On Human Rights Day 2025, which will take place this coming Wednesday on the 10^th we are called to remember not only the rights enshrined in law but the relationships that make those rights real. In the realm of social care, this is not a theoretical exercise but rather it is a daily, lived reality.

On reflecting upon this I was reminded of a great speech I heard whilst in Boston for the Global Ageing conference a few weeks ago. It was given by the essayist and journalist David Brooks. Several times during his contribution he used the word ‘beholden.’ It sent me searching the dictionary for its origin and meaning.

I discovered that beholden comes from Middle English, originally the past participle of behold. It was a word which did not mean simply to see rather it meant to hold, to keep, to be bound to another. To be beholden is to live in obligation, not as a burden, but as a bond. It is to recognise that our lives are entangled, that our dignity is shared, and that our rights are sustained not only by law but by love.

In an age that prizes autonomy and self-sufficiency, beholden sounds uncomfortable. In our age of individualism, beholden sounds archaic. We prefer autonomy, independence, self-sufficiency. Yet in the realm of social care, and indeed in the moral ecology of our communities, perhaps it is a word we most need at the present time. Because care is not a transaction but rather it is a covenant. Care is profoundly about relationship not task.

Reading a bit more about his writing I have discovered that David Brooks, in his work on the Weave Project and in The Second Mountain, as he did in his speech, speaks of a society fraying at the edges. One that is lonely, tribal, spiritually hollow. His response is not technocratic but relational. He calls for a “relationalist” ethic, one that sees people not as consumers or clients, but as neighbours, as kin.

Brooks writes of “radical mutuality,” of lives built not on independence but on interdependence.

In The Second Mountain, in particular, Brooks argues that the first mountain of life is about personal success, but the second is about moral joy found in commitment to others, in covenant, in community. To climb that second mountain is to become beholden – not in weakness, but in strength. It is to say: I am because we are.

This is not sentimentality. In this view, social care is not a service – it is a covenant.

This is not weakness. It is strength. It is a strength those who work in social care will easily recognise. It is the strength of carers who show up day after day, often unseen and underpaid. It is the strength of communities who hold their elders not as burdens but as bearers of wisdom. It is the strength of a society that says: I am because we are.

In Scotland, we are facing a crisis in social care. But it is not only a crisis of funding or infrastructure – it is a crisis of moral imagination. The centralisation of care contracts, the economic fragility of rural care homes, and the bureaucratisation of support have eroded the relational soil in which human rights grow.

As I’ve said before, “You would be, quite frankly, insane to waste your money building a private care home in any part of Scotland, unless you were guaranteed 100% of private income.” But the deeper insanity is imagining that care can flourish without community.

The National Care Home Contract has failed not only economically, but relationally. It does not reflect the reality of being beholden – to elders, to carers, to the land and its people.

In my writing on the local democratisation of social care, I have argued that we must move from a model of delivery to one of relationship. The Self-directed Support Act of 2013 was meant to empower individuals, but its implementation faltered because it did not embed itself in the moral soil of community.

We need a care system that is not just efficient, but beholden – to the values of dignity, inclusion, and human rights. We must move from a model of delivery to a model of relationship. From care as service to care as covenant. From rights as entitlements to rights as responsibilities held in common.

Ageism, as I’ve explored in recent speeches, is a symptom of a society that has forgotten what it means to be beholden. When older people are seen as burdens rather than bearers of wisdom, we lose not only their stories but our own moral compass. The rise in age-related hate crimes, the media’s portrayal of ageing as decline, and the economic marginalisation of older workers – all point to a rupture in our social fabric.

To repair it, we must reclaim the ethics of obligation. Not obligation as duty alone, but as relationship. To be beholden is to recognise that our lives are entangled, that care is not charity but reciprocity.

On this year’s Human Rights Day, I’d love us to reclaim beholden as a word of moral power. Let us say we are beholden to those who age, not as problems to be solved, but as people to be honoured. We are beholden to carers, whose labour is love and whose work is justice. We are beholden to communities, whose strength lies in their capacity to hold one another.

