A new blog from our CEO – Scottish Labour consultation on Health and Care

Human Rights and Social Care Reality.

There is a lot of election talk in the air at the moment. Along with this there is a great deal of media debate and discussion south of the border over the state of social care, it’s under-funding and need of reform. Social care along with health are devolved matters in Scotland and discussions and plans around reform and funding are well under way.

However what happens in England influences the delivery of social care in Scotland regardless of the fact that I would suggest since the commencement of the Scottish Parliament some twenty years ago we have been trying to do things differently and with more collaboration.

Political parties in Scotland are at the stage of both preparing for Westminster elections but also beginning the process of defining positions and policies for the Scottish Parliamentary elections in 2021. As part of this Scottish Labour has put out a consultation on health and social care. Scottish Care has responded to this and we are pleased to publish this response for a wider audience.

Scottish Labour are considering the effective nationalisation of social care and talk of a desire to ‘bring back in house’ social care provision is contained in the paper. Personally I believe such rhetoric and policy articulation needs to be challenged from the perspective of a diminution of citizen choice and a loss of rights.

Indeed I have been led to believe that a number of commissioning officers in Scottish local authorities are investigating whether it would be desirable or possible to bring social care provision in house. I would suggest that this needs to be strongly resisted not least because currently it would be illegal.

So on what basis am I making these assertions?

What is social care?

Within the Labour Party document and elsewhere within the current political debate there is a conflation, sometimes accidental, sometimes deliberate, of what health and social care services are and what they seek to deliver. The equating of the two is damaging and unhelpful. In order to understand how social care (or long-term care) can be viewed we need to understand what it is and what it is not.

The Adult Social Care Reform process which is currently underway acknowledges this lack of robust understanding and as part of its articulation has suggested the importance of talking not just about social care but about ‘social care and support.’

There are many definitions, both legal and philosophical, as to what social care is. Importantly, for instance, social care whilst it may contain services and behaviours which are clinical or medical in nature is not primarily about one’s physiological health.

The Scottish Care working definition of social care is:

‘The enabling of those who require support or care to achieve their full citizenship as independent and autonomous individuals. It involves the fostering of contribution, the achievement of potential and the nurturing of belonging to enable the individual person to flourish.’

In essence social care is about enabling the fullness of life for every citizen who needs support whether on the grounds of age, disability, infirmity or health. Social care and support are holistic in that it seeks to support the whole person and it is about attending to the individual’s well being. It is about removing the barriers that limit and hold back and the fostering of conditions so that individuality can grow, and the independent individual can flourish.

Social care is not about performing certain functions and tasks alone for it is primarily about relationship; the being with another that fosters individual growth, restoration and personal discovery. It is about enabling independence and reducing control, encouraging self-assurance and removing restriction, maximising choice and building community.

Therefore, as many of us have sought to illustrate over the last few years, social care is not equivalent to health but a critical component to the realisation of health.

Human rights.

For me social care has always been profoundly about human rights. It is about giving the citizen control and choice, voice and agency, decision and empowerment. These sentiments are well reflected in the international literature both on the role and purpose of social care – especially independent living and its acceptance as a human right – and in what has been written about ‘long-term care’ , including a growing volume of human rights case law.

Included within the United Nations International Covenant on Economic, Social and Cultural Rights (CESCR) there is the right to health. The right to health is the right to a universal minimum standard of health to which all individuals are entitled without discrimination. What this means in practice has been long debated but there is now a mature conviction that the right to health is not solely the right to physical and clinical health but to psychological, emotional and societal well-being. There has been a considerable volume of debate, not least in the ten meetings of the UN Open-ended Working Group on Ageing (over the last decade and more) that part of what constitutes the right to health for older persons and people with disabilities is the full realisation of ‘rights’ in relation to what the UN terms as ‘long-term care.’

I would argue that such ‘long term care’ or what we would describe as ‘social care’ is inherent to the realisation of the human right to health, and that we need to seek to develop and articulate what are considered to be the key characteristics of exercising a right around ‘long-term care or ‘social care.’ I intend to argue both points more substantially in a future publication later this year (for Human Rights Day on December 10th).

Self-directed Support (SDS)

Human rights and social care practice come together in our SDS legislation. The Self-directed Support legislation in Scotland unapologetically grew out of the independent living movement of the learning and physical disabled communities in the 1970s. With the closure of large-scale institutions there was an emphasis on enabling individuals to live more independent lives. Policies and practice at the time and since emphasised the importance of building social care supports around the life of the individual rather than expecting the individual to fit into what services were available. A one size fits all approach was replaced by the urge to develop and offer bespoke individual services and supports. This has been eloquently re-articulated in the current reform process.

The Social Care (Self-directed Support) (Scotland) Act 2013, is a direct continuation of this earlier work on personalisation. The pursuit of citizen control, independent living, autonomy and choice is not a recent one. It is clearly a pursuit at the heart of the disability civil rights movement and a contributor towards the realisation of human rights.

