It was Alcohol Awareness Week at the start of the month and during it I was reading some of the latest research and data on alcohol and older age in Scotland. It was both disturbing and yet sadly predictable.

Across Scotland today one of the hidden harms of alcohol is its impact on the lives of older Scots and their families and the relative lack of specialist social care provision to address that crisis. This growing issue is not only a personal tragedy for those affected but fractures too many families and communities. It is also a harm which as I’ve reflected upon last year in this blog space we still remain poor at calling it out and resourcing the change that’s needed.

Alcoholism among older adults is often overshadowed by other public health concerns. However, the statistics tell a worrying story.

Research indicates that alcohol misuse among those over 65 in Scotland is on the rise, exacerbated by factors such as loneliness, bereavement, and physical health problems. Unlike younger drinkers, older adults often face more severe health consequences from alcohol misuse, making early intervention and support crucial.

Health data indicates that a significant proportion of older adults consume alcohol regularly, with a notable segment drinking more than the recommended guidelines.

The 2022 Scottish Health Survey indicated that 24% of men and 13% of women aged 65-74 drink more than the recommended weekly alcohol limit (14 units per week). For those aged 75 and over, these figures are 16% for men and 8% for women.

In addition, data from the Information Services Division (ISD) Scotland reveals an increasing trend in alcohol-related hospital admissions among older adults. In the past decade, there has been a marked rise in admissions for alcohol-related conditions such as liver disease, falls, and cognitive impairment. ISD Scotland reported that in 2021, there were approximately 2,300 alcohol-related hospital admissions per 100,000 population for those aged 65 and over, a significant increase from previous years.

And further National Records of Scotland recorded 467 alcohol-specific deaths in 2022 among individuals aged 65 and over, an increase of 15% compared to 2021. Statistics show that individuals over 65 have higher alcohol-specific mortality rates compared to younger age groups, reflecting the severe health impacts of prolonged alcohol misuse.

Older adults struggling with alcoholism face a unique set of challenges. Physiologically, the aging body is less capable of metabolising alcohol, increasing vulnerability to its effects. This can lead to a range of health issues, including liver disease, cardiovascular problems, and cognitive decline. Moreover, alcohol can interact dangerously with medications commonly prescribed to older adults, compounding health risks.

Socially, older adults may experience isolation and loneliness, which can drive them to use alcohol as a coping mechanism. I’ve known too many times where the loss of a spouse, or retirement, or relocation has led to folks turning to the drink in older age. All this can sever social ties, leaving individuals even more vulnerable and the stigma associated with alcoholism can further isolate them, making it difficult to seek help.

The rise of alcoholism among older adults has profound implications for social care in Scotland. More and more frontline workers especially in homecare are telling of noticing an increase in alcohol addiction. They are often the first to notice the signs of alcohol misuse, such as frequent falls, memory lapses, or neglect of personal hygiene. However, recognising these signs can be challenging, as they are often attributed to aging itself rather than alcohol use.

Care providers face the complex task of managing the immediate health needs of these individuals while also addressing the underlying issue of alcoholism. This dual challenge requires a nuanced approach that combines clinical care with psychological and social support. In other words, the response has to have social care at its heart.

The data underscores the growing need for targeted interventions to address alcohol misuse among older adults. The current system is stretched to a point that it struggles with the majority and is failing to pick up this growing demographic and their acute needs.

Social care providers must be equipped with the knowledge and resources to identify and manage alcohol-related issues effectively. Investment at this level will support preventative work and will thus reduce the growing pressures on hospitals and residential care settings.

However, social care workers require specialised training to effectively support older adults with alcoholism. This includes understanding the signs of alcohol misuse, managing withdrawal symptoms, and providing compassionate, non-judgmental care. Without adequate training and resources, care providers will struggle to meet the complex needs of this population.

Addressing alcoholism among older adults in Scotland I believe requires a multifaceted approach, including:

Awareness and Education: raising awareness about the issue is the first step. This includes educating the public, care providers, and policymakers about the signs of alcohol misuse in older adults and the unique challenges they face.

 Integrated Care Models: developing integrated care models that combine medical, psychological, and social care support is essential. This holistic approach can ensure that older adults receive comprehensive care tailored to their specific needs.

