When a plan prepares for failure: the crisis of social care.

We are all of us used to the art of planning. Whilst there are occasions and moments in our lives which happen ‘out of the blue’ and by ‘happenstance’ most of the major events of our life involve a degree of planning. Be it the birth of a child, getting married or moving into a new house, planning is part and parcel of an event’s positive outcome and success.

It wasn’t for nothing then that planning was considered to be intrinsic to the art of successful political leadership. Benjamin Franklin (one of the greatest US Presidents) once wrote: “By failing to plan, you are preparing to fail” and another great strategist Winston Churchill stated: “He who fails to plan is planning to fail”.

An examination of both their writings shows the extent to which careful, meticulous, and methodical planning was intrinsic to the successes of their leadership whether militarily or on the political and domestic front.

The importance of planning has been to the fore of my mind this past week, and it has indeed been a busy one in terms both of politics and the world of social care but we are probably in these last days of October and given its 24 hours before the clocks go forward, at a key stage in both the meteorological season and in terms of the state of our social care system in Scotland.

We are also at that time of the political and parliamentary season when the gears go up a level or at least change. The party conference season is all but over (though the Scottish Greens meet today) and the curtains are being drawn on the political conference theatricalities with their usual mixture of aspirational optimism and depressive pessimism dependent on which party you belong to, which polls you are reading or which pundit you speak to. And of course, the party conference always grants the opportunity for those in government to pull rabbits out of unexpected hats in order to leave loyal followers feeling a bit more positive as they walk, drive or train into the approaching winter. In Scotland that has seen the bizarre and for me misplaced decision to freeze the Council Tax at a time when thousands are going without social care because of a lack of funding.

In the last week Parliament started to stir itself from its post-conference slumber.

For those of us in the world of health and social care, the annual joy which is the publication of the Scottish Government’s Winter Preparedness Plan took place on Tuesday last. Presented by the Cabinet Secretary for NHS Recovery (we now know why ‘social care recovery’ was not in the portfolio title) this work of seasonal solicitude comes this year with an empty budget and no additional resource – that is if you come from the social care world. But like all Halloween seasonal offerings it had its own mixture of fantasy and reality – the fantasy was that it pretended to be for the whole health and social care system, the reality was some extremely worrying failures to really understand the social care world and the very real crisis it is enduring.

But it has not been the only event this week because we also had the publication of the Real Living Wage and the announcement that from next April it would now £12 an hour. This recognition that those who are the lowest paid deserve a significant wage increase is to be welcomed but it poses a problem for the current Scottish Government.

Regular readers of this blog will know that for months – along with others- I have called for our First Minister and the Cabinet Secretary to come true on the promise to pay social care staff £12 an hour. A promise made in April 2023, only to be underlined 20 weeks later when it was announced that workers would have to wait till April 2024 to get that salary increase. And lo – instead of the intervention bringing real positive change, enabling organisations to retain and attract new staff through the summer, autumn, and winter – we are now faced with the reality that come next April there will be no additional benefit, no additional attraction for those thinking of staying or joining a social care organisation. A significant political misstep and own goal and before anyone opines that there was no resource available – let’s just say I am sick to the proverbial of the way in which this administration magics up money from invisible corners when others strike, protest or complain. There is resource – it is all about priorities and what is deemed to be of greater value and what is considered as of lower significance – and the social care world isn’t blind to that political and fiscal truth.

As the seasons change, we are going to be moving into a winter period which will bring about real challenge. We’ve already seen thousands spent by the Government on a campaign to remind people to make sure that they only try to access support from the right source at the right time when they really need it. Nothing wrong ordinarily with such messages but when a system is so fragile and collapsing, they have a ring of preparatory avoidance about them.

Then we have the actual winter plan. It is not a plan worthy of the name because to my mind at least (and dare I say for most people involved in contingency, emergency, and resilience planning) you prepare for an impending challenge by making sure (amongst other things) that you have all the data, all the information, all the facts available to you. This plan is devoid of reality because singularly in its development and political articulation it has failed to fully and realistically involve those who are going to be responsible for delivering the majority of social care provision. Now I have no problem in the public sector saying this is our NHS and public sector winter planning – but I do have an issue with the pretence that this is a plan which is for the whole system and that it has included all. At the risk of repetition nearly 70% of social care provision in Scotland is delivered by the third and independent sectors. A plan which does not include them, speak to their reality, address the challenges of their workforce is not a plan worthy of its name – it is a delusion, deceit and exercise in political spin-doctory.

