‘We don’t talk about Bruno’ from the amazingly successful Encanto children’s animation has dominated my personal airways for months – like all ‘earworms’ I have found it impossible to stop humming or silently singing it.

It was a song that I’ve kept thinking about in the last week. My week started with a train journey to Aberdeen in early Monday morning. Because of the impending rail strike the carriages were deserted and there was just a smattering of folks in the carriages, some with masks and some without. I was in Aberdeen both to visit the exciting collaborative work being undertaken by Scottish Care colleagues and members alongside the local HSCP, not least their care technologist work, but also to attend the annual NHS Scotland conference where I took part in a couple of sessions on the Wednesday. At the conference the vast majority of the several hundred delegates were unmasked and after years of not seeing folks social distancing was most certainly not in evidence! It felt natural and normal but if I’m truthful I also had an undercurrent of anxiety and caution.

The primary reason for my caution was the emails and messages, the calls and conversations I was getting from social care providers including hearing about our weekly member surgery. They were telling me a very different story, presenting voices of concern rather than celebration. It was a hard story to hear.

It was a story of growing numbers of staff being off with Covid, of organisations especially homecare ones struggling to cover shifts because of staff shortages and long-term absence from conditions such as fatigue, depression, burnout and traumatic grieving; it was the story of the impossibility of recruitment with one provider recounting that 22 people were called to interview for a homecare post and only 3 turned up and that out of 12 organisations delivering homecare and housing support all of them had lost over a dozen staff in the previous few weeks because of the cost of living and fuel crisis. It was a story of growing anxiety that folks were not able to go on their summer holidays because they felt the need to cover shifts, in particular managers were saying their staffing crisis was now as bad as it had been at the peak of the Omicron wave a few weeks ago.

Now I am not naive – I know that the nature of a pandemic is of peaks and troughs – but at the moment it feels we are in a very challenging place and at a time when the social care sector is already stretched and exceptionally fragile.

The data published by Public Health Scotland on Wednesday underlined what I think is a change in the Covid story which we would do well to pay attention to. Last Wednesday there were 2,200 cases in the week to the 22nd compared to 1,181 positive cases a fortnight before which is a 30.5% increase on the previous 7-day period. Again, the numbers are likely to reflect a substantial under-recording and reporting. From what I hear many people are not testing, going to work or activities with what may be a common cold, hay fever but could equally be Covid19. The number of Covid re-infections stood at 15.5% compared to the 12.5% previous fortnight. There are now 948 people with Covid in hospital compared to 637 a fortnight ago – again another significant increase. There were 17 people in ICU which is more than double the 8 people a fortnight before.

In the week to Thursday 23rd June there were a total of 41 Covid19 deaths compared to 20 people the previous fortnight.

Again, there is evidence of an increase in the number of deaths in the Care Inspectorate data when for the week to the 21st June there were sadly 12 deaths including from suspected Covid compared to only one a fortnight before. Outbreaks have also risen sharply with a total of 131 in the week to the 21st June compared to 61 homes in outbreak a fortnight before.

This data should not be ignored. I really hope it is a blip and a result of activities such as the Jubilee long weekend but if it is not, I feel we need to start considering how do we respond.

Amid all this I am sure I am not alone in having a sense of conflicting and sometimes contradictory voices and thoughts in my head.

I hear the voices that say that this is a mild virus, that it is just a cold and that we need to learn to live with it. But tell that to those hospitalised or who have a really bad response, despite being vaccinated.

I hear the voices – and not least in a powerful workshop at the NHS conference – of the impacts of Long Covid – now affecting at least 155,000 people in Scotland according to a recent ONS estimate but which campaigners argue is much much more. These are lives limited, changed, altered, and diminished by what others describe as a ‘cold’ or ‘just like the flu.’  And we do not even know the impact of the new strains in terms of Long Covid risk or likelihood.

I hear the voices that say that vaccination has changed everything, and people just need to get protected. They are right – imagine a world without the protection of vaccination – but we know with distance of time that protection is waning and lots of us are not as protected as we once were.

I hear the voices arguing that we can never go back into restrictive lockdown, and I agree as long as vaccination protects the majority that we need to find other measures to ensure those most vulnerable are safe from harm, that their rights are upheld and that their independence, citizenship and contribution remains valued.

