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

It was encouraging to read over the weekend research which had been undertaken by Ipsos Mori. It was the latest ‘Ipsos Mori Issues Index – 2018 in review’, which gives a “snapshot” of the top ten major concerns across individual parts of the country. Brexit and its implications was not surprisingly revealed as the most important issue facing Britain, topping the list. However, what it also showed was that Scots worried about the ageing population and social care much more compared to concerns over immigration and crime than the rest of Britain. 16 per cent of people were concerned about social care compared with 11 per cent for the rest of the country. This is at least encouraging considering that ‘Scotland’s population is ageing at a faster rate compared with the rest of the UK, while the population is growing at a slower rate and fertility, life expectancy at birth and net in-migration are all lower.’ When I read the report I was encouraged by the prominence not least because the social care sector as well as facing huge demands in terms of capacity is eagerly awaiting a Scottish Budget that prioritises it rather than provides leftover crumbs from other fiscal concerns. But when people talk about social care what do they really mean? Indeed I am reminded of a senior public official who recently confessed that it isn’t at all clear what social care is and what it’s distinctive role is. There are many definitions, both legal and aspirational, as to what social care is and what it is not. For instance social care whilst it may contain services which are clinical or medical in nature is not primarily about one’s physiological health. For me the role of social care is:

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

That may all sound a bit nebulous but in essence social care is about enabling the fullness of life for every citizen who needs support whether on the grounds of age, disability, infirmity or health. Social care is holistic in that it seeks to support the whole person and it is about attending to the individual’s wellbeing. It is about removing the barriers that limit and hold back and fostering conditions so that individuality can grow and an individual can flourish. Social care is not about performing certain functions and tasks alone for it is primarily about relationship; the being with another that fosters individual growth, restoration and personal discovery. It is about enabling independence and reducing control, encouraging self-assurance and removing restriction, maximising choice and building community. Therefore as many of us have sought to illustrate over the last few years, social care is profoundly about human rights. It is about giving the citizen control and choice, voice and agency, decision and empowerment. All of the above is why social care is critical to Scotland’s future. That is why we need a social care workforce which is valued, well-rewarded and appropriately resourced. That is why we need to undertake necessary reforms and critically that is why we need to properly resource a sector that is a major contributor to Scotland’s economic and national progress. Social care is not the handmaiden of the NHS- there as an adjunct department to clinician care and medical intervention . This why we cannot treat the two as if they were the same. Whilst inextricably linked the healthcare we deliver is vastly different from the social care we should rightly demand. One of the fundamental areas of difference has to do with choice. If I have a medical emergency then personally I want the best clinical care and don’t really want to have much say in who delivers that care as long as they are trained, suitably qualified and supervised. A short term stay in a hospital is very different from the place and people with whom I spend my life. For if I am living with a lifelong condition or need support in any way because of life circumstances or age then I most certainly do want to have more choice and control both over who is in my life as a carer and what the nature of that support and care might be. The critical importance of legislation like Self-directed Support is all about embedding that control and choice, building those rights with the citizen. We are absolutely right to value social care as intrinsic to the fabric of our society and as a marker of the maturity of our commitment to support and uphold one another in community. In the weeks ahead social care will continue to face fiscal and workforce challenge but in those times it will remain critically important that we defend the intrinsic role and distinctiveness of social care rather than acquiesce in attempts to limit choice, control outcomes and thereby restrict individual rights. It is to be celebrated that Scots care about social care and the ageing population and it is incumbent upon all of us to ensure that social care is advanced and protected in the years ahead. Donald Macaskill @DrDMacaskill

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New Scottish Care Blog: Robert Telfer

Sharing is Good for You

I have always felt it is good to share whether that be specific knowledge or just general life experiences. Before joining Scottish Care I worked for a number of years in nursing in both NHS and Independent Care settings where there was always some degree of sharing of knowledge between care professionals. I can remember the Clinical Team meetings from early in my nursing career with input from various members of staff being sought, these then seemed to expand into Multi -Disciplinary Team meetings with, as the name suggests, input from a wider range of health care professionals. No matter what title you called the group it all came down to sharing knowledge, experience, views and opinions.