The third and independent sectors do not have all the answers to the crisis of workforce, lack of integrated working, misplacement of resource, lack of preventative and community-based care and support – but asking us might just have helped. It is not too late – so Scottish Government could start to pay social care staff £13 an hour from now (working up to a Fair Wage); we could invest in community based homecare to ensure people really are able to remain independent at home for longer; remove competition from care and increase collaborative practice; pay the registration fees for all those wanting to enter the social care system (regardless of employer); remove requirements for qualification if you are in the last years of career and so on and so on. We are not short of ideas just a system and political leadership wanting or willing to listen.

I really hope the winter will be one which we get through without long waits at A and E, increasing delayed discharges, a rise in the number of people unable to access urgent social care, and a continued drain of workers from social care organisations. I really do hope the early signs I am seeing of delayed care packages; people being told they do not meet ‘emergency criteria’ and perversely care workers being laid off because of a lack of ‘work’! are not harbingers of what is to come. But the failure to include, involve, listen to, and learn from the social care sector does not give me much confidence.

Apparently another political leader, Dwight Eisenhower, this time said ‘”a bad plan is better than no plan”. That may be true philosophically but the quality, naivety and lack of whole system thinking of the Scottish Government and COSLA’s Winter Preparedness Plan 2023-2024 is leaving most of us in social care extremely anxious about the weeks and months ahead.

Donald Macaskill

I’ve been spending the last few days in Skye where as many of you know my family originally came from and where I still have close relatives. It is always good to return ‘home’ and to catch up with folks, explore parts I do not know and get on with some tasks. It is an escape from my world of work into a place that simply possesses another rhythm and pattern of living to anywhere else I know. In October the seasons meld into one another on Skye but this time despite the robust winds the weather has been glorious, and I have rarely seen the place look more beautiful and awe-inspiring.

Yesterday with other members of my family I spent some time re-painting the lettering on a family gravestone. Might seem an odd activity but it was both rewarding and humbling to spend time in making sure that the names and memories of my kin would be visible despite the Atlantic gales which sweep that part of north-west Skye. It was good to share stories, learn new things and be together. One of the people whose name I repainted on stone was my uncle Donald who sadly died in his forties now some forty years ago.

Donald was my mother’s only sibling which in itself was an unusual fact in a Hebridean family pre the Second World War. His birth was difficult, and it resulted in him developing some learning disabilities which included a stammer and stutter that more pronounced the more anxious he was. But I absolutely loved Donald as a child and adolescent and very much regret the fact he died when I was in my late teens. His instinctive knowledge of nature, of animals and the seasons was far more important and impressive to me than the fact he struggled to read and could barely write. His influence on me was marked not least in that I became aware through the time I spent with him how much he was the victim of bullying and harassment because of his disabilities and especially his stutter. Although at times he found communication difficult what was certainly the case was that with patience and interest anyone could communicate with him and vice-versa. Sadly, not all people showed him such patience. Far from it. He had a manual job and one of his foremen made his life a simple hell with constant mimicking of his speech and other behaviours which today would have resulted in dismissal. But not then. The truth was that though Donald tried to hide his upset I knew how much it hurt him to be the victim of such belittling inhumanity and to be continually the object of another’s derision and amusement.

I thought a lot yesterday about how hard his life was as I re-painted his name on his gravestone. So, it was with some sense of synchronicity that in searching as I often do for what is happening in terms of the global calendar of events and occasions that I found out that tomorrow is Stuttering Awareness Day.

Organisations like the Scottish Stammering Network use the day to raise awareness of stammering and also to challenge and address some of the stereotypes and presumptions which exist around this remarkably common condition. They and other groups are well worth exploring not least if you are involved in the world of social care and support where many individuals who receive services and support in their own home or in a residential home live with stuttering or stammering.

