As we all know what we say at the start of the year often sets the tone for our expectations, hopes, and promises for the year to come. In looking back at previous first of the year blogs there is a remarkable consistency if not similitude to the comments I have made. I could therefore save myself a great deal of effort and get the copy and paste key working and I suspect it would read with an air of authenticity about what we still need for social care in the year to come. Yet this year feels very different.

The word ‘crisis’ is everywhere I read and hear; it’s the word of alarm on many of the lips that I have heard or spoken to in the last few days. This year feels so very different to the previous winters even the last two which although exceptionally challenging felt for many reasons different to the one we are now going through. I therefore want today – perhaps at a bit more length than usual – to focus on the crisis in social care and why addressing that is or should be a primary focus of political and economic priority in the weeks and months ahead.

But to begin with – that word ‘crisis’ is an interesting one. Allow me a moment for a semantic sidestep if you will. Originally, the word ‘crisis’ meant “the turning point for better or worse in an acute disease or fever.” But nowadays its commonest meaning is “a difficult or dangerous situation that needs serious attention.” There is something in the original that I like not least because in its root in the Greek it has a connotation of opportunity and new beginning. A crisis can become a moment when things change, and a new or different direction is taken. I think we are very much at such a moment of opportunity.

The state of the NHS

The media over the holiday period has been dominated by stories about what is happening in the NHS in Scotland. They make unpalatable and alarming reading with long delays in A&E, very high levels of delayed discharge, exceptional occupancy levels in our hospitals, an exhausted, weary and morally harmed frontline workforce, and continual warnings about not accessing emergency and urgent services unless the need is essential and very necessary. The focus on the NHS and its state of crisis is understandable although I would want to stress that the work of all those at the frontline and behind it over the last weeks  and indeed for months has been exceptional and sacrificial of self and time. In the midst of a narrative of breakdown and chaos  I think it is equally important to recognise the brilliance, the quality and the success of what is being achieved every day by colleagues in our health service – not least of which is the fact that well over 95% of discharges from hospital are consistently without delay – saying that does not devalue the impact of delay on those who are stuck in hospital but it affirms the hard work of the practitioners in social work, social care and secondary care. It is also critically important that we do not deny the impact of Covid19 upon our health system. As we have rushed back to normality and to adopt a societal vow of silence about Covid and its continued existence we ignore its ongoing impacts at our peril – not least of which is the impact of Long Covid. People are entering hospital in a highly deconditioned state and with exceptional levels of frailty. As a result, patients are staying longer with a greater degree of required treatment which in turns increases the pressure on wards and staff. And at the end of their stay more people than ever before are requiring social care packages in either their own home or in a care home.  At a time of real challenge our health services are supporting more and more people with less and less staff.

The ‘crises’ facing our NHS have been well documented and commented upon but there is a remarkable link with those challenges which I have often commented upon as afflicting social care. That is not just that social care has added to the issues of ‘delayed discharge’ – to narrow things to that single lens is a serious error. I would go further and assert that in the year to come unless we address the challenges and ‘crisis’ of social care then we will continue to fail to meet and deal with those facing the NHS – a focus on one without the other will simply not work. They are two sides of that perennial same coin.

Social care crisis is a workforce crisis.

Over the years I have written a lot about the challenges facing social care in Scotland and do not want to repeat all that here – although despairingly its truth remains. In reducing challenges to one single factor there is always a risk towards oversimplification, but I do not think it unfair to argue that the single continual challenge facing social care both in residential and nursing care home provision and in the community is one of workforce. I might hear you say that it was always the same – and to a degree that is true. Social care has always struggled to compete with others not least the NHS because of a lack of an equal playing field – but we are now in a situation where we aren’t even playing the same game such is the divergence between sectors.

Again, it is worth asserting here that the exceptional professionalism of the women and men at the frontline of social care has been breath-taking, not least the thousands who remained at risk in caring for others during the early stages of the pandemic both in the community and in residential care. But the fact is that we have lost thousands of those staff due to fatigue, exhaustion and because we have failed to recognise, reward, and remunerate their professionalism both before but certainly since the pandemic. We have also shot ourselves in the foot with self-inflicted wounds such as over-zealous oversight and lack of professional trust and regard. Then this week I have read of Sainsburys increasing the salary of frontline staff to £11 an hour in recognition of both cost-of-living pressures and of the need to compete against other retailers. This is clearly to be applauded in these challenging times but compare that to the value society bestows on the work of frontline carers. And this is a point which needs to be made regardless of whether the employer is a charity, private organisation, or a local authority because after all most of the contracts and terms and conditions for frontline care are set by the State at both national and local level.

A frontline professional carer is required to be registered, to be qualified and trained over a period, to maintain that qualification through further study, to be regularly inspected and monitored and work under a fitness of practice regime etc. All this to a degree is appropriate and right for those who care for and support some of our most important citizens whether as children or adults. But to do all that and to remain motivated in challenging times requires society and the taxpayer to appreciate and recognise that role as vital to the functioning of a modern society – I ask you (even with the enhanced Real Living Wage) does £10.90 an hour cut it? I think not. Not surprisingly people are leaving the sector to work in retail and hospitality. All this is not even to mention the unequal treatment in regards to terms and conditions for the thousands of nurses who work in social care and who are increasingly being attracted to join agencies where they are able to earn so much more money whilst working alongside former colleagues – though you can imagine the impact on your morale by working alongside someone who you know is perhaps getting paid double what you are earning for doing the same shift!

