Miss Duncan, Miss Allan, Mrs Randall and Mr Hollywood. Names etched on my memory – they were four of my primary school teachers. There are others too especially in secondary school who if I close my eyes, I can still see them and hear their voices. I know I was lucky. I loved my school experience – well most of it. It opened a world to me of learning and imagination, of escape and possibility. The people who took me on that journey were individuals who through their professionalism and dedication sowed in me a hunger and desire to know and to discover. I have always had the fullest admiration for those who teach. A good teacher opens a door of possibility and lets you enter a world of potential. Rolled up in one person, a good teacher is an inspirer, dramatist, communicator, creator, listener, carer and so much more. But it was only later in life as I began to teach and train adults that I really appreciated just how hard the work of a teacher is. So, I am always so proud of the fact that my eldest daughter is a primary school teacher – I can think of few roles more rewarding and fulfilling yet challenging at the same time.

I’ve been reflecting on education and teaching a lot in the last week partly because I have been involved in discussions on learning and training but also because this coming Monday we will be celebrating the International Day of Education, which is a celebration of the role of education across the world.

It is a day which amongst other things, is a reminder of how critical education is in tackling so many of the injustices and needs of our world. As the United Nations has stated:

‘Today, 258 million children and youth still do not attend school; 617 million children and adolescents cannot read and do basic math; less than 40% of girls in sub-Saharan Africa complete lower secondary school and some four million children and youth refugees are out of school. Their right to education is being violated and it is unacceptable.’

Education and learning are critical for the future of society, and that includes for the future of social care in Scotland. This past week we have seen in an Audit Scotland report some substantial critique of the lack of leadership and focus on social care and its necessary skills. Given that social care is a major contributor to the whole Scottish economy, if we are not getting training and learning right for this sector, then we are impacting the whole of our economy. But even more important than that we need to continually make sure that in our learning cultures around social care that we are reflective of the changing realities of care around us.

Two things have struck me this week.

The first is that having spent the last few weeks highlighting the very real challenges that the social care workforce has been facing because of Omicron someone asked me, ‘Then why do the work of care?’. Now before I get accused of rose-tinted glass wearing, I am not denying and would strongly argue that we need to substantially improve the reward and remuneration, the terms and conditions of those who work in social care. We are slowly getting there although at times I think our national and governmental response has been more focussed on headlines than addressing the baseline issues of sustainability, structure and process which affect the social care system in Scotland. We cannot have fair work conditions, a workforce valued and respected, professional and recognised, if we have systems in place which make their organisations and employment unsustainable, forced to sacrifice quality on the basis of cost, and to continually be treated as outsiders in partnership and collaboration.  There is no point in having a better paid carer if the organisation that employs them has gone to the wall. The social care system in Scotland is in a perilous state and will only be changed by the sort of radical transformation which requires partnership, mutual respect and collaboration. The best teachers inspire not by instruction but invitation, by authenticity rather than acting, by offering possibility rather than predictability. Such change is not just systemic – for instance creating a National Care Service – it is profoundly attitudinal and cultural. Have we in Scotland the ground in which to sow a change that involves and includes, that respects diversity and difference, nurtures choice and capacity? I sometimes fear we do not because too often I witness partisanship and defensiveness, a desire to keep things as they are, to hold onto power-base and predicability.

The way we support and care for others is changing all the time, I very much hope that when we talk of skills in relation to social care in the months and years ahead, that firstly we will value the existing professionalism of those working in care, and secondly that we will give equal attention to the softer skills of affectiveness and compassion, communication and relationship, as we often do to functional and transactional activities and abilities.

We also need to ensure that the potential of a career in social care is talked up. And that change has to start early – we need to start inspiring the children now at primary school to consider care as a career of choice and as of huge societal value. That is up to all of us who are adults to be the enablers of that inspiration. My answer to the question I was asked is what I have heard so often – that there are few jobs in life, despite the challenges, that enable you to support someone else to change their life, to achieve their potential, and to live to their fullest until the end of their days. For many it is the best job in the world and surely that is worthy of all focus and attention, of our value as a society and respect as a community?

