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

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

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

In our media statement I said that:

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

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

Visible​

Social Care that works for Scotland ​

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

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

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

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

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

social care is rather:

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

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

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

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

Viable

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

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

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

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

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

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

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

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

​Valued​

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

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

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

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

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

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

​Visionary​

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

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

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

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

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

An American actor once said:

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

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

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

Donald Macaskill

Karen Hedge

Photo from Joshua Sortino from Unsplash

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

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

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

Going back to move forward.

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

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

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

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

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

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

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

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

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

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

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

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

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

What does all this mean?

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

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

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

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

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

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

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

Donald Macaskill

Photo by Konrad Hofmann on Unsplash

A week ago yesterday I was privileged to be delivering a session at the annual conference of the Australian Community and Care Providers Association in Adelaide. My theme was whether or not aged care and support could learn some lessons from the historical and traditional approaches to care of the dying and the support of the bereaved which occurred in north west Scotland and the Hebrides.

In describing what I argued to be some of the distinctive elements of the Hebridean approach I mentioned the practice of keening, and it has made me in the days since to have cause to reflect on just why it remains important today for those of us who work in the care and support of the dying and of the bereaved to give space and time to raw emotion and the real depths of grief. Let me expand on that a bit at the start of ‘To Absent Friends Week.’

‘Keening’ is perhaps one of the most distinctive Gaelic traditions around death and grief and was for centuries the norm in the islands of the northwest of Scotland and in parts of Ireland. Keening (caoineadh) was a form of ritualised mourning which involved wailing, crying, and singing to express grief. Historically, keening was performed primarily by women (often professional keeners) who would gather at funerals or wakes, helping the community express collective sorrow and marking the transition of the deceased. It involved a rhythmic and often emotional wailing or chanting, expressing sorrow for the dead.

This practice, while virtually almost gone in Scotland and a lot less common today in Ireland, was once central to the grieving process, helping both the mourners and the community release their emotions. In many ways it has similarities with traditional practices across the world. So, for instance Ghanaian Ga funerals involve elaborate, often loud ceremonies with song and dance that allow people to express sorrow publicly. In India in some regions, particularly in Rajasthan, women known as Rudaalis are hired to express grief openly, allowing families to engage with death publicly and vocally. And perhaps linked to Irish-Scoto heritage, in New Orleans, jazz funerals feature a blend of sorrow and joy, starting with a slow dirge and progressing to more upbeat music, allowing mourners to transition through grief and celebration.

Because of the stress upon helping the soul to journey onward which existed in the Celtic tradition, the Gaelic keening was not only an expression of grief but also seen as a way to guide the soul of the deceased to the afterlife. But centrally it helped the community come to terms with the loss, providing an outlet for collective sorrow.

The American writer Amanda Held Opelt argues that such raw expressions still have validity today. We all need sometimes in our grief the permission to fall apart, to lose decorum; to name the hurt deep inside and keening enabled Hebridean and Irish people to do that. It provided the ability to link yourself to the sadness of the past and of the moment and of the morrow.

Death is truly awful, and we need to create permission to fall apart. When we fail to allow space for the deep emotions of loss within the rituals of our grieving and at the heart of our bereavement then we store up hurt for days and years to come.  My own personal experience is that in our desire to distance ourselves from the painful reality and raw truthfulness of death, that as a society we have created an almost clinical detachment from grief and loss, not least around the immediate death, and that such has ill served our ability to express our deep emotions.

Expressing emotions like anger and lament in early grief (a process which the keeners facilitated so well) offers psychological benefits that can aid in the healing process. Studies highlight several key aspects of how such expression impacts grief recovery:

Allowing yourself to express anger helps individuals process complex feelings and begin to confront the reality of loss. This expression can also prevent emotions from becoming “bottled up,” which can lead to prolonged and complicated grief. By outwardly expressing emotions, individuals often find a path toward acceptance, which is crucial for moving forward (Verywell Mind, 2024).

Research from the American Psychological Association (APA) suggests that expressing grief-associated anger can alleviate physical symptoms linked to stress, such as increased heart rate and muscle tension. Suppressed grief can lead to long-term health issues, while allowing these feelings to surface can reduce stress hormones and promote physical well-being (APA, 2024). I don’t think it was accidental that the great thinker around bereavement Elizabeth Kubler-Ross argued that anger was a critical early stage response to loss.