I hear the voices that express anxiety that they will be shut out from care homes. I am very aware a tweet I put out about growing Covid numbers in the community and its impact on staffing levels together with a suggestion of the need for more restrictions was interpreted as a request to return to care home restrictions. For that anxiety I apologise but agree we can NEVER lock people out of our care homes again. That is what Anne’s Law now part of the newly published National Care Service Bill is going to make sure alongside existing protections. No one I know wants to go back but rather think about how we can better involve and empower families. Care homes are amongst the safest places now – we have enough protection – the fear is the loss of staff as the virus gains ground in the communities in which they live.

I hear the voices that say that ‘life has to be more than existence’ and I agree that we need to bestow much more autonomy onto people to balance the harms in their life – protection from the virus against personal restriction; the emotional and psychological trauma of isolation and separation against being together with others even if there is a risk in that belonging.

I hear the voices of those who say they cannot cope with the psychological harm caused by measures which restrict their freedom and choice; that they are not prepared to be directed and told anymore.

But this last week in at least two meetings I heard the voices and was moved almost to tears by the stories of isolation and a sense of forgottenness, of felt abandonment and lack of priority that so many with long-term conditions, that so many informal and family carers are feeling at the current time. The newspaper piece by Dr Sally Witcher this last week was a powerful description of that sense of marginalisation and felt discrimination.

It has been a week of lots of voices, lots of conflict and lots of contradiction. By the end of the week as I travelled to meetings yesterday on the train, I had my FFP2 mask back on and I’ve started to test again.

But it is also a week where we saw the publication of the Bill to create The National Care Service. There is a lot to read and its emphasis on co-design and collaborative involvement is good but as with all things the proof will be in the consumption. But to be truthful it’s hard to get overly excited about a future prospect when the present reality is so precarious. I’ll reserve for another time further comment on the NCS but right now as I have described it before it feels like we are enduring a perfect storm – rising Covid cases, a unique recruitment and retention crisis, an energy and fuel cost nightmare, a cost of living breakdown and an inflation rate of 9.1%, together with staff fatigue and breakdown and so on.

There are some levers of influence and change beyond our grasping but why for instance has Scottish Government decided that next Friday they will stop paying social care providers and others sustainability payments for critical tools necessary to ensure infection prevention and the enhanced use of PPE? A fuller statement details our concerns. Timing is everything and during growing Covid community cases, a very fragile sector, and a depleted workforce this is one piece of timing in which is a huge and dangerous miscalculation.

I would dearly love to believe that Covid19 is over, that its threat has so diminished that concern is misplaced and that anxiety is unnecessary and inappropriate – but simply failing to face up to emerging challenge, to address these and to prepare for autumn and winter resurgence, will not result in safety. Pretending threat is not there because you want to get on with other priorities and address other issues and challenges is naïve and dangerous. Simply not talking about Covid will not stop it still impacting on our lives. We cannot stop talking about (and addressing) Covid even if we can about Bruno!

Donald Macaskill

I was fortunate to be able to attend a conference held by the organisation Migration Policy Scotland this past week. Migration Policy Scotland is a relatively new organisation, founded by Dr Sarah Kyambi and it seeks to

‘work to improve immigration systems and enhance migration experiences through research, policy influence and inclusive engagement… [and] aim to offer principled and effective solutions to the challenges that migration may pose, while actively championing the benefits it brings.’

I was the last speaker at the event which was focussing on the experience of the changes to the immigration system over the last eighteen months or so. Being last allowed me to have the opportunity to listen to other contributors share what was happening in their sectors. It was a less than positive story with farming facing the reality of lower supply of fruit and vegetables because migrant workers were simply not opting to come or return and so there was simply no point in putting things in the ground to grow and not be picked; with hospitality and tourism taking a massive impact running at around 40,000 vacancies in Scotland meaning 60% of hotels were understaffed; with hearing that whisky is being blended in France, that salmon is being cured in Spain and so on. There seem to be critical shortages across so many sectors in the Scottish economy.