The Self-directed Support legislation seeks to enshrine in law and social care practice the core values of inclusion, contribution and empowerment through real choice and respect.
The legislation is underpinned by a set of core values which at times mark the link between social care legislation and day to day practice.

The following words describe the values that have helped to inform the guidance:

• Respect
• Fairness
• Independence
• Freedom
• Safety’

It will be clear that such values are rooted in the earlier concepts of personalised services and greater independent living. The Act and Guidance then go on to indicate that there are certain core principles at the centre of self-directed support. Principles are described as ‘....... the means by which we put our values into practice. The 2013 Act (Sections 1 and 2) provides four legal principles

• Participation and dignity
• Involvement
• Informed Choice
• Collaboration.’

The Guidance then goes on to root these principles and values within a human rights-based framework. The Guidance reflects the conviction that the provision of social care and the facilitation of choice as part of this, is a way of protecting human rights.

‘Effective, person-centred social care, determined and led by the individual in partnership with the relevant professional increases the choice for the supported person and provided them with the opportunity to take more control and manage their life.’ (Guidance section 4.9).

The Act and its Guidance envisage various ways in which the values and principles are put into effect. In practice this means that there needs to be as much emphasis placed upon the universal needs of an individual as much as attending to their basic needs. There is a clear distinction between addressing needs which keep you alive and healthy and those which are more holistic and relate to well-being. To remain in relationship, to maintain friendships and be connected up to the community are as important requirements of support as being nourished, healthy and safe.

‘Participation and dignity are core aspects of independent living whereby all supported people should expect to have the same freedom, choice, dignity and control as other citizens at home, at work and in the community. In some respects, the concept of independent living provides a modern interpretation of the social welfare duties provided in the 1968 Act.’ (Guidance section 4.4).

Choice:

Informed choice is therefore critical to the implementation of a human rights-based approach to SDS. Choice is very different within the social care context compared to the health environment.

If I have a medical emergency then personally I want the best clinical care and don’t really want to have much say in who delivers that care as long as they are trained, suitably qualified and supervised. A short term stay in a hospital is very different from the place and people with whom I spend my life. If I am living with a lifelong condition or need support in any way because of life circumstances or age then I most certainly do want to have more choice and control both over who is in my life as a carer and what the nature of that support and care might be. The critical importance of legislation like Self-directed Support is all about embedding that control and choice, building those rights with the citizen including fiscal and budgetary control.

This has implications for the social care ‘market.’ At the moment within the legislation there is a requirement to ensure the diversity and reality of this ‘choice’ of provision for citizens. (section 19). Is it possible to fulfil this requirement and Statutory Duty if you only offer one provider (in-house provision)? Such proposals not only fail to understand that we never had a national social care system, but that historically social care was delivered in large part by charitable bodies such as the churches. But the suppositions also challenge the real potential creativity of self-directed support which was about enabling local individuals and communities to recognise and use their own assets to care for those in their midst. Where would such micro community provision stand in a nationalised system?

So, in our discussions and debates on the future of social care in Scotland I do not think we can avoid the reality that in practice and in law social care is a human rights issue and any changes to its delivery has to be rooted in human rights.

Donald Macaskill

CEO Scottish Care

@DrDMacaskill

You can view a copy of Scottish Care's response to the Scottish Labour Party consultation below.

Scottish Labour Party Health Care - Scottish Care Response Aug 19f (003)

A blog from our CEO for Professional Care Workers Day

I am very pleased to be writing to support Professional Care Workers Day being held on the 4th September.

It might be stating the obvious to say that care workers are the life-blood and heart of all the care services which are delivered by any provider across Scotland. This day is an opportunity for wider society not only to recognise their invaluable role but to acknowledge that we need to do a lot more to support them in their work.

So it is no accident that the theme of the day this year is ‘well-being.’

Scottish Care has been at the forefront in highlighting the pressures which our care staff are working under which impacts on their personal health both mentally and physically. We recognise that there is an intimate relationship between how someone is supported to do their job and how they feel. That is why we have consistently called for a distinct national fund and resource which is dedicated to the support and welfare of social care staff. Such a resource would foster the necessary work that needs to happen to for instance support the hundreds of staff who struggle with issues of mental distress caused by continually caring, by encountering death and loss on a daily basis and dealing with the distress of others in facing their illness and decline. Such a fund could develop real support and intervention on the issue of bereavement, on how you look after your physical health in what is an arduous and demanding physical job, or in developing specific resources focussed on caring for those with the continual mental strain of neurological conditions such as dementia.

There is now boundless evidence to show the relationship between staff retention and the direct meeting of the well-being needs of staff.

