We are just two days out from the annual Scottish Care, Care at Home and Housing Support Conference which will be held in Glasgow on Friday 18th May. If you haven’t already got your tickets there is still time to join us at what looks to be an intriguing and enjoyable day.

This year’s conference is entitled ‘Practical promise: making the vision of home care real.’

The word promise is an interesting one. In strict definitional terms a ‘promise’ is a ‘transaction between two persons where the first person undertakes in the future to render some service or gift to the second person’

What’s that got to do with care in someone’s home? – I would suggest everything.

At a very basic level the concept of promise is at the heart of the human exchange which good care and support offers. Every time an act of care takes place there is a service offered and a gift exchanged. Not a gift in the literal sense but the gift of support and person-led care which enables an individual to live their life to the full. At its heart that is what good home care is – it is an enabling process which offers an individual the prospect and ability to live as independently as possible for as long as possible.

All too often in some of the debates I take part in about the future of care and support in our community there is a presumption that care at home and housing support are about maintenance – keeping people safe and healthy. Of course, that is part of the story, but it is by no means the whole.

People who require to be supported in their own home require that support not just to keep healthy but to enable them to lead as fulfilling and as rewarding lives as possible. Life does not just stop with a diagnosis it moves to a different level. Affective, human-centred care at home and housing support is about providing the support to enable people to still dream their dreams, achieve their goals, and create their future. Homecare should never be seen as maintenance – it is always about the promise of a life still to be lived; good homecare is not about a set of tasks to be performed but enabling people through support to achieve their full potential, regardless of age.

The relationship of care is infused with promise at its very centre. It says that I as I support you and care for you, I will be here to make sure that you have a life which is as full and meaningful as possible; that you are not limited by your need of care or support, that you have contribution to make and abilities to share.

But there is also another sense to the word promise which will no doubt be reflected upon during our conference on Friday – and that is the degree to which a promise has a future orientation and perspective. Within the word promise there is a sense of hope, of expectation, of things yet to be achieved… a sense that things will be better and that new direction will be found.

The care at home and housing support sector is at a critical juncture in Scotland at the present time. We are living and working in extremely challenging financial environments, and with great uncertainty and fear for the sustainability of the care at home and housing support sector. But there needs to be promise.

With political conviction and appropriate financial investment, the future direction can indeed be one of promise. Rather than disintegration and paralysis. There simply has to be a future vision of homecare where grounded in the realities of day to day care-giving, we can create a social care system in Scotland which values the human rights of the individual, treats all with dignity and respect regardless of their chronological age, and which seeks to ensure that the individual person is in control not only of their care but of the direction in which they want their living and dying to move. There has to be a vision which gets us beyond the reckoning of support by segments of time for allotted tasks, which seeks to purchase that care at the cheapest price and pays lip service to the principles of choice, control and involvement of the supported person.

We all know what the ‘promise of care’ in the future needs to look like. It is a rooted, grounded practical vision of a Scottish society which cares and manifests that care not just in word but in action. The time is surely here for fulfilling that promise and building that vision into practical reality rather than uttering yet more pious platitudes.

That is the promise – a system which would make all of us who do the work of care and support rightly proud – a social responsibility for a nation. Join us as we continue creating that practical vision rooted in the promise of dignified support and care.

Dr Donald Macaskill

@DrDMacaskill

“Writing is easy. All you do is stare at a blank sheet of paper until drops of blood form on your forehead”  – Gene Fowler

That is how I felt as I stared at the blank screen of my iPad!! A “blog” what is that!! I am too old to learn about these new-fangled methods of communicating!!  I like to talk to people – how spooky is that in this digital world? I have been in the Care Sector for over 30 years and I have experienced, both professionally and personally, the highs and lows that we all face every day.

This Blog could be a “low” but I hope you will find it at least a “medium” . I am the Local Integration Lead for Perth and Kinross; not sure my mother would appreciate me being called a “LiL” as is the affectionate term for us all.  As in every Partnership area we are striving to meet the challenge of supporting the Independent Sector in a period of change and continual pressure on resources. Despite these everyday issues there are still examples of good practice and successful initiatives that we can share.

P&K were successful in being selected to take part in the National Pressure Ulcer Project whose aim was to reduce pressure Ulcers in care homes by 50%. A pilot group of five care homes participated in the programme to test and evaluate documentation and processes that had been put in place initially. Valuable lessons were learnt in P&K and elsewhere during this pilot project. A celebration event in P&K was held in January where the care homes that had participated were asked to present their learning and experiences and share them with the wider care home group.