As we seek to inspire the young with the attractiveness of social care, can I suggest you look at sharing with the children you know the fantastic ‘ When I grow Up I want to be a Carer.’ written by Jenni Mack. It is superb!

The second main reflection about teachers and education that I have had this week is personal and that is that I probably am learning more now than at any other stage in my life. In other words education and learning, knowledge and insight did not stop when I left school or university – it just took on a different form. Now I hope that that is stating the obvious, but I suspect as a society it probably is not. There is a terrible presumption about older age in particular which suggests that learning and teaching have sell by dates. What nonsense – and I am thankful that increasingly I read of people in their eighties and nineties graduating with degrees or going back to school to learn a new subject or discover a new skill. We learn until we die and it is a fundamental part of our society that we should enable such learning into later age, and value the contribution that the gaining of such knowledge offers to our society. Education is too important and liberating for it to be the preserve of children and the youthful.

I conclude with one of my favourite children’s writers, Allan Ahlberg who write the poem ‘The Supply Teacher’. I said at the start that I enjoyed most of my school experience except perhaps one supply teacher who put the fear of the divine into me every day she appeared. If nothing else she made me appreciate the brilliance of those who had become my routine, and for me all teachers in school, care home and community, open our hearts to the essence of what it means to be in relationship with one another, in care and compassion. The best teachers, wherever they are, and whatever job they do, help us to reach our potential and flourish.

The Supply Teacher

Here’s the rule for what to do
If ever your teacher has the flu
Or for some other reason takes to her bed
And a different teacher comes instead

When the visiting teacher hangs up her hat
Writes the date on the board, does this or that
Always remember, you have to say this,
OUR teacher never does that, Miss!

When you want to change places or wander about
Or feel like getting the guinea pig out
Never forget, the message is this,
OUR teacher always lets us, Miss!

Then, when your teacher returns next day
And complains about the paint or clay
Remember these words, you just say this:
That OTHER teacher told us to, Miss!

 

 

Donald Macaskill

It has been another significant week in the Covid pandemic. I will leave it to others to comment on the shameful goings on at Number 10 Downing Street, but alongside these events and the commentary attached to it, one of the announcements that I took note off with a degree of regret was the news that the English Deputy Chief Medical Officer, Prof Jonathan van Tam will soon depart to return to his substantive post at Nottingham University.

I cannot have been the only one that liked van Tam’s metaphorical turn of phrase, not least his footballing analogies, as he attempted to convey the meaning behind complex information, science and data. One of his best moments, for me, was when he said:

“It is a bit like being 3-0 up in a game and thinking we can’t possibly lose this now. But how many times have you seen the other side take it 4-3? Do not wreck this now. It is too early to relax.”

Having been ‘that fan’ at too many Scottish lower division games I know precisely what he meant! It has, therefore, intrigued – and I will be honest irritated me a bit – that this last week so much of the discussion has been about ‘learning to live’ with the virus and moving from a pandemic to an endemic stage. I accept the hopeful prospect of both, but these are phrases which it is self-evident mean so many different things to many people, and I cannot but feel at times that we are in danger of scoring a few own goals. Indeed, the irritation I mention is that for tens of thousands of social care staff right now work and life is about surviving exhaustion and fatigue as they spend themselves in supporting those who use services in the greatest crisis anyone can remember, and not just since the start of Covid19.

It is also important to acknowledge that yesterday we passed the horrendous toll of 10,000 of our fellow Scots who have died because of this Covid virus. Talk of ‘moving on’, of ‘learning to live’ and the ‘end stage’ has to be wholly sensitive to the grief and pain, hurt and abandonment so many feel today. For so many the rawness of reality does not make us feel that life now is any easier than it has been, quite the reverse.

In this blog, therefore,  I want to reflect a little bit about these concepts of ‘living with the virus’ and the endemic phase and specifically what they may potentially mean for social care services and those who use social care support.

Language, as van Tam powerfully illustrated, is always important and there has been a sense in the past week that in the rush back to ‘normality’ that the  careful use of language and appreciation of its subtlety has gone out the window.

