In one of those calendar quirks today the 15^th July happens to be St Swithin’s Day and also the first Saturday of the Glasgow Fair. St Swithin’s Day as many of you might remember from the rhymes of childhood is a day when according to tradition, whatever the weather is like on St Swithin’s Day – whether rainy or sunny – it will continue for the next 40 days and 40 nights.

‘St Swithin’s Day, if it does rain

Full forty days, it will remain

St Swithin’s Day, if it be fair

For forty days, twill rain no more.’

Now I am no meteorologist, but I doubt the late St Swithin, the Bishop of Winchester in the 800s, has much influence over the weather. But it would not at all surprise me that on this first day of the Fair that the rain is pouring somewhere in the west.

As a child growing up the Glasgow Fair was very important. It was the time of year when my family made our annual pilgrimage to Skye to visit grandparents, and to allow my father to turn the day job into a fortnight of shearing sheep, picking potatoes and having more than the occasional dram to catch up with friends and relatives. It was also a time when it was either sweltering heat or continual rain – so good old St Swithin might have known a thing or two.

The story of the Fair is an interesting one. Historically it’s the oldest ‘Fair’ of its type and dates back to the 12^th century and indeed up until the late 19^th century markets and fairs were always held around the fields and green spaces around Glasgow Cathedral.

Before the 1960s it was commonplace for most businesses, factories and the shipyards to close on ‘Fair Friday’ to allow workers and their families to attend, and for folks to take their holidays by going “doon the watter” to the Ayrshire coast. Today whilst the name lives on people in the city take their holidays at many and diverse times to fit into a very changed pattern of work and leisure. You are likely to see many more Glaswegians in the streets of Palma and Albufeira than in Ardrossan and Troon.

The way we holiday may have changed but for many people taking a couple of weeks off in the summer has become almost a ritual. This year I have heard of families who despite the pressure of money and the cost-of-living crisis trying their best to give especially their children some time away even if it is just another part of Scotland.  I have also been having quite a few social media chats and DMs around the issue of holidays at this time of year from staff who work in social care struggling to make ends meet to older people who struggle with holidays per se both on the grounds of finance and also in the sense that their normal contacts and routines are so changed that it often leads them to feel so much more alone and lonely during the summer months.

Holidays are very often hard times for people for so many reasons. The loss of routine can be hard for all ages. The constant being together with people who you may not always get on with in new environments can be stressful. The process of travelling, staying in a new place, feeling you need to keep children entertained and amused – a lot of family holidays whilst fun can be the complete opposite. And in soaring temperatures tempers can become frayed and strained. Dealing with heat and humidity can be very hard for many people.

Like many of you I am well acquainted with SAD (seasonal affected disorder) and having worked in Orkney for a while was very aware of the impact the short days and long winter nights could have on the mental health and wellbeing of people. What I have been less well aware of is the impact of summer and of summer holidays on folks.

I recently came across a fascinating article by Michelle Pugle which explore the issue of Summertime SAD. It states that summer affected disorder whilst less common is just as serious. It argues that we all of us, not least those who support others, need to become much more aware of the impacts of summer and the holiday season on the health and wellbeing of people, not least as the impacts of global warming and climate change are worsening as the years go by.

“It’s important to remember that everyone is different, and while most seasonal episodes of depression occur in the winter, up to 30 percent of people [with seasonal depression] will experience summer depression…

People with summer-pattern seasonal affective disorder (SAD) — aka “reverse SAD” — typically experience common symptoms of depression for about four to five months each year when the weather is warmer.”

It goes on to detail the effects of such depression, such as feeling sad or low most days, having lower energy levels, losing interest in activities and relationships, insomnia, loss of appetite, agitation and restlessness.

