Home Care Day 19: Changing times for home care – a blog by our National Director, Karen Hedge

 

How is home care changing…

The pace of change is fast, yet the principles of care and compassion are age old. Whilst practical methodologies have changed in how we might support someone, the way we want to feel when we are cared for has not. Care, which is grounded in dignity and compassion, which supports us to be independent and to have choice and control, to be part of and contribute to our communities for as long as we might wish, and which makes us feel safe and connected.

We are now in a place where idea to execution can take only a matter of weeks, making it all the more important to ground progress in human rights. There is much conversation about the role of technology in social care – increasingly more of us use wearables, tech is becoming much less intrusive, but the development of products has often been in isolation from the sector, or solution- focussed rather than innovative. Earlier this year, Scottish Care launched A Human Rights Charter for Digital and Technology (https://scottishcare.org/wp-content/uploads/2019/10/Tech-charter.pdf), developed in collaboration with people who access care and support, care providers, academics, software and hardware producers and others. By signing up to the charter, organisations commit to founding their developments in human rights, and with this in mind technology is developed which can help to create the conditions or that positive care experience. The development of the charter came from Dr Donald Macaskill’s report ‘Tech Rights’ which can be found here.

For the last 2 years, Scottish Care has been working with the European School of Innovation and Design at GSA on what the future of care should look like. You see it is important as Megatrends drive change, that to ensure these principles remain as key drivers, we are not only ready, but are part of leading change to come (https://futurehealthandwellbeing.org/future-of-care-at-home).

What was initially seen as a 20-year vision is already coming to being (I said the pace of change is fast). Out of the research came 3 new roles for home care. They have a particular focus on connectivity and feeling connected, which chimes with the human rights approach outlined in the aforementioned ‘Tech Rights’ report. Much of this is about freeing up care staff to simply ‘be human’, and with that the potential to optimise their wide-ranging skills in care and support.

We have since ran workshops with providers and regulators and many others to test out the applicability of the roles and as a result, some organisations have made changes to practice. The roles were designed to stimulate conversation and inspire the sector towards meeting requirements of the future, yet we are now seeing components of the roles in action.

Some care organisations have begun to monitor vital signs which is leading to a reduction in unplanned hospital admissions or GP visits. Some have invested in digital software and staff who will analyse the data contained within to inform care plans for the future. The opportunity to introduce e-MAR in care at home has reduced mistakes as well as medicines wastage.

The regulators are getting behind the trends with the SSSC developing open badges in the use of technology, and the Care Inspectorate looking to upskill their own staff to be able to inspect in a technological age of care.

Technology is being used to support people to live more independently, where an alert system or other can offer security that care, and support will be there when needed. This is not just about in emergency situations, although this is obviously important and can form part of the home care support offer, but this is about longer term data analysis which in identifying trends sooner allows us to intervene sooner.

The challenge with this is the multiple systems which we all use – I am frustrated when my laptop and phone don’t speak because one is Apple and one is Android, but imagine if you have several systems, all collecting data. The solution is not to make them interoperable, nor to have one tech provider owning the market, but instead to have a cloud-based system where citizens hold their own data, and which they get to choose who has access to it. Better still, imagine if this data was held across a person’s care journey and could be accessed across health and social care. Scottish Care is working with organisations to pilot this technology in 2020 and of course will be developed with the Tech Charter at its foundation, because there are many ethical questions to be answered in this context.

But megatrends do not point solely to technological advances. There is much talk of collaboration and whilst laudable, it is merely being promoted as a systemic diversion rather than a real solution. The change required in social care remains as it always has done, by focussing on the individual and how they can lead in their care and support. The future is about creating the conditions to achieve that, and collaboration may be one aspect, but what is truly required is the realisation of integration in the widest sense. Every week I read the Economist, there is a call for a change to capitalism – what is needed in home care is a route to address the power imbalances tied up in tender process and contracting, shifting the importance to achieving person-led care and support with systems which support all who are involved in making it happen. Another example of such a shift is the increasing number of employee-owned organisations in social care – widening the offer which people who access care and support have available to them.

