#VoteforCare

Over the next few weeks if you don’t like politics or like Brenda from Bristol you are fatigued by the constancy of being offered to vote in elections and referenda, it might be best if you leave the country for two months.

Within hours of the General Election being announced the political rhetoric was being refined, the battle buses were being serviced and the party spin was being texted to aspirant and existing politicians. Before even 24 hours had passed the print and visual media had polished up their appearance, the studio couches had been vacuumed and the logos and backdrops had been re-designed.

There is on one level something theatrical about the ‘event’ which is an election, whether at local or national level. The machine whether smooth or juddery, new or old, usually follows predictable tramlines. We’ve already had a dose of mud-slinging mixed with accusations of betrayal and personal condemnation. Increasingly you either love it or loathe it.

What is inescapable, is that all too often the critical issues get brushed aside by a wave of reportage which focuses on personality and a popularity contest. What is regrettably all too common is that debate and rhetoric are reduced to sound-bites rather than an articulation of complexity and a search for shared solutions. What is almost inevitable is that an election diminishes consensus and consolidates polarity.

The role of an organisation like Scottish Care is always a challenging one during an election. We walk a tightrope seeking to avoid being party political whilst at the same time wanting to articulate the issues that matter to our members, to workers and the people being supported and cared for.

Social care has rarely been at the critical juncture it finds itself at the current time. We are a sector no longer on the edge of crisis but daily battling for survival. That may sound melodramatic but it is the acute reality for all too many.

So, we aren’t going to tell you who to vote for but over the next eight weeks through the Scottish Local Elections and up to the General Election what we invite you to do is to #VoteforCare. We will release weekly statements on what a Vote for Care might mean.

We invite you to ask your candidates and parties what are they planning to do for social care in Scotland?

What will they do to address the fact that:

• We have a 28% vacancy level for nurses in care homes in Scotland
• We have 9 out of 10 home care companies struggling to recruit staff
• We pay as a society only £3.97 per hour to support an older person in a care home with 24/7 intensive nursing care
• We pay our frontline care workers on average a £1 less than they can get for stacking shelves in the local supermarket
• We have workers forced to get someone out of bed, washed and fed in less than 20 minutes
• We have people being cared for in their last few days by staff who are stressed and burnt out because of overwork
• We have family carers at breaking point because more and more is expected of them
• We risk losing 1 in 12 carers who work in Scotland but come from Europe
• We daily hear from older Scots who feel they have been short-changed in the care the Government will pay for them

So whoever you are, someone who receives support at home or is cared for in a nursing home, a family member or a friend, a care worker or someone who simply wants the vulnerable to be supported with dignity, let us all make care matter in the midst of the political noise.

Let all of us ask candidates what they plan to do not just what they plan to say, and together let’s make sure we all #VoteforCare.

Donald Macaskill

@DrDMacaskill

 

You may have noticed in the last couple of weeks one of the augurs of summer- ants have started to appear. In fact they are appearing in numbers and at a time which is a bit unusual but I am reliably informed this is as a result of a mild winter and not a sign of impending environmental disaster.

Explaining the role and nature of ants to a very young child has been an interesting challenge for me over the last few days. They are both fascinating and annoying insects. They are on the one level irritating, getting into homes and places where they are not wanted or desired. But they also carry out a significant role in cleaning the environment. They have abilities beyond their size. An ant can lift 20 times its own body weight. They have a complex and developed sense of communication in that whilst they don’t have ears they nonetheless “hear” by feeling vibrations in the ground through their feet. As well as this when foraging, ants leave a pheromone trail so that they know where they’ve been. Most of all they are profoundly social insects, which means they live in large colonies or groups. Depending on the species, ant colonies can consist of millions of ants.

So what’s this all got to do with anything I hear you ponder. Well I’ve been reflecting a fair bit over the last week about the year that’s just passed. The reason for this pondering was that the 1st April has been the subject of much media reminiscing- chiefly around the first anniversary of Health and Social Care Integration.

It just seems like yesterday that the much heralded process of Integration started – never mind a year. Prominent figures have been making comment in the media.

Writing in Holyrood Today the Health Secretary Shona Robsion said she was ‘extremely proud’ of integration, stating:

‘I think it’s entirely reasonable to think that most of us would rather receive support and care at home or in a homely setting when we need it. Too often, frail older people in particular are admitted to hospital as an emergency when earlier provision of a package of care in their own home or community would have been better.

