I’ve written before in this blog about the fact that English was not my first language and that in my early days at school I struggled with language and in part as a result lacked confidence both in the use of English and as a result in some of the subjects I was taught in early primary. I always felt that I wanted to finish every sentence with a verb or adverb just as in Gaelic!

That lack of confidence began to change because of the inspiration of one or two individual teachers not least those who showed me that the world didn’t have to be boundaried by the tightness and restriction of prose, by the starchiness and structure I then felt it imposed, but that there was a dimension of the imagination and a world of possibility which was the realm of poetry. From very early on poetry became my love, energy and inspiration. It has thankfully remained so for most of my life since.

On Monday we will be celebrating World Poetry Day. It is 21 years since it was established by the United Nations Educational, Scientific, and Cultural Organization (UNESCO) in 1999. Two days later- the 23^rd March will be the second anniversary of the Prime Minister’s speech which that evening put the nation into lockdown as we confronted the unknown fear and anxiety of a novel coronavirus for which we had no vaccine and about which we had in relative terms little knowledge.

I remember that evening well, and after all the organisation and calls, all the emails and bits of work I had to do, as I would on quite a few evenings after and still do, I took myself away and sat in a quiet room with a book of poetry. Poetry became for me both an escape, a consolation, a comfort and a challenge. I know I have not been the only one who has discovered or re-discovered a love of poetry during the period of the pandemic, and no doubt as I reflect in a moment of peace on Wednesday the events of the last two years, I will again do so with the words of one or more poets in my head.

I’ve often sat down and wondered why it is that poetry matters so much to me. Undeniably it is in part tied up with the discovery as a primary school child that in poetry that words and language were malleable and playful, that you could use and do with them as you wanted and wished, and that rules could be broken without meaning being lost. Poems were a form that offered freedom and possibility. But there was more. Probably it is poetry’s ability to describe intense emotions which is what rooted the genre in my soul and psyche. I think it is poetry’s ability to paint truth and insight in word and rhythm that for me is the very essence of poetry, and I think that’s why I still believe it has something to still teach me today not only about the pandemic but about how I need to live in the days and years ahead.

It is generally acknowledged that the first poems appeared in ancient Babylon some 4,000 years ago in the “Epic of Gilgamesh” which coincidentally I would later study at university. But in all likelihood probably from the moment someone used sound to structure sense, words to offer dream and meaning, poetry has been in existence both orally and in written form. The genre is so diverse from Shakespearean sonnets to free verse, from haiku to rap, from song lyrics to limericks. Poets have found a way to tell something of the story of their times, of their communities and society. Poetry has stretched our imagining into new visions, has helped to express the depths of pain and loss and has soared the heights of love, desire and passion. There is quite literally a poem for every emotion and feeling, every season and moment under the sun.

One of the reasons it appeals is that for me poetry is inherently rhythmic and musical, it is dynamic and energetic. I need to either hear a poem spoken aloud or hear it inside my head because it has an energy that struggles to free itself from the confines of a page into the air of my imagination. Whether it is an Angela Gorman, or a Benjamin Zephaniah or my all-time favourite Maya Angelou – poetry can become a performance which is an art in its own right; an experience separate from the words you take inside yourself. A good poem takes me on a journey whose destination is unknown but whose companionship is assured and confident.

I know I was lucky. Unlike so many children who have been put off poetry by the way it was taught – I was the opposite – I was inspired because as luck would have it I had teachers who brought poets to school, to inspire, encourage and enliven bored school children. I think every school should have a poet, whether in residence or not! Poetry helps to improve the ability of children to express emotions that might be locked in and imprisoned deep inside them, to find new rhythms and meaning, new insights and freedoms. It certainly did for me.

Poetry allowed me during the pandemic to see the world through different eyes, to see possibility rather than just pain; to find words to express my fear and my deepest sense of loss and sadness. I could never have found the energy which has kept me going were it not for the fact that someone before me, alongside me, has done that job for me and has gifted their insights through their poetry to make life better and richer.

Years ago when I was visiting a care home where someone I knew was a resident I came across Jean who I later discovered was a retired English teacher. She was living with what I would now recognise as advanced dementia. She had lost all memory of family and loved ones, had forgotten basic things and the knowledge of what actions to take in particular circumstances. To all intents and purposes, she required the most basic level of personal care and support. But… Jean continually and assuredly recited poetry to anyone who would listen. And I did. And from those lips tired of speech, having lost recognition of love, came tumbling words in rhythm and beauty, consistent in memory and recall. She was a marvel – when everything else had left her, her comfort were the words of the legion of poets she had gathered into her heart over decades. For me in that moment the sheer power of poetry to own and occupy our hearts was made visible.

