2017 saw Angus Health and Social Care Partnership provide funding for care home staff to attend a series of learning and development days. Staff were able to hear speakers on a variety of subjects including – UTI Prevention; Well Being in Dementia Care; Adult Protection; Maintenance of Hearing Aids and Management of Chronic Pain. Events were held locally and care homes sent staff within their own locality. Having secured funded places I felt sure that this would be of interest to all care homes in Angus and the majority of care homes took up this offer. Sessions involved presentations from a range of services. Interestingly, those people who previously had had little contact with care homes would remark on the enthusiasm and knowledge of care home staff.

After the sessions, homes developed action plans for change and then reported back to session presenters as to how they had got on. Many of the homes came up with well thought out plans but for me one home stood out.

The staff of a small home in Carnoustie rose to the challenge and the range of actions was inspiring – from developing posters for families on over use of antibiotics to starting up a “relax shack” for supporting people with chronic pain. Time and again they would come to follow up sessions with their new ideas and brimming with enthusiasm for further knowledge which they would then use to improve the lives of the people in their care.

I would like to say well done to the team at Braehill Lodge in Carnoustie – at a time of worry and concern over funding and the future of care homes they have taken advantage of opportunities offered.

For 2018 we are going to continue our development days but in a different format making full use of new technology in an effort to make the sessions more accessible across Angus. I suppose the message here is to take the opportunity and try to use it for improving the lives of people living in care.

 

Ivan Cornford,

Local Integration Lead, Angus

Since I started at Scottish Care I have noticed a change in the advertising feeds that show up on my computer. Clearly some algorithm has assumed that my interest in health and social care, and the human rights of older people is because I have aged significantly in the last 6 months (mind you, given what I have seen by way of pressures on the sector, there could indeed be some figurative truth there).

It has been an interesting experience to see aging through the eyes of an advertiser. Many of the photographs contain trendy looking silver haired ladies – ‘move over sage and beige, grey and black are where it’s at’. The women smile back at me with a confidence that I could only have dreamt of in my twenties. They have seen, and quite possibly, done it all.

But as the products move from beauty and adventure to assistive, there is a marked change in the photographs. The face vanishes to be replaced by hands. Oh so many wrinkly hands. Or backs, they are popular too.

The philosopher Levinas describes the face as “Living presence”, the Oxford Dictionary defines faceless as “remote and impersonal”. Whilst there is countless research into the reasons behind this de-personalisation, and campaigning to refocus the lens, the reality remains that the portrayal of older people in advertisements is often the opposite of presence. It is absence.

And whilst it may be a reaction associated with ignoring the stark reality that will affect us all, surely this is a point where we should afford ourselves some dignity.

Perhaps then it is of no surprise that theme of absence is what I also see the social care sector battling with.

In my final blog of 2017, I raised a thank you to our partner organisations for our invitation to the table, but this is still work in progress – the independent sector have representation at only 7 out of 32 IJB’s. I also asked our partners to listen. If presence is only notional, then there will be no useful impact. Without our voice, it is not possible to properly map and evidence the landscape of the health and social care sector as a whole. Without that map, it is not possible to commission or deliver effectively.

At yesterday’s Scottish Evidence Summit hosted by the Alliance for Useful Evidence and Iriss, everyone was asked to take away an action – mine is to tackle that disconnect between evidence and implementation. The health and social care sector as a whole needs to incorporate our evidence and make it real and applicable, and, have the bravery to follow through with necessary action.

So, let us stand up proud of our contribution to the sector – social care is so often the buffer for health care, it seems obvious that they need to be considered in totality.

And with that, let us stand up proud of aging – 2018 may be the year of the young person, but do not let that distract us from the bigger picture. Young people will get old too.

Greater presence and indeed prescience of aging and older people should bring greater presence and prescience of the sector, so let’s ban those faceless photos, and raise our voice in a manner that will be heard.

2018: The year of positivity or negativity?

So here we are… the second week of 2018 and I have already written a report about how strained the social care sector is and why partners need to start listening to us.

This particular report focuses on the sustainability or otherwise of the care at home sector, with survey data from members telling us that 2017 saw half of providers not tendering for Local Authority contracts and 40% handing work back to councils.

Looking ahead to 2018, home care services tell us they are concerned about their ability to continue operating this year.  In fact, only 14% feel confident about their provision this year and nearly a quarter have extreme concerns.

What a way to start to the year.