With the associated learning, such as the newly introduced pocket guide, the Pressure Ulcer Project is now being rolled out in care homes throughout P&K. The pocket guide, which came as a direct result of an idea from a care home in P&K has now been adopted nationally.

A new initiative in P&K is to support the Care Sector in the recruitment of Care at Home staff. We have always known that the recruitment and retention of staff is one of the Care Sectors’ major challenges. How do we demonstrate that the Sector can provide worthwhile training and a fulfilling career?  We have recognised for many years that there is a high turnover of staff generally. Our challenge is to start replacing their knowledge and experience now. The joint initiative between the Local Authority and Care at Home Providers sets out to utilise the Modern Apprenticeship scheme in a way that benefits both the individuals and the sector. The Council will effectively be the managing agent and the staff will be seconded to the Care at Home service for a period of 18 months. During this time, they will undertake the SVQ Level 2 qualification and gain valuable practical experience, At the end of the 18 month programme the Apprentices will be offered a permanent position with the Care at Home Service. I am delighted to report that five Providers have signed up to the scheme.

Every now and again despite the challenges we all face attending endless meetings and discussions, and we have all been there!!  My faith in the sector was restored recently, in terms of reinforcing why I feel so passionately about delivering excellent care. I sat in Perth Concert hall not listening to Andre Rieu, although that would be good as well, but at a conference organised by the Life Changes Trust listening to four enthralling individual stories of the demands and commitment faced by unpaid family carers. They all had different life histories, but the common thread was their wish to ensure their loved ones had the best support through the most difficult period of their lives. They talked about the basic day to day challenges they had to overcome and despite this they maintained a focus and commitment to continue supporting their loved ones.

It isn’t always about policies and procedures at the end of the day, it is about dealing with people in a caring and dignified manner. This was outlined brilliantly by Donald Macaskill in his opening address.

We must always ask the question: “Are we delivering the care and services that people actually want!” 

 Mother Teresa said:

“The most terrible poverty is loneliness, and the feeling of being unloved.” 

Perhaps we should remember that unpaid carers can feel alone and unloved and how we interact with them as individuals and organisations can have a huge impact on their wellbeing.

 

Bernie Campbell

 

Bereavement support is not an option

Professionally I have been involved in the work of bereavement for most of my adult life, both teaching and writing about the experience, not least for those who struggle to express their thoughts and feelings. In some senses I am at ease talking about death and dying, about the pain of loss and the emptiness which the absence of love leaves. You could say it has been my particular field of professional and academic interest.

At a personal level like so many I have had times when I have lost those close to me. I have been forced to do the hard work of grief on too many occasions and for too many moments. In those times I have struggled to find a path through and a sense of balance when the waves of absence overwhelm.

Bereavement is the sense of feeling robbed and bereft. For no matter how expected or anticipated a death or loss is, its ache is still sore, its pain still raw, its touch a cold beyond description.

This sense of lost-ness is beautifully conveyed in the original word for ‘bereavement’ from the Old English- ‘bereafian’ which denotes a sense of deprivation, of being robbed by someone, of being seized or grabbed out of living and life.

One of the reasons I wanted to write about bereavement is that at Scottish Care we have decided to make it a focus for some of our work this year. We have held useful and creative discussions with organisations like Cruse Scotland and colleagues in health and social care.

But in wider discussions on bereavement I am sadly detecting a resistance or a certain degree of apathy. It’s almost as if it’s okay to talk about palliative care and end of life, to develop a framework and priorities for those, but somehow bereavement is considered to be the concern and the preserve of the individual.

There seems to be an attitude that bereavement is a grief work which is not deserving of resourcing or strategic priority. I think this is both sad, mistaken and damaging.

We have loads of evidence to show that as a society in Scotland we have lost the cultural and societal ability to deal with dying and have misplaced our skills at working through loss in bereavement.

It is for that and many other reasons that we have solid research which shows that many doctors are struggling to cope with death and dying and are needing support to grieve and to do the work of bereavement.

For social care the Scottish Care report ‘The Trees that Bend in the wind’ last year spoke movingly of the way in which care staff whether in care homes or in the community in homecare services felt poorly equipped to deal with the continual losses they have to experience.

Bereavement support should be a central and critical priority for all who commission care and for all those who make strategic policy and practice decisions. To do other is to fail to support clinicians and carers at their point of real vulnerability and pain.