On the night of the 23^rd March 2020 I read words of one of my favourites, the Irish poet Derek Mahon, whose work I have shared here before. It was a night of anxiety and the unknown was palpable, and the words of two others came to my mind. The first was a very ancient piece from the medieval mystic Julian of Norwich who wrote in the face of both danger and challenge, ‘And all will be well”, “all manner of things shall be well”; the second the words of Bob Marley. I grew up with the music of Marley ringing in my ears every time I fell asleep such was my late brother’s fascination with him. Indeed, my brother’s gravestone has inscribed on it the words, “Don’t worry about a thing’ Cause every little thing gonna be all right.’

I turned to the poetry of Derek Mahon. Frequently challenging and uncomfortable and as I read it at different points during the pandemic it seemed at times almost cold and then at other moments reassuring – but that is a mark of great poetry it speaks differently at diverse times and in distinct circumstances.

Poetry does not have all the answers it just provides us with the silence to make sense of the sounds and the sounds to make sense of the silence. It takes us further along the road and it is usually a journey worth taking.

Everything is Going to be All Right

“How should I not be glad to contemplate

the clouds clearing beyond the dormer window

and a high tide reflected on the ceiling?

 

There will be dying, there will be dying,

but there is no need to go into that.

 

The poems flow from the hand unbidden

and the hidden source is the watchful heart.

 

The sun rises in spite of everything

and the far cities are beautiful and bright.

 

I lie here in a riot of sunlight

watching the day break and the clouds flying.

 

Everything is going to be all right.”

 

Derek Mahon, from Selected Poems

Poetry Corner – Derek Mahon ‘Everything is Going to be All Right’ – Infinite Harmony

 

Donald Macaskill

Along with many others I signed a letter this last Thursday which was sent to the UK Prime Minister and the United Kingdom Government. Key organisations working with and for older people throughout the UK came together to call on the Prime Minister to take further action to support older people in the Ukraine, and those seeking refuge in other countries, and to ensure that our response to the escalating humanitarian crisis takes account of the specific impacts and challenges older people will face.

As we have witnessed the increasingly distressing images of war from Ukraine many of us have felt helpless as we have heard the stories of children, young people and women, to say nothing of the men staying behind to fight and defend. A voice rarely covered in the stories has been that of older people and those with conditions which limit their ability to flee and escape easily.

The joint letter sets out the action required, highlighting that many older people in Ukraine will be trapped and isolated in their homes, with limited support available from families, friends and neighbours, as they will be unable to make the treacherous journey towards safety due to limited mobility or ill-health. As well as expressing real concerns over food, water, and other supplies, we have also called in the letter for the removal of visa restrictions to ensure that more older people are able to find safety and sanctuary in the UK. This includes a call to:

• Use all possible avenues to ensure that humanitarian access is given to all civilians in Ukraine, including older people.
• Ensure that explicit attention is given to the needs and rights of older people in Ukraine and surrounding countries in preparing and implementing the humanitarian response with other national governments and international organisations.
• Ensure older people in Ukraine or those seeking refuge in neighbouring countries have access to appropriate medical supplies, medication and mobility aids through donations, funding or the sharing of technical expertise.
• Remove the visa requirements on Ukrainians fleeing the war to ensure that older people without relatives in the UK are able to seek refuge here.
• Consider the needs and rights of older Ukrainians who are seeking refuge in the United Kingdom and what support they may need upon arrival.
• Continue to provide support to charities involved in the humanitarian response including HelpAge International and Age International to ensure that they and their partners can provide the crucial support that older people in Ukraine desperately need.

Can I also draw attention to the amazing work of Age International who have set up a dedicated fund to support older people in Ukraine. Please consider giving a donation and you can get more information at https://www.ageinternational.org.uk/donation/ukraine-appeal/#step1

A colleague wrote to me yesterday to highlight that the national flower of Ukraine is the sunflower which has become a sign and symbol of hope amidst the trauma. In a lovely gesture his Edinburgh company Home Instead are giving sunflower seeds to people to plant hope into the hard ground, and also giving a donation on their behalf to  Age International.

