“Always listen to the earth because it speaks to you.” A personal reflection for World Earth Day.

My late uncle Donald died suddenly when I was seventeen but by that age he had already left an indelible impression upon me and had taught me so much. Donald was born and lived all his life on Skye and as far as I can remember never left the island. He was a man who had many struggles not least the fact that he found it hard to communicate. He was someone who in modern diagnosis would be described as having a learning disability. Though he found reading very hard his wisdom was one which rarely appears in the pages of a book. It was an authentic and immediate knowledge, one of intimacy with the seasons and with nature. Donald loved the land and the outdoors; he taught me more than I have remembered about the earth and the rhythm of nature and instilled in me a life-long appreciation and respect. One of the things I remember from the many walks into the hills and moors which we went on was his oft used phrase: “Always listen to the earth because it speaks to you.”

“Always listen to the earth because it speaks to you.”

On Thursday one of the most popular global days of observance will be held. It is World Earth Day. Every year on April 22, Earth Day marks the anniversary of the birth of the modern environmental movement in 1970. As on previous years it is expected that it will be marked by more than one billion people across the globe. The theme of Earth Day 2021 is Restore Our Earth™.

Both individually and collectively we are increasingly aware of the urgency of addressing the destruction caused by climate change and the necessity to sustain and protect our natural environment. However, whilst there is increasing recognition of these challenges, even amongst the most sceptical of politicians, there is also a growing frustration at the pace of response and change. Many of us were disappointed that the Paris Agreement in 2015 demonstrated such a low level of commitment and action. It is clear from all the political party manifestoes for the Scottish Parliamentary elections in a few weeks’ time that the climate and environmental sustainability will be one of the key issues which will influence people’s choice of candidate. Whilst Scotland has been more progressive than some, it is also evident that we have some considerable distance to go.

My colleague Karen Hedge has written about how important it is that those of us who are involved in social care contribute to this urgent national effort to meet climate and environmental challenges. Part of that, I believe, involves supporting the aims of the Health and Social Care Alliance, who recently published a report: Sustainable Health and Social Care: Climate Change and COVID-19’ in which they call for £25 million to support a climate change innovation fund for social care.

We cannot care for humanity without caring for the earth. We cannot hear the dislocation of human community without also hearing the fragmentation of our natural world. To care fully requires a holistic understanding that we are all of us children of the soil and intimately entwined to the earth. Care leaves a legacy of compassion and connection in the lives of those supported and it changes the person who offers care. So too the way in which we care has to be something which future generations recognise as enabling and fostering of their ability to flourish on the earth as citizens of the natural world, connected one to the other. Care is never neutral, it always enhances humanity and it should also sustain our earth.

I believe that we have lost the ability to hear the accent of nature and the truth the earth is telling us. We need to re-discover the rhythms of the seasons of the heart where we accept that to care is not just about caring for a human being in isolation from others in community or from the natural world in harmony. Social care to be holistic needs to do more than pay attention to the challenges and issues of sustainability and environmental protection, it needs to mirror, mould and enhance these. There is a real opportunity that in the creation of a National Care Service in Scotland that we bring together the world of ecological and environmental responsibility with the world of human and social care, be that from the energy we use in care homes, the use of sustainable PPE all the way to the use of electric transport in the delivery of homecare.

I remember many things from my walks with my late uncle, not least the astonishing range of wildlife that at that time flourished on the island in river and moorland. Yet today I am aware of the sad reality that so much of it is gone possibly for ever. Our failure to nurture the earth has led to a shaming of our humanity. As we seek to restore and reframe our social care in Scotland I hope that alongside it and as part of that renewal we can also  nourish the restoration of our earth.

One of my favourite poets was someone who had a rare ability to hear what the earth was whispering to him. It is not without coincidence that the moors and rivers I walked in youth, where I was taught to listen to the earth, are the same ones, in the same glen, beautifully captured in one of his poems.

May we all learn to listen and learn.

Summer waterfall, Glendale

I watch a rock shone black

Behind thin water that falls with a frail sound

To the ferny pool. Elvers are roping upwards,

Tumultuous as hair. The rippling ground

Is elvers only, wriggling from crack to crack.

 

Above, a blackfaced ram,

Its viking head malevolent on the sky,

Peers down, stamps and is gone. A rowanberry

Skims and swims, a scarlet coracle, by.

Between two stones a grassblade breaths I am.

