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
A blog from our CEO for Professional Care Workers Day
A new blog from our CEO for World Elder Abuse Day
Open our eyes and ears… Jean to all intents and purposes was a confident, articulate and outgoing individual. She put a good face to the world with a close group of friends whom she had known for years and who all still kept in touch with each other even if less frequently. Jean was in her late 80s and lived a quiet suburban life with her son and daughter-in-law. As her health declined over the years and particularly following a stroke she needed more and more support to manage the ordinariness of living. But she got there and often with a humour beyond her conviction and a positivity which was the object of much admiring comment. She went out as much as she could, attending a local lunch club for older people and was also consistent in her attendance at her local church. That was the Jean that the outside world saw. The real Jean was a woman whose life had been turned upside down since her son lost his job and came to stay with his mother, bringing along with him his wife who Jean had never really seen eye to eye with. After a brief honeymoon where everyone danced on the eggshells of shared living, being polite and sensitive to accommodating the rhythms and routines of others, things began to get first moody and then heated and angry. It started with small verbal barbs and putdowns and soon escalated into loud arguments and verbal challenges; open and subtle domination on the part of her son and snide, belittling asides from her daughter-in-law. Jean began to retreat into her own world, using silence as a weapon to create absence in her own home. She watched her words so much that she stopped conversing and just watched the television when she was at home. The domination reached a new level when her son, on the pretext that he thought Jean was developing dementia, persuaded her to allow him to be her Power of Attorney, and then took charge of her pension card. Jean was given pocket money whilst her son’s taste in fine wine developed literally at her expense. Jean is the victim of abuse and harm. She is hidden, in part by her own sense of shame and embarrassment, in part by the inability of people around her to think the unthinkable and to see the signs of abuse. Today (Sat 16thJune) is the United Nations World Elder Abuse Awareness Day – a day when we reflect on the harm which countless millions of older people experience across the world. Scotland has some fantastic legislation which protects and supports the victims of harm and abuse. But of course, legislation is not what ultimately safeguards individuals who for whatever reason might be vulnerable. What protects is a community which recognises the small signs that things might not be right. It is relatively easy to recognise the victims of physical harm, albeit that bruises and marks are often hidden. It is much harder to recognise the countless older women and men who are the victims of sexual abuse, psychological and financial harm or are the objects of hatred. But sadly they live in every community of Scotland. They live in homes with threadbare carpets and lace curtains, they live in streets of Georgian townhouses and Victorian tenements , behind quaint scenic village doors and in newly built housing estates. Abuse knows every village and town, every social standing and occupational group, every ethnic heritage and every sexual identity. Today look around you. Listen for the dropped remark and quiet word. Hear the fear in a trembling voice or a shed tear. Spot the furtive anxiety and desire to be invisible and small. Don’t dismiss your intuitive concerns but take a moment to think about whether you need to ask, to speak, to do. Jean and countless like her depend on our eyes, our voices and our actions. Thankfully in Jean’s case her home care worker spotted the signs and now Jean is free. Dr Donald Macaskill @DrDMacaskill
Blog: Madonna as a champion of age
Our CEO Dr Donald Macaskill was pleased to take part in Scotland’s first Festival of Age which was held in Glasgow on Thursday 23rd May.