David Brooks reminds us that moral renewal begins not with systems, but with stories. And in Scotland, we have stories of care that stretch from croft to coast, from ceilidh to care home. They are stories of people who are beholden and proud to be so.

Let us write policy, yes. But let us also write poetry and story. Let us build care systems but let us also build kinship. Let us be beholden, not as a relic of the past, but as a radical vision for the future.

Human rights are not sustained by policy alone. They are sustained by people who are beholden to one another. By carers who show up. By neighbours who listen. By governments who remember that dignity is not delivered but that it is held.

Let us be beholden. Not as a relic of the past, but as a radical vision for the future of social care.

Because to be beholden is not to be bound – it is to be human.

In his poem The Poet’s Obligation the great Pablo Neruda shares a declaration of the poet’s moral duty to awaken others to the vitality of life. Neruda sees himself as beholden to those trapped in routine, pain, or isolation. His obligation is not merely artistic but rather it is human, spiritual, and communal. The sea becomes a metaphor for freedom, and the poet a conduit for its liberating force.

I leave you with his words as we approach Human Rights Day in the spirit of beholden.

 

The Poet’s Obligation

by Pablo Neruda

(Translated from Spanish)

 

To whoever is not listening to the sea this Friday morning,

to whoever is cooped up in house or office, factory or woman

or street or mine or harsh prison cell;

to him I come, and, without speaking or looking,

I arrive and open the door of his prison,

and a vibration starts up, vague and insistent,

a great fragment of thunder sets in motion the rumble of the planet

and the foam, the raucous rivers of the ocean flood,

the star vibrates swiftly in its corona,

and the sea is beating, dying and continuing.

So through me, freedom and the sea

will make their answer to the shuttered heart.

 

https://www.tnellen.com/cybereng/poetry/obligation.html

 

Donald Macaskill

Photo by Andrew Hall on Unsplash

The following extended blog is the substance of an address delivered to the Scottish Partnership for Palliative Care conference on the 13th November.

I want to begin not with policy, nor with strategy, not even with the practice of social care itself. I want to begin with a poem.

It is for me one of the great poems of the twentieth century, written in Gaelic, by Sorley MacLean who was born on the island of Raasay just off Skye. His work has been credited with restoring Gaelic tradition to its proper place and reinvigorating and modernising the Gaelic language.

His poem Hallaig, published in 1954, achieved an almost “cult like status” outside Gaelic-speaking circles for its supernatural representation of a village depopulated in the Highland Clearances. For those like me who had grown up with grandparents who were the children of the thousands who were ‘cleared’ off their land to make way for sheep and the profits of landowners, his words echo a truth of painfulness.

Hallaig is a poem about place, about people, about presence and absence. A poem that carries both lament and hope, both grief and rootedness.

In translation part of it reads:
“Time, the deer, is in the wood of Hallaig.
The shadow of the birch is in Hallaig,
and the trees are standing tall
where people once stood.”

When you walk into Hallaig, the cleared village on Raasay, you see no houses, no children, no hearth smoke. The people are gone. And yet in MacLean’s vision, they are still there. Their memory abides in the birch trees, in the glen, in the silence that is alive with absence.

I want to take Hallaig as our guide this morning. For in considering what social care contributes to palliative and end of life care I want to start by saying that I believe it is precisely that: presence in absence, the rootedness of memory, the holding of community when it seems no longer there.

Right at the start it is useful to say what social care is

One definition I work with is this:

“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 not about maintenance but about life in all its fulness.

It is delivered by around 212,00 people that’s over 50, 000 more than in the NHS

It is witnessed in care homes, in people’s own homes, in housing support across the country.

We do not, in Scotland, like to talk of death. We do not, if truth be told, like to talk of decline, of diminishment, of ageing, of endings.

We are a nation of euphemisms.
“She’s passed on.”
“He’s away.”
“She’s no longer with us.”

We avert our eyes. We walk on the other side of the road.