A noticeable trend over the past 12 months has been the extent to which Scottish Care’s research and statements have gained widespread media coverage in a way that didn’t happen before.  The publication of today’s report is no different, with STV and the Herald already covering it this morning.  Whilst this is a positive reflection on Scottish Care’s ability to reach and influence others, it is probably much more an indication of just how important the issues we raise really are, not only to the sector but to the whole of Scotland and to the health and social care infrastructure which as a whole seems so fragile.  Does it mean people are starting to listen?

This new report comes on the back of the 2017 reports I wrote, which included work to highlight the lack of support for care staff’s palliative and end of live provision (Trees that Bend in the Wind), the impact of the removal of preventative homecare (Bringing Home Care), the growing recruitment & retention crises (Care Home Workforce Data & Independent Sector Nursing Data) and the strain placed on care staff’s mental health (Fragile Foundations).

And coming up in the next few weeks will be the uncertainty around the future of the National Care Home Contract.

This all sounds extremely negative and in many ways it is, showing again and again just how undervalued and under-resourced the independent care sector is.  So is this negativity the theme of 2018?

Well, not entirely.  All these reports also highlighted how many examples of compassionate, innovative care take place in spite of the vast array of challenges. Even today’s report highlights that care services are trying their utmost to continue delivering high quality care and won’t allow their values to be continually undermined by poor contract terms.

A planning meeting that we held last week within Scottish Care highlighted how many exciting projects and initiatives aimed at supporting reform will be undertaken in 2018.  These include work with the Glasgow School of Art on reforming home care and many other proposals in the pipeline which we’ll share through our blogs in the coming weeks and months.

What’s more, there are so many good news stories to be told about care.  Just this week, I’ve been made aware of a relative of a care home resident who wants to recognise the amazing care they received over the 14 years up to and including their death.  I also heard of another service who realised that across 7 of their staff, they had a combined sector experience of 130 years (an average of over 18 years each), so there are still many people who pursue care as a career and love it.

So is 2018 a year of positivity or negativity?  I would contend that it is partly both, but more importantly it needs to be the year of listening, and of acting.

The challenges won’t be solved overnight, not by a long shot.  And the positive work will continue in terms of everyday good care and the learning and sharing of new ways of working.  Both of those things are a given.

What will really make the difference (and determine whether we have a sector to survey next year on their sustainability), is what partners, policy makers and practice influencers do with the messages we continue to give to them – of the real challenges and the real difference our services make.

As we say in the new report:

“We can no longer tinker around the edges of social care – the challenge needs to be grasped with both hands and driven forward by a political will to ensure there are a range of high quality, sustainable services.”

2018 needs to be the year we move past a flurry of media coverage, a wringing of hands and then a return to the status quo.  It simply can’t happen anymore if we want there to be a social care sector.

Scottish Care doesn’t want to be the constant bearer of bad news.  We want to be a positive partner in finding practical and meaningful solutions so that everyone who requires social care can receive the best.  So this year I ask that you listen to us, and act with us, to ensure the positivity outweighs the negativity in social care.

Becca Gatherum

Policy and Research Manager, Scottish Care

 

Happy New Year and Welcome to 2018.

Within the context of New Year’s Resolutions, and the focus on caring for and creating the ‘better you’ peddled within any one of the many self-help books promoted at this time of year, I see a shift from a focus on having less, to a focus on having more. To be health-‘ful’ by limiting what you give your body, to have more time by limiting how you use your time, to be richer by limiting how, where and when you spend your money: they all require a fine balance so close to being contradictory, and in complete contrast to the holiday feasting.

It’s an analogy which I see, in this time of austerity, being applied across the health and social care sector. Not to focus on cuts, but to focus on what we have and what we can do within that context. And whilst this appears to be a laudible approach, I have not yet found an ‘off-the-shelf’ self-help book on the health and social care sector.

This is because missing from the discussion is the reality that we have been working at this for over eight years now. At what point can we say that we have applied all of the efficiencies possible? Not to say that there is no place for review, but that a focus on what can be saved now leaves the sector exposed to the real risks associated with a failure to future proof.

Last  month I had the privilege to hear Professor Gillian Ruch speak at the Social Work Summit. She spoke about relationship-based approaches to service delivery, and raised the concept of austerity as an ideological choice about making budgets balance, not about looking at the needs of the population.

Often when we plan for our sector, we think about celebrating our aging population who may use health and social care services. But what we need to be aware of is that we also need to celebrate and value our aging workforce without whom the sector as a whole risks folding. Consideration then must also be given to the necessary interaction with and effect of this on the rest of the population, especially given the economic contribution of a sector which employs 1 in 13 Scots. But this has to happen not just in relation to workforce planning, but to all of the aspects of health and social care. To plan for the sector as a whole, we must to consider the needs of the population as a whole.