Take for instance the commentary that we should stop talking about the Covid pandemic and start talking about a Covid endemic stage. As Wikipedia puts it:

‘In epidemiology, an infection is said to be endemic in a population when that infection is constantly maintained at a baseline level in a geographic area without external inputs. For example, chickenpox is endemic in the United Kingdom, but malaria is not.’

There are lots of viruses and infections which are endemic, but it is not true to say that those infections are harmless or not dangerous. Smallpox is endemic but it can and will kill. So being in an endemic stage does not mean there are no risks, does not mean there is no need for measures to protect or precautions which are required for safety to ensue.

Across Europe there has in the last seven days been much chatter about us moving into the endemic phase of coronavirus. This started off last Sunday with the English Education Secretary Nadhim Zahawi, who talked about the transition from a pandemic to Covid being treated as “endemic”. After his remarks news outlets began to reflect on what living with the virus and being in the endemic stage actually means.

Alongside this the Spanish Prime Minister declared a shift in policy away from counting cases and quarantining, towards a model of managing outbreaks of diseases like influenza that seeks to protect the most vulnerable. Others countries such as France and Switzerland have followed that lead in seeking to ‘manage and diminish restrictions’ because they believe the disease is entering an endemic phase.  However, in a word of caution the World Health Organisation stated on Tuesday that it was too early to believe we were entering an endemic stage as it warned that more than half of people in Europe would catch the disease over the next two months.

Covid is undoubtedly here to stay and we will over time have to learn to balance the risk from the virus with the requirement to live our lives. It will become less threatening and hopefully more like the ‘common cold’ as the vaccine discoverer Dame Sarah Gilbert, recently told a seminar.

But of course, life is not as simple as any politician going on air and declaring their belief that we are moving into the endemic phase, as Prof Christina Pagel, from University College London and member of Independent Sage, indicated on Sky News, the endemic stage will mean that Covid is :

“present, but you don’t get exponential rises in the absence of other measures”… We’ve literally just had a month of exponential rises of Omicron in our population – so we’re not at endemic stage… You can’t just say we’re moving from pandemic to endemic. That’s the virus’ timescale. It’s not ours.”

Of course, she and others are also right in asserting that it is a naïve presumption to assume that the progress of any virus, never mind one like Covid19, is inevitably along a trajectory of ever-decreasing threat. Our ability to reduce mortality during Delta as compared with the original Wuhan strain was because of the brilliance of vaccines not the fact that Delta was less severe. Virus threat fluctuates and just like that oft heard warning– they can go up as much as can come down. In Van Tam’s metaphor – the time you are most likely to lose a goal; is when you take your eye of defence.

So what does all this mean for social care?

This last week has been a really worrying one for many who use services and supports, especially those in their own homes. Last weekend’s Sunday Times carried a story suggesting that there would be an end to freely available Lateral Flow Tests (though of course they are not free as we pay for them in our taxes.) Although subsequently denied by Westminster ministers it has left many who are clinically vulnerable in our communities concerned that one of the key protections and mitigations may be removed from the Covid defence armoury especially as nothing was said in the ‘leak’ or ‘briefing’ about social care staff and service users in the community.

Then we had the announcement of a reduction of social isolation in England to five days with two clear LFTs. Whilst this may be acceptable it is argued for the majority population on ‘economic grounds’  (though personally the reality that over a third still remain positive and potentially infective after that time questions the morality of that assessment), the lack of robust safeguards for those who receive care and support in the community, or who have anyone from electrician to friend, come across their front-door, risks imprisoning a whole sector of the population into a perpetual isolation.

The balancing of the harms caused by lockdown and other restrictions cannot be at the cost of those who for whatever reason live with vulnerabilities and who need protection from harm. They deserve equality of citizenship and attention to their basic rights as anyone else.

Why is it that we believe that returning to ‘normal’ is inevitable? What is it in the presumption that ‘progress’ is always a continuum into the future? Perhaps progress is an acceptance that things can never be as they were, that difference is part of our tomorrow, and that maturity is living with that new reality? This time last year we were speaking about a ‘new normal’ of a way of living and being in community with one another that accepted that there may be some elements of behaviour and mitigation which will need to become part and parcel of our being with one another in society. Whether that is mask wearing or testing in defined circumstances and  environments I do not know but I strongly suspect that it will mean a continued period of awareness and support for those in our care homes and those who receive social care supports in their own homes. We will need to re-think social care support.