Community Support: strengthening community support networks can help reduce isolation and provide older adults with the social connections they need to combat loneliness. Yet sadly we are cutting back and defunding these programmes at a time of real need and acuity. Community programmes that offer social activities, peer support, and outreach can play a crucial role in prevention and early intervention.

Policy and Funding: it’s perhaps stating the obvious but national and local government in Scotland must prioritise funding for programmes and models that address alcohol misuse among older adults. This includes investing in training for social care workers and expanding access to treatment and support services.

Alcoholism among older adults in Scotland is a pressing issue that demands our collective attention and action.

The data on alcohol misuse among those over 65 in Scotland paints a concerning picture of a hidden crisis that requires urgent attention. By acknowledging the prevalence and impact of this issue, we can better support our older population through targeted interventions, comprehensive care models, and robust community support. Addressing this challenge is not only a matter of health but also of dignity and quality of life for our older citizens.

It is a challenge that intersects with the very heart of social care, impacting both those who suffer from alcohol misuse and the professionals who support them.

Let us not turn a blind eye to this issue. Let us confront it with compassion, understanding, and a commitment to creating a social care system that supports every individual, at every stage of life.

Donald Macaskill

Photo by Thomas Picauly on Unsplash

Whether it’s Efcharisto, Danke, Gracias, Merci, Takk or simply thank you – wherever those who can and choose to travel or holiday this summer doubtless most of us will learn the basics of communication in the native language of the place we find ourselves in.

Saying thank you to show gratitude is an important part of etiquette in almost all cultures. Whilst manners might change and customs will divert there remains a truth that learning the vocabulary of gratitude is the first step to properly showing your appreciation in a new community.

I think the same can be said of the busy world of social care. Amidst the daily routines and pressing challenges, there lies a profound yet often overlooked practice: saying “thank you.” These two simple words carry immense weight, embodying gratitude and recognition, fostering a culture of appreciation that is vital for both care and support workers and those they support.

Saying thank you might sometimes feel like an afterthought, a perfunctory nod to social etiquette. Yet, these words carry an astonishing power. In my years of working in social care and beyond, I’ve seen firsthand the profound impact that genuine gratitude can have on individuals, relationships, and communities.

At its core, social care is about human connection. It’s about seeing the person behind the condition, label or stigma; it’s about understanding their stories, their struggles, and their triumphs. In such an environment, gratitude is more than just a courtesy; it is a cornerstone of human dignity and respect.

For social care workers, the role they play is both physically demanding and emotionally taxing. They provide support, comfort, and companionship to individuals who often face significant challenges.

This work can be deeply rewarding, yet it can also lead to burnout if not balanced with adequate support and recognition. The central focus of that recognition has to be the continued struggle to give people adequate terms and conditions – and I hope all governments and organisations will heed the criticality of improved pay for the social care workforce as the primary mark of saying thank you!

However wider acknowledgment of the work of a carer is crucial for individual mental health and job satisfaction.

The act of expressing thanks does not just benefit the recipient; it also positively affects the giver. Research shows that practicing gratitude can enhance well-being, reduce stress, and increase overall happiness. In a field as challenging as social care, where the emotional demands are high, cultivating gratitude can serve as a buffer against burnout and compassion fatigue. This is true at all levels of organisations and communities.

For gratitude is not just a social nicety; it is a fundamental human need. Philosophers, psychologists, and spiritual leaders have long extolled the virtues of gratitude, recognising it as a cornerstone of human well-being. Saying “thank you” acknowledges the efforts of others, affirming their value and fostering a sense of connection and mutual regard.

In social care, where the heart of the work lies in human connection, saying “thank you” is more than good manners—it’s a vital practice that sustains the spirit and dedication of caregivers. It strengthens relationships, builds trust, and fosters a culture of mutual respect and appreciation.

In our increasingly disconnected society, where digital interactions often replace face-to-face encounters, expressing thanks has never been more crucial. It bridges the gap between us, reminding us of our shared humanity and interdependence.

So I’m pleased that Thank You Day is returning tomorrow.

Thank You Day began with a handful of organisations looking for a way to enable us all to say a huge ‘thank you’ to everyone and everything that helped us through the COVID-19 pandemic.

