need rather than limiting the demand to fit traditional roles.

Thirdly, Australia also evidences a much more flexible approach to regulatory oversight and its role in service improvement and delivery. In Scotland today the role of the regulator is detached from service delivery and still dominated by a policing and compliance ethos rather than a collaborative, mutual partnership where critical comment and advice works alongside service delivery through service improvement. We are still at the stage of a naïve and sometimes limiting application of standards to practice rather than a consensual collaborative approach which enables services and supports to uniquely express local context and ability. To be blunt accepting that you cannot deliver a service in a remote community with limited staff in exactly the same way that might be possible in a populous urban setting does not mean that you lower standards, but it does require a much more dynamic, partnership oriented and realistic approach to regulation and oversight. Without such flexibility in oversight and regulation any innovation is stymied and limited.

Lastly and it is perhaps stating the obvious the reason Younghusband’s approaches did not see the light of day was that their cost was considered too great. The reason the approaches now being evidenced in Australia are clearly bringing benefit is that there has been a not insignificant amount of fiscal and resource investment. In other words, none of the above will be achievable without the money following the vision.

Scotland’s remote and rural communities are crying out for a spirit of innovative adventure where new models replace tired and outdated, defensive and protectionist approaches. A thriving and vibrant social care sector can be a major contributor to addressing the de-population of our communities – if we decide to make the effort and engage in the adventure.

Donald Macaskill

Photo by Konrad Hofmann on Unsplash