It is clear that the independent care sector is at the forefront of developments for the future. Of course it is, it is a sector of innovators and entrepreneurs and it has the capacity to adapt quickly, with the support of skilled and dedicated staff who come to work because they care. Home care also bucks the business trend by having proportionally more women in leadership roles and as business owners. Scottish Care is working with Women’s Enterprise to promote the sector as such and to explore further why that may be and how other organisations can learn from this, culminating in a Cross-Party Group at Scottish Parliament.

It might be Home Care Celebration Day, but it is not the only day that we should be celebrating home care. It is not only a part of our future but leading the way. As one of very few job roles which sees no threat by automation, it is integral to our future. To deliver care is to care and we should be proud of that.

Thank you

Karen Hedge

National Director, Scottish Care

 

#homecareday19

Home Care Day 19: Working in Home Care, a blog from our Workforce Lead

“It is a privilege to be welcomed into someone’s home and to work with them in their daily lives”

Working in home care is not for the faint hearted, however, for the amazing individuals that do work in home care it is, even with the challenges, a particularly rewarding career.  It is a privilege to be welcomed into someone’s home and to work with them in their daily lives experiencing all their different highs and lows.  The relationship between care and support workers and those they provide services to can be something extremely emotional to behold.

I personally have many stories and great memories from working in home care both as a care and support worker and as a manager.  I started working as a care worker at the age of 24 and it made me into the person I am today.  I learnt so much from the people I supported from practical skills to seeing different perspectives and learning some good old-fashioned wisdom.

When I started as a new care worker, even with comprehensive training, it can be an overwhelming experience going into people’s homes and assisting them with their complex needs.  Learning how to assist an individual to move in a training session is quite different from assisting an actual person with various health concerns and mobility issues.  I was very fortunate to receive great support from wonderful supervisors who were able to demonstrate the job and mentor new staff members with little or no previous care experience.  Care and support workers who had worked in care for many years and had that innate and natural ability to build relationships with people in challenging situations and to make a difference to their lives.  These experienced workers provide reassurance and comfort at distressing times in a person’s life and are invaluable when showing new workers that important aspect of the role.  Many practical skills are transferable and can be taught but having compassion and empathy for others in distress and understanding their needs is at the heart of the job the social care workforce does.

I will never forget the supervisor who received a round of applause upon completing roughly five minutes of the Great Scottish Run in order to get from one side of the road to the other.  The crowd watching the run responded with joy and laughter when the supervisor set off at a jog in pace of the runners to weave her way through the crowd.

This is a lighthearted example but there are so many more of staff going above and beyond to help and care for the service users they support.  This often means taking time out of their own lives and personal time to stay with someone who is unwell or has fallen.  Home care workers rearrange their own commitments and responsibilities to ensure that the individual has a familiar face and someone there to provide comfort while they are waiting on an ambulance and are in pain or unwell.

I had the absolute privilege to accompany staff during the extreme adverse weather we experienced when the “Beast from the East” came to Glasgow.  Staff were walking though knee-deep snow and found the solution of wearing poly bags over their socks and inside their boots to try to keep their feet warm and dry.  On an occasion where people were being advised to stay at home and protect themselves, care and support staff, among others, were out walking through the snow and blizzards to get to people in their homes and give them the care and support they needed.

Within all types of social care valuable relationships are made but it is so inspiring especially as a manager of a home care service when you find that match between care and support worker and service user that is life changing for that individual.  I have seen first-hand the difference that special person can make especially when people have experienced mental health problems and periods of stress and aguish caused by a change in life circumstances.  To see someone flourish under the right support after a time that they thought they would never get back to the person they had been is so rewarding for all involved.

I loved my job as a home care manager going out and meeting some fantastic individuals and hearing stories of their lives and personal experiences.  I met an elderly lady who had worked at the age of 16 during the war on a forty-foot crane and had walked along the gantry whistling with her hands in her pockets.  People are full of surprises from all walks of life and have so much to offer to the younger generations.  This is an important aspect of social care and we must realise that these relationships can go both ways and benefit both the care worker and service user.  Staff often express their pleasure in some of the things that they learn from the people they support, and you can see this empowers the service user too when sharing their life skills with others.

