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

 

They seek him here, they seek him there

Those Frenchies seek him everywhere

Is he in heaven or is he in hell?

That damned elusive Pimpernel

Famous words from Baroness Emmuska Orczy’s The Scarlett Pimpernel which described the heroic elusiveness of the main character as he managed rescue upon rescue of captured prisoners during the French Revolution.

Being elusive is the heart of the success of the Scarlet Pimpernel. It was a thought that came to mind this week as I reflected two weeks into the campaigning for the United Kingdom General Election about the prominence or maybe more accurately the absence of social care within the election. Now I fully recognise that social care is a devolved matter and that it’s delivery in the Scottish context is obviously the responsibility of the Scottish Government and concerns about it belong to debates amongst Scottish political parties. However, I think the nature of the fiscal relationship between the United Kingdom Government and the Scottish Government is such that whatever is discussed and decided about social care in England does have an impact in Scotland not least of which is any increased financial priority and spend.

So, what has been happening south of the border and indeed across the United Kingdom with regards to social care? Well like the Scarlet Pimpernel I seek some knowledge here,  I seek some knowledge there but the damn elusive social care seems nowhere. Not a mention not a whisper.

Writing in the Independent a couple of days ago Kate McCann said that social care was the issue that Sunak and Starmer won’t touch with a barge pole. Of social care she wrote that it was:

“currently the biggest electoral elephant in the room. It’s no surprise that neither of the main parties wants to touch this policy with a barge pole, after Theresa May tried and found herself tied to the drag-anchor of the dementia tax in 2017 – leading to that now-famous “nothing has changed” moment.”

…

“Problems with the social care workforce have fed into questions about immigration policy. A lack of available care places in the community means hospitals end up caring for people who are medically fit but unable to leave, clogging up admissions at the other end.”

Yet no commitment from Labour’s Wes Streeting to either social care reform or on the Dilnot proposals. Even greater silence from Labour on the impact of immigration on social care workforce sustainability. Only the Lib Dems seem to be actually talking about social care.

As McCann rightly observes of the two main parties:

“Neither is likely to propose wholescale change of the kind for which experts in the sector are calling, demonstrating a lack of ambition from both Labour and the Tories on this issue. There are clear reasons for this – not least the costs – balanced against the state of the UK economy. But, as political reporters, it makes it even more important to cut through the sales pitches and ask the questions that get to the heart of the problem, otherwise we risk serving voters poorly.”

So what of Scotland – well echoing absent silence here too and missed opportunity.

Last Monday Alzheimer Scotland published a report of the Commission on the Future of Long Term Care in Scotland. Set up in 2022 and chaired by former first minister Henry McLeish, the commission brought together a wide range of voices, including health and social care experts and those with lived experience of dementia. I was pleased to serve on the group.

Over the piece we heard first hand of the challenges facing those living with dementia and the lack of provision to enable people to live independently for as long as possible as well as the critical issues of lack of investment which would enable greater diversity and choice in specialist residential provision.

The report makes 16 key recommendations designed to safeguard and redefine the future of long term care in Scotland.

These include calls for the Scottish Government to:

• urgently work with health and social care partnerships to undertake a full strategic assessment of the provision of long term care facilities and resources in each area,
• establish agreed levels of care home and alternative care model places that should be equally available across Scotland,
• establish a citizens’ assembly to engage across society on the type of alternative approaches to care that people want to access to meet their long term care needs
• and engage in open, honest discourse around the reality of the current cost of care.

In commenting on the report I said that:

“Long term care matters for all of us. The way in which residential and nursing care is delivered today will inevitably change over the years. This report makes clear that people want to have a wider selection of choice about the care they may need and that they want more voice and control.

The Scottish Government urgently needs to prioritise social care and has to create an environment where external investment is able to support providers to innovate and develop new models of care and support.

In addition, the time has long passed for the inequity of people living with dementia having to pay for support and care which are essentially healthcare needs. There is so much that needs to change and no shortage of people wanting to support that change. The ball is well and truly in the hands of Ministers.”

So it’s an election – social care is devolved – will our Scottish Government take up the challenge and introduce fairness into the way we support people living with dementia? Will we properly invest in long term care  and support? Will we pay for a sector fit for the future?

Or like Sunak and Starmer with heads in the sand – will both commitment to and real change for Scotland’s long term care sector be as elusive as the Scarlet Pimpernel?

Donald Macaskill

Photo by MontyLov on Unsplash

I am writing this in New York City at the end of a week when I have had the privilege of being an accredited participant at the Open-Ended Working Group on Ageing (OEWG). OEWG has met every year over the last 14 years and was established by the United Nations General Assembly because of a growing clamour from some nations who wanted to see the development of an internationally binding legal framework to protect the rights of older persons. This was nothing new – indeed from the earliest years of the UN Argentina and others had continually campaigned for such a Convention to be created. Yet consistently there had been failed attempts to get it off the ground. OEWG was set up to identify whether there were any ‘gaps’ in existing human rights protections. At various points over the last 14 years, it felt it had done its work only to be sent away again to do more … until this week.

