As the festive season descends upon us and just a few days out from the big day itself, our surroundings are full of twinkling lights, sounds of carols or bygone hits, parties and gatherings by the day, and if you’re lucky moments of stillness and reflection amidst the chaos. Part of that chaos has been the very real challenges that are now facing both those who provide and work in social care in Scotland and more important those who receive care and support. We are living in times of unprecedented challenge and considerable uncertainty.

Recently at a gathering of professionals those present were asked to identify the social care needs of the moment and more than one voice agreed that we are all desperately looking for hope. It is a truth, I would suggest, that faced with all our challenge that the concept of hope becomes not just an aspiration but a necessity.

A short time ago I came across Jamil Zaki‘s book ‘Hope for Cynics’. The title appealed to me because, in truth, it wouldn’t be the first time that I have been accused of being cynical and pessimistic about the nature of our current political and social care discourse.

Written by the Stanford psychologist Jamil Zaki, whose work on happiness some might be familiar with, the book examines the rise of cynicism in modern society and its detrimental effects on both individuals and communities. He differentiates cynicism – a blanket assumption that people are inherently selfish and dishonest – from scepticism – which involves critical thinking and openness to evidence. Zaki argues that cynicism is not only a misinterpretation of human nature but also a self-fulfilling prophecy which fosters distrust and negative behaviours.

Zaki’s research suggests that cynicism has been increasing over time. For instance, in 1972 about half of Americans believed that most people could be trusted; by 2018 that figure had fallen to a third. This growing distrust has significant implications, as cynicism is associated with higher levels of loneliness, depression, and even reduced life expectancy.

To counteract cynicism Zaki proposes the practice of ‘hopeful scepticism’. This approach involves critically evaluating information while remaining open to the possibility of human goodness. By adopting human scepticism, he suggests, individuals can foster trust and cooperation, which are essential for personal wellbeing and societal cohesion.

His book offers a compelling exploration of hope not as naive optimism but as a disciplined practice, a muscle that grows stronger the more we use it. For those of us who live and work in social care in Scotland I suspect this resonates deeply. Our work is not built on the illusion that everything will ever be perfect instead it is grounded in the belief that despite imperfections we can create moments of individual connection, shared dignity and community joy. Social care is the bringer of hope for those who feel little ground for optimism.

Now lest you think of this as simply naive optimism, as a seasonal fairytale, it is also worth pointing out that Zaki’s conclusions are supported by extensive research in social psychology and neuroscience, including studies on empathy and prosocial behaviour. His work emphasises that our beliefs about others can shape social reality; expecting the worst in people often brings about negative behaviours whereas expecting the best can encourage positive actions.

Another key strand in Zaki’s study is the continual reminder that hope is not a solitary pursuit but a communal one. This is particularly true in social care and I think is an urgent need for our moment. Whether we are care workers, managers, family members or policy makers, the work we do is woven together by shared intentions and actions. It is in the small everyday acts of kindness – helping someone feel at home in a new care setting, ensuring their voice is heard, that they feel they matter, or simply sharing a laugh over a cup of tea – that hope finds its most powerful expression.

At Christmas these moments seem to take on a heightened significance. They remind us that the core of social care is profoundly human: it is about relationships, about seeing and being seen, about creating spaces where hope can flourish, even in the face of adversity.

The challenges we face in social care and around which I often comment in this blog are undeniable: the workforce shortages and inadequate terms and conditions; funding uncertainties and the ongoing need for systemic reform that puts the supported person first – are not issues that we can ignore but Zaki’s reflections encourage us with what he calls ‘grounded hope’ – a recognition of reality paired with a determination to change it. This is not about turning away from the hard truths, it is about facing them with courage and creativity.

As we gather around trees and tables this Christmas let us remember that hope is not just something we feel – it is something we give in social care. Hope often takes the form of creating moments of normality amidst hard times and extraordinary emotions. It is found in the festive atmosphere in a care home where staff weave memory into future; it is found in the gift of presence a homecare worker shares beyond contract; it is found in all that enables people to discover the chance to thrive.

These small acts are not insignificant. They are the threads of a larger tapestry of care and compassion, woven together by a shared commitment to ensuring that everyone regardless of age, ability or circumstance, feels valued and seen.