Amongst the current challenges it is important to remember the positive aspects of this sector and the good times that happen too.  I will leave you with a story that I feel encompasses home care: I was talking with a provider who told me that during the torrential rain we had back in September they had been calling their staff working out and about in the community to see how they were getting on.  When the manager of the service had spoken with one staff member they had responded that they were absolutely fine: they had been soaked to the skin while getting to their first call, however, they were now getting dry and were nice and warm in the service users home having a cup of tea together and planning the day ahead.  That to me gives a true example of the sharing of lives and experiences and the wonderful benefits that home care can bring to both the workforce and those they care and support.

Caroline Deane

Workforce Policy & Practice Lead, Scottish Care

#homecareday19

Home Care Day 19: Defining home care, a blog by our CEO, Dr Donald Macaskill

 

‘You can change a life in a few minutes…’

In my role I inevitably spend a lot of time with policy makers, commissioners and politicians talking about and not infrequently arguing over the nature and state of the homecare sector in Scotland.  In some of these discussions I get a sense that folks do not really understand the nature of the care and support the sector offers and delivers. For too many there is still an outdated image of homecare as ‘mopping and shopping,’ as a set of practical activities designed to make people feel better but not much more than that. As almost like an added luxury!  This lack of real understanding of what homecare is has become especially evident during this General Election – albeit that these issues are technically reserved matters in Scotland – when it is clear that there is a lack of public and societal awareness about the nature of what homecare is and how critical and vital it is for tens of thousands of people.

But when you strip all the debates – which are critical – around commissioning, funding, workforce and the future away – what you are left with is a consideration of what the essence of care at home and housing support is.

That is why Scottish Care has been articulating our own definition of social care – in part because far too many people (and some of these should know better) keep conflating social care with health care – which it clearly is not! We have stated that:

‘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, the nurturing of belonging to enable the individual person to flourish.’

Homecare is that care and support which enables and empowers an individual to be free, autonomous and independent in their own home. It is the energy which gives purpose to someone wanting to remain in their own space and place, it is the structure of support and care which enables citizens to remain connected to their families and friends, their neighbours, streets and villages. It is not an added extra but the essential care that enables life to be lived to its fullest.

The best of homecare is a care that changes life and gives life.

Some of my readers may know that I am a bit of a Bruce Springsteen obsessive. In an interview which he gave around the time he launched his autobiography in 2016, Springsteen said that:

‘You can change a life in three minutes with the right song.’

He expanded on this by talking about the power of song to change a life and give voice to a story which is not heard or told; the importance of his own challenging upbringing in giving him continuity and boundary, freedom and permission. He spoke insightfully about the way in which words and music can create a possible future for those who feel alone, empty and directionless.

At the time the sense of words and music changing and transforming a life struck me as being a powerful description of the musicality of one of the greats of his genre. But I also think that it is a description of the essential life changing and enabling power which lies at the heart of care. It is this ability to change a life through care and support which we are celebrating in this second Homecare Day.

The women and men who work in homecare are life-changers. The reason that statement is true is that by their acts of personal care, by supporting someone to take their medicines, to get up in the morning; by making sure their space and place is tidy and safe, that hazards are controlled or removed; by taking someone to a club or to their family, to an activity or simply to belong somewhere, these women and men who are the workers of care are the gifters of purpose and meaning to so many. This is not incidental it is essential. It is this work that binds a community together, that truly creates neighbourhood, and moulds togetherness in the midst of our cities, towns and villages.

Most of us are able to be independent – to get around on our own, to have the control that we need not be dependent upon another. As life changes through age or illness the loss of that independence and the forming of bonds which make us reliant upon another can be both challenging and difficult for our sense of identity and self-worth. It is in this territory that the marvellous work of support and care locates itself and comes to the fore.