The article also suggests some coping mechanisms which those who care for and support others might find useful including, identifying summertime triggers ( maybe the heat and humidity, loss of role, changes in family, issues of body image); make sleep a priority ( find out what helps you sleep in the hot nights and accentuate your sleep but do not try and sleep outwith normal patterns) ; develop a routine for the time and keep to it ( it can help you feel more motivated and put-together); attend and make space for your emotions; avoid the traps which can often make you depressed such as eating when you’re bored, but not hungry; playing video games or being on your phone for hours; drinking excessive amounts of alcohol); and build self-care into your routine.

Holiday time and summer-time are undeniable escapes for many but they bring burden and challenge to some and those who work in and receive social care and support are no exception.

So on St Swithin’s Day and during the Glasgow (or any other holiday) Fair let us look after ourselves and others.

Donald Macaskill

Photo by Deep Trivedi on Unsplash

The past few days has been full of events, from the 75^th anniversary of the start of the NHS, to the celebrations around the King receiving the Honours of Scotland, to the first 100 days of our new First Minister. A very busy week indeed. Sadly though the 5^th July was also the 75^th anniversary of modern social care in the UK I seemed to have missed any national celebration. But therein lies the lot of social care!

Closer to home the care home members of Scottish Care have been conducting a vote on whether or not they should accept the COSLA offer of 6% to increase the National Care Home Contract rate. You may have seen from the media statement on the Scottish Care website this morning that the decision was reluctantly made to accept the 6% though in so doing many considered that they were merely delaying their inevitable closure. What the statement also made clear is that Scottish Care, both its staff and members, frontline managers and carers will continue to campaign for a just and equitable pay settlement for the women and men who work in social care across Scotland, whether in someone’s own home or in a care home and for urgent sustainable funding.

At a personal and professional level, I have always been a seeker of compromise and consensus, believing that bringing people with you, working through the hard problems and issues of the moment, is more important than grandstanding or being constantly oppositional. Indeed, even during the largest crisis which social care delivery and people using care and support services in Scotland have faced in a lifetime, during the pandemic, personally and professionally I have sought to find common ground even in those moments of sharp disagreement. So it is that Scottish Care has entered constructively into engagement and negotiation over what is an urgent and national social care crisis.

Coming to a settlement over social care funding has always been a challenge and this year I think we all knew that with such large increases in the cost of living, in energy and food prices together with a critical shortage of nursing and care staff, that it was going to be especially hard. Care providers, whether they are small charities, private family run businesses or employee owned, are continually faced with a reality which is that workers can earn so much more outside the sector with so much less demand. The astonishing human value and affirmation that you get from working in social care has to be set against a personal financial reality that means you have to pay the bills!

It was always going to be the case that because of these pressures where local government simply did not have the monies that the whole process would need to turn to Scottish Government. Why? Because ultimately it is the central government of the day that has legal and moral responsibility for ensuring that there is enough money made available to pay social care staff and organisations who deliver care and support in its name.

To begin with we were optimistic about these discussions with the Government. After all they had recently negotiated a hugely positive Agenda for Change settlement for our nurses and other NHS staff. Indeed, social care providers recognised that this settlement effectively meant that NHS colleagues doing the same job were now getting paid nearly 20% more than their social care colleagues. And after all the Scottish Government has consistently said that social care is important, valuable, and even critical for the delivery of health and care.

Right across the social care sector the asks have been simple. Reward our amazing frontline staff with a pay settlement that treats them with dignity, respect, and professionalism. What was on the table – and now has for the moment had to be accepted – was an offer of 3.8%. All the very real benefits which the Scottish Government had achieved by introducing the Scottish Living Wage and by even going beyond it, have now effectively been lost.

But still those of us talking to Ministers and the Cabinet Secretary were optimistic. After all – surely, they would see the need for equity? Surely, they would recognise the risk that more and more staff would leave social care and thus risk the very foundations of a sector upon which the NHS and so much of Scottish society is so dependent? Surely, they would recognise the trauma for folks at the later stages in life of having their care home close because the provider could no longer pay the bills. Surely, they would want to work with us to end the blight of 15-minute homecare visit and so much more? Surely, they recognised the lack of funding at local level which would mean local authorities were not free to respond in any flexible way to the crisis on their doorsteps?