Yet absence, I believe, is not void. Absence can echo. It can hum with memory. The room of a dying person is heavy with memory, with love, with stories still untold.

Death is not avoidance. Death is presence. It is as real as breath. It is as much part of life as birth itself.

I met Mairi in a care home on Skye. She was a woman with silver hair, her mind drifting like mist – but her hands knew the old Hebridean psalm tunes. Her carer, Eilidh, sang with her each evening. When Mairi could no longer recall the words, Eilidh sang to her, and Mairi’s eyes filled. Even as memory slipped, presence remained. In that moment, social care was a sanctuary. The birch trees, living memory.

MacLean’s Hallaig captures the paradox – that absence can be full of presence. That a glen emptied of its people can still echo with their laughter, their footsteps, their lives.

And that is the role of social care in palliative and end-of-life work.

We are the companions of presence. We are those who stay when others turn away. We are those who sit in silence when there are no more words, those who hold a hand when there is no more cure, those who listen to the laboured breath and still hear the human story.

I have seen in care homes across Scotland what I can only call sacrament. A worker, exhausted at the end of a shift, bending down to kiss the forehead of a woman who is dying, whispering in her ear, “You are not alone…You are not alone.”

I have watched in a cramped tenement flat a home carer arrive with a flask of soup, not just to nourish but to bless. To remind a frail man that he is still part of a circle of care, still someone, still himself.

In those moments, social care is Hallaig. We are the birch trees. We are the presence that stands where absence seems overwhelming.

In places and at times when there are no definitive answers to profound questions the role of the carer is like the potter with raw clay – searching for the story inside, for truth to find its shape, for the moment to appear.

I think this is especially the case in the care of those who are very old and those living their end days with dementias.

I am reminded in that regard of the words of another poet David Whyte, who writes:

“The only choice we have as we mature is how we inhabit our vulnerability, how we become larger and more courageous and more compassionate through our intimacy with disappearance.”

Care, in all its forms, not least social care, – is an intimacy with disappearance. It is the daily act of standing beside someone as they change, decline, recover, or die. It is the art of presence in the face of absence. And it is in this space – this vulnerable, sacred space – that care is being created.

It is important, I think, to say something that is not always heard in the public square.

Palliative care is not only about hospices. It is not only about hospitals. It is not only about the skilled interventions of doctors and nurses, invaluable and irreplaceable though those are.

Palliative care is also, distinctively, deeply, profoundly, about social care.

What makes social care distinctive in the work of dying?

It is not equipment, though we sometimes bring that.
It is not medicine, though we often support its use.
I think it is relationship, it is ordinariness, it is continuity – all of which are about enabling presence in absence.

The carer who has washed your hair for two years is the carer who knows how to wash it when you are dying.
The support worker who has shared your laughter at Christmas is the one who knows how to comfort you when you face your final days.
The care home manager who has phoned your daughter every week is the one who phones her when you have only days to live.

This is not incidental. This is the very heart of what makes social care distinctive.

We do not walk into someone’s life at the eleventh hour. We walk alongside them through the long days of ageing, through the seasons of frailty, through the slow diminishment of memory. And when the time of dying comes, we are already there.

There is, in social care, an intimacy, an ordinariness, that is profoundly palliative.

It is in the cup of tea.
It is in the blanket tucked round legs.
It is in the song sung softly, the prayer whispered, the silence held.

Care homes at their best are communities of memory. They are places where life is lived until the very last breath. They are places where birthdays are celebrated even when candles are hard to blow out, where Christmas trees sparkle even when vision fades, where the ordinary rhythms of life continue right up to the threshold of death.

Care homes are not passive spaces – they are living, breathing communities.

At an Edinburgh care home, the staff celebrated Hamish’s 100th birthday with cake, accordion music, and stories. A month later, Hamish quietly passed away, mid-dance. No medical machinery, just life flowing to its close, and presence, still.

Home care is even more intimate. To die at home, with your own curtains, your own wallpaper, your own cat curled on the bed – this is what many people long for. And it is social care that makes that possible. It is the carer who comes at seven in the morning, at midnight, at dawn, who makes that choice real, not just theoretical.