We all need today to think of how we can best recognise and value those at the care face. Is it just a simple hello and thank you as you pass someone who walks between visits? Is it as a shopkeeper giving a reduction to care staff or a simple gift on this day? Is it as transport companies allowing a day of free travel? Is it as a beauty therapist or physiotherapist or a money and advice worker giving a free session or consultation? Let’s come up with some good ideas!

So for providers the organisers of this day are asking you to get involved and hold your own celebrations. Last year they received great pictures of cards, gift bags, tea and drinks parties. People really showed their staff that their work is valued, and celebrated working as teams and providing great care.

What will you do to demonstrate the value and recognition you place on the care worker?

So let us all celebrate everything that is good about people who work in care with the second annual Professional Care Workers' Day.

Tweet and use the hashtag #ProfessionalCareWorkersDay.

Donald Macaskill

@DrDMacaskill

A new blog from our CEO for World Elder Abuse Day

Open our eyes and ears…

Jean to all intents and purposes was a confident, articulate and outgoing individual. She put a good face to the world with a close group of friends whom she had known for years and who all still kept in touch with each other even if less frequently. Jean was in her late 80s and lived a quiet suburban life with her son and daughter-in-law. As her health declined over the years and particularly following a stroke she needed more and more support to manage the ordinariness of living. But she got there and often with a humour beyond her conviction and a positivity which was the object of much admiring comment. She went out as much as she could, attending a local lunch club for older people and was also consistent in her attendance at her local church.

That was the Jean that the outside world saw.

The real Jean was a woman whose life had been turned upside down since her son lost his job and came to stay with his mother, bringing along with him his wife who Jean had never really seen eye to eye with. After a brief honeymoon where everyone danced on the eggshells of shared living, being polite and sensitive to accommodating the rhythms and routines of others, things began to get first moody and then heated and angry. It started with small verbal barbs and putdowns and soon escalated into loud arguments and verbal challenges; open and subtle domination on the part of her son and snide, belittling asides from her daughter-in-law.

Jean began to retreat into her own world, using silence as a weapon to create absence in her own home. She watched her words so much that she stopped conversing and just watched the television when she was at home. The domination reached a new level when her son, on the pretext that he thought Jean was developing dementia, persuaded her to allow him to be her Power of Attorney, and then took charge of her pension card. Jean was given pocket money whilst her son’s taste in fine wine developed literally at her expense.

Jean is the victim of abuse and harm. She is hidden, in part by her own sense of shame and embarrassment, in part by the inability of people around her to think the unthinkable and to see the signs of abuse.

Today (Sat 16thJune)  is the United Nations World Elder Abuse Awareness Day – a day when we reflect on the harm which countless millions of older people experience across the world.

Scotland has some fantastic legislation which protects and supports the victims of harm and abuse. But of course, legislation is not what ultimately safeguards individuals who for whatever reason might be vulnerable. What protects is a community which recognises the small signs that things might not be right.

It is relatively easy to recognise the victims of physical harm, albeit that bruises and marks are often hidden. It is much harder to recognise the countless older women and men who are the victims of sexual abuse, psychological and financial harm or are the objects of hatred. But sadly they live in every community of Scotland. They live in homes with threadbare carpets and lace curtains, they live in streets of Georgian townhouses and Victorian tenements , behind quaint scenic village doors and in newly built housing estates.

Abuse knows every village and town, every social standing and occupational group, every ethnic heritage and every sexual identity.

Today look around you. Listen for the dropped remark and quiet word. Hear the fear in a trembling voice or a shed tear. Spot the furtive anxiety and desire to be invisible and small.

Don’t dismiss your intuitive concerns but take a moment to think about whether you need to ask, to speak, to do. Jean and countless like her depend on our eyes, our voices and our actions. Thankfully in Jean’s case her home care worker spotted the signs and now Jean is free.

Dr Donald Macaskill

@DrDMacaskill

 

Blog: Madonna as a champion of age

Our CEO Dr Donald Macaskill was pleased to take part in Scotland’s first Festival of Age which was held in Glasgow on Thursday 23rd May.

Before the event he wrote the following blog to challenge some of the stereotypes and negative attitudes which still exist around age.

Madonna – The champion of age. 

Over the years the controversial singer Madonna has spoken about the flak that she had to take because of “using sexuality as part of my creativity” and with being labelled a “sexual provocateur” amongst the politest of critiques.

She is now facing a new battle and in an interview in British Voguepublished on 10th May has argued that she is now fighting ageism in the music industry and that she is “being punished” for hitting 60.

She told Voguemagazine: “People have always been trying to silence me for one reason or another, whether it’s that I’m not pretty enough, I don’t sing well enough, I’m not talented enough, I’m not married enough, and now it’s that I’m not young enough.

All too many people will share Madonna’s angst about ageism and I for one look forward to her battling against it.