Since then the campaign has grown to include hundreds of partners and over 20 million people have taken part in Thank You Day celebrations. Last year 74% of those who took part in a Thank You Day event said they felt a stronger sense of belonging to their local community as a result.

The celebrations this year are focusing on giving thanks to our local communities.

At their heart is the act of gratitude which creates and nurtures the wellbeing both of individuals and communities and not least those who require care and support.

Two simple words – thank you – a powerful act that can transform our interactions and relationships. It is a small gesture with a huge impact, fostering a culture of appreciation and respect.

I hope you have a summer where you are able to both receive and give thanks.

Donald Macaskill

I first knew Jane when we were both in our early twenties. She and her husband had just suffered a bereavement. Their little girl had contracted meningitis and had died within hours of reaching hospital. They were both devastated, searching for sense through the darkness of their despair; looking for any answer to the thousands of questions they had, all of their conversation tumbling out from their tears and sobs. I was there to listen and be present and to help them as much as I could.

I remember so many of those conversations with folks who had suffered the death of a child or baby – even if I’ve forgotten the names involved – or in truth I remember the feelings I was left with rather than the words. Feelings of utter uselessness in the presence of another’s brokenness.

I met Jane again years later and maybe understandably I didn’t recognise her at first. We had both changed, and we were not the people we were once. One thing she said though has stayed with me ever since. We talked about that first time we had met and about her little girl. Jane said to me “I’ve held her inside every step of the way.”

She told me of how it was really hard to go back home, the emptiness she felt and her desperation not to let go of anything belonging to her daughter – almost she said as if throwing anything away would be an act of betrayal. She told me how she’d visited the grave every day – how she just wanted to continue being a mum; she shared very openly about her attempts to hurt and harm herself because she simply wanted to be with her daughter.

All of this led to the breakdown of her marriage as her partner in her own words gave her ultimatum upon ultimatum as he tried ‘to drag her back into living.’

Then over time she said things started to change. Slowly at first – small steps but important ones. She started working again after 3 years; she began to go out and reconnect with friends; she reduced the time she spent at the grave and on some days chose not to go. She then after a while started dating and met someone.

As she told me of her marriage, of the birth of a son, of his first day at school, of his growing into a man and his graduation, after every story of her growing family and ageing self she said that at every moment of memory that she had held her wee girl inside her every step of the way.

I thought of Jane and her life of unforgetting love when I discovered that next Wednesday 3rd July that it is to be National Bereaved Parents Day.

The day was set up four years ago by the charity A Child of Mine, after they realised that there wasn’t a specific day that honoured bereaved parents from all walks of life. In their words:

‘National Bereaved Parents Day brings together anyone affected by the death of a child to show bereaved parents that they are not alone. This year’s theme is “Love Lives On”.

And how true that statement was and is for Jane.

Over the years I have been privileged to have spent time with people who have been bereaved and each and every encounter has been special. But I have found that the impact of the death of a child on parents has been one of the hardest of all experiences. It is a loss that lives with the parents throughout their time. It doesn’t diminish it just changes.

But what especially saddens me are the countless folks I have talked to in late and older age who are still mourning for a lost child or baby. It saddens me not because they are mourning or grieving but because in years gone by their loss was never validated, often ignored and rarely understood. Thankfully things have improved but I’m not wholly convinced that society doesn’t still expect us to speedily ‘ get over it.’ I’m not convinced that we are not still in a situation where it’s assumed that in your eighties or nineties that the grief for a child dead for decades should now be passed and forgotten. I’ve met too many in care home and community who have never had the chance to grieve and mourn, who have never been enabled to say a proper goodbye.

The death of a child remains with parents for ever – the love does not diminish. We all of us need to be much more aware and sensitive to the particular impacts of such bereavement. In fact in older age, it is often the case that parents may experience a resurgence of grief, particularly during milestones such as anniversaries or what would have been significant birthdays. As others see their children grow into adulthood and milestones like marriage or grandchildren arrive the painful longevity of grief touches ever sharper.