Since joining Scottish Care in 2012 initially as a Development Officer, under the Reshaping Care for Older People Project, then as Integration Lead, I discovered that the sharing of experience and knowledge continued to be a recurring theme. At the various meetings different views from the various departments and groups would be heard and discussed before plans and decisions were made. Since Integration this sharing of experience, views and opinions still continues although perhaps not at as a high and consistent level that some of us in the Independent Sector would like. The sharing of good practice was something that the Scottish Government’s Cabinet Secretary for Health and Sport mentioned in her speech at the recent Scottish Care Annual Care Home Conference.

I would like to briefly describe what I consider to be a good practical example of sharing. This is not something that happened at a high strategical level but at a more basic level.

One of the two geographical areas I cover is Renfrewshire and in 2018 my Scottish Care colleague who works in East Renfrewshire and I decided we would facilitate a joint Care Inspectorate Quality Improvement event for both areas. This event would be not only for Independent Care providers but also for Partnership commissioning staff, care home staff and other interested persons. Invitations were duly sent out and one day in late August approximately 40 people from a variety of professional backgrounds turned up at Eastwood House near Rouken Glen for the event. We had representatives from both Renfrewshire and East Renfrewshire, staff from Independent Care Homes, from Independent Care at Home providers. From the Health and Social Care Partnerships we had commissioning staff, care home staff and care at home staff.  Members of the Care Inspectorate not directly involved in any of the day’s presentations also came along to participate.

The day comprised of 9 sessions which I will not go into in any detail, but covered topics such as the “History of Quality Improvement”, “What is an Improvement Collaborative Approach” plus ample time for group discussions. A recurring theme right from the icebreaker session through the day was that processes and improvements are better and more easily achieved by joint working, sharing knowledge and experiences. For me, and judging by the feedback from those attending, one of the main benefits of the event was the variety of different working backgrounds and experiences shared throughout the day.

Sharing good practice does not need to be complicated or difficult. I will share the words of one of the slides from the day regarding Collaborative Principles:

  • Everybody teaches
  • Everybody learns
  • Share generously (transparency)
  • Steal shamelessly
  • Acknowledge graciously

With regards to that last point of acknowledge graciously I would like to thank Aiden from the Care Inspectorate for all his work prior to and on the day and sharing his knowledge with us all.

Robert Telfer

Independent Sector Lead, West Lothian & Renfrewshire

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Re-discovering Compassion: a new blog from our CEO

The start of a year is always an opportunity to look forward, to resolve to do things differently, to relate in a different way and to change direction. It is therefore a risky time. The desire for the new can risk sweeping away the best of the old; the energy to innovate can risk draining sense from what is commonplace; the urgency for change can risk the loss of the safe and familiar. The necessity of action can risk the way we relate to others. The first few days of 2019 have filled me personally with a growing sense of dismay and on occasion real concern about the cohesiveness of society. There seems to me to be a growing sense of dis-ease and a lack of compassion and care in politics, in many of our communities and in the wider media. This personal unease was articulated by the Queen in her Christmas Message when she said: “Even with the most deeply held differences, treating the other person with respect and as a fellow human being is always a good first step towards greater understanding.” These words were immediately seized upon and considered to be a veiled reference to Brexit. Be that as it may I would suggest they have a wider resonance at the start of this year. Compassion is central to all good and meaningful social care. Indeed compassion is one of the five principles which underpin our Health and Care Standards in Scotland. Sadly what seems to be lacking in recent days is a sense of compassion beyond the context of social care and health. Admittedly compassion can be a bit of a nebulous word but it has some essential elements. Compassion conveys a sense of sympathy, fellow feeling, empathy, understanding, and tolerance. It is not surprising therefore that the concept of compassion is central to good care. We recognise that the best of care in care homes and of care in an individual’s own home requires staff who are empathic, sensitive and able to relate and get alongside others – even when personal feelings may make that relationship challenging. Care involves developing the art of being professionally compassionate. The scenes of angry crowds shouting down politicians outside Westminster in recent days, the vitriol and violence expressed on social media and the horror of several murders in open and public spaces in the last two weeks seem to paint a picture of a society which has lost the capacity to be compassionate. Now I immediately accept that this analysis on its own is too simplistic not least because the tens of thousands of staff in care homes, homecare and in doing jobs in the NHS and elsewhere are daily illustrations of compassion in action. But… I suspect we need to recognise that civil society and cohesive communities do not just happen but that they need to be striven for and built. I suspect that the ability to dialogue with difference and to discover reconciliation and compromise is something that has to be developed and worked at. I suspect that the resolution of the massive political and economic challenges we face in the next weeks and months can only be achieved by shared collective resolve and mutual respect. Compassion needs to become the energy not just of professional carers but all who would seek to lead us politically and economically. If we are to move forward on so many issues whether Brexit or a Scottish Budget, whether reform of social care or education, then I suspect we need to rediscover the spirit and power of compassion in civic and political discourse. I believe it is perfectly possible to hold strongly held political and philosophical beliefs without that requiring the disminishing and devaluing of the views and values of others. I believe that it is absolutely right that anger and passion can be utilised in a way which is righteous and convincing. However when anger becomes dismissive and denigrating of the other then it is destructive and dangerous. The philosopher Arthur Schopenhauer wrote ‘Compassion is the basis of morality.’ It is such a political morality we need to urgently discover. The year that lies in front of us will bring undoubted challenge and in the world of social care as elsewhere the necessity to make hard and sometimes painful decisions – I very much hope that it will also bring a discovery of the power of compassion. Dr D Macaskill @DrDMacaskill