With regard to social care the Christmas Eve 2021 announcement from the Home Office which offered visa options and reduced salary thresholds amongst other measures certainly led to a period of increased activity as organisations started to begin the process of international recruitment. The thorough and fair report of the Migration Advisory Council on social care is to be commended for the progress it sought to make. But the whole process of recruiting internationally is fraught with cost, bureaucracy and burden and for small often family run SMEs working in the care sector it is well-nigh to impossible to initiate never mind to consistently implement.

By the end of the event, I was left more convinced than ever before that what we need for Scotland and with a degree of urgency is a radical redesign of immigration policy which takes account of our unique and distinctive demography. As I stated at the event what we have now is an immigration system which is demographically delusional rather than demographically realistic.

Scotland is an ageing society and has a declining population. Sadly, as we age and live longer we are not doing so healthily and that brings a personal and societal cost to it. In addition, our population which is still active and working is older and inevitably less productive as a result of health, fitness and energy. We have also seen as a result of Covid19 an increase in the number of those described as ‘inactive’ in the labour market – that is those of working age who have either retired early or chosen not to work. As someone else has said people are thinking of the ‘life-work’ balance not the ‘work-life balance’ and deciding that doing less work is the way to achieve that.

Therefore, by simple arithmetical calculation we bluntly do not have enough people to do the jobs we need filled in order to function as a modern society.

It would appear that all that Brexit has done is to stop ‘free movement’ from Europe leading to a loss of thousands who went home never to return, and our new immigration system has broadly flipped the coin so that we are now attracting 10s of 1000s of more people coming to the UK to work from non-EU countries, primarily India. Nothing wrong with that though I suspect not what many pro-Brexiteers anticipated! We have not seen in other words anything other than a marginal difference in overall immigration numbers. More worrying still is that a huge percentage of those who do manage to get to the UK are caught in the metropolitan bubble which is London and there is a real lack of folks coming north to Scotland and elsewhere.

All of this and especially the urgent need to plug employment gaps means we need a mature migration policy not one reactive to some very xenophobic motivations. Scotland has always welcomed and cherished new Scots, and as a small nation we desperately need that influx of youth and imagination to ensure we not only sustain ourselves as a society but that we positively thrive and flourish. If we do not do something about this and relatively soon, we simply will not have enough people to care for our population as we age and that for me is not the sign of a civilised society. And just in case you are sitting there thinking we will get robots and computers to ensure longevity and care. Undeniably technology will aid us in the months and years to come as it already is, but care in essence will always remain a human task and exchange and I for one do not want a robot wiping away my tear or soothing my fear as I spend my last days and moments in life.

I am fully aware that many societies are facing the workforce crisis in care and health that we are experiencing in Scotland. I am equally aware that in the long-term migration cannot be the only response to these issues. Increasing the valuing of the role of care, recognising the centrality of its societal contribution by proper reward and remuneration, addressing gender segregation which perceives care as ‘a woman’s role’ – all these and more are critical responses but so too is a mature migration system fit for the demographic reality Scotland is experiencing.

Sadly, all the talk this last week about immigration has been dominated by an ethically empty policy using planes to remove our obligations to another place. Whilst only 7% of migrants in Scotland are refugees or asylum seekers, and a couple of days before UN World Refugee Day, I cannot help but think that the toxic negativity to those who come to our shores has helped to consolidate the failure of the UK Government to take the necessary steps to make real change happen. Social care across Scotland, like so many other sectors, urgently needs an innovative re-design of migration policy that starts from a base of human dignity and ends in a place of appropriate welcome and acceptance and with a system which is manageable, accessible and affordable for all.

Donald Macaskill

In what some folks have suggested as the result of both a disorganised mind and lack of focus I recently attended the Scottish Care conference and awards having forgotten to take my wallet. The sense of fiscal nakedness was both fearful and freeing. I discovered after 48 hours that I actually didn’t need cash or even a card. Now lest you suspect that I have delusions of being a cashless royal or a serial borrower from colleagues – I discovered that I was able to exist without either a card or cash. As long as I had my phone I could travel on the trains with downloaded tickets; and through Apple Pay was able to pay for everything I needed. It was a strange experience but one which clearly a whole generation are getting used to and comfortable with – but not all.