But for social care – even more so than the health service – the situation is worsened by the impacts of Brexit and a thoughtless immigration policy and procedure which has been insensitive to the demographic realities of a Scotland that has both not enough workers as well as an ageing population. We lost thousands of gifted women and men as a result of our departure from the European Union, and they have simply never been replaced (and add to that the hundreds who have left social care to remain in Scotland but to work in retail and hospitality.)

Together with an ageing workforce, issues of gender segregation, the enhanced complexity and volume of social care, huge levels of unmet need in the community, the demotivating use of electronic call monitoring and watch systems, the increased use of fifteen minute visits which make it impossible for staff to care and support someone in dignity, and you have a working context in social care in the community which is at best challenging if not impossible.

‘Delayed discharge’

There has been an inordinate amount of media focus – and no doubt political focus once MSPs return next week – on the issue of people being trapped in hospital when they are fit for discharge. All of us who know this world know that remaining in hospital for longer than you need to is not a healthy option. In response to the growing demand and growing number in such a situation the eyes of the system have turned onto social care as the problem. Well, it is and it is not. There are two main targets within the issue of delayed discharge – the first is that we should be doing all we can to stop people going into hospital in the first place and the second is that as soon as they are in, we should be preparing to get them back to their own home or a homely setting as quickly as possible.

Dealing with the issues of avoiding unnecessary admission is critical. An empty hospital bed will be filled by a patient by the very existence of its presence. Ultimately, we need to be using hospitals less not more and that necessitates treating people as close to their home as possible. An emphasis on local treatment and prevention has been talked about for years and works in some places but requires a massive re-orientation in focus from hospital focussed healthcare to community primary care and social care provision. We have a considerable distance to go down that road, yet it is a journey that is essential if we are to become a healthier community. Too many people are unnecessarily admitted to hospital which not only endangers their lives in the long-term but also lessens their wellbeing in the short term. We need to urgently invest resource in shared social care and primary care models of local support. Care homes which are adequately resourced and staffed are for instance ideal locations for people to be supported for brief times rather than in large institutional acute settings.

At the other end of the spectrum the vast majority of people in hospital today who require a social care package of support are needing to return to their own home but the parlous state of homecare, care at home and housing support means that many charitable and private organisations have handed back care packages, cannot recruit staff and are exiting the sector en masse. There is need for an urgent review of homecare because if we do not get the system right which supports people to remain independent in their own homes then they are unnecessarily admitted to hospital putting yet more pressure on an already strained service. It is worth stating that such reform which requires fair commissioned services, contracts which are equitable and which offers real choice to citizens rather than a one-size fits all model, will require significant resource – the question is as a society are we prepared to finance a preventative approach that values personal choice and independence or to continue to fund an emergency response which is primarily focussed on acute and secondary hospital care?

Lastly in terms of delayed discharge. I have heard it said in recent days that we need to see a return to the old cottage hospitals. Those of us old enough to remember them should be appalled at such a suggestion. There were very good reasons we closed down such units and places and that was that despite the dedication of local staff in many of them that there were too many which had become places to maintain and house older people with degenerative illnesses such as dementia. When we began to focus on care homes as places of long term care for our citizens the emphasis was on creating non-institutional settings and places where people could be rehabilitated and supported in a better environment more conducive to personal care and support and shared living.  At their best care homes have become such places where if adequately resourced and staffed an individual can live a much better quality of life than they could ever achieve in a hospital.

In addition, there has been a huge change in the nature of care homes in the last decade and a half to the extent to which many have become effectively local hospitals and hospices in everything but name. This is especially the case in those homes which offer interim care places which allow someone to be discharged from hospital and to be supported and re-abled to continue their journey home after a few weeks stay in a care home or indeed to move onto another care home of their choice. Believe you me being supported in such an environment in your journey of care is a much better choice than being stuck in an acute hospital with stretched services, exhausted staff and a constant flow and change to say nothing of the risk of infection and deterioration because of lack of mobility and movement.

 

We need I think to have an emergency and urgent response to the whole health and social care crisis that we are facing. There is a moment – even a passing one – for opportunity and collective and collaborative change. I get tired as frontline managers, staff and practitioners struggle with the issues facing them of reading and hearing the constant political fighting over these issues. I’m not naive – I know the role of political parliamentary opposition is to hold government to account, to challenge and persuade the electorate that things are not working. But when does the role of a politician become one of civic responsibility which overcomes party political interest, and which necessitates working in collaboration with others with whom you strongly disagree? I think that that moment has well and truly come for the health and wellbeing of our nation. And so, my most forlorn New Year 2023 wish is that in the spirit of a national emergency (regardless of the reasons for it or from whence it has come) we can work as politicians, policy makers and practitioners in a spirit not of mutual one-upmanship but shared solidarity to address the real concerns of life and limb our health and care systems are now enduring. And yes, I still believe in Santa Claus.

We are at a truly critical phase in the dis-ease affecting health and social care services in Scotland, will we use this crisis to collectively work together to achieve lasting change or rather will we be back here next year with a similar blog spouting the same concerns and challenges? I very much hope it is the former because one thing is clear and that is that these are not simply winter pressures but a crisis for all seasons.

Donald Macaskill

One of the best-known New Year poems is ‘The Year’ written by the American poet Ella Wheeler. She wrote:

“What can be said in New Year rhymes,

That’s not been said a thousand times?

The new years come, the old years go,

We know we dream, we dream we know.

We rise up laughing with the light,

We lie down weeping with the night.