Older adults have often talked to me not least of the child who has died was an only child of how alone they feel as they age. Many older people as they age often face a shrinking social circle due to the deaths of peers or reduced mobility. But the absence of their child can amplify feelings of loneliness and isolation. Without their child to share memories with or support them, parents may struggle with a profound sense of emptiness.

I’d also want to highlight that parents can lose their child at any age and all that I’ve said about grief is as valid for the loss of an adult child as much as for a younger child. But added to the grieving is the possibility that if the deceased child had their own children, grandparents may take on the dual role of supporting their grandchildren while navigating their own grief. This responsibility can be emotionally and physically taxing, especially as they age, impacting their ability to cope and their overall well-being.

Every step of the way, every moment we age, every occasion and memento moment Jane and others will carry their child deep inside their heart. They will never be forgotten; the fracture will never truly heal. Love lives on even if its rhythm alters.

As a society I think we must do more to understand and acknowledge the particular aspects of losing a child at any age both for the parents and for others. We too need to find ways in which collectively and as communities we learn to carry the memory of those who are departed as we age together.

I leave you with a beautiful poem for all ages by the American animator and songwriter Rebecca Sugar called Time Adventure.

‘Time is an illusion that helps things make sense

So we are always living in the present tense

It seems unforgiving when a good thing ends

But you and I will always be back then

You and I will always be back then

If there was some amazing force outside of time

To take us back to where we were

And hang each moment up like pictures on the wall

Inside a billion tiny frames so that we could see it all, all, all

It would look like: will happen, happening, happened

Will happen, happening, happened

And there we are again and again

Cause you and I will always be back then

You and I will always be back then’

Donald Macaskill

Photo by Nick Fewings on Unsplash

Yesterday I was pleased to take part in a Royal Society of Edinburgh session on the challenges facing those who live in rural and remote parts of Scotland as they relate to health and social care delivery. As part of the ‘Islands, past, present and future’ event series it was an attempt to spotlight the stories of Scotland’s Island communities, looking back, taking stock, and imagining the future.

The remote and rural parts of Scotland, not least our island communities, face many of the same challenges which social care provision is experiencing in other parts of Scotland but are doing so with an intensity and immediacy which may not be wholly evident elsewhere. But they also I believe have the capacity and ability to mirror and illustrate for the rest of us some of the pragmatic solutions and potentials for change which we all need to reflect upon and consider into our future.

So what are the challenges and issues?

Geography

Stating the obvious the first and foremost is geography. I am mindful that you define remoteness from where you are – and that it is a very subjective concept. This geographical remoteness impacts on the experience of people who might want to access services but also on organisations who might be willing to provide these. There are fewer services and supports available, reducing the importance of choice and personal control, and also making access to some services challenging because of the sheer distance. I think in particular of the huge number of care homes which have closed in my own island community of Skye where about 20 years ago there were well over a dozen and now only a handful.

A key additional factor both in terms of physically getting to care services and also as it impacts on the ability of staff is the issue of transport or perhaps more the lack of robust co-ordinated public transport together with the cost of self-transport in terms of fuel etc.

Workforce

A related major challenge facing providers is the availability of a skilled workforce. Even without mentioning the ‘B’ word and the hugely damaging impacts of Brexit on rural social care workforce recruitment, it was still immensely difficult for rural and remote provision to attract an available workforce. This is for a huge number of reasons, isolation, lack of support, availability of social housing, cost of living and so on. As hospitality and retail have become more attractive especially during what increasingly feels like a ‘whole year tourist season’ then it has become really hard to sustain workforce levels in social care. So what provdiers end up doing is using agency staff. The exorbitant cost of this emergency provision soon becomes unsustainable.

Since 2022 and the introduction of the Social Care Workers Visa there has been a not insignificant increase in inward attraction to both island and rural communities, but the death knell to such positivity has been sounded by the Tory Government’s restriction on dependents of workers here on a visa.

There are other factors which are evident in island and rural communities. One clearly is demographic – I am not the first nor will I be the last to fear what one newspaper called the new ‘Highland Clearances’ – with an increasing trend of younger people leaving island communities and more townships and communities losing the essentials of infrastructure and community. Added to that is the fact that proportionately the population is older and that this increases demand at a very time when that demand cannot, or it is very difficult to meet. Our islands attract many older individuals who choose the locations in which to retire, and this has and is putting tremendous strain on services when inevitably the ageing process leads to an increased demand.