Ageism is so endemic that it has become part and parcel of the wallpaper of our realities – so subtle, so pervasive that it is not even noticed; it is just accepted as a given, as a state of unalterable being. It’s almost the same position that racism was in the 1950s and early 1960s – so unconsciously accepted as a social norm in the UK that it went unnoticed – except by its victims. It is in the language we use, the stereotypes we accept, the rhetoric we hear.

What do a ticking time bomb, a silver tsunami and a population apocalypse all have in common? No, they aren’t the latest plotline from an episode of Line of Dutybut rather they are phrases used to describe the fact that we are living longer. They are highly negative descriptions of a reality that most of us would or should want to celebrate – we are dying older and healthier than at any time in Scottish history. So why the negativity? Why is it that so much of our cultural and political discourse about old age paints such a dark and depressing picture of decline?

Old age is something which should be valued, but alarmist attitudes fail to recognise the benefits and potential of older age and feed into the myth that getting old is about losing something rather than gaining something new and potentially positive. Old age is seen as a challenge rather than an opportunity.

Everywhere you look there are negative stereotypes which perpetuate the myth that older people are incapable and dependent, have nothing to contribute but rather are a burden and a drain on society. We see this in many of the current debates about social care and health which count up the costs an ageing population results in but fail to recognise that over 90% of care delivered in this country comes from the hands of people who are themselves old thus saving the taxpayer countless millions.

In Scotland I am sure we would like to believe that we treat all peoples as equal, regardless of colour, creed, disability, sexual orientation and we have indeed made great strides in addressing discrimination and hate. But have we made the same progress against negative stereotyping and discrimination which is based on age? I think not – why is it that a child in receipt of residential care will have nearly double the amount of public resource allocated to their care than an older person of 90 in a care home? Why is it that countless individuals talk about not even getting the chance of an interview if they are over 60 and are seeking employment? Why is it that at the age of 65 people who are accessing social care support move from being an adult onto being an ‘older person’ and in some areas such as mental health services they tell us they suddenly find the level of their support diminishes? Do we feel it is adequate that for thousands of older people seeking social care support that you can only now be eligible if your need is ‘critical’, that our social care services are critically under-funded?

We need to take off the heather-tinted glasses and face up to the reality that Scotland is as ageist a nation as many others in the world but rather than just recognise this we need to act . Yes, the Scottish Government has just published a great summative strategy, but …

Scotland has a real opportunity to do things much better. Embedding human rights at the heart of economic, social and political systems is a start. However, regardless of good policy intention and political priorities unless we address the pervasive cult of youth in our society, we will continue to acquiesce with ageist discrimination.

So, with Madonna I will continue to fight against the ageist discrimination that fails to value contribution, for me that means fighting for Scotland to have an Older People’s Commissioner and for a Convention of the Rights of Age. What does it mean for you? How can we together create a country which is the best place in which to grow old and in which value and contribution is recognised regardless of chronology?

 

In the words of Madonna:

“I have a dream
But dreams are not for free
We all need to change
Or just repeat history.”

Dr Donald Macaskill

CEO, Scottish Care

Latest blog from our CEO – Redressing the balance: the potential of homecare

In just over a week Scottish Care will be hosting our annual Care at Home Conference, Exhibition and Awards. It is shaping up to be a great day of debate, a very full exhibition and a real opportunity to celebrate the best of homecare across Scotland in the evening.

The title of the event as a whole is Redressing the balance: the potential of homecare.’

To some extent it is a bit disquieting and disappointing that we are still talking about re-dressing the balance of care in Scotland. After all we have had a policy direction of enabling independent living and support in our communities and homely settings for over two decades – and yet we are still talking about re-dressing the balance from acute to community, from health and clinical dominated concepts to social care practice, from time and task commissioning to relationship, trust-based approaches.

To redress the balance means to achieve ‘an even distribution of weight to ensure equilibrium within a system.’ It is that care equilibrium that is significantly missing from our current approaches to health and social care in Scotland. That’s what we are after in social care – namely the gain of truly integrated services and supports which we are meant to achieve.

At the heart of the debate and all the policy and political priorities in terms of re-dressing the balance is the need to move the focus from reactive response to need on to one which is truly preventative in nature. This is the massive and largely untapped potential of homecare within the whole health and social care system and economy.

For what we are seeing in practice on the ground across Scotland is yet more sophisticated approaches to reacting after the horse has bolted. Our eligibility criteria which determine the level at which social care supports and services can be accessed have now reached critical in most parts of the country; and resources for innovation and new models of care are depleted and drained as we seek to keep the ship of care from grounding on the rocks of reality. As a sector with some of the best independent care and support, providers and frontline workers alike are straining under the stress of ever-growing demands being met from ever-tightening funding.

It is the care economics of insanity not to recognise that we need to prevent people from accessing the expensive and unhealthy acute system in the first place rather than to seek to respond to their needs once they have been in it. Let us stop people from going to hospital after their latest bout of mental distress and illness; let us prevent unplanned admissions as a result of an unnecessary fall or incident; let us ensure that malnutrition and poor diet, unaddressed lifestyle factors and loneliness are not the vehicles for the inevitable journey into the acute system.