In a Fife care home, a man called George loved fish suppers. Every Friday, for years, staff brought in a bag of chips from the local chippy. Even when swallowing grew difficult, they still brought the chips. They placed them near his bed, so he could smell the vinegar and salt, the comfort of familiarity. George died one Friday evening, with that scent in the air.

Medical charts or care records did not record that moment. But it was a palliative act – ordinary, rooted, profoundly human.

This is what the national palliative care Strategy calls “timely, co-ordinated care based on what matters.” But to me, it is simply social care – ordinary love made visible.

In all these moments, it’s not just what we do – it’s who we are. Social care brings ordinariness, relationship, continuity.

The new Scottish Government strategy, Palliative Care Matters for All, affirms a vision:

‘By 2030, everyone in Scotland, adults and children, should have equitable access to well-coordinated, timely, and high-quality palliative care, care around dying, and bereavement support based on what matters to them – including families and carers.’

The strategy also calls for Scotland to be a place where communities support each other, talking openly about serious illness, planning, dying, and bereavement. This is our calling: to turn avoidance into conversation, absence into presence.

For these ambitions to be realised in social care, workers must be seen, trained, guided, supported – and the lived, ordinary moments honoured in policy as much as the specialised ones.

When people ask me, “What does social care do in palliative care?” I answer: it makes dying human. It makes dying ordinary. It makes dying part of life.

But let us be clear: this is not just sentiment. It is not just good practice. It is a matter of human rights.

For me to die well should not just be a privilege for the few.
It is a right for all.

The right to dignity does not end when disease progresses.
The right to autonomy does not vanish when memory falters.
The right to participation does not fade when speech is lost.

As most of us in this room know the majority of people die not in hospitals, not in hospices, but in care homes and in their own homes.

Most palliative care in Scotland is delivered through social care.

• 89% of people in Scotland will need palliative care.
• Over 30,000 frail older people receive care at home each week.
• Most people in care homes are in their last 18 months of life.

And a critical part of that social care contribution is the work of unpaid carers who are the Invisible Backbone

They are the mothers, fathers, daughters, sons, neighbours, and friends who provide the majority of palliative care in Scotland – not for pay, not for recognition, but out of love and duty.

The 2025 Carers Update estimates that there are 694,000 unpaid carers in Scotland, including 27,000 young carers.

Unpaid carers carry the weight of love and loss, often in silence. They need more than our gratitude – they need our support, our policy, our resources.

And yet – and yet –  policy, funding, public discourse all too often overlook the reality of both paid and unpaid social care and support.

Let us not enshrine policy without teeth. The Strategy must be backed by funding, staffing, equity. The ambition of the strategy is right. But ambition without investment is poetry without music.

Unless palliative care in social care is resourced, unless the workforce is valued, unless communities are engaged, then those words risk becoming another uninhabited village, another Hallaig of policy – present in name, absent in reality.

This is not simply unfair. It is unjust. It is a violation of rights.

And so we must ask: how do we make sure that Isa or George, are not exceptions, but expectations?

The trees of Hallaig remind us: absence does not mean invisibility. The people are still there, even when the state forgets them. And in social care, we stand with them. We make them visible.

Of course, it is not easy.

Our sector is stretched. Staff are underpaid, undervalued, exhausted. Recruitment is hard. Retention is harder.

We cannot talk about a “dignified death” while those who enable that dignity are themselves denied a dignified wage.

And we also have as everyone in this room knows only too well to acknowledge that death itself is demanding. To sit with dying day after day takes a toll on the soul. To lose people you have loved – and make no mistake, carers do love – is to carry grief upon grief.

Yet despite the hardness I also see hope.

In Inverness, a care home created a “memory tree” in its hallway. Every time a resident died, a leaf with their name was hung upon it. Families came back months later to see their loved one’s leaf still there, still part of community.

In Dundee, a team of carers took it upon themselves to bake scones every Saturday morning for a dying woman who had baked all her life. Even when she could no longer eat them, they baked. They filled the house with the smell of her past. That was hope in flour and butter.