Increasingly elsewhere when faced with increasing demand, workforce shortage and fiscal challenges both commissioners and providers of social care have turned to technological and digital interventions. Before going much further I would want to declare that I strongly believe such solutions have a place but only alongside humanistic presence and care delivery not as a replacement for and crudely as some sort of cost-saving strategy. But whether it is the increasing use of Ai, of in-house smart devices to monitor acuity and so much more, or simply data and record management, never mind the potential of robotics there are obvious challenges including digital connectivity, technological infrastructure robustness and access, digital poverty and so much more which are potentially faced by island and rural communities.

And of course, the elephant in this island room is economic limitation, lack of investment and the raw reality of rural and island poverty which affects everything not least the availability of social housing – though I was delighted to read this week that the island of Rassay off Skye has after over a decade finally got some more social houses!

Personally, I believe that if our island communities are not just going to maintain themselves in some sort of Celtic aspic then they need focussed and urgent national investment – an Islands Fund! We need social care providers for instance to have a fiscal weighting that enables them to be sustainable in the delivery of services given increased workforce, housing, infrastructure, commodity and related costs.

So the challenges are not insignificant but I also think the potential is equally capable of addressing and overcoming these. Addressing the challenge of social care in island communities requires a multifaceted approach, including improved funding, targeted recruitment and training initiatives, infrastructure development, and the integration of innovative care models. But it can be done and is being done.

Take workforce as an example. NHS Highland is currently funding my own organisation in appointing someone to a post as a Sector Career & Attraction Lead for Care Homes in North Highland. It is a new post yet the post holder Laura Dobinson who comes with a rare blend of sector knowledge but also recruitment and HR skills is working to develop new and innovative approaches to recruit working with local communities to achieve real people into real roles. This is the first post of its kind in Scotland and is already bearing fruit. I hope we will see more of focussed and targeted approaches like this one rather than relying on some of our more traditional methods.

Key to enhancing recruitment has to be a whole system approach – there is no point in having a work ready carer if she or he cannot find a house to come into the island and live in.

But as well as workforce we must look at innovative ways of working. At the heart of this is what already happens in our island communities and that is a degree of integrated and collaborative, whole system working that is the envy of others and is I think the only way forward. Islanders cannot afford the luxury and fantasy of silo working. People who require care and support don’t care a toss about the uniform you wear, the organisational badge you work under, what they want is immediate, professional care and support and a level of continuity, consistency and quality which is the heart of all person-led care and support.

But perhaps we also need to build on the communitarian and co-operative strengths of our island communities, not in a romantic sense but in practical realistic ways.

Communities whether rural, remote or urban, will increasingly have to look after one another more – and as a community is nothing more or less than a collection of individuals – that means we all have and increasingly will have an individual responsibility to ‘be our sister’s keeper’ and look out for one another, care and support one another. Put simply if we do not then no one else will not least given the global ageing, health and care dynamic we will increasingly face.

There are insights and lessons of how we can achieve this all over the world – and if nothing else at least in my experience of having seafarers in the family islanders are the best folks for having an openness to learning from others.

So whether it is the truly integrated and community based approach with care hubs bringing together healthcare, social services, and community support under one roof and so offering a holistic approach to care and improving coordination between services as has been successfully operated for some time in Tasmania, Australia, or the model in New Zealand where the government offers scholarships and incentives for healthcare and social care professionals to work in remote and island communities, and financially fosters a locally trained and dedicated workforce.

There are global insights to learn from. And one I have got to know is a new community-based approach to working developed by Dr Emi Kiyota who I have been privileged to know and work with.  Emi is an environmental gerontologist. She has taught and published across the world but most of her work is in East Asia, especially Singapore, Japan and the Philippines. She established an organisation called Ibasho and developed a model for delivering care and support led by older people themselves in rural and island communities.

‘Ibasho means “a place where you can feel like yourself” in Japanese.

As Emi says: ‘At Ibasho we believe this is what every person should have as they age – a place to live in safety, comfort and dignity, where he or she is valued as a person full of history and experience.’