This year in a historic moment on Tuesday a decision was taken ‘by consensus’ to put forward a report suggesting that there were gaps which needed to be filled and to offer some solutions including the creation of a new instrument, a Convention. Yesterday it was decided that this decision should be passed to the UN General Assembly session. So significant progress. I was honoured to be part of the week and to have played a small role in the events by addressing the Session on Tuesday morning. Throughout the week I heard moving and passionate speeches from people who evidenced the harrowing harm and abuse that so many older people are suffering across the world, of the economic harm and abandonment of millions more, and of the desire for millions to be allowed their voice and to find their seat at the table of decision-making and government. But I also witnessed the art of political negotiation, international compromise, vacillating excuse, and blatant national self-interest.

At the end of such a momentous week I am left in a reflective mood about whether or not all this matters. Does any of it have any consequence for the experience of older people anywhere never mind in Scotland. And I am reflecting on all this at a time when a UK General Election has just been called during which I really hope that we will have debates and discussions on the experience of older people and most especially the nature of social care.

In short, I really do believe that for the advancement of all older people and their human rights that an International Convention on the Rights of Older Persons is urgently needed (and I hope the Human Rights Council in Geneva will soon start working on it when the General Assembly so instructs). I would argue that this is the case because as citizens of a global world we cannot but be connected to one another. The passionate Argentinian advocate Alex Kalache spoke of a visit to a favella on the edge of Rio where he stood talking to a woman knowing that 800 metres away the houses of the rich and wealthy meant that their residents were likely to live 20 years longer than the residents of the favella. The old woman Nina asked him ‘Do you know where my parents are?’ And he responded, ‘No I don’t.’ and she said ‘They are underneath your feet. We could not afford to bury them elsewhere, we could not afford it – so they are here.’ This sad encounter is indicative of the grinding poverty and socio-economic injustice which faces many older people; from those who lose their properties when they get old, to those who are abandoned by their families and made homeless because they have ceased to be useful and economically contributive. All of this might seems light years away from our lived experience in Scotland, but if there is anything about the Scottish character that is worthy of acclaim, it is our awareness that we are all ‘our brother and sister’s keeper’, we are all linked to one another in a common humanity and co-responsibility.

We could just rest in Scotland, struggle even more for the rights of older Scots, fight to ensure a better social care system, work for a reduction in discrimination and ageism; we could and will continue to campaign for an Older Persons Commissioner and the rights of older persons to be explicitly evident in any new Human Rights Bill; we could and will continue to call out the economic injustices which treat older people less favourably, to highlight the grinding poverty so many of our older Scots endure. But we also I believe have to do more. Putting our own house in order without sorting the mess of the world in which it is set is simply a retreat from responsibility. Human rights matter for all, everywhere and at all times.

In the coming weeks during a General Election political parties of all colours will engage in an appeal to self-interest – that is almost an inevitability of the political struggle and class. But I earnestly hope that we will also be able to ask questions, make challenges, and raise the voice of those not here but with whom we are global citizens, because what we decide and the government we elect makes a difference to them. Sustainability of our planet is not just an ecological question it is a profoundly demographic challenge and as the population of the world ages the way we address that reality matters.

In my speech at the United Nations, I tried to argue that the creation of a Convention certainly would offer protection for the world’s older people (protection and safeguards which are not there) but that just like the UN Charter in 1948 it also offers us potential. It offers us the ability to recognise the inherent dignity which comes with being old, it offers us the ability to celebrate the giftedness of age with all the richness of its diversity and experience, its creativity and contribution. We have to challenge the ageism which suggests that the old are yesterday’s humans and that the future belongs to a younger generation. Such ageism is rife across the globe. I heard this week that even in a document which is being drafted at the UN about the future – there is barely a mention of the old.

The older generation are as much the future as they have been the past. To deny their contribution, their capacity, their inventiveness, their entrepreneurship, is to limit all our futures. I hope in our own General Election we will not witness such stereotypes and stigma but will witness acceptance that the future belongs to us all, old and young alike. I also hope that our own political parties will come out and clearly state that they are in favour of a UN Convention on the Rights of Older Persons, so that we affirm our belonging one to the other.

During the week I spent some time getting away from the noise and heat of the debate and discussion, the politics and politicking and I wandered around and found a place in front of a painting which had been gifted to the UN by El Salvador in 2019. It was titled Mi Pueblo by Camilo Minero. Minero was a prominent Salvadoran painter, muralist, and engraver. The colourful painting has two themes, one is peace, represented by the light of the sun and the abundance of the natural world. The second theme is human rights, represented in the faces of children, the labouring hands of workers, and the hopeful look of the population that works for a better future.  All living their lives unimpeded under the guarantee of peace.

That should surely be the aspiration of us all, a world where we can live our lives with no discrimination. I am pleased to leave the UN knowing that the struggle for the rights of all including older people lives on but that it is also one that is worth the fight. For me rights matter today more than ever.

Donald Macaskill