We hug the world until it stings,

We curse it then and sigh for wings.

We live, we love, we woo, we wed,

We wreathe our brides, we sheet our dead.

We laugh, we weep, we hope, we fear,

And that’s the burden of the year.”

https://poets.org/poem/year

Wilcox’s rhyming couplets have a real ring of truthfulness about them in their description both of the year that is passing tonight and the one that is dawning tomorrow. There is a natural predictability of patterned time on this day. As we gather with friends or family, or sit on our own, no doubt some of us will have much that we will gladly say goodbye to and have much to desire to pull us into tomorrow; there will be those not with us whose absence will ache and those we will meet in the days to come whose presence we will yearn. The ‘burden of the year’ is the constancy of continued humanity for good and ill for there is in truth nothing new under the sun.

However, the sense of the immovability of the things that challenge us, a sense that there is nothing we can do, that the barriers to progress and the obstacles to change are insurmountable is one that I have heard mentioned and felt with increasing vigour in the last weeks and months. These last few days have been no exception with the media full of stories of the very nightmarish challenges facing our health and social care systems across Scotland not least of which have been heartfelt pleas from frontline A&E staff on social media. It has never been this bad is the common litany of despair. It is important that we name these challenges for what they are and do not seek to delude ourselves or mask the reality of what is being felt and experienced. Owning the truth and avoiding the lie is the first step to positive movement. Although I am not always convinced we have done so with real authentic honesty in the last few months when we have talked about the real critical and life-damaging challenges facing social care in Scotland nevertheless I remain convinced of the necessity of such articulation as a first step to moving forward.

I have long rehearsed an argument in these blogs which is that you cannot seek to address the health and wellbeing of our nation without accepting the inextricable connection and inter-relationship between the NHS and wider social care systems. That attending to the major faults of one without an equal focus on the ruptures within the other only serves to design even more instability and weakness into the whole. The analogy I have often used is that if you repair or replace a broken part in a machine without looking at the rest of the machine then you make the whole less efficient and less workable and actually more than that you make a breakdown or fault in the part you have not repaired much more likely to occur. Whole system solution is the only effort that prevents whole system dissolution and breakdown.

Another constant and I suspect tedious observation of mine is that you must also recognise the uniqueness, the distinctiveness, the particularity of each part of a whole system in order to understand the ‘machine.’  Treating social care services as primarily an aid to the health system is to wholly fail to understand the unique and distinctive value and role of social care. Care homes and homecare services are there and in existence to enable people to achieve the fulness of a possible life and to live to the dignity of a life of potential. They are not there as the help maiden, the rescuer for a health system with delays in discharging people from hospital or which has run out of beds to accommodate those who could more healthily be supported in their own home or a homely setting. Reactive rescue is always an emergency response to a system that is failing, preventative collaborative innovation is always the solution for long term challenge and change.

Having made those two observations like others I am alarmed at the current state of health and social care, but I suspect my analysis would not be the same as that of others and my prognosis would be distinct.  Primarily I have always stated that the solution to our NHS set of crises is not going to be achieved within that system alone but from an increased collaborative working with the social care system and its providers.  There are too many people engaged in a revolving door of continued admission and discharge into our NHS acute settings; too many individuals capable of being supported both clinically and in terms of social care in their own homes for so much longer; there are too many folks not benefitting from the potential of technology in their own homes which acts as preventative support and enhances personal independence; there are too many frontline staff moving around like pawns between different providers in a system of inequity and unequalness which does not benefit the individual worker in the long term and certainly does not benefit the system as a whole; there is indeed increased financial resource but much of it is in the wrong place, targeting the wrong priorities and all too often wasted.

2023 must be a year of building on collaborative efforts to work together and to move beyond siloed solutions for whole system problems. You cannot address the workforce challenges in social care by continually improving the terms and conditions of healthcare staff and ignoring the in-work poverty of home carers for instance; you cannot meet the rising demands within ‘paid’ social care without addressing the crisis of exhaustion and lack of resource in informal care; you cannot create a sustainable care home sector by continuing the disparity between those who the State chooses to pay for and those it does not; you cannot continue to address the major healthcare need which is dementia by not creating equivalence with other long-term conditions; you cannot continue to justify unequal treatment between in-house local authority provision of care at home and the hypocrisy of contracting third and independent providers at lower rates, poorer terms and worse conditions. We have all of us across all sectors in the NHS and social care and beyond, to do the unpredictable and start working seriously with one another because we know the truth that where it has been happening in 2022 there has been real benefit to patient and resident, the fostering of real trust, reciprocity, innovation and creativity.

The challenge at any time but especially as we enter a New Year is that we blindly and uncritically accept the constancy of a predictable patterning of the future, or we seek to do something different – to contradict the rhythm of the same with a new direction and by the disturbance of disruptive innovation and practice. That surely has to be the year of 2023.

We need not to dwell on the actions and aspirations which lie crumpled up in used papers of regret in the year gone by – rather as we pin the calendar to the wall and turn a picture to January we need to find purpose to be the promise agents of all we want to achieve which has yet still to be fulfilled. We are the ones who change our morrow because there needs to be an urgency and an impatience of hoping and a demand for ever stronger loving and commitment to others.

The winter clouds are starting to move apart, the challenge for all of us in the worlds of health and social care is to help in their dispersion and to replace a scene of challenge with one of promise and potential. I truly believe it can be achieved– together.