If carefully and thoughtfully planned, implemented and resourced, there are currently many opportunities for the sector; the reform of many of our partners, the new health and social care standards, self-directed support, integration, and so on. But my concern is that the pre-requisite context is not a given, and the current impact of winter on an already under-resourced and under-valued sector, means that change will come too late.

At the time of writing, we await the response of the Health and Sport Committee to the evidence given in relation to the ‘Save Our Bield’ campaign. Whilst I support the call to create an independent commission to review the crisis in the Scottish care home sector, I am wary that to consider the outcomes of this in isolation from the sector as a whole – from care at home through to acute provision – would be limiting and wasteful. What happens in one part of the sector will inevitably affect another, inevitably affecting the citizens of Scotland. And so the pressure is on to consider our vision for the future of care as a whole; a vision which values our population as a whole, the sector as a whole, and the contribution that it makes to the population of Scotland as a whole.

#careaboutcare

Mince Pies and Mulled-Over Wine!!

Well its nearly here, the adverts have been telling us since Halloween finished and we’ve seen plenty of premature Christmas trees peeking through the windows with their dazzling array of lights, and music playing within the shopping centres and on the radio – Yes it’s time to put on weight and blow all your earnings – Sorry what I meant to say is its Christmas time, a time for joy and celebration, as well as looking back as we face another year, at the year that’s gone and the year to come!

One film comes to mind at this jolly time, yip the Sound of Music, a firm favourite for families to sit around watching and singing along to the wonderful uplifting songs, whilst they sit uncomfortably full around the TV.

The song “Climb every mountain” rings true for me. Many years ago when I managed a Church of Scotland older person’s home in Helensburgh, we were celebrating the care home’s 40th anniversary. One of the many events we had was a fund raiser climbing Ben Lomond. Please note this is the one and only Munro I’ve ever climbed and whilst it was hard going up, coming down was also a challenge! My excuse now is a knee problem, honest!!

If it were not for one of my staff, who literally talked to me all the way up the mountain, which kept me focussed and from turning back, enabling me to concentrate on putting one foot in front of the other. Was it worth it? Yes; I emotively recall the moment as we looked down upon the vista of Loch Lomond, eating our well-earned sandwiches!!

Well, as you rightly will be asking, nice story and what has this to do with me, working hard within the social care sector? The parallels with climbing over obstacles – I found going up step by step a real problem. For many working within social care, this year has been a tough one (of many)! As I accompanied Donald on his tour of the branches within Scotland, common themes emerged: many providers face challenges of recruitment and retention of staff, continuity of business due to financial viability, stress of working within a seemingly over regulated care sector, dealing with complexity of care and an ever demanding commissioned service at low rates of reward, to name but a few. Many excellent providers have decided enough is enough and given up on the provision of care, having worked hard to provide quality care and employment. It has not been easy to make that decision, but forced into it by circumstances in many cases, out with their control. We hear within Scottish Care that this is now a common occurrence, with 9 out of 10 providers facing stress and major obstacles in continuity of service and care.

As was highlighted at our recent events for Home Care and Care Homes, this is a crucial time for our sector, and we need to work together in partnership (not necessarily harmony), as we walk up the social care mountain together. There are organisations like Scottish Care who are like that staff member who with her incessant talking, kept me company, encouraging and guiding me to take the next step, to watch for the pitfalls of a jutting rock or smelly bog, and just kept me going. We need to work and walk together with our partners to ensure that we are united in a common concern, keeping our head in reality, but looking upwards to our goal, just around that next bend!

Partnership does not just mean our sector, but those partners within Scottish Government, regulators like SSSC and the Care Inspectorate, Integration Boards, and those within health and social care to name a few. A recognition that we need to work together, putting aside differences, unblocking barriers and seeing beyond political mountains and obstacles. The people in Scotland deserve the best care and support we can offer, and this must be matched up with proper resourcing of funds, recognition for the important, complex work we undertake, and being regarded as equal partners within the care system. In this way we can indeed:

Climb every mountain,
Ford every stream,
Follow every rainbow,
‘Till you find your dream………..

In my last blog I mentioned my newly qualified niece, a nurse who chose to leave the NHS and work with older persons in the care sector. She still works there, and is investigating further academic possibilities within the sector. In addition my son in law worked for a large national retailer (one that’s open 24 hours a day!) but recently decided on a career change. He is now flourishing working in a care home. He loves being able to help those who need and deserve a kind heart.

So let’s stop the tide of folk leaving our sector, and encourage others to join us in a worthwhile compassionate job with the rewards of caring for many in their twilight years!