I’ve heard from people who have said they would have felt more comfortable in their own home rather than an unfamiliar hospital ward. We want to do all we can to ensure that care and recovery takes those feelings into account, which is what integration is all about.

It’s built around the needs of the individual, and it’s often not about medical needs –  it can be about providing support to people to remain part of and connected to their families and communities, allowing people to carry on doing the things they love with some additional help.’

I have written a number of times in the last year about the potential which Integration offers for achieving a truly person focussed approach to health and care. But the lessons of the last year show that for all the first steps of innovation there have been not a few stumbles and failings. So how might we avoid the second year toddler tantrums and blues? I’ll take some insight from my ant friends to make brief suggestions:

Shared vision: One of the real strengths of the ant colony is the sense of shared purpose, direction and vision. I’m not convinced that those of us who work in any health and social care sector have yet grasped the magnitude of the vision of truly integrating supports and care around the person. We need to start to robustly influence a debate which has to date been still dominated by the preservation of local health services at all costs. If we want people to be supported and cared for where they want to be rather than where another decides they should be, then that will involve some uncomfortable home truths and choices. We cannot keep preserving the acute health sector in its present composition at the cost of developing social care supports and provision. We need to own and share the vision.

Shared risk: Every worker ant in a colony shares in the risks of the whole. If the ant heap is attacked or at risk then all suffer. This doesn’t always feel like the reality for those who work in integrated health and social care. The protected terms and conditions of health and statutory social care workers are a life-time away from the often fragile experience of frontline staff in commissioned social care services. The largest social care workforce of over 100,000 staff is continually beset by changes in commissioning practice whereby providers, private or charitable, risk being unsustainable and going out of business. We desperately need continuity of commissioning beyond the vicissitudes of a tendering cycle to provide continuity of care.

Shared workforce: Every ant in a colony has a role, a value and a purpose. There may indeed be some degree of priority but there is a natural acceptance that there is an inter-dependency and relationship one with the other. We desperately need for there to be a whole systems approach to valuing the distinctive role of the social care workforce. It should not be that someone wearing a stethoscope is considered as more important in the economy of care than someone who is a home care worker or a care home nurse. Yet that is what it feels like to so many – that is what they have told Scottish Care staff over the last year. If we are serious about achieving person centred care for individuals then we have to work at person centred valuing of the independent sector care workforce.

Shared communication: The way in which ants communicate using sight, touch and pheromones is truly astonishing. This socialised communication means that subtle changes are instantly recognised and the direction of travel is literally altered and changed. Lets face it we are not good at communicating in health and social care. We need to get better whether that is through shared assessments, the development of anticipatory care planning or simply the development of shared collaborative working.

Shared resource: For any system to work there has to be a recognition not only of inter-dependency but the need to support all elements and parts of the system. We are not there and need to get there soon. Transferring resources to the community is one of the primary areas of focus for Integration. The independent sector is brim full of ideas around innovation and new models and forms of care and support. These need recognition and resourcing. Care purchased on a shoestring suffocates innovation and leads to poor quality provision.

So at the start of summer – let us learn from the ants in my back garden and make the second year of integration a success. Let’s communicate, share our vision, work collaboratively and resource equitably. Then we might get to what Ms Robison desires, namely pride in a system of health and care that puts the person as the driver of the support they need rather than the accidental insect caught in the system’s web.
Dr Donald Macaskill

@DrDMacaskill

 

 

My name is Brian Polding-Clyde, and I’m the Local Integration Lead for West Dunbartonshire and Inverclyde Health and Social Care Partnerships. I have worked in both areas for over four years and this has offered me the opportunity to work and influence across every sector of health and social care.

As a key Scottish Care partner, I was an invited to the Employee Recognition Awards for a colleague, Wendy Jack (Planning Improvement Manager, HSCP), who received a commendation under the Team Leader of the Year category. Wendy, along with Selina Ross (Chief Executive of CVS West Dunbartonshire), are instrumental members of a strategic partnership that helps to build ever closer links between the statutory, third, and independent care sectors. I was also invited to the Scottish Association of Social Workers (SASW) awards last week, where West Dunbartonshire’s HSCP’s Care at Home Team won the Special Award for ‘Best example of collaboration in an integrated setting’, recognising not only the worth of the team itself, but its impact as part of the wider integrated health and social care provision for adults and older people in area.