I have often said in this blog and elsewhere that the mark of any civilised society is the way in which those without voice are heard, that we witness equality of treatment and response regardless of age, and that we recognise the particular and especial needs of those who are frail, elderly, and old.

Those sentiments are very much in my mind as this weekend we mark several anniversaries of the Covid19 pandemic.

Two years ago the World Health Organisation (WHO) officially declared COVID a pandemic and in that time an estimated 6 million plus people worldwide have died from COVID-19, while nearly 448 million cases have been recorded. The vast majority of those who died were older individuals but more positively it is estimated that almost half a million people aged 60 plus were saved due to vaccines against COVID-19.

Today also marks the two-year anniversary that many care homes went into voluntary lockdown in Scotland in response to the pandemic and evidence from Europe and tomorrow (13^th) two years ago saw the publication of Scottish Government Guidance on managing the coronavirus in care homes and other settings.

A lot of hurt and pain, sadness and regret has happened since. Too many lives have been lost and to many memories have not been shared. Too many people have spent their last days in hospital or care, both from Covid and other conditions, without the presence of those they love beside them. The public inquiries – including the UK one whose terms of reference have been published this past week – will, I hope, give space and opportunity for people to tell their story and share their experience as well as to hear an account of clinical, political and system response during the last two years. But for so many the pandemic even on this two year anniversary is far from over.

In the last week right across the United Kingdom we have seen a rise in cases of Covid, a rise in hospital and ICU admission, a rise in the number of care home staff and residents who are contracting the virus and sadly a rise in the number of care home residents dying from the virus. These are hard times.

On the one hand we want all of us to nurture the restoration of normality not least in terms of care home visiting and access to families recognising the huge damage that has been done by disproportionate exclusions, by limiting the quality of life of residents in such drastic ways, but on the other there is a growing fear about what the virus will do in the next few weeks and months. Will it ‘burn itself out’, will there be diminishing impact, or will there be increasing numbers of cases, more lockdowns, more damaging isolation periods insensitive to the particular needs of residents, families and staff? Will there be a new wave and if so, will it as some argue be less of a threat or will we see a strain developing which escapes the protections we have. This last week we have seen the start of a fourth vaccination round which most would agree is very necessary as increasingly those admitted to hospital are older people whose immunity and protection is depleting following their 3^rd vaccination some months ago.

I do not have black and white and hard answers to most of these questions and suppositions, but as we approach the second anniversary of so much pain, I am very aware that we need collectively to not just learn the lessons of the past but to make sure that those lessons alter our actions into the future.

No more lockdowns in the name of infection, prevention, and control, which are disproportionate, insensitive to the trauma which isolation causes, and blunt in its use as an instrument of protection.

Let us re-define what we mean by an ‘outbreak’ so that living with the virus means that we will not constantly see the cycle of infection leading to perpetual exclusion and isolation.

Let us remove the use of masks to all but a minimum of high-risk situations.

Let us use testing in the short term as a safeguard and be prepared both to increase but also critically to decrease its use.

Let us urgently get Public Health advice which is reflective of reduced risk rather than which continues to increase the risk of individual harm. We need infection prevention control approaches which embed human rights and person-led care and support.

Let us find a collaborative way of working together, families and advocates, residents and staff, managers and providers, clinicians, and public health, so that in community and care home, we take control over from national ‘guidance’ and instruction and enable local decision-making.

Let us get real about what we mean by public assurance and stop victimising care home professionals by using disproportionate scrutiny and fallacious ‘support’; let social care take back the ground of compassion stripped from it by others in the name of oversight and regulatory expertise.

Let us restore the trust in the professionalism and skill, the compassion and care of frontline nurses and staff, rather than denude their integrity even further by spurious politicised interventions.

Let us begin to value the story and life of every resident and let care homes start to be homes again and avoid the creeping clinicalisation of places which have the very real potential of bringing life to fulness.

Let us find our way back to hope and celebration, to community and integrity.

Let us plant a sunflower of hope to shatter the dismay and hurt, and to bring forth healing and togetherness.

As we stand on the edge of the third year of living with Covid let our future be markedly differ from our past. Whether in the Ukraine or in our own communities, let us stand in solidarity with older age, rather than the pretence of care and support whilst in truthful reality we walk by on the other side.