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The state of care in Scotland: new blog from Dr Donald Macaskill

The State of Care in Scotland

Over the next few days our newspapers and magazines will be full of reviews of 2018 and the expression of hopes and resolutions for 2019. It would seem churlish not to add to that volume. So here are some social care hopes and reflections for Scotland. Worker pay and conditions: ‘A fair days wage for a fair day’s work’. The adage is very familiar and describes the desire to pay staff according to the skills they evidence. The nature of social care has changed dramatically over the years. Social care is a major part of the Scottish economy with 1 in 13 Scots employed and delivering multi-skilled and professional care and support. Yet we have consistently failed to adequately reward and remunerate them at an appropriate level. Even an initiative such as introducing the Scottish Living Wage for frontline carers has failed to make the step-change that was desired because put simply it has been only partially funded at National Government level and poorly implemented by local authorities. The ongoing effects of underfunding are being seen right across the country as care home and home care organisations struggle to recruit people for the fundamental job of care. If we are serious about care in 2019 we not only need to establish a Pay Commission to set proper targets for worker terms and conditions but we need to stop deluding ourselves into thinking that paying the minimum is enough and start attempting to pay with respect for a job well done. Workforce retention and recruitment The survey published today by Scottish Care is the last in a long line of research we have produced in 2018 and illustrates that we are way beyond the point of crisis in terms of recruitment and retention in Scotland’s social care sector. It’s all too easy to read figures which state for instance that we have 9 out of 10 organisations who simply can’t find staff, that we have a nursing vacancy rate of 20% equivalent to having no NHS nurses at all in the whole of the Western Isles, Shetland and Orkney put together, that we are losing nearly 2/3rds of care staff within the first six months of their employment. These are the statistics but behind them is a story of staff struggling to cover shifts, working far too many hours to fill in the gaps, and being quite frankly exhausted by their care. Behind them is a story of younger staff deciding enough is enough and walking away with their skills and abilities. Behind them is the truth that unless we start to sort out the crisis of the social care workforce in 2019 then we will begin to see closed signs over care homes up and down the country and more people stuck in hospital because there are no social care staff to care for them in the community. The statistics are easy to read but the stories of people at risk should challenge us all to do something urgently. Brexit and migration It is impossible to reflect on the year that has passed or the year to come without mentioning Brexit. The social care sector in Scotland is significantly dependent upon and grateful for the skilled and dedicated staff – some 12% in care homes – who have come to care for Scotland over the last few years. Brexit is not going to happen in March because it is already happening up and down Scotland today as individuals and families are making hard decisions on whether or not to stay and contribute or to leave. Employers are already reporting to us the loss of dozens of staff in the last few weeks who feel that their future lies elsewhere. The depth of uncertainty, the lack of political will and what sometimes appears to us as a failure to appreciate that decisions being made or not being made are for many a matter of life and death is having a profound impact on the social care sector in Scotland. We urgently need a sense of certainty. What we are getting however is a set of proposals around immigration that shamefully describe social care staff as low-skilled and set levels of pay expectation that will make it impossible for us to plug the gaps in our already critical workforce shortage. How dare politicians and policy makers describe the intensive skills of palliative care, neurological support, behaviour management and compassionate care which is being delivered in our care homes and home care organisations as being ‘low-skilled’.  2018 has already seen a massive drop in recruitment from Europe. 2019 has to see the development of a model of immigration that really takes people seriously rather than playing to the crowd. Scottish Budget The Finance Secretary is busily trying to build a political consensus around his initial budget proposals. Our colleagues in Cosla and elsewhere have expressed alarm about the extent to which the current offer will fail to meet the needs of local government. This is the primary route for funding social care in Scotland. Scottish Care has called and continues to call for an investment in social care  in 2019 of £200million. It is not our role to say where that resource has to come from or how we pay for it. It is absolutely our task to flag up the insufficiency of funding which is frankly putting lives at risk. Yes we need to reform how we are doing things and we are working robustly with others to achieve this. Yes we need to ensure that individuals are able to better self-manage and remain independent for as long as possible. Yes we need to ensure that we have services which are adequately resourced from cradle to grave … but. We cannot continue to collude in a system which purchases care on the cheap and sets levels of eligibility so high that you have to be in some instances at death’s door before you get social care support. We cannot continue to collude with a system that purchases care by the minute and considers that care is about tasks rather than being with people .Let’s stop expecting social care to pick up the fiscal crumbs leftover on the plate – let us together change the size of the cake!   