Stuttering or stammering is a disruption in speech pattern involving disruptions, or dysfluencies, in a person’s speech, but there are nearly as many ways to stutter as there are people who stutter. Yet like so many conditions it is often misunderstood. It is now widely recognised that stuttering is a neurological condition which impacts and influences the production of speech and the use of language. But as with my uncle so many presumptions are made about people who stutter, and they are often the victims of discrimination and inappropriate treatment. In addition, the impact of such behaviours upon the self-esteem and self-value of those who live with stuttering can often be very negative indeed.

In exploring a world, I knew so little about I discovered that there are many myths and misunderstandings around stuttering, including amongst other things that:

‘Because fluent speakers occasionally become more disfluent when they are nervous or under stress, some people assume that people who stutter do so for the same reason. While people who stutter may be nervous because they stutter, nervousness is not the cause.

Emotional factors often accompany stuttering but it is not primarily a psychological condition. Stuttering treatment/therapy often includes counselling to help people who stutter deal with attitudes and fears that may be the result of stuttering.

Adults and children who stutter may sometimes be hesitant to speak up, even if they are not otherwise shy by nature. People who stutter can be assertive and outspoken, and many succeed in leadership positions that require talking.

Although the manner in which people stutter may develop in certain patterns, the cause of stuttering itself is not due to a habit. Because stuttering is a neurological condition, many, if not most, people who stutter as older children or adults will continue to do so—in some fashion—even when they work very hard at changing their speech.’ (see About The NSA – National Stuttering Association (westutter.org))

It is estimated that perhaps one per cent of the total global population stutter but that perhaps as many as 5% of all children go through a period where they stutter. It is also generally accepted that stuttering is more common among males than females. In adults, the male-to-female ratio is about 4 to 1; in children, it is closer to 2 to 1.

In other words, these are remarkably common phenomena. It is therefore really important that appropriate support and resource is identified to addressing the issues of those who stutter or stammer.

I leave you with a poem written by Natasha Foster called ‘Lighting Candles’ . Natasha wrote of the poem:

“Sometimes I have felt that my stammer stole the words from my mouth, but in writing, I can express things as I want to. There are losses and gains connected to having a stammer, and I tried to reflect that in my poem.

‘I called my poem ‘Lighting candles’ because when I’m open about my stammer, and share my experiences, I like to imagine lighting a small candle of awareness in others. I find motivated to think of increased ‘light’ being shed on the subject, and how this might help me, and others like me, who stammer.”

LIGHTING CANDLES

Knotted words

Angry Heart

Shame and pain

A faltering start

A sense of grief

At a life a bit bashed

By a loss of speech

Some opportunities dashed

My stammer is my uneasy friend

One that will probably stay till the end

City Lit, Stamma, and my fellow peers who know

Helped me change my thinking, learn and grow

I’m working on being a woman of pride

My stammer lives within me, part of me,

By my side

I’m free to speak with a stammer

And share who I am

My person, my experience, my spirit, I can!

Unknotted words

Thankful heart

Self acceptance and hope

Every day is a new start.

(Taken from Poem: ‘Lighting candles’ | STAMMA)

Donald Macaskill

In just under a month on the 1^st November the working group which published Scotland’s Bereavement Charter for Adults and Children will be holding a webinar entitled ‘The Space Between: understanding anticipatory grief.’ You can sign up for it and get more details here. On the day we will hear from invited speakers who will reflect on the loss of a parent, the loss of a child and sibling, and the loss of a loved one who you have cared for. The day will also see the publication of the refreshed and updated version of the Charter Guidance document which contains advice and guidance on grief and bereavement. At this time there will be a new section focussing on anticipatory grief.

The phrase might seem a bit strange or alien to those who are not part of the bereavement and grief support world. Sadly, however I suspect the experience of anticipating grief will be all too familiar to many of us.