In my own island of Skye, I have taken part in many a vigil. Neighbours gathered outside a croft as someone lay dying inside. They sang psalms in the dark, their voices carrying through the wind. Social care and community entwined, ancient and modern, grief and love in song.

This is our hope – not abstract, but real, rooted, ordinary.

I see hope despite the hardness of days.

I see it in the resilience of staff who turn up every day, who walk into rooms heavy with breath and do not flinch.

I see it in the creativity of care homes that hold vigils, that sing, that weep, that honour the dead with dignity.

I see it in the rituals of remembrance – the photographs, the memory books, the trees planted, the candles lit.

In our Gaelic and Scottish traditions, we are not strangers to grief. We have keened, we have sung laments, we have told stories round the fire. We have known how to hold loss as community.

Social care, I believe, continues that tradition.

We are the keeners of today.

We are the singers of lament in the corridors of care homes.

We are the holders of memory in the tenement flats of Glasgow, in the crofts of Skye, in the bungalows of Dundee.

And there is hope in that.

For a Scotland that can face death is a Scotland that can face life. A Scotland that can accompany the dying is a Scotland that will value the living.

In closing let me turn again to poetry, for it is in poetry that we find the language for what is hardest to say.

Sorley MacLean, in Hallaig, reminds us:

That is what social care does.

We make the dead present in memory.

We accompany the living into death with dignity.

We stand as trees in the glen of absence, rooted, ordinary, beautiful, enduring.

A poem:

Beneath the Trees

Beneath the trees, where birch and rowan speak to the wind,

the memory of people flows like the sound of water—

gentle as peat, strong as oak roots

holding the earth together.

Social care is the quiet road,

threading through the glen of living and leaving,

where human hands become branches,

offering shade, shelter,

and courage when the light draws to its close.

Palliative care is not an ending,

but a circle drawn in kindness—

a hearth of listening,

where pain is met with presence,

and loneliness with love.

Let us be the forest,

deep and interwoven,

where no one dies alone,

and where every breath is honoured

as part of the song of the hills.

Let us never forget:

Life is a forest, and every leaf matters.

Donald Macaskill

Photo by Ann on Unsplash

As the UK Chancellor prepares to deliver the Budget next Wednesday, Scotland stands at a crossroads. For too long, social care has been treated as an afterthought or as the underling of the NHS, yet it underpins everything we value: dignity in later life, support for unpaid carers, and the ability for people to live independently and participate fully in society.

This is not a marginal issue. It is the infrastructure of compassion that sustains our communities. And right now, that infrastructure is collapsing.

Scotland’s social care system is at breaking point. Workforce shortages, rising costs, and chronic underfunding have created a perfect storm.

In rural areas like the Highlands, geography compounds the crisis: delayed discharges cost millions, care homes close, and families face heartbreak as loved ones are sent hundreds of miles away because there is simply nowhere local to go. This is not dignity rather it is systemic failure.

Audit Scotland has warned repeatedly that urgent action is needed to change how services are delivered. Yet despite record allocations on paper, the reality is stark: councils and health and social care partnerships are in year debt to the region of around £500 million. Providers are closing. Skilled workers are leaving because they cannot afford to stay in a profession they love.

When I think of the two main sectors that my membership comprises both are on their knees in the majority of locations.

Homecare is the backbone of independence, but it is collapsing under financial strain. The latest Minimum Price for Homecare in Scotland, as calculated by the Homecare Association for the financial year 2025–2026, is £32.88 per hour. No Scottish council meets the minimum price. Notice it’s a minimum price not a fair price!

To add insult to injury providers report late payments averaging £300,000 per organisation, threatening viability and continuity of care. And the obscenest occurrence is the explosion in 15-minute visits when we were supposed to be seeing the end of this practice which is an absolute assault on dignity.

Every hour of care at home is an investment in human flourishing. It prevents hospital admissions, reduces loneliness, and sustains wellbeing. Yet this lifeline is fraying if not already broken.