Commission for Social Care Scottish Care has called for the creation of a Commission on the Funding of Social Care in Scotland.  England and Wales are shortly to be presented with a White Paper on how they will fund social care., There are lots of ideas floating around – in Scotland we have not even started to have these debates. There is a real urgency faced with the increasing demands on social care, faced with workforce challenges, and the reality of financial uncertai8nty for us all to plan for our personal future. We are expected to do that at a personal level so it is incumbent upon those who call themselves our political leadership to work together in order to arrive at proposals for how we are going to as a society pay for our care in the years to come. Care is too important to be used as a political football. We need to get around the table and start talking.   Integration In the last few weeks of the year we have seen published a report on the Integration of Health and Social Care from Audit Scotland. It made uncomfortable reading and has highlighted clear points for improvement. What we need to do in 2019 is to build on what is working and to once and for all make it clear that integrating health and social care is first and foremost about making life better for our fellow citizens. Integration is not about health and social care professionals learning to work together and talk to each other, though it is in part, it is trying to create a system where the individual citizen has greater control and choice, and the ability to direct their care and support. That is an aspiration which we should surely all work towards achieving.   A future that cares The mark of any society which might want to describe itself as civilized, rights-based and mature is the degree to which it cares for those who are in greatest need and most vulnerable. There is such an amount of excellent care and support being delivered every minute of every day across Scotland. We are fortunate to have tens of thousands of staff who offer amazing care and astonishing love. There is so much to herald as positive and inspiring. But there are still challenges of resourcing, of workforce and of structure. Scotland has a proud heritage of putting people at the centre, of listening to those who have no voice, of creating space for those who feel threatened so they can feel secure, of giving welcome to those who are strangers. We have the capacity to direct our future into one that cares. But this future will not just happen rather it has to be moulded and built, nurtured and nourished, resourced and struggled for. As we finish a year and stand at the door of another we have the prospect of creating a nation that truly cares or one that walks by. Dr Donald Macaskill @DrDMacaskill

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Latest Blog from our CEO: a Letter to the Finance Secretary

Dear Mr MacKay I appreciate that in the run up to the Scottish Budget that you will have lots of reports to read and voices to hear, but I wonder if I can take a moment of your time and suggest that your budget needs to prioritise the social care sector in Scotland. It’s often said, sometimes even by politicians, that social care is an expense and drain on society and that it’s holding back investment in other areas. That’s a lazy pitch because I’d like to suggest that by investing more in social care that the economic benefits – never mind the societal ones – are even greater than might first be imagined. I say that for several reasons but probably the most important is the argument that social care enables the rest of society to function well and be economically active. That was the conclusion of an independent report published a few months ago which showed that social care is a net contributor to the Scottish economy of around £3.6 billion. The arguments and figures are there in black and white. Might I suggest your budget is a great opportunity for Scotland to become a champion of putting social care at the heart of our nation. I could draw up a long list of how you can spend your money – and I wouldn’t be the first I suspect. But we are facing real challenges in social care made event worse by the uncertainty over Brexit. We have 9 out of 10 care providers struggling to fill jobs, nearly a fifth of nursing posts in care homes are vacant, we have people now being supported in care homes who would have been in hospital five years ago. Homecare providers are struggling to pay the Scottish Living Wage and remain sustainable. Costs and prices are soaring. I could add a lot more to that list but the reports and the facts and the figures are all out there. What I want to say is that we need a priority and targeted resource – I have argued for over £200 million – to make adult care a priority for all Scotland. It was Human Rights Day on Monday and with others I was at Parliament celebrating the successes of the last decade. We have a great opportunity to build a nation which puts human rights at the heart of our communities. You can continue that process by a human rights based budget which puts the interests of the vulnerable, the old and young, those living with mental distress or at the end of their lives at the centre of your financing of our futures. That’s what social care does it gives hope and healing but it needs resourcing. Social care makes us into the country we are and want to be. Thanks for reading Donald Macaskill @DrDMacaskill