Donald Macaskill

Tuesday sees the celebration of International Women’s Day, 8 March, 2022. This is an annual event which raises the profile of the experience of women and girls around the globe. The theme for 2022 is “Gender equality today for a sustainable tomorrow.”  Regular readers of this blog will know that I have written often about the strong female influences in my personal and professional life, so I want to spend a bit of time this week reflecting on some connected thoughts from those insights.

1.

It was as far back as 2017 that I appeared before the Scottish Parliament’s Economy, Jobs and Fair Work Committee and gave evidence relating to the Gender Pay Gap in Scotland. A few months later the Committee issued its thorough report ‘No Small Change’  which identified that gender segregation was a real phenomenon within the care sector in Scotland. Indeed, Scottish Care in its evidence to the Committee argued that there existed systemic gender discrimination in the way in which we treated the predominantly female social care workforce in Scotland. Sadly, some four or five years later despite all the rhetoric about reform and reconceptualising care services we are still faced with clear gender discrimination in the way in which we prioritise social care and its largely female workforce. I am more and more convinced that we will not address the dis-ease afflicting social care provision unless we call out the gender discrimination which is so characteristic of the way in which social care in general and its workforce in specific are treated sector. At the risk of personal repetition, I said five years ago that were this a workforce which was 86% male and not 86& female then we would not have had the travails of unequal pay nor the ludicrous terms and conditions which are deemed acceptable by contracts from local authorities. Indeed that latter point was forcefully and cogently articulated in the Fair Work in Scotland’s Social Care Sector Report in 2019. It stated:

‘The evidence suggests that the undervaluing of care work is, to a significant extent, linked to the predominance of women workers in the sector. 11 The view of the Social Care Working Group was that part of the failure to value social care comprehensively is due to its status as women’s work. Women face systematic labour market disadvantage, including occupational segregation, workplace discrimination and lack of flexible working. Institutionalised undervaluation is common in highly feminised jobs and occupations, contributing to the gender pay gap (of 15% in Scotland). Social care work is also less visible than other work, taking place in service user’s homes rather than workplaces, with implications for skills recognition and for collective organising.’ (page 14)

Calling out gender discrimination in social care requires us to continually underline the reality that gender segregation is a fact which requires attention. Part of the reason we fail to value social care as a whole is that it is still seen by and large as ‘woman’s work.’

2.

At the heart this gender segregation challenges our understanding of what care itself is and the value that we put on the art of care. In the last few years, we have seen the offensive articulation of a belief that care is ‘low skilled’ and I cannot help but believe that such an assessment is in part because of both the fact it is undertaken predominantly by women but also that care itself is deemed to be of lesser value and import to society than a technical set of skills or attributes. Such pervasive gender stereotyping must be challenged not just for what it says about the workforce but just as importantly for what it conveys about social care.

It will come as no surprise that for me social care and our ability to prioritise it and value is both the bedrock and heart of our society and should be valued because it evidences a priority which captures the essence of who we are as a society and as communities. But clearly despite the fact that social care is a massive economic contributor to the overall economy wider society still perceives it in negative terms, in language of cost, burden and deficit. Take for instance the much heralded launched of the Scottish Government’s National Strategy for Economic Transformation report ‘Delivering Economic Prosperity’ in the last week. Except for mentions of support for the Living Wage in Adult Social Care and a passing reference to technology in care, social care doesn’t merit a mention.  I am utterly dismayed that despite the travails of the last two years and the heightened awareness of the intrinsic and fundamental importance of social care that this document fails to prioritise social care and its workforce, businesses, and employers. Instead of a nation considering that part and parcel of economic prosperity is a prioritisation of a social care system and supports that potentially becomes the engine of that prosperity there is a complete failure to think radically and creatively with people at the heart. Gender bias and the pay gap are mentioned as is the need for radical childcare, but the contribution, entrepreneurship and creative potential of the largest female workforce (outside of the health sector) is ignored.

3.

But the systemic gender discrimination we witness isn’t just to be found in the way we treat our social care workforce, or fail to recognise its economic value and ingenuity, it has also been sadly the experience of our response to the global threat which has bene the pandemic.

As the United Nations in various reports in 2020 and 2021 has underlined the pandemic has highlighted the way in which as modern societies, we are so reliant upon women both in the frontline of care and health services but also at home.