No matter how skilled and experienced you are we all need to be supported and upheld through our grieving, we all need to find a solace that comforts us in our weakness and binds us up when we feel broken.

When we have a sense of futility and despair, both personally and professionally, we need there to be space to open up and pour out our feelings; we need there to be people who have time and capacity simply to be present and there for us.

Good bereavement support is no optional extra, it is rather fundamental to a society basing its character on dignity and human rights. Good bereavement support renews and restores, it can give a sense of purpose and direction, for many it’s what has literally saved their lives.

I fear that if as a society in Scotland we fail to enable and resource those who do the work of care to grieve properly and to enrich them through good bereavement support then we are sowing the seeds of a harvest of regret and despair.

Dr Donald Macaskill

@DrDMacaskill

The Scottish Budget was passed by the Scottish Parliament yesterday evening. So that’s it over for another year. The chance of smaller political parties to get their pound of flesh from a minority administration has passed over the yard arm.

And what’s it done for social care in Scotland? Well pathetically little.

Admittedly we got our £66million, which is amongst other things supposed to cover the increase in the Scottish Living Wage, the effect of changes on sleepovers, Free Personal Care increases and the start of the Carers Act. Mind you last year we had £100 million allocated for the Scottish Living Wage which had then just gone up by 20p- but it’s amazing what £66million is going to stretch to given it’s a 30p increase this year! That’ll be one to watch!

But I don’t want to just dwell on the Budget because no doubt I’ll be back talking about the back of a fag packet economics of it all at a date in the not too distant future. What I want to talk about is that I’m scunnered and getting really quite angry at the whole charade.

I’m scunnered at what feels like standing in the middle of the public square with a begging bowl each year calling for extra funding for some of our most vulnerable watching out for a passing MSP who might hear the need for serious investment in care.

I’m scunnered at saying we need a dramatic serious investment – I called for a third of a billion in December and we got £66million and at the time I was made to feel as if I was dreaming of Utopia rather than the socially just and human-rights based country that I thought I was a citizen of.

I’m scunnered that there seems to be no real debate despite political rhetoric that admits that the sums are simply just not adding up – and that’s a lesson in the arithmetic of austerity that people who are today grabbing 15 mins of rushed care rather than being treated with respect and dignity have learnt only too well.

But I’m also angry…

I’m angry at the wasted opportunity of having a grown up non-partisan political debate about what is the real and not the affordable cost of rights-based dignified social care and not the system we have at the moment where eligibility makes social care the preserve of the few and not the requirement of those who need it.

I’m angry that a week after the Kings Fund published a major report offering a range of proposals for the funding of public social care in England, no political party north of the Wall seems prepared to look beyond the next ballot box to think seriously about how we are going to pay for care into the future, what system will fit us and how we are to create equity rather than accidental access.

I’m angry that we seem to spend so much of our time hiding behind data to show that what we are doing is making an apparent difference to the health and care experience of our fellow Scots, and that we engage in a self-congratulatory back-slapping of what’s going well. Let us hear the good news stories but let’s not pretend everything in the garden is blooming!

And I’m angry that despite the rhetoric of prevention and self-management we are still dominated by the sacred cow of the NHS against whom no critique should be offered and are thus failing to address the fact that we need to transfer resources from the privileged few in that system to the majority in communities who experience inadequate social care provision.

So yes, the Budget may be over for another year but for goodness sake let’s not be here next year arguing over scraps for a crumbling social care system where the word ‘crisis’ is already beginning to sound empty and hollow. Let’s start to work together to transform the woefully inadequate funding and priority given to social care. And that means we all of us have to take charge and control and start talking up the critical importance of social care.

Social care should not just be for an election debate or a budget negotiation – it should be the central characteristic of the society we wish Scotland to be.

 

Dr Donald Macaskill

@DrDMacaskill

 

Love is all around…

The 14th February has become synonymous with love and depending upon your perspective it is either a day for the purchase of over-priced red roses or a day of true romance.
It’s a little known fact that some of the relics of the famous St Valentine, whose day it is, lie in a church in the City of Love. Paris? Rome? Venice? I hear you suggest but No – Glasgow. St Valentine is (at least in part) resting in the unlikeliest of places – in the Church of the Blessed Duns Scotus – in the Gorbals, a part of the city once synonymous with gang violence and searing poverty.