Displaying emotions, including anger, allows others to understand the mourner’s needs better, fostering an environment where social support can be effectively provided. Such support is crucial for mourning, as studies indicate that those with strong support systems generally adapt to grief more healthily. This social validation helps mourners feel less isolated and more connected to others in their grief (Psychology Today, 2024).

Overall, openly expressing anger and sorrow can reduce the risks of complicated grief and enhance emotional regulation, which is critical for long-term mental health. This approach can encourage mourners to feel acknowledged and supported, offering a healthier path through bereavement.

Keening and other similar traditions from our historical approach to dealing with grief have, I believe,  much to teach us today and can offer powerful ways to honour grief, making mourning a communal rather than isolated experience, and allowing those left behind to feel supported and understood.

Fear not the tremble of hands

Grief, raw as iron struck red in the forge,

is not softened by silence, nor stilled by polite nods,

it erupts – fire in the heart’s quiet chamber –

burning with questions, cutting through fog.

For grief is more than sorrow, a deeper rage

at a world turned cold, that dare not yield

to the polite comforts, the softened sighs,

but roars at absence, demanding to feel.

Anger sharpens our sorrow, gives it weight,

a fierce testament to love’s deep scar,

a howl that shatters the pretence of calm,

declaring loss with a voice unbarred.

Let us not fear the tremble of hands,

the raw, unbidden tears that break

through our masks, these brittle walls,

for anger too is a holy ache.

It is a memory, an indignant vow

that love was real, that we will not erase

the fury of loss, the burn of despair,

nor will we hide what should be faced.

So mourn with untempered, furious grace,

let the heart unclench its tightly held song,

for in rage we honour what cannot be spoken—

and find, at last, where we belong.

Donald Macaskill

Photo by K. Mitch Hodge on Unsplash

This past week I have had the privilege of being a guest of the Australian Aged Care Providers Association. As well as being able to take part in speaking and workshops at their National Conference with over 2400 delegates attending, I’ve also been honoured to spend time visiting care and support facilities and projects in the area around Adelaide.

It’s been very insightful, and I want in a future blog to share some of what I discovered about how Australia is tackling issues facing aged care in remote and rural communities and whether there might be things we could adopt and adapt here in Scotland.

But without a doubt the most dominant topic of conversation during my seven days away has been what has recently occurred at the political level in Australia around health and social care.

In Scotland, the conversation around health and social care reform is urgent and vital, and there is no shortage of diverse opinions but it is often overshadowed by political squabbling as evident even in the last few days. Whether it is discussions about the National Care Service about which the Green Party will take a decision today or proposals to address workforce challenges including discrete approaches to immigration, these debates quickly devolve into party-political contests.

Along with many others I have stated before and am more than ever convinced having spent time in Australia that meaningful, sustainable reform of our health and social care system requires collaboration across the political spectrum. Such comment has been dismissed as utopian and folks have said to me it’ll never happen. But it can and I’m suggesting it should.

The recent experience in Australia – both with its Aged Care Act of 2023 and the ongoing 2024 reform, I believe, offers us an instructive example of how we can depoliticise health and social care reform and delivery and focus on the needs of people rather than the priorities of political parties.

The Australian Approach: A model for consensus

Australia’s aged care sector had long been in crisis, but it took the Royal Commission into Aged Care Quality and Safety to bring about comprehensive reform. The Commission’s recommendations resulted in the Aged Care Act 2023, which was a transformative piece of legislation. Central to its success was the bipartisan approach that Australian politicians adopted. After the release of the Royal Commission’s findings, the reforms were not treated as political capital for upcoming elections, but as a national imperative requiring cooperation.

In fact, the introduction of the new Aged Care Bill in 2024 was hailed as a rare instance of bipartisan commitment to long-term social care reform. Both the government and opposition worked together to craft a legislative framework that focused on the rights and dignity of older people. The Bill was designed to address systemic issues in funding, workforce support, and governance, with the shared understanding that reform was needed urgently. It is an ongoing process, and it is not quite over the line and the impressive Aged Care Minister addressed the conference and committed to robust partnership working with the care sector and those who use care supports. But there have already been massive strides including a huge eye-watering commitment to the workforce to increase terms and conditions, which has meant billions of additional resources committed to care and support.