Well, we continued to have hope – after all the junior doctors were yesterday offered 12.4%; and earlier this last week we heard that NHS Scotland senior medical and dental staff and general medical practitioners will receive a 6% pay increase for this year, backdated to 1 April 2023. Constructive offers and deals and a valuing of people for the work they do. So surely the social care staff who literally gave everything during Covid and beyond – as politicians have stated – would receive equal treatment?

But despite numerous asks – the current Scottish Government has not even been able to give to employers and staff a timetable for the introduction of the £12 an hour which the First Minister promised in one of his earliest speeches away back on 18^th April. So why the ability to find urgent response to a crisis amongst the NHS and a bending over back response to alleviate their challenges and yet deafening silence and inactivity for social care staff and providers? One rule for the NHS and a completely different response to social care.

Is this an administration characterised by delay, dither and dysfunction or is there a ‘cunning’ strategic plan which they are just unable to share? Social care providers and frontline staff have probably already made up their own minds on that question. Is this a government that really cares about care or is it only a pretence for photo opportunities and political grandstanding? Is there any genuine attempt to deal with a crisis which is happening now or are we simply witnessing a desire to hide heads in the summer sands in the hope all troubles will blow over?

The care sector has had enough of the political promises, the empty words, the feigned sympathy and understanding; we need action, decision, and determination to really make the changes that will value our workers and maintain our organisations.

I hope with the opportunity to reflect that we can really move things forward in the next weeks and months. The alternative is a deepening social care crisis made all the worse by avoidance. The alternative is quite frankly more care homes shut, more homecare organisations lost, more staff leaving for ever , and most importantly more lives diminished and devalued amongst those supported and cared for.

Donald Macaskill

Photo on Unsplash

This coming week is Alcohol Awareness Week which is an annual event run under the auspices of Alcohol Change UK. It is an event designed to change our relationship to alcohol and this year the focus and theme is on ‘alcohol and cost.’

Alcohol brings with it some very real costs, both personally, in terms of families as well as societal and community costs.

Alcohol Change state that:

‘The total social cost of alcohol to society is estimated to be at least £21 billion each year. We as individuals also spend tens of thousands of pounds on average on alcohol over the course of a lifetime.’

In the last week a whole host of organisations and clinicians in Scotland have published a call to not only maintain Scotland’s current Minimum Unit Pricing (MUP) policy but to improve it as our MSPs begin to reflect on its continuation. Thirty-four organisations including the BMA Scotland, the Royal College of Physicians of Edinburgh, and the Royal College of General Practitioners have called for restrictions on alcohol marketing, an increase in the minimum price from 50p a unit to at least 65p, a levy imposed on alcohol retailers to fund local prevention and treatment and substantial investment in alcohol support services.

This call comes on the back of new research from Public Health Scotland which shows that the MUP policy had reduced alcohol-related deaths and hospital admissions and had lowered alcohol consumption. The new report said that MUP had reduced deaths directly caused by alcohol consumption by 13.4% and hospital admissions by 4.1% and that the largest reductions were seen in men and those living in the 40% most deprived areas.

Whilst the economic costs of alcohol dependency and use are significant it is always the personal costs that are felt most acutely. Deaths from alcohol across the UK have gone up since the start of the pandemic and there are many more individuals who are living with worsened mental and physical health every day because of harmful drinking. As well as the pandemic the current cost of living crisis and anxiety over income are resulting in many people turning to alcohol.