Poem for a New Year

By Matt Goodfellow

Something’s moving in,

I hear the weather in the wind,

sense the tension of a sheep-field

and the pilgrimage of fins.

Something’s not the same,

I taste the sap and feel the grain,

hear the rolling of the rowan

ringing, singing in a change.

Something’s set to start,

there’s meadow-music in the dark

and the clouds that shroud the mountain

slowly, softly start to part.

From A Poem For Every Day Of The Year

Happy New Year.

Donald Macaskill

It is certainly a week of happenings. Wednesday past was this year’s Winter Solstice. It has always been a night of hope and light which begins the hallowing of days till the spring and summer beckons and bursts life through darkness. From ancient times the lengthening of days, however slow and imperceptible, has presaged hope in the midst of harshness and re-birth in the place of grief. It is a day when we turn in a new direction, it is one of potential re-orientation and focus. But like so many days of light in darkness at this time of year it has a quality which it is hard to describe and fathom. That’s why for me days like the Solstice and Christmas are often best described by our poets. One of my favourite poems around the Winter Solstice is by Gillian Clarke a former National Poet of Wales. She wrote ‘The Year’s Midnight’

The flown, the fallen,

the golden ones,

the deciduous dead, all gone

to ground, to dust, to sand,

borne on the shoulders of the wind.

 

Listen! They are whispering

now while the world talks,

and the ice melts,

and the seas rise.

Look at the trees!

 

Every leaf-scar is a bud

expecting a future.

The earth speaks in parables.

The burning bush. The rainbow.

Promises. Promises.

From Selected Poems (Picador, 2016).

That last line says it all, I feel, ‘promises, promises.’ Clarke pictures renewal and rebirth incarnate in apparent decay and emptiness. She sees a world dormant with hope and promise. And today there is no shortage of expectation and promise in the air.

I hardly need to mention that tomorrow is Christmas Day because mine cannot be the only household full of the energy of childhood expectation. Tonight, is one of those evenings where the focus is very much on what is to come; when all the emphasis and preparation is about an experience yet to be savoured and moments still to be shared. There seems to be so much preparation and planning, organising and arranging for a day of just a few hours. But whether for good or ill what happens tomorrow becomes the stuff of memories and future reminiscence in a way that few single days are able to be.

Today then and especially tonight is one in which we stand on the edge of possibility and on the eve of promise. I often find it sad that the sense of expectation and promise, of not wanting to fall asleep lest you miss the happening; of wakening up before dawn breathless with anticipation – that all that seems to diminish as meaning and ‘adult truth’ replace childhood wonder and naivety.

Promise is an intriguing concept and one I’ve reflected on over the years. I have done so because I think there is something intrinsically to do with promise and hope, with expectation and discovery, at the heart of all good and meaningful social care support. Now some see social care as a set of functions or tasks, as something that is done for or with another. But I think that fails to see the whole truth. For social care support is surely much more adventurous and open than simply the performance of action or function? To reduce social care to a spreadsheet of activity is surely to lose its spirit and essence, to commission out its dynamic and unpredictability?

Every encounter we have with someone is a moment of promise, it offers us an opportunity to bring positivity, healing and meaning on the one hand and equally on the other it offers us the risk of harm, hurt or rejection. There is nothing definite or defined about the act of caring for another, it is at its best always a reaching out not to take control but to support the spirit of another to be independent and to grow into the fulness of their own self. I suppose that is true of all relationships but there is for me a special and unique dynamic about care support relationships when they are working well and most especially as folks get to know the pattern of the other.

In her poem Clarke beautifully describes the dormancy of hope in the midst of a cold winter day. There is a sense that the natural world is just waiting, patiently for the thawing of the days till it flourishes life into being. In care support where workers are allowed time to relate, to get to know, to attend and be present with, there is the potential for a life to be refreshed and renewed, for light to overcome the emptiness of absence or pain. Some of you might describe such sentiments as naïve or even false, but I have seen it too often in the compassionate care of a nurse or a carer in care home or in community to not have witnessed something which in this season we might describe as the incarnating of true humanity and love. At a very deep level social carers are promise keepers tomorrow and every day. That promise is lived out in their care, support, love, and compassion for others.

Tomorrow will be a day of excitement and joy for so many especially those who are younger. But we also have to be honest and reflect that for others it will be a slow twenty-four hours in which they will be touched by absence, cradled by regret and held by the tears of memory. There will be thousands of women and men who will combine their thoughts and feelings with going out to work in care home or in the homes of those they support as home carers. They will some of them carry their regret and some will be eager to return to the warmth of others – but for the moments and times they are with others they will be present in that person’s joy or sorrow, delight or pain – for it is the rhythm of presence that creates a carer able to make a moment meaningful for another.

But ‘promises, promises’ also has another tone to it and that is one of challenge; a dismissiveness of a commitment made with voice but not followed through. I cannot but think of all the political and societal promises we made with gestures like clapping hands to remember the women and men who were the frontline of professional compassion and care in the darkest of days during pandemic and since. I cannot but reflect that we have all broken our collective promise to recognise, reward and remunerate those women and men. A promise is empty and hard without the energy of commitment and response. That is the task and call to all of us who have a role to make change happen, to ensure that such promises do not become the stuff of fairy-tale or platitude but are lived out in societal and political commitment and action. There is nothing more important to the creating of true human community than the recognition and value of all, the fostering of compassionate care and support to those who need it to play their part as citizens, and I would argue the primacy of valuing those whose role is care and support whether paid or unpaid as intrinsic to our being in community with each other. We have some considerable distance to travel before we fulfil that promise.