Living with the virus needs to become a state of being responsible in relation to others not an abandonment of the knowledge we have gained in the last twenty-one months. If the science is to continue to give insight, we cannot pick and chose the bits we like and ignore the evidence of challenge.

Living with the virus will for those working in social care undoubtedly mean an awareness that we have a workforce which is exhausted and drained, many of whom today as they fight the threats of Omicron are desperate for a rest, and many of whom might well be considering can they possibly go through this again.

Living with the virus will mean a necessary requirement to adequately resource the social care sector not solely as the appendage of the acute NHS sector, or even as the enabler of independent living and individual citizenship, but as a sector and workforce that equips the whole community to continue to remain healthy and which fosters the wellbeing of those who are at particular risk. The likely demand of continuing testing, IPC measures and other mitigations and precautions requires focussed planning and strategic attention now.

Living with the virus will mean that we have to acknowledge the massive extent of unmet social care need, the drained and diminished ability of family and non-paid carers to give any more, and their desperate need for real support and practical assistance.

Living with the virus should mean that we have especial regard for those who are at most risk, a characteristic of behaviour and priority because of the priority of those individuals regardless of age, disability or circumstance who are as vital a part of our place as we are, whose creativity and contribution need to be fostered and enabled as much as yours, whose rights and dignity require to be enhanced as anyone else’s in any day.

Living with the virus requires a re-orientation of all our lives, not just the lives of the few. It is one which can only be made together, in partnership and collaboration, in engagement and consent, and cannot be achieved by a rush to the exit door of caution and precaution. We are 3-0 up let us not lose the game.

 

Donald Macaskill

I discovered this week whilst listening to the radio that our national tourism agency Visit Scotland had launched the Year of Stories 2022 – a year which they describe as one where we celebrate stories inspired by, written, or created in Scotland. They go on to say that ‘stories are a vital part of Scotland’s culture, and every community has a different tale to tell. Shared stories, whether spoken, written, sung or filmed are what give a sense of place, history and belonging.’

As part of the Year of Stories there are already being organised hundreds of events across the country in museums, cinemas, community centres and visitor attractions which will focus on storytelling and the art of story. All of this in an attempt to capture the imagination, to entertain and inspire.  You can find out more on their website and by following the hashtag #TalesOfScotland.

I have written a few times about the power and importance of story and storytelling, not least in social care and in palliative and end of life care. I have reflected that stories are not just about a source of entertainment and escape, but rather that the real power of story is as a force for change and a tool to make a difference to our lives and communities.

But as I heard about the Year of Stories there were two stories which that day were uppermost in my mind, firstly Omicron and also the experience of living with dementia.

As I sat there I could not but reflect on the stories which I have been hearing and am still being told; these have been stories of this aching pandemic and of the response of the social care workforce and organisations to the Omicron virus. They have been stories of people separated again from loved ones in care homes struggling with outbreaks, of people in the community frightened of being supported lest someone brings the virus in to them, of family carers with nothing left to give such is their exhaustion.

This past week has been one of the hardest ever for anyone running a social care organisation or working in frontline care delivery. The levels of staff absence because of Covid have been crippling with some care organisations running with 25% absences, whilst the majority are experiencing absence rates of between 10-15%. What this means is not just a stretched service but an exhausted one especially the women and men who are now working double and sometimes triple shifts. They are drained to the bone of energy and yet they keep coming back to the frontline because they care and because they do not want to see those being supported whether in care home or community abandoned.