Scottish society has always had an uneasy relationship with alcohol and sadly there are still too many people dying from the effects of alcohol consumption, and still too many individuals and families blighted by addiction to alcohol. One group that is often forgotten about when we reflect on alcohol dependency and addiction are older people. But those who work on the frontline of care and support frequently recognise the signs of a dependency and addiction that strips people of purpose, health and wellbeing. The crippling loneliness which many of our older fellow Scots are living with in these days is often one which some chose to fill with the illusory comfort and escapism which comes from a bottle. This is not being helped by the savage cuts at local level which are leading to the closure of older people day centres and a reduction in opportunities for folks to get out of the house. Nor is it being helped by the disproportionate impact of the cost of living crisis upon older people in specific.

Yet despite the data and the numbers, the research and the knowledge, there is often an uncomfortable silence around talking about alcohol and its impact on Scottish society. To call into question its value and impact sometimes risks the commentator running the accusation of being a Calvinistic kill-joy. The stereotypical image of a drunk Scotsman (or woman) much beloved by comedy-writers of the 70s and 80s may no longer be the central image of the Scottish persona but our close association with alcohol remains a popular aspect of our international reputation and seems to be a badge of character held with pride by some.

The See Beyond, See the Lives campaign which was launched in Scotland some weeks ago is much to be praised. It seeks to tell the story of the impact of drug and alcohol on ordinary lives. Like it or not there still remains a painful stigma around alcohol and drug deaths in Scotland and the collective silence that results from that prevents us from having a proper, open and honest discussion about alcohol and drugs. Those who have taken part in the campaign are much to be applauded, as it focusses on getting people to write letters to those loved ones who have died. Two of those who have taken part are the two MSPs Miles Briggs and Monica Lennon who have written letters to their late fathers. They both tell their first-hand experiences as the children of fathers who drank.

In 2021 there were 1245 alcohol-specific deaths in Scotland. These deaths leave families torn apart, relationships ended and lives and hopes empty. They and the thousands upon thousands before them were avoidable.

I have been around alcohol addiction for most of my personal and professional life. It has a power over people which at times appears to be inescapable as it pushes hope and warmth and love into the dark corners of living, as it turns gentleness into anger and calmness into chaos. It makes a child cower in the corner fearful of unpredictable wrath and brings hunger and emptiness where there could have been a house full of love and touch. It feeds on a culture amused by its impact on the one hand and yet incapable of talking about real harms on the other.

My hope this Alcohol Awareness Week is that we all of us start to talk a lot more about alcohol and its impact on our society, not least the growing alcohol dependency amongst our older population which in too many instances is going unnoticed and unrecognised.

As many of you know I love poetry and it has always fascinated me how few poems there are telling of the pain and distress brought about by alcohol addiction compared to those extolling the delights of drink. But one I came across some time ago really speaks of the harm of the booze though I would counter its lack of hope by saying that for some if not all there can be angels who attend unto the end. It is The Silence by the Pulitzer Prize winning American contemporary poet Philip Schultz

for RJ

You always called late and drunk,
your voice luxurious with pain,
I, tightly wrapped in dreaming,
listening as if to a ghost.

Tonight a friend called to say your body
was found in your apartment, where
it had lain for days. You’d lost your job,
stopped writing, saw nobody for weeks.
Your heart, he said. Drink had destroyed you.

We met in a college town, first teaching jobs,
poems flowing from a grief we enshrined
with myth and alcohol. I envied the way
women looked at you, a bear blunt with rage,
tearing through an ever-darkening wood.

Once we traded poems like photos of women
whose beauty tested God’s faith. ‘Read this one
about how friendship among the young can’t last,
it will rip your heart out of your chest!’

Once you called to say J was leaving,
the pain stuck in your throat like a razor blade.
A woman was calling me back to bed
so I said I’d call back. But I never did.

The deep forlorn smell of moss and pine
behind your stone house, you strumming
and singing Lorca, Vallejo, De Andrade,
as if each syllable tasted of blood,
as if you had all the time in the world. . .

You knew your angels loved you
but you also knew they would leave
someone they could not save.