But to achieve all that we have to change not just the rhetoric but the reality to properly resource our social care sector in order to enable real prevention to happen. It is not rocket science so why decades after policy initiatives are we still talking and not doing?

There is a real opportunity for us to be brave and dynamic, innovative and creative in working together at local level, commissioners, planners and providers in developing models of preventative care which are up to the mark. We can do so much better than we are at present in developing models and approaches which prevent an individual from either early or unnecessary access to enhanced care, hospitalisation or sharper personal physical decline and deterioration. We can do so much better in working together to re-balance care so that we focus on approaches which enable independent living for a longer period of time and which focus on maintaining a higher quality of life and wellbeing. Our obsessive functionalist approach to social care is not only degrading and demeaning of worker and recipient alike, it is a public health hazard and threat.

Let us work together to re-balance care by achieving the potential of care at home and housing support, by maximising autonomy and control.

Join us on 17th May and get involved in the debate!

Dr Donald Macaskill,
CEO Scottish Care
@DrDMacaskill

Latest Scottish Care blog: National Director, Karen Hedge

Putting human rights into the commissioning cycle

 

This has been a period of uncertainty and deadlines. It seems every other headline covers Brexit, but for the care sector there is a real and significant effect of negotiation at various levels.

When 19 care homes closed last year, and 9 out of 10 of our care at home providers told us that they may not survive until the end of the financial year, it confirmed that we are in worrying times indeed.

The Freedom of Information request by Robert Kilgour on the cost of statutory care home provision highlighted that the cost for the Local Authority to run a care home is double that of what they pay the independent sector. We know that for care at home providers the proportionality is similar. But it is not simply about cost.

The care sector is exactly that, a sector which cares. Choice and control is critical to the Self Directed Support Act and the independent care sector is sufficiently diverse to meet that; made up of charitable, voluntary and private providers; and they range from small, single, family-owned businesses through to large corporates. It is a vibrant sector, grounded in Human Rights and the National Health and Social Care Standards which enable person-led care and support in a flexible way. We know this from our conferences and awards ceremonies; held to facilitate innovation at the forefront of the sector, and to celebrate the dedicated but often overlooked staff with whom it is an honour to work.

I am fortunate to have had a varied career in health and social care and have experienced the sector from many different perspectives. The intent of the system is to have the person at the centre, yet, there are glaring gaps and confusion.

All too often commissioning (the delicate balance of facilitation and planning to ensure the right services are provided at the right time) is confused with procurement (the purchasing of services). With only one major purchaser – integrated authorities, the concept of competition in the sector is a false one, and the push to drive down costs has led to a focus on the wrong things. We measure the amount of time that we spend with a person, not what difference we made for that person during that time. This competition also limits opportunity for the collaboration needed to maximise the full potential of the sector and is worsened by the tendency to consider only one part of the system and not the totality as intended by the Public Bodies (Joint Working) Act on integration.

Back when I was a Local Authority commissioner, the Commissioning Cycle was my guide as remains true for commissioners today; Plan, Do, Analyse, Review (repeat). But I came into that role with the experience of having been a carer, social worker, researcher and citizen. I knew that bringing those components and more to the table would change the nature of the process. So we changed the make up of the Board. It was, I now realise ‘integrated’; it consisted of 50% citizens and 50% professionals comprising of health, social care, commissioners, providers and procurement managers. This was over 10 years ago now and at the time it was not considered revolutionary, it was merely a step on the road to getting it right.

Together, we could map a realistic picture of a complicated landscape, and create the conditions to share resources, maximising the potential of the totality of our assets, but most importantly, we could sense check this approach with those who matter. It took time and courage, but we created a safe space to try out new ideas, quickly focussing on successes, continually improving as we went, always coming back to the person.

It is this realistic and person focussed embracement of the commissioning process which meant that the changes we made were meaningful and had impact; increasing the number of people who could access care and support by 110% at no extra cost, and with every one of them saying that the service had made a positive difference to them.

The current frustrating focus on measuring outputs limits our possibilities, as do the invisible and enduring barriers of silo-working. But change takes bravery. We had to put in systems to support those involved in decision making to enable them to equally and fully participate in the process. At Scottish Care we do something similar for the independent sector through our Branch structure and Partners for Integration Team, representing our members, creating trusting relationships with our partners to enable collaboration.

We have some great examples where working together has led to people getting the right support in the right place at the right time; implementing an enablement approach, supporting people to move back into the community, reducing falls and pressure ulcers to prevent admission to hospital, and targeting medicine waste to make tens of thousands of pounds worth of savings per month in just one area of Scotland.