May I take this time to wish you and yours a restful and restoring time as we move through this eve of promise.

Donald Macaskill

As many regular readers of this blog might know I read a lot of poetry for both enjoyment, stimulation, and relaxation – and lots of other reasons.  Most recently I have been reading a fair bit of Gaelic poetry – sadly and guiltily in translation – and have been struck by so many examples of visceral truthfulness from the pens of many contemporary and historical Gaelic poets.

My experience of Gaelic poetry is a long one. I well remember being taken to ‘ceilidhs’ in the 1970s held in Partick Burgh Hall in Glasgow under the auspices of a local Highland Association. These were opportunities for those who belonged to the Gaelic diaspora to come together, to listen to music, song, poetry, and story, and to share company together with friends and new friends. In the 60s and 70s and even into the 1980s they provided an essential place of support and belonging for those who had formed part of a West Highland and Island community because of the wave of immigration into Glasgow. The history of Highland immigration into the city is an old one but perhaps has two dominant waves – the first seeing the arrival of economic migrants as a result of the actions of grasping landlords in the 19^th century and a second one after the Second World War in the 1950s where thousands left their homes in the north to seek employment and opportunity in the cities of central Scotland. It was one such movement that led my own parents to come to Glasgow in the very early 1960s.

I can remember after having listened to yet another Gaelic song of tear and departure and yet another poem of sadness and absence, asking my mother why was so much in Gaelic culture about these themes. She said – from memory – that people who leave where they feel they belong are always trying to return there in their songs, words, and music. That memory struck me again as I delved into the poetry of the Gaels more recently and in reading around this area, I came across a concept which I had not known of but beautifully summarises so much of my personal experience and story , namely the notion of cianalas. The dictionary defines it as a deep sense of longing for the place where your roots lie, a homesickness and nostalgia for the homeland. It is not always melancholic or sad, it is frequently hopefully and energetic, but it is a sense which I think I have felt and heard throughout my childhood and adult growing.

These thoughts came to mind this past week as I watched and read a lot about immigration, as I discussed the prospects of social care providers supporting new immigrant communities into the employment opportunities that social care can offer in Scotland, and sadly reflected on the tragic loss to drowning of those who attempted to get to Britain by sailing in an unfit boat in atrocious weather across the English Channel. I have personally found the discussion and debate around immigration in the UK Parliament to have been toxic and distasteful, an appeal to the basest form of xenophobic arrogance, selfish individualism, and a failure to recognise the inter-connectedness of all peoples, never mind the demographic realities of a country like Scotland which is desperately in need of the vitality, creativity and energy provided by new peoples.

Tomorrow on December 18th the United Nations, through the UN-related agency International Organization for Migration, will hold International Migrants Day to remember all individuals who have been migrants or still are and to reiterate the need to respect the rights and dignity of all. It is a day set aside by the United Nations to recognise the estimated 272 million migrants that are integral members of all our societies today.

I think at this time of the year and at a point when immigration is the subject of such lazy media stereotyping and political soundbites it is imperative for us all to develop a mature and humanity infused understanding of immigration. Our equal humanity bestows dignity on our breathing and presence, it is the behaviours and attitudes, the laws and policies of others that seek to remove that dignity and make that humanity illegal. It is an act of stigmatising which can and must never succeed. I am proudly the son of a diaspora, whose culture and heritage, whose moment and dreaming has been nurtured with the longing of a place I have rarely lived in but which lives in me. I am the child of cianalas and celebrate the strength and vison to be gained by belonging to a people who have in the past ventured into the new in order to achieve and fulfil their dreams. That is surely the story of migration the world over, as true yester year of my parents as it is true of those who struggle to journey to a new possibility today. It is a longing for place and purpose, for belonging and safety. The hospitality of nationhood is in the acceptance of welcome of stranger and migrant. It is in the finding of our immigrant soul that we discover our place in a community of diverse belonging,

The legality of immigration has been much discussed this past week and is a common reflection in the poetry of Juan Felipe Herrera, the Poet Laureate of the United States. In his poem “Every Day We Get More Illegal”, he speaks for those “in-between the light,” whose status of legality in the United States is at best ambiguous. I leave you with his insights as we reflect a few days out from Migrants Day.

 

Yet the peach tree

still rises

& falls with fruit & without

birds eat it the sparrows fight

our desert

 

burns with trash & drug

it also breathes & sprouts

vines & maguey

 

laws pass laws with scientific walls

detention cells   husband

with the son

the wife &

the daughter who

married a citizen

they stay behind broken slashed

 

un-powdered in the apartment to

deal out the day

& the puzzles

another law then   another

Mexican

Indian

spirit exile

 

migration                     sky

the grass is mowed then blown

by a machine  sidewalks are empty

clean & the Red Shouldered Hawk

peers

down  — from

an abandoned wooden dome

an empty field

 

it is all in-between the light

every day this     changes a little

 

yesterday homeless &

w/o papers                  Alberto

left for Denver a Greyhound bus he said

where they don’t check you

 

walking working

under the silver darkness

walking   working

with our mind

our life

 

Copyright © by Juan Felipe Herrera.  Everyday We Get More Illegal by Juan Felipe Herrera – Poems | poets.org

 

Donald Macaskill

Today is Human Rights Day which is an annual international celebration and recognition of the critical role that human rights play or should play in all our lives.