Good care is not about taking over another person’s autonomy, good support is not about creating dependency – they are both the total reverse. They are the actions and deeds, the words and encouragement that enable others to either re-discover or find for the first time, the abilities to make decisions, to exercise choice, to be in control and to be independent even if support is needed to achieve that goal.

This is why homecare is important – it is because for so many of us being in our own space and place surrounded by familiar furnishings of our memory and the story of who we are,  are critically important to enabling us to be ourselves or to be the person we dream of becoming. The autonomy that homecare gives  a supported person enables them to flourish to their best and continue to grow into the person they want to be.

So, if a good song can change a life in three minutes then good care and support changes a future forever.

So today let us celebrate homecare as the lifeblood of a society which cares.

Dr Donald Macaskill

CEO, Scottish Care

#homecareday19

Latest blog from our CEO: Time to raise awareness of Self-directed Support

Reform of our health and social care services cannot only be an ambition but is an urgent requirement. The recent annual report from the Auditor General on NHS Scotland made this extremely clear. If we are to meet the current and future health and care needs of our country, we have to change how we deliver care and treatment, with more services based in our communities, meeting individual care needs. Audit Scotland’s annual report said the NHS was “seriously struggling to become financially sustainable” and the Auditor General Caroline Gardner said the integration of health and social care was too slow and staff were under intense pressure. The conclusion was that Scotland could face a £1.8bn shortfall in less than five years if it is not reformed. Change is urgently needed but the pace of change is too slow. We have achieved a consensus on the need to integrate health and social care services and reform social care. Health and Social Care Partnerships have been established to bring about more effective collaboration, but progress is patchy. Yet by embracing rather than resisting reform of health and social care, we have the opportunity for transformational change which will benefit the thousands of people in our country who are supported by care services. 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 principles underpin the Scottish Government’s flagship social policy of Self-directed Support, which seeks to give people more control over the care services they receive.  The policy means local authorities now have a legal duty to offer people eligible for social care four options on how to use their personal budget. The four options are direct payments; an Individual Service Fund held by the local authority and allocated to a provider of your choice; the local authority arranging support on your behalf; or a mix of these options. Human rights and social care practice come together in our Self-directed Support legislation in Scotland which 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. A personalised approach has the potential to benefit and empower people with a range of conditions and care needs. This is why we have been keen to assess levels of awareness of Self-directed support among those groups of people who could potentially benefit most. We have been working with Royal Blind to research awareness of Self-directed Support among people with visual impairment. People living with sight loss require care which meets their specific needs to enable them to flourish and foster their full contribution. Self-directed Support offers them the potential to ensure they are provided with specialist support, equipment and accessible information to help them live well with visual impairment. There are around 188,000 people in Scotland living with significant sight loss, around three quarters of whom are over 65, and this number is projected to increase to over 200,000 by 2030. This means Scotland requires a social care system which can support an increasing number of people with sight loss. Self-directed Support has the potential to benefit thousands of people with sight loss, enabling many to maintain their independence and live at home for longer. So it is disappointing to learn that there is low awareness of Self-directed Support among many people with sight loss. Over 100 people with sight loss were surveyed by Royal Blind and Scottish War Blinded to learn their views and experiences of Self-directed Support. When asked the question “have you heard of Self-directed Support,” two thirds of respondents said they had not. Only five respondents said they had a support plan funded through Self-directed Support.  Over 60 percent of respondents had never been informed of the budget available to them for their care and support. 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 is why it so frustrating that for too many people, including people with sight loss, the promise of Self-directed Support is not being realised. The legislation is now in its fifth year – bedding down should have long since passed. The excuses are running out and we are left with the conclusion that this human rights-based policy is being consciously ignored, blocked and underfunded, or that only those who shout the loudest are being given choice and control. We are still defaulting to models and a provision of assessment and care which too often do not meet individual need and are economically unsustainable.  This situation needs to change urgently if we are to secure sustainable models of care and the rights of people accessing care services to be fully included in our communities. There is little point in having fantastic legislation if there are is a collective failure to put it into practice. There is little point in having rights under the law if the obstacles to exercising those rights are growing every day. Dr Donald Macaskill  CEO @DrDMacaskill

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