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Carers Rights Day Blog from our CEO, Dr Donald Macaskill

On the 10th December which is the annual Human Rights Day there is reason for multiple celebration. That date is the 70th anniversary of the Universal Declaration of Human Rights, as well as the 10th anniversary of the creation of the Scottish Human Rights Commission. As part of attempts to raise awareness of the significance of these events and the priority of human rights have in Scottish society a social media campaign has been launched with the hashtag – #AllOurRights10.  Starting today (30 November) the Scottish Human Rights Commission will be releasing one short digital film per day, sharing ten different stories of people working to protect and promote human rights in their own community or context. They are all about highlighting the value and relevance of human rights in people’s lives. Today is Carers Rights Day. See https://www.carersuk.org/news-and-campaigns/carers-rights-day/carers-rights-day-resources . It is also St Andrews Day, so a day of celebration of national identity and affirmation of our sense of belonging one to the other. It is therefore very appropriate that it is a day when we consider the importance of human rights to both paid and unpaid care and the role that care for others can have in creating a society in Scotland which values all, has care at its centre, and creates potential for everyone to be treated with dignity and respect. A couple of weeks ago I had the immense privilege of speaking to the Coalition of Carers conference in Edinburgh. The room was full of dedicated individuals who were involved in either supporting family carers or who were individuals who cared for a family member. I spoke to the group about how important it was for us to see the rights of family carers as basic human rights. We reflected on the way in which over the last ten years and more since the Scottish Parliament was formed that human rights have become embedded in political and policy discourse, and how so many pieces of our social care legislation have human rights at their core. However, I also shared my belief, and it is not inappropriate to reflect upon this today as we start to consider the approach to the 10th December, that the journey towards  the realisation of human rights cannot conclude with the passing of innovative and good legislation. The real journey towards embedding rights for unpaid and family carers and for those who work in social care has to be in the robust implementation of all this good human rights based social care legislation. In that analysis, I believe, we still have a considerable distance to go on the journey. Sadly we know all too often and for far too many, especially older Scots, that the promise is unfulfilled. There are too many citizens today across Scotland who are not being able to fulfil their rights to the provisions of e.g., the Self-directed Support legislation. There are too many instances where we are playing at the system change and power transfer which some of our social care legislation predicates. There are too many who are not being properly assessed for their social care outcomes but for whom basic needs are only being addressed; too many who are not being told what budget they have to spend and are being denied information to enable them to exercise informed choice; too many who are having even their already basic packages of care diminished and reduced. We stand or fall in human rights terms not by what we promise and speak of, not by what we legislate and declare, but by what we enact, do and fulfil. In those terms we have some way to go before we have the ability to say that social care in Scotland has truly embedded human rights principles and is realising the human rights of our citizens. Implementation of rights is as critical as the articulation of those rights. Robust monitoring and inclusive evaluation is fundamental to ensuring people are not being led up to the top of the hill of promise and then let to slide backwards into disappointment. Every day 6,000 people across the UK become carers but often it’s not something they have prepared or planned for. This year’s Carers Rights Day is focusing on supporting people to prepare for the future through the theme Caring for Your Future.  It has three main focus areas:

  1. Making carers aware of their rights.
  2. Letting carers know where to get help and support.
  3. Raising awareness of the needs of carers.