 

Small insect glitters run

On the water’s skin… I turn away and see

Distances looking over each other’s shoulders

At a black cliff, a ferny pool and me

And a tress of elvers rippling in the sun.

© Norman MacCaig, Collected Poems, Chatto & Windus, 1990

Financial Sustainability Webinar – 22 April

Sustainability Payments and related payments such as the Social Care Support Fund are crucial for services to carry on in the fight against Covid-19.

Scottish Care has been gathering information from the members at our weekly surgery meetings, as well as reporting on a regular basis to Cosla. It was noted there are many ongoing questions and concerns members have about these payments.

We have arranged a webinar update on Financial Sustainability on Thursday 22 April at 2PM  with colleagues from COSLA and the Scottish Government.

We are delighted to be joined by:

  • Mirren Kelly (COSLA)
  • Clare Thomas (COSLA)
  • Catherine McGoldrick (Health and Social Care Scotland)

This session is for Scottish Care members only. Please join this session to ask any questions or raise any issues you may have.

Details to join will be available on the Members Area of this website. If you have any issues accessing this area, please contact [email protected].

If you have any questions for the webinar panellists, please email [email protected].

Localism vs National models of care: a false dichotomy?

This week Scottish Care has published our Care Manifesto for the Scottish Parliamentary Elections. It has been developed by my colleagues to suggest the areas where they believe the most significant changes in social care need to happen. One of these relates to the proposed development of a National Care Service as suggested by the Independent Review of Adult Social Care, also known as the Feeley Report. I have mentioned in a previous blog how I personally consider the concept of developing a ‘social covenant’ to be one worthy of further exploration and development.

What is meant by a National Care Service is something which has received much consideration since the publication of the Feeley Report. The Scottish Care Manifesto has stated that:

‘We believe such a service can drive consistent, high quality social care support if its’ role and remit is clear and it is developed in partnership with people who have a right to receive that support, the social care workforce and providers. We are presented with an opportunity to improve relationships and understanding, and to rightly elevate social care to equal status with NHS Scotland in terms of leadership and accountability.’

I could not agree more – the potential is enormous. But so too sadly are the obstacles to achieving such an outcome. One is the resistance to the very concept of a national service because of what has been argued as a risk of centralisation and a threat to what is presented as the benefits of keeping things ‘local’. I want to give consideration to some of these arguments in this short blog and to suggest that this is an erroneous and false dichotomy and that the arguments often presented have more to do with self-interest than a coherent defence.

The Feeley Report heard from hundreds of voices, especially those with lived experience of using, working and delivering social care supports. What they heard was a shameful litany of disappointment that original, human rights-based legislation, such as the Carers Act and Self-directed Support Act, had singularly failed to be properly implemented. Scotland has, as I have often argued, enough progressive social care legislation and policy to make this one of the most forward-thinking countries in the world. But we are not. There are many reasons for this, and the Feeley Report articulates the ‘implementation gap’ as a major reason for the disrepair and malaise that is afflicting social care not just now but for decades.

These voices and the testimony of missed opportunity and failed implementation cannot be ignored or set aside as insignificant or unimportant. It is also clear that the fractures and failings of the system of care cannot be dismissed as simply the results of fiscal austerity. The failures to implement progressive social care, to deliver models of collaborative partnership, which give citizens control and autonomy over their care are decades old. These failures are systemic and as Feeley underlines, include the contradictions of diverse charging policies and the postcode lottery of provision dependent upon where you are in Scotland, which local authority department you happen to be under and what focus happens to exist in a particular local area. In other words, and though it was not put as bluntly as this in the Report’s analysis, the failures are in large part because of the very nature of localism which has created such inappropriate divergence from policy alongside piecemeal and patchy implementation. It has been argued that diversity of approach and flexibility of local implementation was so critical. It was not. In an attempt to avoid ‘top down direction’ the world of social care has received local led atrophy.

The delivery of social care placed in the hands of local authorities has clearly failed for thirty plus years and those who use supports and services deserve much better than what they have received. Again to underline lest I be misunderstood, this is a critique of a system not of the individuals at local level charged with working within it. Having trained hundreds of frontline social workers in the SDS Act I never met one who wanted to limit the control, choice and autonomy of someone who used social care support, but I have met plenty who railed against the system, the controls, the oversights and constraints which at local authority level prevented them from truly and authentically doing the job they loved – to help change people’s lives for the better.