But as the United Nations Women report on Covid19 states:

‘In times of crisis, when resources are strained and institutional capacity is limited, women and girls face disproportionate impacts with far reaching consequences that are only further amplified in contexts of fragility, conflict, and emergencies…

Despite these numbers [in health and care], women are often not reflected in national or global decision-making on the response to COVID-19. Further, women are still paid much less than their male counterparts and hold fewer leadership positions in the health sector. Masks and other protective equipment designed and sized for men leave women at greater risk of exposure. The needs of women frontline workers must be prioritized: This means ensuring that health care workers and caregivers have access to women-friendly personal protective equipment and menstrual hygiene products and are afforded flexible working arrangements to balance the burden of care.’

4.

Lastly any consideration of International Women’s Day and a reflection on social care has to also face the challenges posed by the unequal treatment of women in terms of their health and social care. It is not just the social care workforce which is predominantly female and the victim of gender discrimination it is also sadly the fact that the majority of those supported and cared for are also themselves women. It is estimated that in the United Kingdom that 61% of people with dementia are women and 39% are men. Accepting that this is in part because women live longer than men it is not that difficult to evidence discrimination behind the data. There is relatively little research focus on the specific genderised characteristics of the disease that may impact upon women. Indeed an earlier report by the Alzheimer’s Society rightly stated that women and dementia are the ‘marginalised majority.’ The fact that dementia is the major cause of death of women across the United Kingdom is a reality that few consider or talk about. I cannot be the only person who having marvelled at the unified scientific community which brought about such astonishing breakthroughs in the discovery of the Covid19 vaccine, has pondered what would happen if equal focus and priority was given to finding treatments and interventions for dementia. Is it too simple a leap to suggest that both age and gender discrimination has a contribution to such relative lack of fiscal priority?

International Women’s Day is an opportunity for us all to focus on the contribution and creativity of women in our communities; it should also be a call to address the systemic discrimination that treats women and girls less favourably and equally, whether in social care, economic opportunity or in disease management and research.

Donald Macaskill

I’ve often remarked in this blog that in the strange patterning of days some words seem to become prominent in the conversations of the moment. Perhaps the word of the past week and for such strange times is ‘freedom’.

Freedom, that most elusive of desires, an emotion and state unable to be grasped and held, always open to escape, always unsettling, rarely achieved. It carries with it connotations of being empowered, having the right to act, to speak, or think as one wants. We celebrate freedom of choice, the liberty to be autonomous, the right and privilege to not be shackled or imprisoned by another or indeed by ourselves. In literature and art we try to depict the freedom of birds that fly, of oceans that stretch out, of rivers that determine direction. Freedom so hard to describe but so precious when absent.

Our newspapers across the political and tabloid/broadsheet spectrum were trumpeting headlines this last week declaring ‘Freedom Day’ a day when restrictions will be removed or largely limited. All of this following the announcement by the First Minister that on March 21st, the mandatory wearing of face masks in all public places, including pubs, restaurants, and shops along with the one metre physical distancing rule and the legal requirement for businesses to keep customer contact details will be removed. She declared this “is possible only because widespread vaccination coverage and better treatments have reduced the direct harms of the virus.”

Whether or not the slow restoration of former practice can be defined as freedom is a moot point. Indeed, along with the removal of restrictions comes the advocacy for caution and concern, a call to take public and personal responsibility. This is to be manifested in individuals choosing voluntarily to wear masks in crowded or public places, to be ‘sensitive’ to those who may have particular risks and vulnerabilities, and to act responsibly should one become ill.  A call to good neighbourliness and social responsibility is to take the place of mandating, legislation and requirement.

For many fellow citizens the reverting to former practice will indeed feel like a sense of freedom, but for not a few the next few weeks and months remain uncertain and fearful and feel like the lessening or loss of freedom. The disability advocate Dr Sally Witcher (@SalWitcher) writing on Twitter this past week asks:

“ Why should we have [to] be at the mercy of other people’s selflessness & willingness to protect/look after us? We’re not objects of charity. We’re equal active citizens. We fought for years for equality & human rights as relying on people to do the right thing just doesn’t work.

Of course we all want to go back to ‘normal’. None more than me after 2 years indoors. That’s what I call a massive restriction! Compared to that wearing a mask, etc is no restriction at all. And if businesses installed air filtration there have to be business benefits.

So-called ‘restrictions’ are protections that enable everyone’s freedom, not freedom for some at the cost of loss of it for others. They keep everyone safe from long Covid, new variants, and still unknown long term clinical consequences of even mild illness.”