The shift to a cashless society is a particular challenge for older people and exposes them both to the heightened risks of exclusion and financial abuse. A RSA report in March suggests that as many as 10 million people in the UK are being left to struggle with their finances as we drift to cashlessness. ‘The Cash Census: Britains’s relationship with cash and digital payments’ indicates that 48% of the population say that a cashless society is personally problematic. The describe this group as ‘Cash dependents’  but there are other groups who they call ‘cashless sceptics’ with 12 million; ‘cashless keepers’ at 12 million; the ‘cashless occasionals’ at 9 million and finally the ‘cashless converts’ at 11 million.

Increased isolation, digital fraud and an inability to control finances and debt are cited in the report as points of concern. Undeniably Covid has resulted in a huge change in the use of cards and digital payments as too has been the loss of free to use cash machines.

All this is creating a world where those who are old are at very real risk of trying to survive in a cashless world but without the knowledge and skills, the confidence and assurance of knowing how to live in that world. I personally support the RSA call that legislation is necessary to ensure everyone has access to cash near to where they live. The report also argues that essential services such as council tax and utilities should not become entirely cashless.

All of this was in my mind when I had another brush with our digital world last week.

A few days after I had returned from London I got a text message from ‘NHS-UK’ and it read: ‘You have been near a person who contracted the new SARS-CoV-2. Please arrange a PCR kit now via: https://nhs-protect.care-uk-now.co.’ (I have altered the actual address.)

My first reaction was to think that I must have – with a sense of inevitability – picked up Covid again on the Tube, train or at a meeting. Then I began to think.

There is no NHS UK; there is no contact system operating now; how did they get my number because I hadn’t signed in anywhere. With caution I then went onto the website and saw a very believable homepage with links to other genuine NHS information. I was asked to input data and did so without revealing accurate information. To cut a long story short this was a sophisticated scam ostensibly to book a home delivered PCR and pay for the postage at 0.99 pence – by which time I would have put in bank details etc.

After further investigation I discovered this scam had been flagged as occurring across the UK.

My reason for mentioning all this is to illustrate just how easy it is to be convinced to do something which in essence is designed to scam or rip you off. Even with a degree of awareness and confidence as a citizen of our increasingly digital and cashless world I very nearly became the victim of a scam. The level of sophistication and ingenuity of those who would seek to hurt and harm us is scarily impressive.

Next Wednesday is World Elder Abuse Awareness Day (WEAAD) which since 2006 has been held on that day and is held under the auspices of the World Health Organization and the United Nations.

The purpose of WEAAD is to provide an opportunity for communities around the world to promote a better understanding of abuse and neglect of older persons by raising awareness of the cultural, social, economic and demographic processes affecting elder abuse and neglect.

According to the national elder abuse organisation Hourglass Scotland a 2020 poll showed there were over 225,000 older victims of abuse in Scotland. They also stated that:

• Only 10% of people in Scotland think of older adults (65+) when they think of victims of abuse. Nearly a quarter (24%) think of animals
• The Scottish public woefully underestimates the number of older people who experience abuse – not one person surveyed thought the number of UK victims reaches over 2.5m every year.
• Hansard recorded mentions of the abuse of older people 35 times in Parliament compared to 3603 mentions for domestic abuse, 746 mentions for child abuse and 915 mentions for fox hunting

The lack of societal appreciation of the reality of abuse and harm against older people, predominantly in their own home is shocking. Such lack of knowledge is a complicity in the harm too many women and men are experiencing in our communities. This is partly because the overwhelming number of those who hurt and harm our older citizens are people known to the person, even in terms of financial harm. The increased use of digital payments and cashlessness makes someone already at risk of harm even more at risk.

This coming Wednesday let us all think about whether or not someone known to us who is over 65 might be the victim of hurt, harm and abuse, and rather than crossing the road of indifference, let us stop and enquire, report and act. As we move into a new digital financial and cashless age let us all make sure safeguards are in place so that those already hidden do not become invisible, those already disadvantaged do not become forgotten, and those already victims do not suffer more.