I wish you all a very Merry Christmas and hopefully a better New Year, so get those walking boots on, tie a rope round each other and together “climb that mountain”!

Swaran Rakhra

Over the last few days Scottish Care has issued a briefing paper to all MSPs and a subsequent media briefing.  In both we have called for our political leadership to prioritise social care funding in Thursday’s Scottish Budget.

At the Health and Sport Committee Inquiry into Care Home Sustainability on Tuesday 12th I was challenged by the SNP MSP Ivan McKee to quantify the gap of funding that I believe exists in social care in Scotland today.  I did so in calling for an additional £1billion over the next three years and not just for older people’s care.  I want to add to that statement in this blog.

First of all we need to, as a society, start to do the serious work of calculating the true cost of care.

At the moment we are all – from Local Government through to Integrated Joint Boards – engaged in the arithmetic of austerity.  What can we afford to do and what can we afford to stop doing.  I have already commented on the human dangers and cost of this game of chance – but it exposes the urgent need for us to move beyond the short term focus of a budget to the long term need to determine the true cost of care for the decades to come.  We have not done this work.  That is why together with others Scottish Care is supporting the call for a Commission on Social Care which critically must include an analysis of not just what care will need to look like but how we are going to pay for that care.  One without the other is meaningless.  Such a Commission has to be rights based, person centred in its focus and fully inclusive of all voices.

Secondly, the debate needs to move beyond the assumption that care is a cost we cannot afford towards recognising social care as an economic driver and contributor.

The 200,000 people who work in social care contribute greatly to the economy and those who are enabled to work by the care given to their relatives are a key economic benefit to our economy.  So why don’t we, like the Welsh Government has recently done, decide to make social care an economic priority, as equally worthy of investment and enterprise activity, just as significant a player as the next inward investor?  Why don’t we recognise the potential of social care to enable Scotland to be an economic driver and growth agent with the care of our citizens at the centre of our growth?

Lastly, where did we get the £1billion figure?

In their report on social care in late 2016 Audit Scotland said:

“If councils and IJBs continue to provide services in the same way, we have estimated that these changes require councils’ social work spending to increase by between £510 and £667 million by 2020 (16–21 per cent increase).”

From Social Work in Scotland report (Sept 16) 

Now I am the first to accept that we need to remodel the way we deliver care by drawing on community capacity but only to the extent that that is safe, enabling and enhancing of life.  I am the first to argue that we need to transfer resource from acute into community settings.  But the last year alone has shown in countless reports how far short we are in terms of a robust funding of social care.  So my call for £1 billion over three years is about 10% of the current annual spend, which is roughly £3billion.

Such a figure and level of investment would:

• Move the care at home and housing support sector closer to the delivery of a preventative approach which is outcomes focussed and time flexible; one built upon the outcomes of the supported person, respectful of the autonomy of the worker by training and equipping them better, and respectful of the provider by moving from time and task tendering to a commissioning model which is collaborative.

• Move us closer to really embedding the Self-directed Support legislation which is clearly not working for the majority but only for a small minority . Indeed a submission from COSLA to the Public Audit Committee for an evidence session on Thursday (14th) highlights the funding crisis for SDS.

• Move us closer to a situation where we are able to start plugging the gap Brexit is already creating in the workforce; to addressing the fact that 9 out of 10 organisations have care vacancies and we have a 31% nurse vacancy level; to meet the vacancies we fear might arise from the growth of the early years care sector.

• Move us to a context where social care really can be a career of choice, properly funded with terms and conditions which are appropriate for the astonishingly professional work undertaken and where we can continue to attract the best of our society.

• Move us to a place where we might be able to fund the developments around the reform of the care home sector in Scotland.

And in addition to all that we need to address how we are going to fund the plethora of proposals and initiatives which are impacting on social care for older people – be that the extension of Free Personal Care to those under 65 or the plans to extend Safer Staffing legislation to the whole of the social care sector; the embedding of the new Care Standards or changes in registration of the workforce; the right aspirations of the Palliative and End of Life Framework or the Third Dementia Strategy.

The gap between policy and legislation and implementation is widening; the gap between what is currently resourced and what is demanded is even greater. The cost of failing to bridge that funding gap will be met by the lives of the most vulnerable of our citizens who will be left unsupported and with diminished or no care.

The cost of the fiscal gap may be £1billion pounds over the next three years – the cost for citizens is being felt now and is immeasurable. The Budget offers an opportunity to cut some of that distance.

Dr Donald Macaskill

@DrDMacaskill