It certainly, does not feel like freedom for so many people who have needed the maximum degree of self-protection from this still pernicious and dangerous virus.

What will happen to social care staff in care homes and homecare remains at the time of writing at best uncertain. Take care homes as an example. We are still awaiting guidance from clinicians and Public Health Scotland as to what, if any mitigations and measures will be required into the future. It is likely there will be a degree of testing for staff and potentially visitors. But how this will be undertaken, by whom, and how it will be paid for given the UK Government’s statements to remove free access to tests (including in care homes) in the last week, seems uncertain.  What will be required about masks if anything?

But what is even more pressing is the need for clarity on the current restrictions being placed on care homes. We are still caught in the endless cycle of care home residents having to isolate should an outbreak be declared in a care home and many unable to engage in normal activity and relationships. Such periods of isolation can literally go on for weeks because no sooner does one period of 14 days end then another often seems to start creating a new ‘outbreak’ and often as a response to very few cases. As many of us have been arguing with and trying to convince clinical leaders – and to date unsuccessfully – such extended periods of isolation (even with a named visitor in place) are unacceptable, disproportionate, unnecessary, and hugely damaging.

When is freedom going to come for them and what will it look like? In a week which has seen a significant increase in the number of Covid cases affecting care home residents this virus shows no signs of going away. So what does living with the virus mean for these individuals – a perpetual state of isolation and confinement? What quality of life is that? Anecdotally many managers and staff are saying to me that the level of decline and deterioration of residents forced into such isolation is wholly unacceptable and is they are convinced a set of actions which shortens life and certainly precipitates significant cognitive decline. This is simply not justifiable on any grounds, epidemiological, clinical or moral, nor is it, in my opinion, at all proportionate or legitimate in a legal sense. We have declared freedom for the wider public and yet still have no open door to a better future for those who have suffered the most.

Sounds of freedom outside and the rush to throw off masks and restrictions for so many in our care homes ring hollow and empty in both rhetoric and reality.

But of course, freedom took and has taken on a wholly different level of meaning in the last few days as we have seen the horrific scenes from the Ukraine and the results of a despotic dictator wreak havoc across a modern, inclusive and open society. The fragility of civilisation has never been so vivid as I have watched fathers break down in tears leaving their children behind as they are conscripted into a fight against the enemy of their people; as I watched people cowering to shelter from attacks in underground stations; as bombs were seen to rip open the homes of the innocent and land on kindergartens; as tens of thousands started a journey as refugees seeking a border of peace and escape. As Europe is plunged into a darkness we have not seen for generations, we are all of us yearning for a return to peace. Freedom seems so far away for so many in the blood and tears of the Ukraine this morning.

All of us wherever we are and whoever we are seek that common gift of freedom knowing only too well that sometimes it comes at a very real price. So today with so many I will spend time thinking of the women, men and children of the Ukraine before all else because it is only in solidarity with those who are suffering that true freedom for ourself comes.

I leave you with the words of a poem:

freedom

the elusive one;

once caught always lost,

once lost always found,

where is she to be searched for?

when does she discover you?

 

they look for her in their books

and search for her in their stratagems;

by policy papers and wordy manifestos

they fail to imprison her laughter.

 

they seek her in empty corridors

echoing with the sounds of powerless dictators,

dined to bloating on their own importance

fed to obesity by a diet of propaganda.

 

they seek her in the warmth of missiles

and search for her amongst a bed of nuclear pillows

pulling back the blanket of macho security

to reveal the nakedness of fear.

 

they seek her in the words of hatred

where prejudice becomes the scapegoat’s friend

and bullying the national sport

of nations too ashamed of difference.

 

they seek her in your heart

where she lies dormant

emptied of enthusiasm,

lazy through lack of exercise

exhausted by inactivity.

 

freedom

the elusive one;

when will they learn

she is not a place but a sound

not a word but a whisper

not a weapon but a heart

not a prize but a gift.

 

When will they learn?

when freedom imprisons hate

and freezes out fear.

 

Donald Macaskill

Behind every policy and legislation there is often a passion and a movement; behind every change there is frequently a vision and an aspiration. The world of social care and social work in Scotland is no less than any other sector. We have plenty of aspiration and hope, expectation and possibility.