The independent care home sector provides 86% of all registered places in Scotland yet has seen a 34% decrease in residents since 2014. Over the past decade, 476 care homes have closed or changed hands, sometimes forcing families to travel 100 miles or more to visit loved ones. This is not just inconvenient, it is cruel. Any fair analysis shows the £1,027 per resident per week for intensive 24/7 nursing residential care is a good £500-£1000 short of the true price of dignified care and even that ties return or profit to 4%, way below what most economists argue is needed to keep a business, be it charitable, not for profit or private going.

Empty beds today mean closures tomorrow, and every closure strips communities of choice and dignity.

Delayed discharge is the most visible symptom of a whole system paralysis. More than five million bed days have been lost since 2015 at a cost of £1.5 billion. Hospitals are gridlocked because social care is starved of funds.

But the invisible cost is what really matters. It’s the thousands who are waiting up to 18 weeks to be assessed for the care they need; it’s the hundreds who die without the dignified end of life care they deserve; it’s the burnt out and exhausted thousands of family and friend carers who are at their wits end with fatigue and emptiness.

And just in case you think I’m engaging in hyperbole and exaggeration – the avoidance critique of those made uncomfortable by the raw truth of political failure, others are in agreement.

COSLA, the representative body of local government in Scotland, has issued a clear warning: without fair and sustainable funding, we risk the viability of services that people rely on every single day. Their manifesto calls for an additional £750 million investment in social care and an end to 15-minute visits in homecare.

More immediately they have also called for the urgent reconvening of the Financial Viability Response Group of which providers through Scottish Care and CCPS sat on at the start of the year and which in April offered a truthful report with recommendations to the Cabinet Secretary.

Councillor Paul Kelly put it bluntly:

“Local Government cannot do this alone. Demand is increasing, costs are rising, and the workforce is under immense strain.”

Yet we have been faced with silence from the Scottish Government other than a statement to address winter pressures by giving £20 million to NHS Boards to address ‘social care’ needs. An allocation not to local authorities or HSCPs but to the sacrosanct NHS.

Scottish Care has consistently argued for a budget that values social care not one that kills reassurance and forces closures. As I said recently, people are dying because they cannot get the social care they need. This is not hyperbole; it is happening now. Services are closing, staff are being made redundant, and communities are losing lifelines.

The UK Government must also shoulder responsibility. Immigration policy changes such as scrapping social care visas, raising salary thresholds, and increasing sponsorship costs are reckless and inhumane. In rural Scotland, internationally recruited workers make up more than 25% of the workforce. Removing this lifeline will devastate communities and put lives at risk.

Both governments must act decisively. The UK Government needs to reverse damaging immigration changes, exempt social care from National Insurance hikes, and deliver Barnett consequentials that prioritise care. The Scottish Government needs to commit to COSLA’s £750m ask, deliver multi-year funding agreements, and accelerate reform that values workforce and community-led care models.

This is not about party politics – it is about people. Every delay deepens the crisis. Every cut costs lives.

Social care is not a drain on resources; it is an investment in humanity. It is the infrastructure of compassion that sustains our communities. As we await the Budget, let us demand a budget that cares; a budget that restores dignity, strengthens the workforce, and ensures that no one in Scotland is left without the support they need.

I appeal to our political leaders to stop the rhetoric and start the rescue.

To the public I say, raise your voice for those who cannot.

Social care is the foundation of a fair Scotland. If we fail to act now, we will not just lose services but inevitably we will lose lives, communities, and trust in the very idea of care. “Social care is not a cost – it is the currency of compassion.”

We cannot afford another winter of reactive measures. We cannot afford to lose more care homes, more workers, more trust. The UK Budget must deliver for social care. The Scottish Government must match ambition with action.

This is not just about funding. It is about the kind of country we want to be. One that values its elders, supports its carers, and builds communities of care rooted in dignity, belonging, and hope.

This Saturday, before the Budget, let us make one message clear: Scotland demands a budget that cares. Nothing less will do.

Donald Macaskill