Before the event he wrote the following blog to challenge some of the stereotypes and negative attitudes which still exist around age. Madonna – The champion of age. Over the years the controversial singer Madonna has spoken about the flak that she had to take because of “using sexuality as part of my creativity” and with being labelled a “sexual provocateur” amongst the politest of critiques. She is now facing a new battle and in an interview in British Voguepublished on 10th May has argued that she is now fighting ageism in the music industry and that she is “being punished” for hitting 60. She told Voguemagazine: “People have always been trying to silence me for one reason or another, whether it’s that I’m not pretty enough, I don’t sing well enough, I’m not talented enough, I’m not married enough, and now it’s that I’m not young enough. All too many people will share Madonna’s angst about ageism and I for one look forward to her battling against it. Ageism is so endemic that it has become part and parcel of the wallpaper of our realities – so subtle, so pervasive that it is not even noticed; it is just accepted as a given, as a state of unalterable being. It’s almost the same position that racism was in the 1950s and early 1960s – so unconsciously accepted as a social norm in the UK that it went unnoticed – except by its victims. It is in the language we use, the stereotypes we accept, the rhetoric we hear. What do a ticking time bomb, a silver tsunami and a population apocalypse all have in common? No, they aren’t the latest plotline from an episode of Line of Dutybut rather they are phrases used to describe the fact that we are living longer. They are highly negative descriptions of a reality that most of us would or should want to celebrate – we are dying older and healthier than at any time in Scottish history. So why the negativity? Why is it that so much of our cultural and political discourse about old age paints such a dark and depressing picture of decline? Old age is something which should be valued, but alarmist attitudes fail to recognise the benefits and potential of older age and feed into the myth that getting old is about losing something rather than gaining something new and potentially positive. Old age is seen as a challenge rather than an opportunity. Everywhere you look there are negative stereotypes which perpetuate the myth that older people are incapable and dependent, have nothing to contribute but rather are a burden and a drain on society. We see this in many of the current debates about social care and health which count up the costs an ageing population results in but fail to recognise that over 90% of care delivered in this country comes from the hands of people who are themselves old thus saving the taxpayer countless millions. In Scotland I am sure we would like to believe that we treat all peoples as equal, regardless of colour, creed, disability, sexual orientation and we have indeed made great strides in addressing discrimination and hate. But have we made the same progress against negative stereotyping and discrimination which is based on age? I think not – why is it that a child in receipt of residential care will have nearly double the amount of public resource allocated to their care than an older person of 90 in a care home? Why is it that countless individuals talk about not even getting the chance of an interview if they are over 60 and are seeking employment? Why is it that at the age of 65 people who are accessing social care support move from being an adult onto being an ‘older person’ and in some areas such as mental health services they tell us they suddenly find the level of their support diminishes? Do we feel it is adequate that for thousands of older people seeking social care support that you can only now be eligible if your need is ‘critical’, that our social care services are critically under-funded? We need to take off the heather-tinted glasses and face up to the reality that Scotland is as ageist a nation as many others in the world but rather than just recognise this we need to act . Yes, the Scottish Government has just published a great summative strategy, but … Scotland has a real opportunity to do things much better. Embedding human rights at the heart of economic, social and political systems is a start. However, regardless of good policy intention and political priorities unless we address the pervasive cult of youth in our society, we will continue to acquiesce with ageist discrimination. So, with Madonna I will continue to fight against the ageist discrimination that fails to value contribution, for me that means fighting for Scotland to have an Older People’s Commissioner and for a Convention of the Rights of Age. What does it mean for you? How can we together create a country which is the best place in which to grow old and in which value and contribution is recognised regardless of chronology? In the words of Madonna:
“I have a dream But dreams are not for free We all need to change Or just repeat history.”
Dr Donald Macaskill CEO, Scottish Care
Latest blog from our CEO – Redressing the balance: the potential of homecare
In just over a week Scottish Care will be hosting our annual Care at Home Conference, Exhibition and Awards. It is shaping up to be a great day of debate, a very full exhibition and a real opportunity to celebrate the best of homecare across Scotland in the evening. The title of the event as a whole is ‘Redressing the balance: the potential of homecare.’ To some extent it is a bit disquieting and disappointing that we are still talking about re-dressing the balance of care in Scotland. After all we have had a policy direction of enabling independent living and support in our communities and homely settings for over two decades – and yet we are still talking about re-dressing the balance from acute to community, from health and clinical dominated concepts to social care practice, from time and task commissioning to relationship, trust-based approaches. To redress the balance means to achieve ‘an even distribution of weight to ensure equilibrium within a system.’ It is that care equilibrium that is significantly missing from our current approaches to health and social care in Scotland. That’s what we are after in social care – namely the gain of truly integrated services and supports which we are meant to achieve. At the heart of the debate and all the policy and political priorities in terms of re-dressing the balance is the need to move the focus from reactive response to need on to one which is truly preventative in nature. This is the massive and largely untapped potential of homecare within the whole health and social care system and economy. For what we are seeing in practice on the ground across Scotland is yet more sophisticated approaches to reacting after the horse has bolted. Our eligibility criteria which determine the level at which social care supports and services can be accessed have now reached critical in most parts of the country; and resources for innovation and new models of care are depleted and drained as we seek to keep the ship of care from grounding on the rocks of reality. As a sector with some of the best independent care and support, providers and frontline workers alike are straining under the stress of ever-growing demands being met from ever-tightening funding. It is the care economics of insanity not to recognise that we need to prevent people from accessing the expensive and unhealthy acute system in the first place rather than to seek to respond to their needs once they have been in it. Let us stop people from going to hospital after their latest bout of mental distress and illness; let us prevent unplanned admissions as a result of an unnecessary fall or incident; let us ensure that malnutrition and poor diet, unaddressed lifestyle factors and loneliness are not the vehicles for the inevitable journey into the acute system. But to achieve all that we have to change not just the rhetoric but the reality to properly resource our social care sector in order to enable real prevention to happen. It is not rocket science so why decades after policy initiatives are we still talking and not doing? There is a real opportunity for us to be brave and dynamic, innovative and creative in working together at local level, commissioners, planners and providers in developing models of preventative care which are up to the mark. We can do so much better than we are at present in developing models and approaches which prevent an individual from either early or unnecessary access to enhanced care, hospitalisation or sharper personal physical decline and deterioration. We can do so much better in working together to re-balance care so that we focus on approaches which enable independent living for a longer period of time and which focus on maintaining a higher quality of life and wellbeing. Our obsessive functionalist approach to social care is not only degrading and demeaning of worker and recipient alike, it is a public health hazard and threat. Let us work together to re-balance care by achieving the potential of care at home and housing support, by maximising autonomy and control. Join us on 17th May and get involved in the debate! Dr Donald Macaskill, CEO Scottish Care @DrDMacaskill
Latest Scottish Care blog: National Director, Karen Hedge
Putting human rights into the commissioning cycle
This has been a period of uncertainty and deadlines. It seems every other headline covers Brexit, but for the care sector there is a real and significant effect of negotiation at various levels. When 19 care homes closed last year, and 9 out of 10 of our care at home providers told us that they may not survive until the end of the financial year, it confirmed that we are in worrying times indeed. The Freedom of Information request by Robert Kilgour on the cost of statutory care home provision highlighted that the cost for the Local Authority to run a care home is double that of what they pay the independent sector. We know that for care at home providers the proportionality is similar. But it is not simply about cost. The care sector is exactly that, a sector which cares. Choice and control is critical to the Self Directed Support Act and the independent care sector is sufficiently diverse to meet that; made up of charitable, voluntary and private providers; and they range from small, single, family-owned businesses through to large corporates. It is a vibrant sector, grounded in Human Rights and the National Health and Social Care Standards which enable person-led care and support in a flexible way. We know this from our conferences and awards ceremonies; held to facilitate innovation at the forefront of the sector, and to celebrate the dedicated but often overlooked staff with whom it is an honour to work. I am fortunate to have had a varied career in health and social care and have experienced the sector from many different perspectives. The intent of the system is to have the person at the centre, yet, there are glaring gaps and confusion. All too often commissioning (the delicate balance of facilitation and planning to ensure the right services are provided at the right time) is confused with procurement (the purchasing of services). With only one major purchaser – integrated authorities, the concept of competition in the sector is a false one, and the push to drive down costs has led to a focus on the wrong things. We measure the amount of time that we spend with a person, not what difference we made for that person during that time. This competition also limits opportunity for the collaboration needed to maximise the full potential of the sector and is worsened by the tendency to consider only one part of the system and not the totality as intended by the Public Bodies (Joint Working) Act on integration. Back when I was a Local Authority commissioner, the Commissioning Cycle was my guide as remains true for commissioners today; Plan, Do, Analyse, Review (repeat). But I came into that role with the experience of having been a carer, social worker, researcher and citizen. I knew that bringing those components and more to the table would change the nature of the process. So we changed the make up of the Board. It was, I now realise ‘integrated’; it consisted of 50% citizens and 50% professionals comprising of health, social care, commissioners, providers and procurement managers. This was over 10 years ago now and at the time it was not considered revolutionary, it was merely a step on the road to getting it right. Together, we could map a realistic picture of a complicated landscape, and create the conditions to share resources, maximising the potential of the totality of our assets, but most importantly, we could sense check this approach with those who matter. It took time and courage, but we created a safe space to try out new ideas, quickly focussing on successes, continually improving as we went, always coming back to the person. It is this realistic and person focussed embracement of the commissioning process which