So it is perhaps not that surprising that the voice of local authority government has been resistant to the concept of a National Care Service.  In true ‘turkeys voting for Christmas’ style they have argued against the loss of ‘local democracy’  and ‘accountability’ whilst ignoring the Report’s damning critique of failures over which they have presided for decades.

We get a flavour of some of this critique from local government in the COSLA statement on the Feeley Report which whilst welcoming the emphasis on those who use supports and its workforce, goes on to state that Leaders ‘unanimously expressed their grave concern at the recommendations around the future governance and accountability arrangements contained within the Report.’ It went on to say:

 ‘Council Leaders together voiced their opposition to the recommendation which proposes the removal of local democratic accountability from Adult Social Care and the centralising of the service under a National Care Service with accountability falling to Ministers, a move that they described as being detrimental to the local delivery of social care and its integration with other key community services.  They also felt that given the level of funding set out in the Review, Local Government would be well placed to continue to deliver this vital service.’

This presentation of social care reality simply does not ring true for the vast majority of those who have received social care and who spoke to the Feeley Review group nor to those who have as charities, not for profit and private providers delivered social care under local authority commissioning approaches which have consistently treated in-house provision more favourably than out-sourced contractors.

A further joint statement was made with the Scottish Government days before the Parliamentary election commenced. That statement re-stated COSLA’s concerns that ‘it is evident that there is significant discussion needed around the areas in the review that relate to governance and accountability within the report.’ The Cabinet Secretary observed that:

‘Radical reform is never easy and I understand COSLA’s concerns around governance and accountability and we will continue to discuss those. There is much on which the Scottish Government and COSLA agree and by working closely together on the fundamental principals in the report we will overcome the obstacles to build a world leading care service.’

I hardly need to add that those who use social care support, the organisations. which provide the majority of it, and the workforce also need to be at the table lest it become a classic cabal of inter-governmental decision-making.

Resistance to radical change from vested interest is nothing new. When the NHS was being created in the late 1940s we saw the same. GPs and local committees voted 10 to 1 against the proposals of a national service in 1946, demanding things be kept local, ‘near the people and locally led.’ The politicians were also disunited with the Winston Churchill led Conservatives voting against the proposals no less than 21 times. But the vision of a national service prevailed over what one commentator described as ‘obsessive localism.’

What all of this highlights is the age-old debate between national and local approaches. It has aye been thus and those of us old enough to remember debates about a national police service  – which we achieved – or a national education body – which we did not get – will recollect the reaction of local government elected leaders at the perceived loss of influence, budget and accountability. But in reality is this not just a false dichotomy? For social care it is not a choice between a local model on the one hand and a national one on the other. It is a choice between a model accountable to Government centrally with a strong local voice and enabling of local choice or one which is dressed up in the clothes of localism but is as remote and detached from the citizen as any distant central service. risks being. What social care as a whole needs in Scotland at this time  is a change to the failures of the present.

If you look across Europe the balance between local autonomy and central control is a perennial issue in the territorial organisation of states. How much power do you hold in the centre and what do you devolve or delegate to local level? Equally there is much debate today about how you re-invigorate local democracy as right across Europe people have become more and more disengaged from local decision making unless its relevance is seen as being of direct interest and impact. At the same time there has been a renewal of democratic engagement in national and regional governments.

Time does not permit in this blog to consider further the local and national dichotomy in its widest sense but from the perspective of social care,  being able to make decisions locally which directly impact on your care and support is clearly beneficial. I am not arguing, and I do not think anyone seriously is, that all decisions, policies, interventions and accountabilities should always and inescapably be at a national level. But in the timeless tug-of-war between centralisation and decentralisation what should remain the priority is how do we enable the person who uses the support or service to feel in control, autonomous and in the lead? The person and not the system is what matters.

In an age where it is possible to exercise influence and autonomy through the pressing of a phone key, where apps have enabled real participation and meaningful engagement; where democracy has the potential to be ever more proximate and personal, then it is perfectly possible to reform the accountabilities of social care without maintaining a failed status quo.

There are many lessons which need to be learnt from the experience of the pandemic. One of these has undoubtedly been that when it mattered most in a crisis there was an ability to lead from the centre, to instigate change and initiate intervention but whilst still taking account of the uniqueness of the particular and the requirements of the local. We did not have 31 different pandemic responses but one response delivered at local level – albeit as social care providers can attest the multiplicity of local approaches was itself beset with difficulty. There was clearly a time and a benefit for a centralised model and if it works in a crisis it can work anytime.