Carers Rights Day raises awareness of the needs of carers with the wider public, decision makers and professionals. Its aim is to realise the vision of a society that respects, values and supports carers. Too often in the past the voices of paid care organisations and family carers have been seen in opposition or discord, but the truth is that care unites us around a joint desire to ensure that the human rights of those cared for are upheld, that the abilities of unpaid and paid carers are valued and resourced, and that together we work to create a society where those who require support achieve and receive adequate care which enables them to continue to be the full citizens of our shared community, entitled to full rights and to be treated with full dignity. That journey starts with good legislation for carers and social care, it progresses with robust implementation of it, and it reaches its end with a society that truly gives value, affirms and welcomes the contribution and presence of all. That, I would suggest, was the energy and passion which inspired those who sat and signed the UN Declaration nearly 70 years ago. It should be our shared task on this Carers Rights Day and every day. Dr Donald Macaskill @DrDMacaskill

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New Scottish Care Blog: Aberdeen Team

Open morning in Aberdeen City - October 2018

As part of Aberdeen City Health and Social Care Partnership Conference Week 2018, Scottish Care Partners for Integration Team hosted an Open Morning on 4th October.

We thought it would be a good way to engage with communities and partners, inviting them to come along and meet our team and hear how Scottish Care are supporting Independent Sector care homes and care at home services as part of the integration of health and social care.

The Scottish Care team in Aberdeen has doubled in size over the past year and is a team with a wide range of experience in development, training and research. An open morning would serve as an opportunity to learn about what the Aberdeen team are involved with, what projects we are working on and the opportunity to network with us – with the main aim not to eat all the pastries ourselves. It was also a chance for folk to see our new office base at Centurion Court.

 As part of the session, we found ourselves hosting an impromptu seminar on integration with our international visitors from Robert Gordon University.

Professors of nursing studies and health journalists from Japan and Finland, as well as Scotland, were keen to understand how our work fits alongside the work of the third sector and the statutory health and social care agencies.

Around the table were informal carers, care co-ordinators, care at home managers, community planning reps, care home managers and nursing staff, researchers, third sector staff and volunteers all keen to demonstrate the value of their approach to building partnerships and developing better relationships.

We had a good time with lots of visitors and there were even some pastries left over!

Julia, Fiona, Gosia, Nicola and Marnie

Aberdeen City

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Our CEO’s latest blog: Turning remembrance into action

On Sunday the world seemed to stop and rest for a moment in remembrance of the millions who gave their lives in the First World War and in memory of all those since who have died after the war to end all wars. Remembrance Sunday was a day full of words and music, poetry and prose, pageant and solemnity. It was also, I suspect, for many a day when more personal stories and memories were brought to mind and shared with family and friends. For me it was a day when I remembered my own grandfather who left his Skye village as a boy and returned years later a man who whilst he carried a medal for his bravery also brought back the scars of encounters and experiences that would fragment his living and ache his heart until he died. Remembrance is many things to many people. It is both an act of literally ‘re-membering’, of putting back together the stories of a broken past but it is also about a resolve and a conviction that the lessons of that painful past need to be so real and so vital that the journey into darkness can never be repeated. In a few days’ time many of us will be gathering in Glasgow for the annual Scottish Care conference which is this year called, ‘A Caring Place.’ In thinking about it I could not stop recollecting the first person I ever met in a care home on a visit as a child. I forget his name but I remember his face etched with lines of laughter and fun, and the fact that he was introduced to us children as an old soldier of the First World War. Characters like him are long since gone from our communities and our care homes, but Friday in its own way at the conference is about remembering, putting together stories and developing resolve to learn from the lessons of the past. Scottish Care’s policy and research manager, Becca Gatherum will be publishing her latest report. This report is an exploration of the role of care homes, past, present and into an uncertain future. It is a remembering of the role of care homes through good and ill, it is a challenge to the casual myths and stereotypes which still dominate the public perception of care homes, and it is an articulation of what the future needs to be if we are to continue to celebrate the best of care. Care homes are very much ‘caring places’. Places where those with memories fragmented by the awful disease which is dementia are able to find assurance, comfort and a degree of purpose; where those who are living with palliative and end of life conditions are able to live to their fullest until the moment of their end; where those who have grown into frailness find the support and strength to still contribute, be valued and have purpose. Care homes are marvellous places of care … But there are still too many times when care homes are painted as places of negativity, of emptiness and abandonment. But there are still too many colleagues in health and social care who do not value the work of those whose skill we will be celebrating at our Care Awards on Friday evening, who do not see the professionalism and recognise the excellence happening in care homes up and down Scotland every moment of every day of the year. But there are still too many in places of policy development and decision-making who have an image of those who reside in care homes and what care homes do which is dangerously out of date and unappreciative of the reality of complex compassionate care. But there are still too many who decide upon resource allocation and strategic priority who dismiss the ‘homely setting of our ‘caring places’ as spaces beyond our contemporary need and purpose without realising the tremendous untapped potential of care homes in the modern era. Remembering the past can become a dangerous illusion if we remain in the memory but can be the most enormous strength if we use the energy that it gives to change the world around us and find new purpose and direction. The Scottish Care conference on Friday is both a reflection on the contribution of care homes in the past but much more importantly it is a looking forward to how these places can become the heart of our compassionate communities, how they can become oasis of belonging for the thousands who live in loneliness in our villages and towns, how they can be at the forefront of innovation, person-led dignity and rights based choice and control for all. Come and join us at ‘A Caring Place.’ Dr Donald Macaskill  