Just like any relationship, expecting the unexpected and challenging stereotype are probably two useful characteristics for this St Valentine’s Day. In that light three stories struck me in the last week that have relevance and challenge for the care sector. They are each about relationship and value, about human contact and dignity.

The first was the news of the growing challenge of loneliness facing our population.

In a world which presupposes relationship as being intrinsic to well-being it was noticeable that last week saw the launch in Glasgow of research by the National Campaign to End Loneliness which found that of the 15,000 older people in the city, it is estimated that 10% can go days or weeks without having any contact with anyone. It is stated that loneliness and its impact can have such negative health determinants that it is the equivalent of smoking fifteen cigarettes a day.

With over 1.4 million in the United Kingdom reported as being lonely, the issue has not surprisingly become one of great significance with both a Scottish Government Strategy and a UK Minister with responsibility for loneliness to name but two political responses.

With around 7.7 million people living on their own, of whom around 2.2 million people are over 75, the issue of loneliness is likely to become of even greater prominence.

But I for one have become increasingly uneasy with some of the loneliness narrative. It is certainly important that as individuals and communities we should try to include, involve, engage and enable participation and contact. But we also have to be careful that we don’t develop some reverse morality when faced with such loneliness data.

Being on your own is not intrinsically negative and much of the recent debate has ignored the benefits of solitude. There is a world of difference between social isolation and forced loneliness over which you have no control and which you do not desire, and the reality for many which is a decision to be single and alone. Have we lost the capacity and ability to be alone? There has been an automatic presumption of the negativity of aloneness in much of the consideration of these issues. What we need rather is a serious debate about what loneliness is and what interventions are needed, which will be beneficial for both the individual citizen and society as large. I am not convinced our sometimes guilt-ridden knee-jerk reactions have developed such maturity.

The second insight from last week’s media came from a disturbing report from the Leonard Cheshire charity. This research is not unrelated to the issue of isolation and loneliness we have just considered. The research undertaken as a result of a Freedom of Information (FOI) request has shown that a third of Scottish councils commissioned 15 minute visits for the provision of personal care in 2016/17. This has meant that over 5,000 Scots were being subjected to the degrading practice of flying visits. At least 5,182 people received personal care visits of 15 minutes or less for support with intimate care, based on data from councils that responded to the FOI request.

Freedom of Information responses from councils in Scotland found that one in three – 31% – were commissioning 15 minute visits for the provision of personal care in 2016/17.

For many individuals receiving support at home, 15-minute personal care visits barely allow for tasks to be completed, let alone to develop a positive relationship between the individual and their carer.

Given that in January, the Scottish Government’s Minister for Social Security Jeanne Freeman launched a consultation and draft strategy on isolation and loneliness, highlighting the link between loneliness, poor physical and mental health, one might ask what benefit such short, task-oriented visits are making. They do little for effective mental well-being but then given the Mental Health Strategy hardly mentions older people its maybe not a surprise that there is a priority on loneliness but not on some of the causes of it.

Leonard Cheshire’s Director for Scotland, Stuart Robertson said:

“These damning figures show that many vulnerable people are being failed by the social care system… We have to urgently address this scandal and ensure people receive the person-centred care they deserve. No one should have to choose between going to the toilet or having a cup of tea, and this practice must come to an end.”

I couldn’t agree more with Stuart Robertson and Scottish Care has called over a long period of time for an end to the shame of short time and task oriented visits which leave no room for dialogue and dignity, never mind conversation and relationship. It is really sad that on a day we are celebrating love and relationship, for so many their only opportunity for exchange and interaction is reduced to a fragment of time.

The third media story I remember from last week was the report that the well-known and formerly respected broadcaster Jeremy Paxman, told an audience last week that he is in favour of removing the vote from anyone over the age of 65. This is somewhat ironic in the week we celebrated the 100th anniversary of woman’s suffrage.

Paxman’s easy dismissal of the contribution and role of the over 65s is indicative of the acceptable ageism that is all too prevalent today. Paxman states that the elderly have done very well out of life and that they are now using their voting power to ensure that they, rather than young people, are getting the best out of the state.

On St Valentine’s Day love has surely to be for more than a Hallmark day. A society where loneliness becomes a political policy priority, but not where the same political system is prepared to allocate resource to address the issue is less than it should be; a community where contact is reduced by the arithmetic of affordability does not in any sense value those who it should care for; and a place where older age is considered to be beyond contribution – such a society needs to rediscover the essence of a love and regard for others, which can’t just be for one day.

Donald Macaskill
@DrDMacaskill