There will be much debate in the coming weeks and after the Parliament is selected no doubt in the coming months, I hope we can all agree that the local-national accountability and delivery issue does not need to be an either/or.

The Feeley Report envisaged a transformed local accountability in Integrated Joint Boards where representation was real, local, participative and immediate. Most importantly the Report and its ideal of a national care service held before us a vision that those who matter most, the folks who use and will use social care supports in the future, were really in control and in charge, were the engineers of decision-making – that is a vision we simply cannot lose, and which will outlive all the transitory interests of the system defenders. It is their voice, not those of local or national politicians, of workers and the unions, of providers and their representatives, that must be at the heart of all design and delivery. We cannot fail to build a future service rooted in that voice.

Donald Macaskill

Scottish Parliamentary Elections – Care Hustings – 21 Apr

Scottish Care is pleased to host a virtual hustings forum on Wednesday 21st April from 13:00 – 14:00 ahead of Scottish Parliamentary Elections on May 6th.

At the event, we will be joined by political party health representatives of the major parties who have existing parliamentary seats. Confirmed attendees include:

  • Donald Cameron – Conservative
  • Jackie Baillie – Labour
  • Alison Johnstone – Green
  • Fulton McGregor -SNP
  • Alex Cole-Hamilton – Liberal Democrats

Each party representative will be invited to briefly share their perspectives on social care, reflecting on the past year and priorities for the next Parliament.  We will then hold an open Q and A session. This is your opportunity to quiz prospective parliamentarians on matters that concern you most.

Social Care has never been such a prominent issue in an election. Scottish Care has published our own Care Manifesto which centres on the call in the Independent Review of Adult Social Care for a Social Care Covenant – an agreement of and for social care that places the dignity of individuals at the heart of decision-making and at the forefront of a more inclusive social care future.

The session will be an open, online event and requires registration. It will be moderated by Scottish Care CEO, Dr Donald Macaskill. Please sign up at the following link:  https://us02web.zoom.us/meeting/register/tZIldu-vqTkiGd02SpW-u30jCV9HoQmSpEc6

For further information on this event please contact: [email protected]

We look forward to seeing you there!

Twitter hashtag: #carehusting

Scottish Care Nursing Survey 2021

Dear colleague

I am excited to present the 2021 Scottish Care Nursing Survey. This year more than ever, it is paramount that we get the views of our nursing workforce and managers. I appreciate times remain challenging, but I hope you are as determined as we are to make your voices heard. We have a real opportunity to give social care nursing the spotlight it deserves if we work together.

Thank you all in advance for your time in completing this survey.

Survey deadline: 30 April

Survey link: https://www.surveymonkey.co.uk/r/nursingsurvey2021

Kind regards,

Jacqui Neil
Transforming Workforce Lead for Nursing

Scottish Care Manifesto 2021

Scottish Care is publishing our Manifesto April 07, 2021 with our key priorities for the next Government, ahead of the Scottish Parliamentary Elections on May 06, 2021.

Our Manifesto echoes the call in the Feeley report for a Social Care Covenant – an agreement of and for social care that places the dignity of individuals at the heart of decision-making and at the forefront of a more inclusive social care future that recognises its distinctive role in supporting the wellbeing of individuals to live an independent and healthy life of their choice.

Given the particular hardships faced by the care home and home care sectors in the past year due to the COVID-19 pandemic, we have considered the areas in which those accessing care, the workforce and providers would benefit most. We must consider the support that people need as we recover from the effects of the pandemic and how we can deliver that given the new challenges as Scotland exits lockdown.

We have outlined eight areas of focus where we present a future change landscape for social care in Scotland. The Manifesto shares the key areas of focus with accompanying actions towards realising a positive future for the independent social care sector in Scotland.

The Manifesto was developed with input from our members, partners and people who use social care supports. We thank them for their involvement in this work.

Karen Hedge, National Director says:

“We are at a standpoint for social care. The pandemic has highlighted the potential of the sector; the agility of our providers and the dedication and skill of our workforce. This, coupled with the Review of Adult Social Care, has changed parameters and expectations of the sector making the forthcoming election a critical opportunity to address the 8 areas of focus outlined by Scottish Care in their Social Care Covenant, so that we can get this right for the people of Scotland.”