meant that the changes we made were meaningful and had impact; increasing the number of people who could access care and support by 110% at no extra cost, and with every one of them saying that the service had made a positive difference to them. The current frustrating focus on measuring outputs limits our possibilities, as do the invisible and enduring barriers of silo-working. But change takes bravery. We had to put in systems to support those involved in decision making to enable them to equally and fully participate in the process. At Scottish Care we do something similar for the independent sector through our Branch structure and Partners for Integration Team, representing our members, creating trusting relationships with our partners to enable collaboration. We have some great examples where working together has led to people getting the right support in the right place at the right time; implementing an enablement approach, supporting people to move back into the community, reducing falls and pressure ulcers to prevent admission to hospital, and targeting medicine waste to make tens of thousands of pounds worth of savings per month in just one area of Scotland. For all of these to work, they had to be approached with courage, and from the perspective of the person accessing care and support. Without this they would have failed. Planning and Review is all good and well, but what is clear in the current landscape of diminished budgets and increased need is that that we need to change our approach across Scotland. It is time to put human rights into the Commissioning Cycle. Karen Hedge National Director, Scottish Care @hegeit
Latest blog from our CEO: Towards an age-valued Scotland
On Wednesday 3rd April the Scottish Government published ‘A Fairer Scotland for Older People: framework for action.’ Over a year after the creation of the first ever ministerial portfolio for Older People, the document is an important contribution to addressing the challenges facing Scotland’s older population. Sadly, despite what I would consider to be an excellent starting point this Framework report has received only a minimum amount of media coverage. You could say, of course, that Brexit and its shambles dominates the media. However, even without Brexit the absence of any significant media comment is perhaps itself illustrative of the challenges in addressing age apathy within our contemporary society. The Framework is a starting point. In her Ministerial Foreword Christina McKelvie MSP states that: ‘I am also aware that older people can be marginalised. Maybe that is because we fear ageing and the impacts it can have on our lives through deteriorating health or because, quite simply, ageing is something most of us don’t want to think about. ‘It is time to remove barriers, tackle inequalities and allow people to flourish and be themselves. That is why I am publishing this framework. It affirms our responsibility to ensuring equality for everyone as they age and outlines the clear steps, we will take to deliver improvement.’ She goes on to state: ‘Importantly, the framework provides a platform from which we can reframe our thinking about older people, to move from what can be a negative, problem-focused perspective to a positive and cohesive recognition of older people as a vital part of Scotland’s potential for success and improvement in the 21st century. ‘We recognise that change will not occur overnight and will require years of sustained effort and a change in thinking…Scotland’s older people today and those older people of tomorrow are depending on us to deliver.’ I would encourage you to read the document as it brings together in one place actions and priorities around older age and also indicates areas where there needs to be more work and where we need to start addressing the barriers that prevent older people from becoming full citizens. So why is this important? Well on a simple level – if we are to create a fair society then that society needs to be inclusive of all and enabling of all citizens to achieve to their fullest potential. Sadly, this is not always the case for older people especially given the definition of older person in the framework as anyone from age 50. There are too many cases of age discrimination whether that be in the workplace or in accessing services and resources. Scotland has an ageing population, and this is surely something to celebrate although all too often it is the subject of negativity or simple stereotype. The population is ageing at a faster rate in Scotland than the rest of the UK. Median age (the age at which half the population is older and half younger) in Scotland is 42.0 years from the mid-2017 population estimates, around two years higher than in the UK as a whole and is projected to rise to 45.4 years by 2041, compared to 43.5 years for the UK. There is also considerable geographical variation in the ageing of the population within Scotland. In general, it is lowest in the cities and higher in more rural areas. Between 2016 and 2026, all council areas in Scotland are projected to experience an increase in their population aged 75 and over. Clackmannanshire (+48.0%) and West Lothian (+46.0%) are projected to experience the largest increases, while Dundee City (+9.6%) and Glasgow City (+2.9%) have the smallest increases. Therefore we have a particular challenge in Scotland but that also gives us a real opportunity to ensure that Scotland is ‘the best place in the world to grow older.’ Age matters to all of us and most especially to those organisations who work in the care and support of older people in Scotland. Indeed, the Framework addresses some of the very real issues which the social care sector is currently facing in contemporary Scotland. It highlights the importance of social care in enabling older people to remain parts of their community, and to be active and contributing citizens. It addresses some of the challenges in ensuring that a career in care is viewed as a positive choice and that the standards and quality of care and support continue to improve. It requires the voice of older Scots to be at the heart of the decisions around the reform and future of social care and health. Yet the Framework also shows the distance we have to go. It challenges the discriminatory behaviours and attitudes which treat older age persons as less than those of other ages. It calls out behaviours which dismiss the contribution of those whose communication is changing and those who face frailty and ill health. Scottish Care has long