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Our CEO’s latest blog: The challenge of older people’s poverty

Today is the International Day for the Eradication of Poverty. Since the first Day in 1992, it has become a day during which we are invited to give some thought to the grinding reality of poverty across the world. When our television screens are full of the faces of starving children in Africa or India it is probably easier for us to recognise the reality of poverty. It is probably less easy to see that reality in the lone parent struggling to make ends meet, in the child without the material possessions its peers take for granted or in the hidden life of an older neighbour too afraid to put the heating on in winter for fear of spending savings they no longer have. Poverty in our midst and in our community is often less visible and more hidden unless it is quite literally enshrined in a body sleeping rough and destitute on a doorstep. The United Nations has declared Fighting Poverty to be one of the key aims of their Millennium Development Goals. It is a recognition that poverty only grows unless direct action is taken both to address and eradicate it. The impact and effects of poverty are increasingly recognised and known not least in terms of attainment, education, life quality and importantly upon personal health. As a society we are much more in tune today than in the past with the need to address poverty especially as it impacts itself upon children and young people, recognising as we do the detrimental results this can have on the whole of their lives. One area we are less aware of or even open to discussing is the reality of poverty amongst older people. Indeed there is a growing public mantra which suggests that today’s older person has never had it so good and that those who follow will never ever enjoy the same benefits and wealth. At a factual level it is undoubtedly true that there has, especially in Scotland, been a sharp decline in what is often termed ‘pensioner poverty.’ That has to be acknowledged but the starting point of the improvement were the shockingly high levels of pensioner poverty a couple of decades ago. Acknowledging improvement also risks ignoring the reality of acute poverty, emptiness and detrimental health outcomes for a sizeable minority of older people in Scotland today. According to Scottish Government statistics:

  • In 2014-17, before housing costs are accounted for, 19% of children, 16% of working age adults and 17% of pensioners in Scotland were living in relative poverty.
  • After housing costs, 24% of children, 19% of working age adults and 13% of pensioners in Scotland were living in relative poverty.