At this time of year, especially I think there is much to learn from Zaki’s ‘Hope for Cynics’. Let us embrace hope not as a passive feeling but as an active choice – a way of being that empowers us to re-imagine what is possible.

For those of us in social care, hope is both our gift and our responsibility. It is the spark that lights our way through all those dark days, reminding us that even the midst of uncertainty and what feels like a chaos out of our control, that we have the power to make a difference to both individuals and whole communities.

So this Christmas let us celebrate hope, not as a fleeting emotion but as the enduring foundation of the work we do and the world we strive to create. And let us do so together, with courage, kindness and an unwavering belief in the value of every human life.

My favourite poet of 2024 Jackie Kay once said “If human beings don’t have hope, then why do we live?” and so I leave you with her poem ‘Optimism’ which I came across recently:

Optimism

By Jackie Kay

The day is starting out well.

The sun shines on the rain

like a watery promise.

The cat washes itself

with its little rough tongue,

content as anything.

 

A bird flaps its wings

and you think, go on, fly,

you can do it.

The world is out there waiting.

You look at your own hands,

how they rest on the table—

 

small miracles of bone and skin.

And you think,

I have done this before,

I have lived through a dark night

and come out smiling.

 

Today I will take the first step,

hope, like an open door,

a shaft of light on the floor.

 

Donald Macaskill

Photo by Kelly Sikkema on Unsplash

 

Last Tuesday, the 10th of December was the annual international Human Rights Day. It’s a day which gives the global community an opportunity to focus on the importance of protecting the human rights of all citizens. Here in Scotland in a video message for the day I mentioned that it’s important on the international stage that we don’t lose sight of the work being put together to create a Convention on the Human Rights of Older Persons about which I wrote a few months ago. But I also reflected in my message on why it was important that Scotland should seek to re-introduce the Human Rights Bill which had earlier been proposed and around which I have already written. The decision of the current Scottish administration not to continue with the Human Rights Bill is very disappointing not least because in times of straightened budgets and real challenge in the world of social care the rights and dignity of older persons needs a special attention and focus, and a legal framework of rights enables that to happen with a sharper intensity.

More broadly, however, the issue of human rights in social care and aged care in particular has been uppermost in my mind. I’ve been very honoured to have chaired a small working group of individuals who have been concerned about the developing role of artificial intelligence in the delivery of aged care. The group has been working under the auspices of the Oxford Institute for Ethics in AI and the Digital Care Hub. It has developed a set of principles and guidance together with case studies to describe what we considered to be the key components which should lie behind and influence the use of artificial intelligence models and tools in the delivery of Adult Social Care.

This I think is really important because it is in the interface of technology and social care that there can be a danger that the rights and dignity of older persons or indeed any other group of people can be at risk. This is especially, I think, the case in these current times when decisions might be made on economic grounds rather than on the basis of the best interests of individual citizens.

So, I want in what remains of this blog to explore these principles but also to examine what is happening in the wider world of Ai around the practice of ethics and human rights not least in the various codes and conduct documents which have been developed to reassure those outside the tech industry that there are appropriate balances and safeguards which are there to protect us. Whilst many of these are indicative of a robust approach, I want to suggest that for those of us who operate in the world of social care that we need to increasingly be watchful and therefore the Oxford ethical approach and model for social care is all the more important.

The first thing to note is that it is certainly true that for bodies such as the United Nations and leading tech firms the establishment of frameworks to guide the responsible use of Ai has become an issue of real importance in the last couple of years. Take the United Nations for instance. In September 2022 the UN System Chief Executive Board for Coordination endorsed what they called the Principles for the Ethical Use of Artificial Intelligence in the United Nations System. In essence these ten principles emphasise the following:

• ‘Do No Harm: Ensuring Ai applications do not cause harm to individuals or communities.
• Defined Purpose, Necessity and Proportionality: Utilising Ai for clear, legitimate purposes aligned with UN values.
• Safety and Security: Safety and security risks should be identified, addressed and mitigated
• Fairness and Non-Discrimination: Preventing biases and ensuring equitable Ai outcomes.
• Sustainability: Artificial intelligence should be aimed at promoting environmental, economic and social sustainability
• Transparency and Explainability: Maintaining openness about Ai systems and their decision-making processes.
• Responsibility and Accountability: Assigning clear accountability for Ai operations.
• Privacy and Data Protection: Safeguarding personal data within Ai applications.
• Human Autonomy: Ensuring Ai supports human decision-making without undermining autonomy.
• Inclusion and participation: Organisations should take an inclusive, interdisciplinary and participatory approach and promote gender equality.’