The theme this year is Dignity, Freedom, and Justice for All and reflects both the international dimension to the 30 articles that constitute the Universal Declaration of Human Rights which underline the treatment, freedoms and fundamental expectations that citizens in all countries have the right to live under.

There is an added significance this year in that the 75th anniversary of the Universal Declaration of Human Rights will be celebrated on 10 December 2023. Ahead of this a yearlong campaign is being launched today to showcase the ‘legacy, relevance and activism’ of the UNDHR. Under the call to action to #StandUp4HumanRights the organisers state that the UDHR highlighted the “recognition of the inherent dignity and of the equal and inalienable rights of all members of the human family is the foundation of freedom, justice and peace in the world.”

I have often written and commented about human rights in this blog. I have argued most recently that there is much potential in the Scottish plans to incorporate the International Covenant of Social, Cultural and Economic Rights into Scottish law. In particular the embedding of a broadly defined right to health to include the rights to social care, palliative and end of life care and bereavement support has much to offer the citizens of Scotland in the years to come.

But today is a time for honest reflection and appraisal not just recognition of achievements and the articulation of aspiration. Part of that reflection must surely be the extent to which the not insignificant existing human rights-based legislation has or has not made a real difference to people in the ordinariness of their living. Indeed, one of the oft quoted aspirations behind the creation of the UK Human Rights Act in 1996 was the desire to ‘bring human rights home. A desire to ensure that human rights were not restricted to dusty courtrooms, that they were not solely the preserve of legal discourse but that they meant something to everyone in a community regardless of circumstance.

I’ve reflected a lot about whether or not we’ve managed to bring human rights home. I’m not at all sure we have. Now lest I be accused of supporting the latest Westminster Government’s attempts to change and limit the current human right protections we all enjoy – that is absolutely not the case. The so-called plans to replace the Human Rights Act with other watered-down legislation are both damaging and dangerous. Far from replacing the Act I want to see it strengthened and better resourced. I want to see developed a new framework for national enactment, citizen participation and collective realisation.

In reflecting on the experience of so many not least older people during the pandemic and those receiving social care support in community and care home; in considering the extent to which there has been a lack of equal treatment, voice and inclusion over the last two and a bit years and in truth for a long period before – to name but two examples I would argue that there is a significant implementation gap between human rights based legislation and its enactment in practice.

It is all very well to have some of the most progressive and inclusive legislation in the world passed by parliamentarians both in London and more recently Holyrood – but if it is not empowered by enactment, if people are not able to exercise recourse or to know their rights in realisation; if there is a lack of resource to train, equip and engage all stakeholders – then human rights based legislation is empty and potentially duplicitous. There is I would suggest an urgent need to independently assess the extent to which human rights are being progressively realised in Scotland today. There is equal urgency in building and resourcing mechanisms and models that allow every citizen with a concern over the removal or diminution of their rights to have an ability to exercise immediate voice and if necessary to achieve urgent redress. We do not have such.

As we reflect on human rights this day and the coming year I very much hope we will also ensure that we continuously strive to develop a framework of human rights which have real accessible meaning for every citizen and not just a minority who are empowered to understand and access their rights. If we do, then the 75th anniversary will be really worth celebrating. If we do, then we can claim with integrity that we #StandupForHumanRights.

To celebrate the launch of the Human Rights Law Review in March 2015, the Human Rights Collegium asked Queen Margaret University London law students to submit poems on the theme of ‘Human Rights’. The winner was one Thomas Baynes who wrote ‘July 1995’. His words resonate as I read them in the winter of Ukrainian struggle but they also echo to the truth that human rights lost to some command those of us who are alive to act and hear.

 

From the depths they have cried to us,

While we sit by rivers and weep

in remembrance of their tears.

Their silent howl deafens out our

empty courteous words and fears.

 

There upon Balkan valley floor,

does the elemental death dance

over wood-brown coffins shrouded

in grass green cloths, suffocating

the humble dead who hold their breath.

 

White skulls stained brown and drowned in an

ocean of fog and dirt and blood.

Eyes, hair, smiles, all consumed by hate

and by the black ignorant mud,

lost to the tragedy of fate.

 

Why then, this terror and this pain?

For some forgotten lord’s dead name?

Or the glory of ancient gods?

Twas hate breeding love caused stillness

to roar and blameless tears to rain.

 

No affirming flame can be lit

to banish the dark from our minds,

No romantic lie can be told

to ease the reality of

our past torpors and woes.

 

We can only awake now to

the mute alarm of their lament

and raise ourselves from inertia,

so never again we should fail

to hear the breathless dead exhale.

 

https://pickmeuppoetry.org/july-1995-by-thomas-baynes/

 

Donald Macaskill

The following talk was in part delivered at the close of the Scottish Care Care Home Conference held in Glasgow yesterday.

 I don’t get much time for reading these days so when I do something needs to capture and hold me – and one book recently has done just that – Sir Geoff Mulgan is Professor of Collective Intelligence, Public Policy and Social Innovation at University College London. He used to be chief executive of Nesta and held government roles including as Downing Street’s head of policy in the early noughties. He’s written a book called ‘Another World is Possible: how to reignite social and political imagination.’ I’d thoroughly recommend it as it is a book brim-full of ideas and insights, no little challenge and a lot of provocation.

Its main argument is that as societies and the world face the challenges of living in the light of the pandemic and the ‘slow calamity of climate change, we also face a third, less visible emergency: ‘a crisis of imagination.’