Copyright © 2002 by Philip Schultz.

https://poets.org/poem/silence-0

Photo by Kajetan Sumila on Unsplash

Donald Macaskill

There are times when in the midst of all the flurry of publications, reports and essays something appears and often falls under the radar because there is so much happening at the same time. In a week where we have witnessed huge debates in the UK Parliament over a former Prime Minister, a launch of a new approach to independence from the Scottish Government and ongoing issues over health and social care, a couple of days ago the Scottish Government published a framework with a whole set of recommendations called: Discovering meaning, purpose and hope through person centred wellbeing and spiritual care: framework.

It might not be on the top of everybody’s weekend reading but might I suggest it should be. I need to be upfront and declare an interest because I had the privilege of chairing one of the small working groups who fed in ideas and views from the social care and health sectors into what the report contains. But I have honestly to say that it is a great read, its recommendations clear and concise, and it has the potential to really change and add maturity to the way in which people are supported both in social care and in health services – if we grant an adequacy of resource and priority to embedding its suggestions.

Now I fully accept that in the midst of a funding crisis, at a time when we are struggling to recruit and retain social care and indeed health care staff, when the burden of regulation and requirement is breaking the back of so many in our care and support leadership – that a report with a whole host of more things to do and implement might seem to be as welcome as a sunbed in the Sahara but I think that would be an unfortunate dismissal of a report which can indirectly address some of our current system and workforce pressures.

But at the start of any discussion on spiritual care we have to address the issue of its definition and its relevance especially when so many people equate spiritual care directly and exclusively with religious faith and tradition. The report helpfully seeks to do both. The Ministerial introduction states:

‘Historically, spiritual care and religious care were one and the same, but that is no longer the case. Spiritual care is there to help all who need it, regardless of their personal faith, beliefs or life stance. Spiritual care doesn’t fit easily into traditional models of care and, at times, in our modern world some may struggle to see or understand the relevance of spiritual care in our health and social care system. Spiritual care supports people by acknowledging hopes and fears and building resilience to cope with challenging or changing circumstances. Spiritual care helps us to connect to deeply held values and beliefs which inform our life, our work and our relationships. It is in the context of such relationships that questions around change, identity, illness and loss can be explored. It enables carers and those cared for to walk together as companions, supporting each other when life is raw and painful, or our certainties are shaken. Such mutually beneficial and respectful relationships must be at the heart of our health and social care system, allowing individuals to be heard and valued.’   (page 4)

When I have myself written about why I believe spiritual care is of fundamental importance and why its receipt should be viewed as a human right, I have been very aware of the extent to which trying to define it can feel like trying to grab hold of a jelly on the one hand and that trying to sharply define and designate it feels like doing a disservice to its very essence. The report captures this well when it states:

‘We all have a part of us that seeks to discover meaning, purpose and hope in those aspects of our experience that matter most to us. This is often referred to as “spirituality”; informing our personal values and beliefs, and affirming that tears, laughter, pain, and joy are all part of the human experience.

It is recognised that the spiritual is a natural and integral dimension of what it means to be human. Within health and social care, it is widely accepted that questions of meaning, purpose, hope (or the lack of it), identity and relationships can become acute when wellbeing and stability are challenged or threatened by illness, injury, or loss in oneself or in a loved one. At such times people often need spiritual care.’ (page 5)

We are all of us more than the raw bones and sinew, the flesh and mechanics of our human body and frame. Spirituality has to do with the heart and pulse of being human. It is the soundless language which communicates our deepest emotions of love, anger, fear and belonging. It is the rhythm which gives form to many of our innermost thoughts and feelings. It is the space where we rest in the awareness of meaning beyond comprehension and experience beyond description. To offer spiritual care is to give opportunity, time and place to enable an individual to explore and to express who they are as a human individual. It is at the hard times and moments, the transitions of living and loving that spiritual care finds sharper relevance and poignancy but I would suggest it has relevance in all moments when care and support is exchanged.