In Scotland, we are at a similar crossroads. The need for reform is acute, but discussions around the National Care Service (NCS) have been mired in party politics and at present seem to be struggling and bogged down.

While every party and interest group including COSLA and the trade unions as well social care providers offers its version of how the care system should be funded and governed, the fundamental issues remain unresolved, and the people who rely on these services are left waiting. In the meantime, care workers continue to face burnout, residents in care homes lack the adequate resourcing of their care they deserve, and families remain uncertain about the future of social care provision in the community as homecare organisations struggle to continue.

Australia’s example shows us that progress is possible when political parties stop treating social care reform as an election battleground and instead commit to long-term solutions. There is a real need to bring all stakeholders – including politicians, care providers, workforce representatives, and, most importantly, the people who use these services – into the conversation.

Depoliticising reform: what can we learn?

1. Independent Commissions:

One of the reasons Australia’s reforms succeeded was the establishment of the Royal Commission, which provided independent, apolitical analysis of the problems facing the aged care sector.

Some might suggest that the Feeley Report was our Commission and indeed it garnered a lot of consensus when it was published. I don’t really think we need a Royal Commission as is being proposed in England – what we lack is political agreement on how you embed the proposals and vision of Feeley because I simply don’t think that is on the table at the moment. We have lost the collective vision at the hands of party political priority.

2. Bipartisanship:

Australia’s aged care reform was achieved through bipartisan negotiation. In Scotland, we must find ways to depoliticise care discussions by focusing on shared goals rather than divergent ideologies. Political parties in Holyrood must come together to agree on fundamental principles for health and social care reform. This may mean embracing ideas from across the political spectrum if they benefit the people who rely on these services and those who work in and deliver them. Those who work in and use care and support deserve real political leadership and a failure to come together and gain bi-partisan agreement will be a betrayal of the social care community and will not be soon forgotten. This is too important an issue to be kicked into the long grass, ignored or indeed fought over in a Holyrood playground.

3. Stakeholder-Led Design:

The success of Australia’s Aged Care Act also rested on the involvement of a wide range of stakeholders. In Scotland, it is essential that any future reform is designed with the input of the people most affected – those receiving care, their families, and the workforce and employers. We have palpably failed to achieve this thus far because despite the warm rhetoric of embedding design approaches stakeholder engagement has been partial and non-inclusive. We cannot afford to continue to have reform designed by civil servants and politicians.

The inclusive Australian approach has ensured that the reforms are not only effective but also respected by those on the frontlines of care delivery.

4. Long-Term Vision:

One of the issues plaguing Scottish social care reform is the tendency for short-term fixes based on political cycles. Australia’s reforms, while still unfolding, have aimed for a long-term vision of sustainability. By creating a framework that stretches beyond electoral timelines, Australia has demonstrated that meaningful change takes time but is worth the investment. The fruit is already evident even within months of change  – workforce retention has improved, and recruitment has become easier because people can see that they are respected and valued maybe for the first time as a key economic sector in Australia. Scotland’s care system, like Australia’s, must be built for the long haul, with consistent funding, workforce support, and regulation designed to last for decades, not just until the next election.

Rebuilding Trust in the System

Australia’s reform process has also been about rebuilding trust in the system. The Aged Care Act of 2023 included provisions for better oversight, accountability, and transparency – elements that were critical in restoring public confidence. Scotland faces a similar challenge. Years of underfunding, mixed messages, and inconsistent policies have eroded trust in social care provision. We need clear, transparent policies that offer stability to those who rely on these services, those who work in them and those who provide them.

In conclusion, as we look to the future of health and social care in Scotland, we must be willing to take party politics out of the equation. Reforming our social care system to say nothing of the NHS, is not about winning elections; it is about ensuring that every person, whether receiving care and support or providing it, is treated with the dignity, respect, and support they deserve. Australia’s experience shows us that bipartisan, human-centred reform is not just possible – it is necessary. Scotland must follow suit and commit to depoliticised, evidence-based solutions that put people at the heart of our care system.

What do our politicians say? Are they brave enough to let go the levers of power, both local and national, and to allow a wider conversation and control? Or will we continue to squabble, disagree and dissent?

Donald Macaskill

Photo by Kay on Unsplash