Anticipatory grief is variously described but in essence it is the grief which starts before someone dies. It is a grief which is often not talked about and sometimes people can be made to feel guilty if they talk about the loss of someone who they know is going to die. So, they shut up and dismiss their feelings. Yet for many of us who have known a loved one who receives a terminal diagnosis like cancer or who has been diagnosed with a condition such as dementia, the grieving can start there and then. It can be terrifyingly immediate and overwhelming. All the lost dreams and possibilities, all the dashed hopes and aspirations, all the places unvisited and the plans unfulfilled. Knowing that someone you love and care about is going to die is a waiting which paralyses the soul and empties you of the few tears you may have left.

My twin brother died from cancer close to 6 years ago and it has taken until now for me to mention that truth in this weekly blog despite all the writing and speaking I undertake on grief and loss. Many twins reading this will recognise that there is often a connection between twins which you feel to be unique and special. It might not always be easy, and distance and the passing years might lessen it, but growing up so inter-connected with another person from the first moments of life onwards can make the sense of grief all the sharper and more painful. And in truth having spoken to a few twins it is a grief that is rarely talked about or shared.

After my twin’s death one of the most challenging series of statements I had to deal with came from those who said things like ‘it was good you had time to prepare’; ‘at least it wasn’t a sudden death’ or ‘you’ll be content that he is at peace now.’ There is a grain and a morsel of truth in some of those sentiments, but their uttering is a dagger to the heart. I know I am not the only person who has heard such words. So many people today will have recently experienced the death of a loved one who they knew was going to die … but we always hold onto the hope, the dream that they would have more time, that there would be more space to make memory and build togetherness… and yet it was not to be. There is no peace in waiting for hurt.

Waiting for someone who means so much to you to die does not prepare you it exhausts you. Waiting for death to come does not make the emptiness of absence any easier it makes it feel even more hollow. Waiting for death does not make the sheer sorrow of the moment any less raw and real.

Years of working and being amongst the dying and the grieving has taught me how little I know about living and dying. But one lesson whose truth I sense as authentic is that grief is not a moment but a series of memories; it is not a task to be undertaken and fulfilled, but a work to be struggled with for what seems forever. It is a journey whose destination is unknown and whose completion is ever in the future.

Maybe that is what those who are anticipating grief and those who are living through it share. A sense that we are changed because of the love we feel for another here and yet absent, present and gone. For they have riven us through with their loving and we are moulded into who we are by our knowing of them.

As for my twin, I think about him every day – like so many bereaved I hear his voice, sense his presence and catch myself wanting to talk to him; I hear his laughter and his passion; I want to pick up the phone and tell him my news or just hear his voice again. To just have another minute to say what was left unsaid and to say a proper goodbye knowing in truth that I could never finish the sentence of love in any time of minutes and hours. Even as I write this, I can feel the shiver inside my body. Grief sits with me, and I have grown used to her presence, but it is one that continually empties me of energy. So, no I cannot accept the experience of some that knowing about the inevitability of death, that anticipating it, prepares you for the reality.

As many of you know I find solace and escape in the reading of poems. Sometimes I find myself coming across esoteric and rare poems. One such which I recently discovered was in a famous group of poems in the tenth-century manuscript known as the Exeter Book. They are stunningly moving medieval reflections on isolation, loss and grief. One of the most famous is called (in a modern translation) The Wife’s Lament, and speaks of the loneliness felt in summer day, a loneliness brought about by isolation and grief. It introduces to the reader a word ‘uhtcearu, a compound which means ‘pre-dawn-sorrow’, ‘grief at early morning’. In Old English uht is the name for the last part of the night, the empty chilly hours just before the dawn, and so a particularly painful time for grief and loneliness.’

I resonate so much with that sense of uhtcearu because for me at least it is in the last hours of night, when the world is still and strangely silent, that loss feels more intense and memory of those not with me seems to settle in beside me, both to soothe and in love to call me into another day. As we anticipate the dawning of the day we move our grieving heart to face the light of another absent day and we know the task of living through memory is to mould our lost love into a new beginning, however hard, every day. But the morning only comes if we allow the uhtcearu.

Donald Macaskill

Dr Eleanor Parker from Oxford University has written a brilliant piece on the Wife’s Lament. See The Wife’s Lament. A Medieval Poem about Isolation | TORCH | The Oxford Research Centre in the Humanities

Photo by Abbas Tehrani on Unsplash