‘Ibasho recognizes that people fear two things as we age — social isolation and losing respect from others in society. Our goal is to create a shared future in which aging is not something to fear, but to enjoy, as a respected and valued member of communities across the globe.’

She often uses a quote she found at an elementary school in Bhutan said:

“The time to be happy is now, the place to be happy is here, the way to be happy is to make other people happy.”

I believe a lot of what Dr Kiyoto is doing resonates with the Scottish Gaelic concept of dùthchas. It’s a complex phrase that is often used in many contexts but for me it’s one of the many words that suggest ‘belonging’ – that sense of being at one and at home amongst a community or in a particular location.

When my mother developed dementia the most important thing for her health and wellbeing was staying in place, amongst people and spaces she knew, and listening to the language and tongue of her youth.

We can and we must develop models of community-based support which nurture such belonging. It is less about resource than about aspiration. It needs to be less about systems and regulations, than relationships and priority.

As Emi said once:

“Elders living in grass huts in Africa with children at their feet are often happier than people in assisted living homes with a chandelier over their heads.”

Donald Macaskill

Photo by Asa Rodger on Unsplash

I have had some challenging and hard conversations and encounters in the last few days. Indeed, I would go so far as to say that they have been some of the most difficult conversations I have had in many a while. In reflecting at the end of the week on each of them I cannot but conclude that there was a common thread running through the experience of the folks who shared their stories and insights with me – and that was the fact that each of the people were experiencing trauma.

My first conversation was with the manager of a care at home service who informed me that officials at his local Health and Social Care Partnership had told him that they required to make substantial budget savings and because of that they would be reducing the number of packages of care at home which would be available for him to put his name forward for. He reflected that for the council contract staff that this was just about budgets, and finance and numbers but for him it was a change which put the sustainability of his very organisation into question. And that ‘turned his blood cold’ in his own words because he had been in business for nearly two decades, providing what was considered to be high quality care (according to the Inspectorate) and that he had employed a loyal, dedicated and professional staff. He was hyper-anxious when I spoke to him about the limited options he had available; he was desperate to keep things going not only because he was a key local employer in an area where there were few but critically because what broke his heart was the thought of telling customers and staff that things were going to have to change – dramatically. He was in every sense traumatised by what he saw as a short-sighted decision to make savage cuts to local social care and support. He wasn’t sleeping, felt manic, his blood-pressure was through the roof, and he had an overwhelming sense of hopelessness.

My second conversation was with a frontline care worker whose homecare organisation had like so many in the last few weeks been told by their HSCP that cuts were having to be made. However, in this case the organisation would keep going because it was in an area where the folks were able to buy their care even when the local authority had withdrawn packages of care and support. But the reason the worker was in tears was that she had spent that morning on her round saying goodbye to people she had known for months and in some cases years. She recounted one instance where a lady in her eighties who had declining sight and was virtually housebound had up till then been receiving a daily care and support package but after a ‘review’ this had been cut back by a massive degree. The lost relationship, the friendship, the familiarity and knowledge built up between the pair counted for nothing as the HSCP and its ‘reviewers’ (who had not visited her to tell her of the change) cut her service. The carer was in tears as one by one relationships were fractured not because (in her estimation and professional opinion) the care was no longer needed but that someone, somewhere, had decided it was no longer affordable. She was so very upset… she told me she had been traumatised by her morning.

And in a week which has been the national annual Carers Week with lots of photo opportunities for our politicians, I spoke to the wife of a man who had received care and support for many years because of a degenerative neurological condition. Like hundreds across Scotland, she had been told that her husband’s package of care and support was being reduced ‘after re-assessment’. She was at her wits end as to how she could cope. She was getting frail and older herself and the thought of having to do more for her husband was draining her. She had no family nearby and all her neighbours were either older than her or had their own issues. She desperately needed the support to continue, to get time for herself, to have some respite from caring. Yes, she had an increased allowance, yes she had accessed all the financial support she could, but what she really needed was the daily relief of someone else who knew her husband being present, being there, being for her. Someone else to share her burden and questions and exhaustion. She feels utterly and completely abandoned.