A set of Expert Working Groups on key topics within spiritual care was established by Scottish Government and through their work the Report makes specific recommendations developed around four key areas of focus:

• A skilled and compassionate workforce
• The development of spiritual care in community and social care settings
• Data collection and evidence base
• A professional specialist workforce.

I am not going to rehearse all of the recommendations here, but I am delighted that there is such a clear focus and emphasis upon social care within the report.  Historically spiritual care was mainly centred upon and delivered in acute and secondary care settings. As a past occurrence that is understandable but is no longer defensible as we increasingly recognise and live with the inter-reality of health and social care in our personal and professional lives. Spiritual care has to speak to the delivery of clinical care in the community as well as to social and primary care delivery.

However, this re-orientation of emphasis and focus should not be at the expense of the generations of work undertaken in hospitals but rather spiritual care in the community and in social care should seek to build upon that expertise and knowledge.

The first recommendation of the framework puts it as plainly as is possible:

‘Recommendation 1: Health and social care providers should ensure that spiritual aspects of care are assessed, recorded and regularly reviewed within care plans in all health and care settings and services.’  (page 10)

Spiritual care is not an added extra, something to be thought of when all else is ticked off, but rather it is intrinsic to holistic care and support because it addresses the whole person.

The report describes the implications of what this widening of scope and focus means for our social care system from commissioning, workforce development and capacity through to regulatory oversight and inspection. It has many recommendations, but they will only take flight and have any impact if they are owned and championed by the leaders and professionals working in our social care sector and understood by the citizens who receive care and support as their right and obligation.

That may take some time, but it starts with an honest conversation that challenges stereotypes and builds an appreciation of the unique and irreplaceable contribution of spiritual care within the delivery of all care and support. It will involve discovering whether the tools and techniques being used in spiritual care from Community Chaplaincy Listening to Values Based Reflective Practice speak to a different context such as care homes or homecare and housing support services. It will necessitate an investment not just in changing induction programmes and developing training resources but sitting down with the women and men who deliver the diverse range of social care supports and care and discovering what works for them and what makes the translation from recommendation into implementation a reality. Critically it will require commissioners and funders at times of straitened economic pressure to appreciate that spiritual care is not a marginal priority but intrinsic to modern rights-based, person-led, social care and support. Lastly and perhaps most critically for the workforce it will require frontline staff to be supported to be open to the discovery that spiritual care is something which can add benefit and value to their own wellbeing as well as to their art of caring for others.

I strongly encourage you to read the report and its recommendations. If it succeeds as I feel, it will put Scotland at the forefront of this work, but it will also achieve what it states, namely to ensure that it firmly establishes the role of spiritual care as an integral part of health and social care provision.

A few weeks ago, I went to visit the National Trust of Scotland property, the Weaver’s Cottage in Kilbarchan, Renfrewshire. It was truly fascinating and was an eye opener into both the significance and role of weaving in the Scottish economy both traditionally and still today. I found the weaving looms intriguing as they conjured up for me the memories of childhood when I can remember seeing smaller versions of traditional looms in the islands.

Weaving can be used as a metaphor for many things but as I read this report and reflected upon it the image of the weaving looms, I saw a few weeks ago came to mind. Someone who supports another through the art of delivering spiritual care takes the threads of living and loving, the fractures of memory and regret, the colours of joy and tear, into their hand and helps the person being supported blend them together into the rich and unique fabric of individual living. That might have an added poignancy in a life that is nearing its end, but it has value at all times.

Spiritual care if delivered well helps to integrate all the aspects of our identity into a unity of character and personhood; it leaves space for our growth and the discovery of new patterns and ways of being who we are both for ourselves and others. But having visited Kilbarchan I know how much hard work is involved in the art of weaving. If we are as individuals and as a society in Scotland to discover meaning, purpose and hope through person centred health and social care in all settings and places then the recommendations in this framework report can only be the start of all the hard, collective and shared work required to weave a cloth whose pattern is even today being created in the lives of those supported and cared for across Scotland.

Donald Macaskill