Mulgan argues that especially the young struggle to imagine a world better than the one we live in now and that perhaps they are the first generation so to believe – the first generation which is less positive about the future we are creating and leaving for our inheritors. Too many are resigned to fatalism or at most tinkering on the edges of real change and transformation. This crisis of imagination is crippling us and we need to discover ways to reimagine the future to reimagine better and to visualise how we are going to arrive and get there.

I don’t know about you but I certainly want the children of my living and the community of my belonging to be living in a world better than it is now and I still with Mulgan believe a better world is possible.

And I know that’s hard – it’s risky to dream and visualise change and difference and not be accused of escapism and utopian folly – but I think that’s what we have to do even after a day in which we have not exactly avoided or not heard the challenges facing the care home sector in Scotland.

I want to use some of what Mulgan says to spend a bit of time at the end of our day reflecting on the future of care homes. I want the reflection to be practical in nature, but I also want to challenge both myself and ourselves. I am starting from the premise – that we urgently need to re-imagine the future of care homes and aged care in general – in part because I do not think we can stand still, that what we offer now will not be fit for purpose in fifteen or twenty years, and that if the sector and its leadership does not do the work of re-imagining tomorrow’s care and support  – along with those who use supports and their advocates and those who are likely to be users of aged care in the future  – then the re-design will be undertaken by the misinformed, biased and partisan – no doubt accusations which will be directed towards myself. But I’m also convinced that re-imagining always is an activity shared with others never a solitary pursuit if real change is desired.

So why is imagination so important? Mulgan explores this in great depth using insights from Socrates to Star Wars and with him I believe that ‘Society now and in the future depends on imagination.’

He rightly critiques the fact that there is a real dearth of imagination and a poverty of ideas in our society… and I think that accusation can be amplified when we think of the world of social care – and I will be honest from what I have seen thus far from the ideas of the National Care Service – although there is a lot of good stuff, its view of the imagined possible future is predictable, pedestrian and a re-shaping of the known into a familiar future not one that will outlive its designers. And lazy re-imagining is dangerous and inexcusable – because and this is selfish – I do not want a future world of social care support to be the fruit of compromise and affordability, of lazy design and casual engagement – I want it to be a horizon which draws me in and which opens up a new world for me.

Imagination is a powerful force and tool if used well. For something to be it has to become real and imagining something births that reality. Ideas do not come from nothing, new systems, and ways of relating originate somewhere with someone or they remain forever locked in our heads.

Imagining the future of care homes is not about cloud cuckoo land but recognising that the fruit of tomorrow is already growing in the soil of our present experience.

Part of what I think the residential care sector has to do is to develop what Mulgan calls the ‘adjacent possible’ – the nearby options which are the alternatives to present arrangements – but have a spark of the familiar. But I also think we have to go much further than just tweaking or light changes – we have to be much more adventurous and explorative. We have to develop a collective of care imaginaries – people who have the skill and foresight to imagine a better future and a different way of being and doing aged care.

Social care in Scotland badly needs dreamers and people who can see beyond the limited vision of the now. That’s why I have looked with real interest at the HIVE collective. But I hope you will excuse me because I am going to try and picture a different future –to try to expand what Mulgan calls the ‘possibility space’ ; to backcast into the future.

In visualising that future I want to plant certain seeds in the present and you can decide if they grow and flourish or if they deserve to shrivel in the earth.

The first is that we have to urgently re-imagine age:

I do hope that at some point today you have had the chance to drop by the stall staffed by colleagues from the University of Stirling and elsewhere and have learned more about the project Reimagining the Future of Older Age. They have done some brilliant work including producing a gorgeous film by Ray Bird. The project is about how we think about the future as we age and as we become older; does the future matter more or does it matter less? It challenges the dominant stereotype and cultural narrative which presents older age as nothing to do with the future – the belief that the future belongs to the young.

Dr Valerie Wright now of Glasgow University reflects that as we grow up we always ask young people ‘What do you want to be when you grow up?’  but no- one ever asks older people what do you want to do in the future? What do you want to do when you get older? Who do you want to be? And how very true she is.

A reimagining of age is necessary to challenge the inadequacy of those narratives and societal biases. As I have consistently and often said I have personally witnessed first-hand, lives transformed and changed, as in the last months, days and moments of life a reconciliation has been nurtured, a discovery made, a new creative contribution shared, and a new loving started.  The future has no use by date.

And let’s be honest the world of social care and aged care is too often dominated by a narrative which accepts the bias against contribution and capacity of older age.

For instance, we have rightly used reminiscence – a looking back – as a mechanism and a means to ease the distress of those with neurological conditions such as dementia – but I increasingly wonder whether the dominance of reminiscence approaches is misplaced and that we are losing real neurological benefit by not adopting a more futuristic approach to dementia care and support and to older aged care in general.

Reimagining age whether in care home or community is a fundamental first step to the reimagining of a future of contribution and new discovery.

The second seed which I think the world of aged care needs is to re-imagine the very essence and nature of collective living, of being in community in older age with one others.

It is inescapable – and this is true of the world over – that we must ask a fundamental question as to whether or not congregated or collective or group living remains an appropriate modern form of being in community with others.

Or being blunt do we just do it for those who are too old, too frail, too poor, because it is the cheapest way for a society to hold to its moral and ethical duties of care? Hard words but unless we can answer them in an affirmative way which says no – that collective living in older age can be life-changing, life affirming and life enhancing – then we are deceiving no-one.

Now my personal premise is that I really do believe that the future – to say nothing of the present – is about us living by choice not by cost – in community alongside others.