Each of these conversations left a mark on me because it is clear to me in their own way that each person was traumatised and going through trauma because of what was happening in their lives.

I know the response to what I have written will be – especially during an election – to posit understanding and then to cast the blame and responsibility to another – the lack of UK Government funding; the lack of resource from Scottish Government given the level of increased need; the failure of the local decision makers and so on. But to be frank I am tired of the pass the buck mentality and lack of honesty, the failure to own up collectively as a nation, as political leaders, as social care and health leaders, that the system is well and truly broken. And more than that that the decisions to cut care packages, to review and stop, to reduce the number of care beds being occupied or the number of care packages being contracted – all of it has and is traumatising some of the most valuable and vulnerable people in our communities. It is not fair. It is not just. And it is not the Scotland I want to live in.

I am familiar with trauma both as a concept and as a lived reality. We hear a lot of talk in the world of social care about trauma and what has become known as trauma informed practice. Indeed, the latter is now a core element underpinning the latest professional standards from the regulator. More than that Scottish Government guidance states that all social care and related practice should be understood and responded to through a trauma lens.

Trauma can be variously described but a simple definition states that:

“Trauma results from an event, series of events, or set of circumstances that is experienced by an individual as harmful or life threatening. While unique to the individual, generally the experience of trauma can cause lasting adverse effects, limiting the ability to function and achieve mental, physical, social, emotional or spiritual well-being.”

And our trauma informed practice in social care and social work is that which:

“is an approach to health and care interventions which is grounded in the understanding that trauma exposure can impact an individual’s neurological, biological, psychological and social development.”

Social care practitioners and services know what is required to support those who have been traumatised. At the heart of such attention is their physical, psychological and emotional safety and attempting through all means to prevent re-traumatisation for the person being cared for and supported.

Now I recognise that the concept of trauma and trauma-informed practice is not universally accepted and there does indeed need to be safeguards as brilliantly delineated in the recent work of Mark Smith and Sebastian Monteux who have suggested caution in its application ‘lest a  predominant focus on trauma may construct the kind of psychological conditions it professes to respond to.’

But at a very human level what is happening in Scotland to our social care services and supports at this time is resulting in very real trauma, harm and suffering.  Perversely those charged with fostering the delivery of compassionate trauma informed practical care and support are now the agents of re-traumatising a damaged and vulnerable citizenhood.

For the staff and managers I have spoken to there is clear evidence of the trauma they are experiencing resulting in burnout, emotional and compassion fatigue; they are being overwhelmed by resource limitations which are resulting in very acute conflicted values. This level of chronic stress is leading to exhaustion, anxiety, depression and acute self-doubt. It is also for many resulting in what I can only describe as vicarious trauma where the trauma experiences of supported people and those being cared for create a sense of vulnerability and helplessness in the worker and manager.

We urgently need to address the reality which is a traumatised social care system, workforce and those who require social care supports. We cannot continue to do more harm in the name of fiscal and resource re-allocation and prioritisation. There has to be a more honest way of addressing the crisis of social care in Scotland than traumatising those who deliver, work in and use our services.

Donald Macaskill

 

After many requests from not a few the Cabinet Secretary for Health and Social Care, Neil Gray addressed the Scottish Parliament this past week in a speech during which he outlined a vision for health and social care. In his speech he said that:

“I have already outlined to my Cabinet colleagues an overarching vision which will guide our work.

This vision is one with which no one here could argue: a Scotland where people live longer, healthy and fulfilling lives.

This vision is supported by four key areas of work: improving population health, a focus on prevention and early intervention, providing quality services, and maximising access, with all of these underpinned by giving due consideration to the people at the heart of those services.

In the short term we must ensure that our services are delivered in the best way we can within our current arrangements, and in the medium term, we need to begin to transform how we work.

And we must keep our eyes on the horizon, because in the longer term we also need to fundamentally change how we think about the delivery of health and care, driving investment in prevention and early intervention.”

I hardly need to say that those of us who deliver and work in the independent social care sector look forward to being invited to play our part in the shaping of this vision into reality in the short, medium and long term. I very much hope that the stated Expert Reference Group will include those organisations who provide most of the social care delivery because without their expertise then any venture will fail.