Donald Macaskill

 

 

 

 

 

On Wednesday I chaired an open meeting for those interested in the role and value of day services for older people. During the virtual meeting I heard of some of the very real challenges facing services which in large part had stepped down during the pandemic and which have struggled to be re-introduced as things have improved. At that meeting Scottish Care has undertaken to do some more co-ordinated work on evidencing the benefit and the essential critical role of such services and we would hope to produce a short briefing paper in the near future.  In this blog I want to offer some personal reflections on why I think this Cinderella service needs to be more valued, appreciated and understood.

My first encounter with day services in a building-based sense was probably close to three decades ago. At that time, I came to the service where I was to spend a day with some very entrenched suppositions and stereotypes. The phrase ‘adult baby-sitting’ may have accurately described my views which were that these were places where people attended in order to be ‘looked after’ and ‘cared for’ in part to give their relatives and families a rest or respite. I could not have been more wrong. What I found through the doors was a place staffed by professional and skilled individuals and many volunteers which was a destination longed for and looked forward to by many of those who attended. It was a place where the conditions that individuals may have been living with were supported and in no small part alleviated. As one family member said to me, ‘By coming here John is able to meet friends, to socialise but much more importantly to be able through activities and stimulation to keep his brain going and to keep the dementia at bay.’ It was quite clear to me that far from places where people were placed to ‘rest and remain’ these day services were environments which allowed folks to live well, be fed well and nourished and which stretched and stimulated individuals.

I also became aware that in an era of acute loneliness and isolation that local community-based day centres offered an oasis of company, a place to be with others, to no longer be imprisoned by the crowding in of the four walls or to be controlled by the routine of the box in the corner.

That first encounter shattered my stereotypes and convinced me then as now that day services far from being incidental or marginal to social care provision, are essential services and supports that enable people to remain healthy, mentally, and physically; connected to others and which enable independent living in the truest sense of contribution and choice.

I am not alone in such an analysis. After a three-year research project from 2014-17 researchers showed the very clear benefits of day services for attenders, family carers and those who volunteered in such environments. Indeed, the study argued that there was a massive untapped potential for such environments to foster better preventative care and support, to enhance independence still further and to as a result contribute to significant fiscal savings by preventing early use of more intensive social care and health care to say nothing for how much better people who used day care centres felt and how they assisted them to remain healthy.

The benefits of socialisation, of appropriate care, granting respite to family carers, neurological stimulation, enhancing nutrition and health by activity and diet are all evident in day services. One focus of many is the enhanced value given to physical activity in its various forms around which there is mounting evidence that such physical activity can aid the prevention of neurological decline, but also results in a decreased risk of fall, improves cognitive function, improves sleep, and aids coronary health.

Day services need to come out of the shadow and be recognised as a critical arm of enabling effective social care to allow older citizens to flourish. Commissioners of such care and those who assess individuals need both to recognise the essential and substantial benefits of such models of support and need to stop immediately reducing provision based on a lack of evidence and a failed understanding of both personal and fiscal benefit. As the researchers quoted earlier noted:

‘There is a need to look beyond the obvious costs when commissioning or reviewing day centre provision; centres offer added value beyond social inclusion, care, stimulating activities and respite. Commissioning without fully understanding their outcomes contravenes evidence-based commissioning principles by relying on individual knowledge which may be based on assumptions or experience of different client groups.’

On the eve of Carers Week, I recall one of the earliest conversations I had with someone whose wife used a day service for older people. He said that the time and space allowed his wife to breathe, to be with friends and acquaintances, to be away from him in a manner which kept their loving alive and their togetherness solid. He also said that as a carer it allowed him to take a break and if he chose either to be with others or do his own thing – and to do so without guilt but in the knowledge she was supported, understood and well cared for. It kept him going in the love of care. She, meanwhile, said much the same. She felt that the environment of the centre allowed her to breathe and do and be who she wanted to be rather than be the object or subject of care and support.

I am deeply concerned at hearing this week of the threats to existing day care provision and am convinced that all must be done to ensure these essential services not only remain but flourish, thrive and develop. They are an untapped potential which can benefit so many more than they already do. Such breathing places deserve to be given the opportunity to enrich the lives of those who need them and not to be continually struggling for the breath of their own survival.

Donald Macaskill