argued that there is a profound discrimination at the heart of the way in which older people are treated within society. At a simple level discrimination is when one treats another on whatever basis in a less favourable manner than you would treat someone else. That discrimination happens to older Scots far too often up and down Scotland every day of the week. It is often so subtle and unconscious that it is almost impossible to recognise or name – but discrimination it is nevertheless. The Framework is an excellent starting point in the journey towards achieving the ability of older people in Scotland to exercise and enjoy their full rights and entitlements as citizens. It is a summative work describing existing commitments and future aspirations. The challenge is to ensure that it does not simply remain a summary of good intention but becomes the description of action-led response. There are still today too many instances in the social care of older persons where we are daily witnessing systemic discrimination in Scotland. Why are so few older people in Scotland actively and fully participating in the range of choices which are offered under the Self-directed Support Act? Why do I still hear social work assessors say ‘SDS is not for older people’? Why are there so few of the 33,000 people whose home is a care home who have been given an outcomes focussed assessment to determine their needs and wishes, who have been allocated a personal budget and given real choice rather than the fiction they are offered, all of which is their entitlement under the SDS Act? In terms of revenue and resource why does the social care sector have to fight a continual battle to maintain already inadequate resource allocation for vital services and supports? Despite being a major contributor to the Scottish economy why does the social care of older people in Scotland continually get described as a cost and a drain on our society? Why do those who live with dementia effectively pay twice for that care and support whereas those with other conditions do not? There are many instances where we have some distance to go to create a fair Scotland where everyone is enabled to exercise their human rights regardless of age. The Framework makes a helpful start. I for one – not least as I am well into the decade of older age – want to ensure we support its actions and its aspirations. It is up to each one of us to work with some speed to creating that Fairer Scotland which values age. Dr Donald Macaskill CEO, Scottish Care
Compassion – Guest blog from the Care Inspectorate
The Inequity of Social Care – the latest blog from our CEO
The inequity of social care I’ve spent a lot of my professional life working in areas to challenge and address inequity and inequality. Indeed since I took over the role of CEO of Scottish Care a great deal of my focus has been on highlighting the challenges of unequal treatment in older people’s care and support. That has included the very real funding imbalance which has over time seen less and less proportionately allocated to resource older people care whether in the community or in care homes. But increasingly I believe that there is an overarching inequity at the heart of our health and social care policy and practice. At its centre is a critical question. Put simply what defines a support or service as social care and therefore currently chargeable and what defines a condition or illness as a health condition whose treatment and support is free at the point of delivery? I was reminded of this when I listened this week to a presentation from Alzheimer Scotland on their Fair Dementia Care campaign Alzheimer Scotland has recently published a report from the Fair Dementia Care Commission chaired by former First Minister Henry McLeish. At the heart of the report is a description of the life experience of thousands of our fellow Scots who live with or support someone living with advanced dementia. A number which is due to grow significantly in the coming years. As well as offering a definition of what is meant by advanced dementia the report highlights the confusing and complex maze of charging policies for social care services across Scotland’s local authorities which end up meaning that people with advanced dementia pay a staggering £50.9 million in care costs every year. The report does not call for the end of charging per se but for greater transparency, consistency and understanding. But I think one of its greatest services has been to shine a light on the inequity of social care and health in Scotland today. In the dictionary inequity is defined as ‘a lack of fairness or justice.’ Whilst the report from Alzheimer Scotland rightly highlights the inequity faced by people living with dementia I believe the inequity or lack of fairness goes even further. At root is it fair that if in life you are struck down with a life limiting cancer that you will receive your care and support free of charge but if you are someone living with dementia you will face charges for social care which might include disposing of your home and assets in order to pay for care home fees? Is it fair and right that many people living with neurological conditions are treated as having social care needs and not primarily health and clinical needs? I think not. We have too many individuals living with conditions such as Parkinson’s, Huntington’s, Multiple Sclerosis and so on who are paying for the essential support that enables them to continue to live and contribute as citizens in our communities. Is it fair that a person who suffers the ill health that arises from frailty and age and requires appropriate support for that should have to pay over and above their lifetime contributions to taxation for that care including nursing care? Just as Scotland is seeking to create a rights-based social security system I am convinced that we need to seriously start a debate about the inequity, the lack of fairness and justice that lies at the heart of social care charging for specific conditions such as advanced dementia. But I am equally convinced that we need to go much further and start the conversation to move us to enshrining the human right to social care, to have your care and support provided equitably regardless of the condition or illness or disease, regardless of the realities of age or decline, that life deals you. In the words of Bill Gates: “Humanity’s greatest advances are not in its discoveries but in how those discoveries are applied to reduce inequity.” Dr Donald Macaskill @DrDMacaskill