For all of these to work, they had to be approached with courage, and from the perspective of the person accessing care and support. Without this they would have failed. Planning and Review is all good and well, but what is clear in the current landscape of diminished budgets and increased need is that that we need to change our approach across Scotland.

It is time to put human rights into the Commissioning Cycle.

 

Karen Hedge

National Director, Scottish Care

@hegeit

 

Latest blog from our CEO: Towards an age-valued Scotland

On Wednesday 3rd April the Scottish Government published A Fairer Scotland for Older People: framework for action.’

Over a year after the creation of the first ever ministerial portfolio for Older People, the document is an important contribution to addressing the challenges facing Scotland’s older population.

Sadly, despite what I would consider to be an excellent starting point this Framework report has received only a minimum amount of media coverage. You could say, of course, that Brexit and its shambles dominates the media. However, even without Brexit the absence of any significant media comment is perhaps itself illustrative of the challenges in addressing age apathy within our contemporary society.

The Framework is a starting point. In her Ministerial Foreword Christina McKelvie MSP states that:

‘I am also aware that older people can be marginalised. Maybe that is because we fear ageing and the impacts it can have on our lives through deteriorating health or because, quite simply, ageing is something most of us don’t want to think about.

‘It is time to remove barriers, tackle inequalities and allow people to flourish and be themselves. That is why I am publishing this framework. It affirms our responsibility to ensuring equality for everyone as they age and outlines the clear steps, we will take to deliver improvement.’

She goes on to state:

‘Importantly, the framework provides a platform from which we can reframe our thinking about older people, to move from what can be a negative, problem-focused perspective to a positive and cohesive recognition of older people as a vital part of Scotland’s potential for success and improvement in the 21st century.

‘We recognise that change will not occur overnight and will require years of sustained effort and a change in thinking…Scotland’s older people today and those older people of tomorrow are depending on us to deliver.’

I would encourage you to read the document as it brings together in one place actions and priorities around older age and also indicates areas where there needs to be more work and where we need to start addressing the barriers that prevent older people from becoming full citizens.

So why is this important?

Well on a simple level – if we are to create a fair society then that society needs to be inclusive of all and enabling of all citizens to achieve to their fullest potential. Sadly, this is not always the case for older people especially given the definition of older person in the framework as anyone from age 50. There are too many cases of age discrimination whether that be in the workplace or in accessing services and resources.

Scotland has an ageing population, and this is surely something to celebrate although all too often it is the subject of negativity or simple stereotype. The population is ageing at a faster rate in Scotland than the rest of the UK. Median age (the age at which half the population is older and half younger) in Scotland is 42.0 years from the mid-2017 population estimates, around two years higher than in the UK as a whole and is projected to rise to 45.4 years by 2041, compared to 43.5 years for the UK. There is also considerable geographical variation in the ageing of the population within Scotland. In general, it is lowest in the cities and higher in more rural areas.

Between 2016 and 2026, all council areas in Scotland are projected to experience an increase in their population aged 75 and over. Clackmannanshire (+48.0%) and West Lothian (+46.0%) are projected to experience the largest increases, while Dundee City (+9.6%) and Glasgow City (+2.9%) have the smallest increases.

Therefore we have a particular challenge in Scotland but that also gives us a real opportunity to ensure that Scotland is ‘the best place in the world to grow older.’

Age matters to all of us and most especially to those organisations who work in the care and support of older people in Scotland. Indeed, the Framework addresses some of the very real issues which the social care sector is currently facing in contemporary Scotland. It highlights the importance of social care in enabling older people to remain parts of their community, and to be active and contributing citizens. It addresses some of the challenges in ensuring that a career in care is viewed as a positive choice and that the standards and quality of care and support continue to improve. It requires the voice of older Scots to be at the heart of the decisions around the reform and future of social care and health.

Yet the Framework also shows the distance we have to go. It challenges the discriminatory behaviours and attitudes which treat older age persons as less than those of other ages. It calls out behaviours which dismiss the contribution of those whose communication is changing and those who face frailty and ill health.

Scottish Care has long argued that there is a profound discrimination at the heart of the way in which older people are treated within society. At a simple level discrimination is when one treats another on whatever basis in a less favourable manner than you would treat someone else. That discrimination happens to older Scots far too often up and down Scotland every day of the week. It is often so subtle and unconscious that it is almost impossible to recognise or name – but discrimination it is nevertheless.

The Framework is an excellent starting point in the journey towards achieving the ability of older people in Scotland to exercise and enjoy their full rights and entitlements as citizens. It is a summative work describing existing commitments and future aspirations. The challenge is to ensure that it does not simply remain a summary of good intention but becomes the description of action-led response.

There are still today too many instances in the social care of older persons where we are daily witnessing systemic discrimination in Scotland. Why are so few older people in Scotland actively and fully participating in the range of choices which are offered under the Self-directed Support Act? Why do I still hear social work assessors say ‘SDS is not for older people’? Why are there so few of the 33,000 people whose home is a care home who have been given an outcomes focussed assessment to determine their needs and wishes, who have been allocated a personal budget and given real choice rather than the fiction they are offered, all of which is their entitlement under the SDS Act?