By any calculation those are shameful statistics for a society as developed and relatively wealthy as ours. Behind every statistic is a story of personal pain. Thankfully there are no shortage of programmes and projects – and indeed Government focus – to address child and adult poverty and the mental health distress that results. But what is there for the 17% of older people living in relative poverty? Sadly and comparatively not as much as there needs to be or could be. Undoubtedly measures like free prescriptions, support with fuel, free bus travel and elements of free personal care have and are making a difference .. but… more could and needs to be done to address the issues of poverty, older person’s mental health distress, loneliness and isolation affecting too many older Scots. We are rightly appreciative that life expectancy has increased for both men and women. However, the length of time spent in ill health is also rising as the incidence of health problems increases with age. There is an inextricable link to living less and being unhealthy and the poverty an older person experiences. The lower a person’s social status, the more likely they are to enter older age in poor health and die younger than people from higher social classes. This is especially evident when we see the impact of the social patterning of chronic diseases such as heart disease, stroke and cancer. It is quite right that attention is given to child and adult poverty for that will significantly impact on older person health but it is dangerous – I would suggest – to ignore the factual reality of the impact of poverty upon some older Scots today and to primarily focus on poverty and older age as a future challenge. I met Joan a few months ago. She was born to a family which looked after the pounds as she put it. She was brought up with a canny Scottish appreciation of what she had and a desire never to be beholden to another. She worked hard as a secretary and saved the small amount of extra she was left with. She never married and although she had nieces and nephews they have moved away and become strangers. Joan is now in her nineties, lives in a small flat which she has rented for years, and she struggles every day. She laments the fact she can’t look after herself better, doesn’t go out as her friends have all ‘passed’ and doesn’t receive any services or support. Joan is poor but she would never ever use that word and would be affronted if she knew anyone used it to describe her. But Joan eats one small meal a day usually uncooked which in her own words gets smaller as she gets close to pension day; she massively relies on her fuel allowance but it still isn’t enough to keep the cold away in winter; she never sees anyone as she no longer can manage to go to church; she doesn’t watch television since her old set broke and she can’t remember when she last bought herself some clothes. Yet Joan proudly declares she has enough to bury herself – although no one has had the heart to say that what she has saved will never be enough. There are too many folks like Joan living as our neighbours, the quiet forgotten ones in our midst, their silence speaking to the heart of our vibrant communities. They are not included, rarely noticed, and not missed. They do not show their poverty, yet its truthfulness is as real as that we see in those more visible. Joan is poor. Her poverty is not just of material belonging but of connection, contribution and value. Today’s Day for the Eradication of Poverty should encourage us all to continue the struggle to recognise the poverty of older age, which is so easy to ignore and which all too often remains hidden. Dr Donald Macaskill CEO Scottish Care @DrDMacaskill

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New Scottish Care blog: Nanette Paterson

John’s Campaign

I worked as a Local Integration Lead in Glasgow and East Renfrewshire for many years and about 18 months ago, I took up the Local Integration Lead post in South Lanarkshire. It was an interesting challenge as although the post was the same, suddenly I knew no one and no one knew me. As with any new job, it takes time to be accepted and to know what is happening in the area.

Soon after starting in South Lanarkshire I noticed posters etc about John’s Campaign and wondered what it was. I was invited to the Launch of Johns Campaign in Lanarkshire hospitals, and then began my journey.

John’s Campaign was founded after the death of Dr John Gerrard in November 2014. John had been diagnosed with dementia in his mid 70’s but was still managing to live a good life at home. He was admitted to hospital to treat leg ulcers, during his five week stay family visits were severely restricted due to an infection outbreak and his decline was catastrophic. Family said, “ My father went into hospital articulate and able: he emerged a broken man.”

All  three hospitals in Lanarkshire had signed up to this campaign and the launch day was a pivotal moment for me, as I heard first hand from staff and families as to how things had gone wrong and people with living with dementia had not always been given the care they required when they required it. There in the room that day it was obvious that staff were passionate about good care and wanted to improve the experience in hospitals for people with dementia. Johns’s Campaign supports the rights of carers to be involved from the moment of admission until the moment of discharge and this has been proved to give better quality of care and improved outcomes. Carers of people with dementia must have the freedom to  be with them when they are most needed, not to an imposed time table. All Lanarkshire Hospitals now have open visiting to allow carers to be with their loved one as much as they wish.

I reflected later on this and thought how beneficial it would be if care homes could also be part of the campaign. I explained to care home managers that families would take comfort knowing that all our hospitals and care homes were all signed up to John’s Campaign.

Knowing that care homes already have open visiting, it was an easy step for me to take information from John’s Campaign to independent care home managers and discuss, I explained to care home managers that families would take comfort knowing that all our hospitals and care homes were all signed up to John's Campaign. Without exception they all agreed to sign up and be partners in this campaign. As I prepared to have a launch for John’s Campaign, I asked the Care Home Liaison Team to join with me to prepare for a large launch in the  Banqueting Hall of the council buildings, this was  to be on “What matters to me day”,  their help was crucial and they suggested that we should also involve the council care homes. The council care home managers were all keen to be involved and all signed the pledge as well. The launch day was very well attended and was a huge success.

Edinburgh Care Homes have now also signed up to John’s Campaign.  Patricia Chalmers, the new in post Local Integration Lead for North Lanarkshire is now leading on John’s Campaign for that area supported by myself and the Care Home Liaison Team.

Nanette Paterson

Local Integration Lead, South Lanarkshire

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