Few could disagree with Mr Gray’s vision ‘of a Scotland where people live longer, healthy and fulfilling lives.’ Yet sadly the reality is increasingly one which is quite the opposite and is likely to worsen before it improves.

I was also pleased to hear in the speech the emphasis upon prevention and supporting and caring for people close to their own home. Of this the speech stated:

“This will be underpinned by the principles of accessibility, addressing health inequalities, maximising outcomes, and promoting innovation as well as value for money.”

It was also refreshing to hear of an emphasis on the game-changing nature of technologies – and indeed the social care sector in Scotland is world-leading in the use of such technologies such as wearables, the IOT, Ai and robotics which enable independence and citizen control, albeit that its successes are probably better known outside Scotland than within.

I was reflecting on all this potential for a vision and practical change when I attended a couple of days later the impact and celebratory event of the Leading Digital Transformation in Health and Care for Scotland MSc programme run by the Usher Institute of Edinburgh University in collaboration with NHS Education Scotland and the Scottish Government.

Now into the start of its second year the participants on the programme have been exploring a wide range of topics, ‘from fundamental leadership concerns such as communication and change management, to current critical challenges of the digital age such as systems, interoperability and data sharing.’ It was refreshing to hear some of the 40 plus participants talk openly about how they are tackling real world issues facing those of us in Scotland who access our health and care systems.

It was also inspiring to hear inputs which argued that we need to stop talking about technology as tomorrow’s solution and to grasp the fast-moving pace and reality of innovation which is already making a difference to the health and wellbeing of people – if only we can maximise that potential in Scotland. Sadly I suspect we too often cogitate, ruminate and discuss rather than create, embed and commence.

We have so much we can do better and need to do urgently and in no small way at the heart of our health and social care inequalities in Scotland is the health of men and boys. On Monday (10^th June) we start the annual Men’s Health Week which is an event organised by the Men’s Health Forum. Like the Cabinet Secretary’s vision its aim is very much focussed on preventative health and to encourage men to gain the courage to tackle their issues.

We often talk and reflect on health inequalities in Scotland but surely one of the most primary ones is the fact that one man in five dies before the age of 65 and chiefly from preventable conditions.

So in the coming week there is a focus on prostate health. The week is to be called Let’s Talk Prostates (And Everything Else Men’s Health!) As the organisers state:

“Men don’t talk, we’re told. So, for Men’s Health Week 2024 we’re encouraging men to share their stories.

We’re taking our lead from King Charles who, earlier this year, shared that he had a problem with an enlarged prostate. On the day after his announcement, there were 16,410 visits to the relevant National Health Service website page compared with 1,414 visits the previous day. Prostate Cancer UK saw an almost doubling in the number of users of its online risk checker.

This goes to show the difference that honest sharing can make. Most of us won’t have same impact as the King – for a while in the UK media, it was difficult to avoid urologists talking about the prostate and the things that can go wrong with it – but if there is a taboo about men’s talking, well, the best way to beat a taboo is to ignore it.”

I cannot but reflect on how important it is that the three strands of my week just past  combine – a renewed emphasis on preventative health and social care which focusses on where we are; a practical adventurous use of technology to support our wellbeing and a focus on health inequalities, which for the next week at least is upon men and boys.

Men tend to respond well to health programmes that incorporate digital or technological elements, and yet so little of our actual delivery of healthcare, of public health education, of social care delivery utilises the benefits of technology and digital.

We must get better at reaping the benefits of technologies and digital interventions which appeal to men for many reasons but including because they are more accessible and convenient, because they enable engagement and interactivity, and which can be truly personalised to the individual rather than to treat us as a group of individuals.

We have to utilise the benefits which technology give to us in terms of the delivery of health and clinical and care interventions. Digital and technology are not just offering us tools to inform, increase awareness and knowledge, but also to treat, cure and care.

I look forward to contributing to an emerging vision of health and social care which addresses inequalities, but I am increasingly convinced it has to work in close partnership and collaboration with the technological, digital and Ai communities which are already working to effectively improve our wellbeing both individually and societally, and which have I would suggest to date been untapped in their potential to challenge health and social inequalities.

Donald Macaskill

Photo by Jenny Hill on Unsplash