In terms of revenue and resource why does the social care sector have to fight a continual battle to maintain already inadequate resource allocation for vital services and supports? Despite being a major contributor to the Scottish economy why does the social care of older people in Scotland continually get described as a cost and a drain on our society? Why do those who live with dementia effectively pay twice for that care and support whereas those with other conditions do not?

There are many instances where we have some distance to go to create a fair Scotland where everyone is enabled to exercise their human rights regardless of age. The Framework makes a helpful start. I for one – not least as I am well into the decade of older age – want to ensure we support its actions and its aspirations. It is up to each one of us to work with some speed to creating that Fairer Scotland which values age.

 

Dr Donald Macaskill

CEO, Scottish Care

Compassion – Guest blog from the Care Inspectorate

I am part of a group of people in the Care Inspectorate and the Scottish Social Services Council taking forward work to develop a resource exploring compassion, we are partnering with colleagues and stakeholders from many organisations across Scotland. We are currently putting out a call to gather stories of compassion and kindness from people experiencing care and from those working in social care. We hope to start a national conversation, to be inspired and moved, we want to show how compassion is more than often given without recognising it for what it is, but for those on the receiving end it is central to how they perceive their care. Over the coming months we will be sharing stories through social media which will contribute to a resource which will highlight the importance of compassionate care. We might also bust some of the myths around how we relate to people who experience care as well as how we care for ourselves and our colleagues.

Whenever I hear providers and the frontline workforce speak about the work they do and what brought them into social care in the first place I am often struck by the level of compassion they have without them necessarily realising this. Compassion often comes to life through the relationships we have with people around us.  When these relationships are based on empathy, respect and dignity, compassion is given and received.  The impact when we reach out to the people around us with compassion and kindness often goes further than we may ever be aware of.

Compassion can be given in the briefest of moments, with a smile or reassuring touch.  We want to explore why sometimes compassion has been missing, as well as some of the beliefs and myths that people have about the caring relationship.  Compassion may come easier when we have a natural connection to a person or situation that we find ourselves in, but what about when there is disagreement and tension?  This is when we are asked to show compassion and kindness unconditionally.

There is a place for compassion in every aspect of our lives, in the way we support and care for people, how we get along with our co-workers and most definitely if we manage people, how we do that. Importantly there is also the way in which we show compassion to ourselves, it can be difficult to be compassionate to those around us when we are running on empty ourselves.

The Health and Social Care Standards have compassion as one of the five underpinning principles and they described what should be expected by those experiencing care and support.

Compassion

  • I experience warm, compassionate and nurturing care and support.
  • My care is provided by people who understand and are sensitive to my needs and my wishes.

We are keen to hear about compassion across all age ranges and service types and if you have a story of compassion to share with us please send it to [email protected]

 

Heather Edwards

Interim Head of Improvement Support Care Inspectorate

The Inequity of Social Care – the latest blog from our CEO

The inequity of social care

I’ve spent a lot of my professional life working in areas to challenge and address inequity and inequality. Indeed since I took over the role of CEO of Scottish Care a great deal of my focus has been on highlighting the challenges of unequal treatment in older people’s care and support. That has included the very real funding imbalance which has over time seen less and less proportionately allocated to resource older people care whether in the community or in care homes.

But increasingly I believe that there is an overarching inequity at the heart of our health and social care policy and practice. At its centre is a critical question.

Put simply what defines a support or service as social care and therefore currently chargeable and what defines a condition or illness as a health condition whose treatment and support is free at the point of delivery?

I was reminded of this when I listened this week to a presentation from Alzheimer Scotland on their Fair Dementia Care campaign

Alzheimer Scotland has recently published a report from the Fair Dementia Care Commission chaired by former First Minister Henry McLeish.

At the heart of the report is a description of the life experience of thousands of our fellow Scots who live with or support someone living with advanced dementia. A number which is due to grow significantly in the coming years.

As well as offering a definition of what is meant by advanced dementia the report highlights the confusing and complex maze of charging policies for social care services across Scotland’s local authorities which end up meaning that people with advanced dementia pay a staggering £50.9 million in care costs every year.

The report does not call for the end of charging per se but for greater transparency, consistency and understanding. But I think one of its greatest services has been to shine a light on the inequity of social care and health in Scotland today.

In the dictionary inequity is defined as ‘a lack of fairness or justice.’

Whilst the report from Alzheimer Scotland rightly highlights the inequity faced by people living with dementia I believe the inequity or lack of fairness goes even further.

At root is it fair that if in life you are struck down with a life limiting cancer that you will receive your care and support free of charge but if you are someone living with dementia you will face charges for social care which might include disposing of your home and assets in order to pay for care home fees?