Some would say congregated living is always wrong – never acceptable – and Twitter is alive with a narrative which equates care homes as removers of rights, limiters of choice and control, ‘prisons’ of individuality. That critique has to be answered honestly.

But personally, I believe there is a future for collective and shared living and one of the reasons is that it is better than isolated loneliness. It will not be long before the majority of people in Scotland over the age of 65 will be living in single person households – and we have already witnessed a saddening growth in isolation, loneliness and mental distress amongst those who are alone – so it is not unreasonable to suggest that increasingly there will be a growing number of people who choose to live alongside others, and at a stage of  life when they have control and capacity – that shared collective living becomes something that is desirable and beneficial.

But just as I am convinced that collective and shared living has a place in the future of aged care – so I am equally convinced that a radical re-design of the way we deliver care and support in a shared space is very necessary.

There is a narrative which says that shared living is about creating a home from home; that care homes are people’s homes first and foremost. Inevitably there is a counter critique not least as a result of pandemic response and behaviours, that says that care homes have failed in being a person’s home. So the sector has to honestly ask, in replicating a home from home how are we doing?

Are our care homes places where people can live and love, rest and be loved, grow and be fulfilled, discover and change – or are they rather places where folks work, people are checked and viewed, monitored and evaluated? Are they places where we obsess about risk or let the mess flow, are they tidy or unkempt, disease free or life affirming?

We use home not to limit or imprison us but as a place to be ourselves, to be fed and renewed, to rest and relax, to entertain and be entertained, to sleep and restore, to be secure and be comfortable, to hide and be private. Are our care homes such a space and place?

For me a home is a place to make memories – what are the memories made in our care homes? Are they life enhancing or life limiting?

If we answer that care homes are not a home from home, then we have to ask honestly can we change that to a yes?

My third seed is that for me part of the re-imagining of aged care must surely be about build and design. Imagine a world will you where you all live in exactly the same type of house – everything is the same – no variety and no distinctiveness – every room measures the same, the layout identical, the windows are where they are – the mundanity of the predictable rules. But your individuality is allowed up to a point – you can decorate the space as you want – you can even bring some of your own things – providing they are of suitable material as to prevent infectious spread and conflagration. Not that much of a caricature in case I’m accused of it

The future has to be not so much about the architecture of design and more about the imagination of space. I think we need a radical redesign of space and place so that we allow both architectural and design freedom -collective living in space needs a revolution – or we will continue to ghettoise older age – at its worst in places separate from community by geography and cost or separated from connection even in the midst of busyness. Aged care beyond four walls does not just happen by accident it has to be purposefully designed and built.

There are emerging examples of such creativity like the ‘What we Share’ models in Stavanger Norway; Berlin’s ‘baugruppen’; Lange Enk in Denmark or Kraftwerk 2 in Switzerland.

We have a chance to capture the design spirit of the age. The idea of ‘fifteen-minute cities’ – sometimes known as 20-minute neighbourhoods – probably needs little introduction. Strongly associated with the Paris professor Carlos Moreno, and the mayor Anne Hidalgo, it has gained extra energy from the pandemic and the changes in our living in community. Its basic premise is that all our daily necessities can be accomplished by either walking or cycling from our homes. It shrinks the whole concept of what local means to the touching – or walking distance of our neighbourhood. It is closely linked to the concept which is becoming hugely popular of ‘ageing in place’ which is “the ability to live in one’s own home and community safely, independently, and comfortably, regardless of age, income, or ability level.” Ageing in place has something to say to the future of aged care in residential and nursing shared communities.

My last seed is that we radically need to re-imagine the nature of scrutiny, inspection and oversight in aged care. Of course, both families and residents, and wider society needs a sense of assurance about the quality and humanity of care – but increasingly I feel we have the balance all wrong. A care home resident is more closely observed, monitored, and watched than your average penguin at Edinburgh Zoo. The human right to privacy, to dignity alone, to the joy of absence, the hiddenness of living – all are lost when we turn our aged care settings into goldfish bowls. The individuality and uniqueness of the person, the desire to take risks and make mistakes, to fall in your failing and rise in your discovery are put aside if we adopt measures that limit self-expression, individuality, and freedom.

The perverse irony is that all our standards and statements talk about systems being person-centred but leave no room for care support to be person led by resident and family. At the very least we need a radical balancing of risk in aged care regulation. The constant current behaviour and presumption of the right to intrude on the part of outside agencies is offensive and unacceptable.

I could go on but for me this is a conversation not a soliloquy – the future of aged care in Scotland – of collective shared living is too important to leave to accident or happenstance – it needs a work of imaginative discovery and exploration.

I love old maps because at their best they are not about helping you find your way, but they tell you the story of a community or nation at a particular time. None more so than ancient medieval maps. On many of these maps at the edge you can sometimes see a picture of a wild beast and the words ‘ Here be dragons…’ – that was for all the places which were unknown and yet to be discovered.

Explorers use the knowledge they have to try and test the waters of the future – they venture into the unknown, but they are not just dreamers searching for utopia – because they use the skills and instruments of their known reality to create a different tomorrow.

Reimagining the future of aged care is about travelling beyond the known into a new world of discovery – it’s about re-designing with others, a future we want to achieve – it is a world where older age still grows And flourishes and changes and contradicts; it is a space and place where conformity to design is replaced by the adventure of personal control and choice; it is an experience of self-freedom rather than external monitoring; put simply it has to be a world which we would be proud for our children and our grandchildren to inherit.

 

Donald Macaskill