We have also witnessed similar frameworks being developed by the major tech companies such as Microsoft who adopted ethical Ai principles focusing on fairness, reliability, privacy, inclusivity, transparency, and accountability. Google established AI principles emphasising socially beneficial Ai, avoiding harmful applications, and incorporating privacy design and IBM have sought to implement Ai ethics guidelines prioritizing trust and transparency.

This flurry of ethical activity led to eight global tech companies in February 2024 committing to applying UNESCO’s Recommendation on the Ethics of AI, integrating these values into their Ai development processes.

The Oxford Institute for Ethics in AI outlines seven ethical principles for AI in social care: truth, transparency, equity, trust, accessibility, responsiveness and humanity. These align closely with both UN and tech companies’ frameworks:

Truth and Transparency: Correspond with the UN’s emphasis on transparency and explainability, and tech companies’ focus on open Ai operations.

Equity: Reflects the UN’s fairness and non-discrimination principle and tech firms’ stated commitments to unbiased Ai.

Trust: Parallels the UN’s responsibility and accountability, fostering confidence in Ai systems.

Accessibility: Aligns with inclusivity efforts, ensuring Ai benefits are widely distributed.

Humanity: Echoes the UN’s human autonomy principle, ensuring Ai supports rather than replaces human roles.

Despite these alignments, certain gaps persist which I think will pose particular challenge and priority for those of us who work in social care in the months and years ahead, specifically

Implementation and enforcement: While principles are established consistent implementation and enforcement across very different contexts remains a challenge. What will be really important for the Oxford Principles is that they are continually evaluated, tested and assurance is sought that they are being implemented in as robust a manner as they should be.

Secondly addressing bias. There needs to be an ongoing effort to identify and mitigate biases in the Ai systems in order to prevent discrimination. It is sadly the experience of many of us who work in and deliver aged care services that the unconscious and sometimes subconscious age discrimination bias which exists within wider society is evidenced in so many of the systems of support and models of intervention. We need to make sure that Ai systems aren’t just non-discriminatory in terms of other characteristics but that they are definitively age unbiased.

In addition, it is important that we prioritise global inclusivity ensuring that Ai governance includes diverse perspectives from the whole global community and not solely those nations often described as being ‘developed’.  We risk a real marginalisation of communities and nations in the ongoing development of Ai not least in aged care if we do not ensure global inclusivity.

And lastly, transparency. Operationalising transparency and complex Ai systems requires continuous refinement. We are some distance away from that degree of sophistication which would ensure the absence of bias, consistent application and the enforcement and robust adherence to ethical principles whether that be the ethical framework developed by the UN or by the major technology companies.

I would suggest that these all to some extent align themselves with the common ground which the Oxford Institute Principles for Social Care describe. It is positive that there is such a convergence, but that reality also highlights the need to engage in continuous dialogue between those who are developing Ai tools and models, those who commission, contract and purchase such tools and fundamentally those who are impacted in the way in which they live their lives as individuals who use and access social care support.

There is a real possibility that Ai can positively revolutionise the support of some of our most valued citizens but if Human Rights Day shows anything it shows us the urgent continuous need to be ever watchful to ensure the realisation of human rights for all across our shared world.

Donald Macaskill

Photo by Markus Spiske on Unsplash

The Scottish Budget was published on Wednesday and to say that the social care sector in Scotland was disappointed would be a massive understatement.

I think it is fair to say that regardless of organisation type, charitable, public or private most people involved in social care delivery in Scotland at this time are deeply troubled at the failure of the Scottish Government to own up to the crisis currently being endured by and the risks being faced by the sector.

The reality on the ground behind the rhetoric of claims of additional spend and funding for social care is that Health and Social Care Partnerships in order to balance their budgets are having to make horrendous decisions to cut services. It seems truly perverse that whilst there is significant additional funding going into the NHS (including into delayed discharge work) that the social care sector is facing some of the most savage cuts it has ever had to endure. That means only one thing – people will die.