Is it fair and right that many people living with neurological conditions are treated as having social care needs and not primarily health and clinical needs? I think not. We have too many individuals living with conditions such as Parkinson’s, Huntington’s, Multiple Sclerosis and so on who are paying for the essential support that enables them to continue to live and contribute as citizens in our communities.

Is it fair that a person who suffers the ill health that arises from frailty and age and requires appropriate support for that should have to pay over and above their lifetime contributions to taxation for that care including nursing care?

Just as Scotland is seeking to create a rights-based social security system I am convinced that we need to seriously start a debate about the inequity, the lack of fairness and justice that lies at the heart of social care charging for specific conditions such as advanced dementia.

But I am equally convinced that we need to go much further and start the conversation to move us to enshrining the human right to social care, to have your care and support provided equitably regardless of the condition or illness or disease, regardless of the realities of age or decline, that life deals you.

In the words of Bill Gates:

“Humanity’s greatest advances are not in its discoveries but in how those discoveries are applied to reduce inequity.”

Dr Donald Macaskill
@DrDMacaskill

The essence of social care – our CEO’s latest blog

It was encouraging to read over the weekend research which had been undertaken by Ipsos Mori. It was the latest ‘Ipsos Mori Issues Index – 2018 in review’, which gives a “snapshot” of the top ten major concerns across individual parts of the country. Brexit and its implications was not surprisingly revealed as the most important issue facing Britain, topping the list.

However, what it also showed was that Scots worried about the ageing population and social care much more compared to concerns over immigration and crime than the rest of Britain. 16 per cent of people were concerned about social care compared with 11 per cent for the rest of the country. This is at least encouraging considering that ‘Scotland’s population is ageing at a faster rate compared with the rest of the UK, while the population is growing at a slower rate and fertility, life expectancy at birth and net in-migration are all lower.’

When I read the report I was encouraged by the prominence not least because the social care sector as well as facing huge demands in terms of capacity is eagerly awaiting a Scottish Budget that prioritises it rather than provides leftover crumbs from other fiscal concerns.

But when people talk about social care what do they really mean? Indeed I am reminded of a senior public official who recently confessed that it isn’t at all clear what social care is and what it’s distinctive role is.

There are many definitions, both legal and aspirational, as to what social care is and what it is not. For instance social care whilst it may contain services which are clinical or medical in nature is not primarily about one’s physiological health.

For me the role of social care is:

‘The enabling of those who require support or care to achieve their full citizenship. The fostering of contribution, the achievement of potential and the nurturing of belonging.’

That may all sound a bit nebulous but in essence social care is about enabling the fullness of life for every citizen who needs support whether on the grounds of age, disability, infirmity or health.

Social care is holistic in that it seeks to support the whole person and it is about attending to the individual’s wellbeing. It is about removing the barriers that limit and hold back and fostering conditions so that individuality can grow and an individual can flourish.

Social care is not about performing certain functions and tasks alone for it is primarily about relationship; the being with another that fosters individual growth, restoration and personal discovery. It is about enabling independence and reducing control, encouraging self-assurance and removing restriction, maximising choice and building community.

Therefore as many of us have sought to illustrate over the last few years, social care is profoundly about human rights. It is about giving the citizen control and choice, voice and agency, decision and empowerment.

All of the above is why social care is critical to Scotland’s future. That is why we need a social care workforce which is valued, well-rewarded and appropriately resourced. That is why we need to undertake necessary reforms and critically that is why we need to properly resource a sector that is a major contributor to Scotland’s economic and national progress.

Social care is not the handmaiden of the NHS- there as an adjunct department to clinician care and medical intervention . This why we cannot treat the two as if they were the same. Whilst inextricably linked the healthcare we deliver is vastly different from the social care we should rightly demand. One of the fundamental areas of difference has to do with choice.

If I have a medical emergency then personally I want the best clinical care and don’t really want to have much say in who delivers that care as long as they are trained, suitably qualified and supervised. A short term stay in a hospital is very different from the place and people with whom I spend my life. For if I am living with a lifelong condition or need support in any way because of life circumstances or age then I most certainly do want to have more choice and control both over who is in my life as a carer and what the nature of that support and care might be. The critical importance of legislation like Self-directed Support is all about embedding that control and choice, building those rights with the citizen.

We are absolutely right to value social care as intrinsic to the fabric of our society and as a marker of the maturity of our commitment to support and uphold one another in community.

In the weeks ahead social care will continue to face fiscal and workforce challenge but in those times it will remain critically important that we defend the intrinsic role and distinctiveness of social care rather than acquiesce in attempts to limit choice, control outcomes and thereby restrict individual rights.

It is to be celebrated that Scots care about social care and the ageing population and it is incumbent upon all of us to ensure that social care is advanced and protected in the years ahead.

Donald Macaskill
@DrDMacaskill