The creators of the seminal and ground-breaking Social Work Scotland (1968) Act were inspired by the realities of deprivation, harm and failure evidenced in the 1950s and 60s across a Scotland impoverished by the trauma of war and the failed priorities of consecutive Westminster administrations.

The disability civil rights movements of the 1960s through to the 1980s declared that all people regardless of disability had equal rights to belong, to be included, to be heard and to be valued. They inspired and influenced policies such as ‘The Same As You?’ (2000) which led many of us to be involved in the closure of our long stay hospitals. And with an adequately resourced Change Fund it enabled a process of people with disabilities beginning to be included in their communities not shut away from belonging; it gave voice to people so that they could articulate their story and their hope; it rooted in practice and policy a change in orientation which recognised that it was mainstream society that disabled individual contribution rather than the labels and conditions by which we imprisoned individuals in asylums.

The desire to have control and choice, to be able to take charge of your own social care support and care, to be freed from the presumption that the Nanny State knows best and delivers best, to be able to become the director of your own decisions, all  under the umbrella of the independent living movement was that which provided the energy and spark which brought about perhaps one of the most dramatic changes in social care legislation and policy in the form of the Social Care (Self-directed Support) Act in 2013. Being present at the Ministerial launch I recall the passion and hope, aspiration and creative possibilities of designing a better tomorrow from the recognition that things were broken.

So too the creation of what became known as a health and social care ‘integration’ policy enshrined in the somewhat dry and limiting Public Bodies (Joint Working) legislation in 2014 – was centred around the aspiration that there would be one continuous pathway from first point of contact with social work all the way through support and care whether in hospital, community or care home, all the way to the end of an individual’s life. The dream and vision was that a person should not have to tell their story to multiple people, should not have to undergo multiple assessments which detailed and described the same thing because data was not transferred, professionals did not communicate and systems did not speak. Integration was primarily and always motivated by a vision of the person, the citizen, at the centre having control and agency.

Then most recently we have had the huge amount of commitment and shared vision and desire which made the Independent Review of Adult Social Care – also known as the Feeley Report – into a document whose words came off the page and painted a picture of possibility for the future of social care delivery in Scotland. It is a document which attempted to live up to the vision of a new beginning rooted in the at times painful experience of the pandemic and before. It was a vision of human rights and choice, of person-led agency and support, of contracts and commissioning of services which were equitable and fair, of reward and recognition of care as a career of potential – and so much more. It was less concerned with the structure more interested in the soul, less about the model more focussed on the energy.

The landscape of social work and social care in Scotland is indeed rich in movements of change and in voices of challenge. There is enough in text and legislation to motivate and inspire. The problem has always been implementation – the challenge and the failures have always been our ability to drain the vision from the text, to limit the possibility which progressive legislation offers. The sin has been to be tempted to make the system and the model, the vested interests of power and traditional practice, the familiarity of the known and the predictable – into the gods of the moment.

Our ‘implementation gap’ as Feeley termed it, has been the pit down which many an initiative, so much creativity, and so many hopes and aspirations have fallen. It is a deep hole but not an accidental one and it can be filled in!

This last week in so many conversations I have heard voices of fear and anxiety being raised about what the future of social care supports and social work might look like in Scotland. I share those very genuine fears and concerns but knowing and naming them, calling them out and recognising the risks, is part of the way in which we can avoid failing to live up to the aspirations which so many have articulated and so many hold.

The most obvious fear and this is well represented in much of the feedback and analysis in the consultation to the National Care Service is that we become so obsessed with the structures and systems, with the models and processes, with the titles and power-bases of a creating a massive new system that we lose sight of the vision and the energy which is necessary to ground real change into felt reality.

The First Minister has on a number of occasions articulated her desire to bring from the hurt of the pandemic a change which will be worthy of that pain – the creation of a National Care Service. A noble aspiration but one which has risks of falling into that implementation hole well before the summit of promise is reached.

One of those risks, I believe, is that the energy that directs success has to be fed by a proper awareness of what social care is and is not. Social care is not health care – we certainly do not want a shadow of the National Health System – and any attempt to achieve that would be a crippling failure and a massive denial of the hopes of those who use, work and deliver social care services and supports. We have all of us to be aware of and defensive against the creeping medicalisation and clinicalisation of social care and social work delivery. Such is an anathema to individual choice, citizen control, personal agency and an approach which is about enabling participation not fostering dependency, nurturing citizenship not limiting contribution. Social care can never be the maidservant of a National Health Service. What we want are the principles of choice and individual control, of independence and real engagement and involvement, of participation and personal control to be at the heart of what grows out of the next few years.