Now that might sound like scaremongering, but it is sadly what has always happened when social care services are cut and withdrawn. I have written before about this, indeed nearly a year ago I shared the data which shows that every day two people die in Scotland whilst waiting for or not receiving the social care support they need to stay alive. Anyone at the frontline today knows that a year on the situation is so much worse.

The truth behind the fable of parliamentary debate is that care providers and employers will enter this winter not by increasing services and meeting the growing demand, including from delayed discharge in hospitals which are at record levels, but instead will be making staff redundant, closing units in care homes and handing back packages of homecare to local authorities who have themselves no capacity to meet the needs of those who are desperate to be supported. And this is all without the nightmare caused by the UK Labour Government through the changes in Employers National Insurance which unless mitigated risks whole system collapse.

If you turn on the television screens in the last couple of days you will hear frontline clinical staff in the acute NHS sector talk of the pressures being faced across the UK, and that includes Scotland, from what has been termed a ‘quademic’ of RSV, influenza, Covid and norovirus cases. Respiratory conditions at this time of year put inordinate stress and pressure on our social care and health systems so one would have hoped for a targeted and specific focus on social care in this week’s Budget.

What we got instead on Wednesday was the reality of a lack of priority. In a parliamentary debate lasting most of the afternoon social care was virtually invisible – it was mentioned 12 times in the thousands of words and only four times by the Finance Secretary who did, however, acknowledge that:

“social care funding,… is absolutely vital if we are to tackle delayed discharge and look at the system as a whole system, including both the NHS and social care. That is why we have put record investment into social care, including, of course, by ensuring that our social care workers get the pay that they deserve.’

No one is denying the record sums but if they are not enough, they are not enough no matter what records are broken. Equally no one is going to deny the importance of paying the Living Wage to frontline care and support staff though in truth that level is a very very low level to seek to be pleased to be achieving.

But it seems nonsensical to be faced with the reality that care staff and care home nurses are being laid off this past week not because there is no work to do but because organisations cannot afford to deliver the care needed by what they are paid, and commissioners cannot afford to allocate packages because they have run out of money. Knowing you are getting more money tomorrow rings hollow when you lose your job today.

Paradoxically today is Small Business Saturday which is now in its 12th year and has a focus every year on encouraging an increased awareness of the needs of small local businesses.

The vast majority of social care provision in Scotland is not delivered by large corporate organisations but by small businesses, whether charitable, not for profit or private. Many of these are small family run businesses with some being in families across the generations. They are often in remote and rural parts of the country but also in areas where in the town or village concerned they are the largest employer.

I find it increasingly ironic that we hear our political leadership emphasising the criticality of small businesses to our economic wellbeing as a nation, and yet at the same time one of the largest sectors in the small business world are our social care providers.

Indeed the Scottish Government recognises that small businesses are a critical part of the Scottish economy and the Government’s own national strategy asserts that:

‘We aim to grow our economy by making Scotland one of the best places in the world to do business. This means supporting and listening to small and medium-sized enterprises (SMEs) and working to deliver the right support at the right time.’

I find this fiscal silence around Scotland’s small business social care employers and providers truly baffling if only because it makes no economic sense whatsoever to say nothing of its lack of health whole system thinking.

Investing in small and medium-sized enterprises (SMEs) within Scotland’s private social care sector offers substantial economic and societal benefits. Indeed, the Independent Review of Adult Social Care in Scotland – the Feeley Report – emphasised that social care support is an investment that creates jobs and economic growth.

It makes complete sense to invest in small social care businesses not just as economic contributors and drivers in our communities, but critically as a key partner in the nation’s health and wellbeing. Instead of investment at this time we are faced with restriction and closure.

The Budget last week has failed Scotland, it has failed our small social care businesses and the sector as a whole, and shows that there is little or no understanding of the critical issues facing those who deliver care and support or indeed those who use social care services.

In the discussions and negotiations, the debates and deals before the Budget is settled in February, we simply have to put social care as a whole sector at the centre of our focus rather than the invisible sector it has been turned into.

Donald Macaskill

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