I have never before heard reports of such stress as those I have heard in the last week. And one of the things that is making it really hard for all involved is the constant drip drip of commentary that suggests that Omicron is a mild virus, ‘like the common cold.’ Now apart from the fact that we have been warned this week by experts such as the World Health Organisation that such comment is dangerous, the severity of Omicron does not really change the fact that because it is so infectious thousands of health and care staff are off ill or isolating and that those left are on their knees. A system can collapse through a mild disease just as quickly as through a severe one. In many of the conversations that I have shared this past week folks are despairing of the reality that as they are struggling ‘in the trenches’ the rest of the world has become dismissive and blasé believing that the pandemic is over, that we just have to ‘ride it out’, rather than taking the threat to our health and social care systems as seriously as they should. And that threat should absolutely worry us – any of us – who might sometime in the next few weeks want to call an ambulance, experience an emergency health incident, be worried about the health of a sick child or relative. If we do not take actions to protect others in this crisis then they will not be there to take action to protect us in our crisis.

As I reflect on storytelling in a week such as this I cannot help but remind myself that stories are not always works of fiction and make-belief, tall tales of impossibility and miracle. Stories are the happenings of our moments, the actions of our heart, the fruit of our relationships. We are not passive actors on a stage which we cannot control and using a dialogue we have no influence over. We are not the playthings of a writer beyond our ken, but rather we are the agents able to influence the outcome. In other words the real power of story is that the page is still unwritten and we have the ability to determine what is the ending to our most important stories. We have control in this Year of Stories of the story of our time, and that at this moment in this year is still the story of Covid. We can determine whether with the aid of reflection at the end of this year we look back and read of the folly of forgetfulness and the narcissism of self-interest, or we can read of collective solidarity and support, where once again we rolled up our sleeves and were present for others.

So as well as Omicron, as I sat listening to the plans for the Year of Stories, I could not but also think of the fact that it was my parent’s birthday that day. As a child it was a great benefit to have your parents’ birthday on the same day! Now that they are no longer alive inevitably it is now a day of reflection and remembrance. But it was also this year a day where – albeit on the margins of media stories covered that day – new research was published on dementia, the disease which took my mother from life and with which we had as a family lived with for years. The Global Burden of Disease report was the first international study of its kind and it was reported as stating that:

‘The number of adults living with dementia worldwide is on course to nearly triple to 153 million by 2050… Experts described the data as shocking and said it was clear that dementia presented “a major and rapidly growing threat to future health and social care systems” in every community, country and continent.”

It went on to state the substantial evidence indicating ways in which health and lifestyle could be improved and changed in order to prevent dementia which for the majority is not ‘inevitable.’ It also argued quite clearly that there was a need for major investment and research to ‘find a cure’ for a disease which will outstrip all as a threat to humanity and the quality of life.

To some extent this research tells us nothing those of us involved in the world of dementia did not know or at least fear. Its robustness and rigour is what is terrifying. But it also shows the way forward and the prospect of change offered to us.

I cannot be the only person who has marvelled at the way in which the global pharmaceutical and research community has come together and within an astonishing period of time has managed to find vaccines of such effectiveness and safety that we have prevented the Coronavirus pandemic from being even more disastrous than it has been, The vaccine discoveries have been an astonishing result of science and collaboration. Equally I cannot have been the only person, not least those whose lives are shortening as they live with dementia and those who love someone with dementia, who has not asked the question, ‘If they can do this for Covid, why cannot they do it for dementia.’

I am the last person to demean or diminish the dedication and energy of those over the years who have been involved in researching dementia and a potential ‘cure’, but I will be the first to question the moral priority of societies which continue to fail to invest and prioritise such research. I will be the first to call out the reality that when push comes to shove a disease that predominantly affects the old (but by no means exclusively) is deemed and viewed by society as less significant because of an inherent cultural and global ageism. That simply has to change. We must get serious and with the same international and national focus which brought us the Covid vaccines turn our attention to dementia.

In this Year of Stories, we need to be reminded that within us all is the ability to write a new page, to create a new ending which is of hope and change, restoration and light. In the dark winter days where in a care sector stress and exhaustion run rampant, we need to know that every change worthy of its name has been brought about by ordinary women and men deciding to change the story of their living. The power of story lies within each one of us to become a narrative which changes lives and improves community.

In this Year of Stories I hope we can use our words and actions for the betterment of all and not just the entertainment of a few. Because stories at their best, I believe, can change the world, re-orientate direction and motivate lethargy and tiredness.

Let us all therefore write a new story for this year and every year.