The danger is that legislation can either strangle aspiration or even if well formed can falter at the point of implementation. Integration became a bun fight between two goliaths – the NHS and local authorities – with Health and Social Care Partnerships the emasculated body in the middle and with Chief Officers engaged in a constant referee match between vested fiscal interests and power dynamics. As someone who examined why integration did not work – a lot of the time – the system failed the people by failing to make hard decisions when they were needed and failing to bring order to chaos when it occurred. Instead of the dream of integration with the person at the centre of a continuous pathway of consistent support and care – we have shamefully disappointed the dream.

Even if we get the legislation right – as we certainly did in the Self-directed Support Act – again the gap of implementation where fiscal limits and austerity, where power bases in senior management at local level, led to an inevitable suffocating of promise and a marginalising of creativity. Even today I hear the ridiculous scenario where people talk about SDS on the one hand and social care assessment and provision on the other – there is and should only be one way of accessing social care and that is through self-directed support. There is no excuse – and for my area of interest especially for older people – of citizens being denied the choice, budgetary control, individual say over which provider you want – in any place in Scotland today. Yet the reality is that in so many places choice is based on what age you are, who you know, what party colour the local authority political leadership is, and how much of a battle the local HSCP has managed to wage against the Big Two. We have shamefully disappointed the dream.

The next few weeks and months will be critical for the formation of the National Care Service and the much wider hopes and dreams of the Feeley Review. The concerns and fears I am hearing are that we will focus so much on structure and process that we lose the passion and purpose. We will be so concerned on achieving the model that we will lose sight of the necessity to really involve and include, engage and engender the energy of the people who need to make that journey with us. There is a real fear that the necessary leadership with real world knowledge rather than acquired  awareness to achieve this change is simply not there either politically or operationally. Such leadership demands inclusivity and involvement, not partisanship and a failure to engage. There are too many whispers and behind the door conversations. Indeed, this is perhaps especially the case in the bringing together of health and social care – especially the providers of the latter – a reality that in the last calendar year has barely happened at all. Meaningful change is never achieved by siloed management.

There has always been an energy and movement in social care across Scotland. It is one at its best that has mirrored our humanity and hospitable concern for the other, to include and involve all, to be open to the challenge of the new and the creativity of the different. It is a social care world which has rooted equality and fairness, human rights and dignity at the heart of all that is delivered. It is also one which has authentically talked the talk and been real rather than fictional whether that be about fiscal reality or delivery challenge.

We are about to start a whole series of political debates on the creation of a National Care Service – in these I hope our leaders will listen, not to the rhetoric of political echo chambers, but to the people who use social care supports, the workers who deliver them, and the providers and employers who are the organisations by whose agency most social care support is enabled.

When all is said and done change is born out of a vision of betterment and of new possibility, of a new and better way of being and belonging, of caring and compassion. The current Poet Laureate Simon Armitage in his poem ‘A Vision’ warns of the possibilities of our visions landing in the landfill site of disappointment. But the way we prevent the architectural dreams of a changed world becoming the missed opportunity of our future, is to work hard; to involve all; to listen deeply; to learn openly and to create together rather than apart. The future of social care deserves no less.

 

A Vision

by Simon Armitage

The future was a beautiful place, once.

Remember the full-blown balsa-wood town

on public display in the Civic Hall.

The ring-bound sketches, artists’ impressions,

 

blueprints of smoked glass and tubular steel,

board-game suburbs, modes of transportation

like fairground rides or executive toys.

Cities like dreams, cantilevered by light.

 

And people like us at the bottle-bank

next to the cycle-path, or dog-walking

over tended strips of fuzzy-felt grass,

or model drivers, motoring home in

 

electric cars, or after the late show –

strolling the boulevard. They were the plans,

all underwritten in the neat left-hand

of architects – a true, legible script.

 

I pulled that future out of the north wind

at the landfill site, stamped with today’s date,

riding the air with other such futures,

all unlived in and now fully extinct.

 

From:  Tyrannosaurus Rex Versus The Corduroy Kid

Copyright ©:  Simon Armitage

A Vision poem – Simon Armitage poems | Best Poems (best-poems.net)

 

Donald Macaskill