Wendy, Selina, and I, hosted a participation event in West Dunbartonshire which brought together Care at Home and statutory providers and commissioners. At the event, Chris McNeil, (Head of Health and Care) provided an overview of West Dunbartonshire’s present demographics and how the future may look. Chris was clear in noting the crucial role of the Independent sector in the ongoing delivery of care to the local population. Selina highlighted the role of the third sector and the ‘Link-Up’ programme, a single call telephone advice line run by well-trained local older volunteers, in helping to support people within their community. Link-Up, in addition to offering advice, also follows up on calls ensuring users are satisfied with the resolution. Lynne McKnight (Integrated Operations Manager for Care at Home) and I then gave a joint and integrated presentation on what we saw as the challenges and opportunities in delivering a Care at Home service. The room agreed that one of the key ways for us to move forward is to share resources and training. To be able to do this effectively will require the development of a Practice and Development Forum co-facilitated by the independent and statutory sectors.

In Inverclyde, we recently made a successful bid to have Care at Home and Housing Support Services become part of the Care Inspectorate’s ‘Care About Physical Activity Programme’. With partners in the third, statutory and independent sector we are developing awareness and interest in the programme, which will allow the Care Inspectorate to recruit fully committed participants.

Also in Inverclyde, we’re close to publishing ‘Come On In’, a resource developed to enhance the experience of visiting a care home. The publication has grown organically from the shared experiences of visiting family and friends, nursing staff, and reflections from Heather Edwards (Care Inspectorate), and myself.

Over the four years I have been working in West Dunbartonshire and Inverclyde, it has become apparent that the success of the work we’re involved in is dependent on closer partnership working and a commitment to joint leadership across all sectors. This will give us a better understanding of the complexity of the landscape we work in and the role we can play in enhancing the care of the people for whom we work.

What do a ticking time bomb, a silver tsunami and a population apocalypse all have in common? No, they aren’t the latest plotline from an episode of Sherlock but rather they are phrases used to describe the fact that we are living longer. They are highly negative descriptions of a reality that most of us would or should want to celebrate – we are dying older and healthier than at any time in Scottish history. So why the negativity? Why is it that so much of our cultural and political discourse about old age paints such a dark and depressing picture?

Old age is something which should be valued, but alarmist attitudes fail to recognise the benefits and potential of older age and feed into the myth that getting old is about losing something rather than gaining something new and potentially positive. Old age is seen as a challenge rather than an opportunity.

Ageism as a concept was first coined in 1969, and describes a context where there is discrimination against, contempt for, abuse, stereotyping, and avoidance of older people.

Everywhere you look there are negative stereotypes which perpetuate the myth that older people are incapable and dependent, have nothing to contribute but rather are a burden and a drain on society. We see this in many of the current debates about social care and health which count up the costs an ageing population results in but fail to recognise that over 90% of care delivered in this country comes from the hands of people who are themselves old thus saving the taxpayer countless millions.

In Scotland I am sure we would like to believe that we treat all peoples as equal, regardless of colour, creed, disability, sexual orientation and we have indeed made great strides in addressing discrimination and hate. But have we made the same progress against negative stereotyping and discrimination which is based on age? I think not – why is it that a child in receipt of residential care will have nearly double the amount of public resource allocated to their care than an older person of 90 in a care home? Why is it that countless individuals talk about not even getting the chance of an interview if they are over 60 and are seeking employment? Why is it that at the age of 65 people who are accessing social care support move from being an adult onto being an ‘older person’ and in some areas such as mental health services they tell us they suddenly find the level of their support diminishes? Do we feel it is adequate that for thousands of older people in the last few months of their life that we allocate the sum of £3.85 an hour to provide 24/7 intensive nursing care home support? That’s less than the cost of a packet of 10 cigarettes!

Many of us feel that Scotland needs to address the challenges of the silent, pervasive and systemic age discrimination which impacts on the lives of countless of our fellow citizens. We are not alone. Last September the United Nation’s Expert on Older Age, Rosa Kornfeld-Matte, stated that current international provisions are not sufficient to fully protect older people’s rights, and she called on states to consider a new convention. A few weeks later I chaired initial discussions with interested parties to explore whether Scotland needs its own Convention of the Rights of Older Persons and/or an Older Persons Commissioner as Wales and Northern Ireland have.

The creation of a convention for older people in Scotland would not add new laws and rights but would go a long way to ensure equal treatment for older citizens, not least by demanding adequate financial provision for that group of the population.

Equally an Older Person’s Commissioner would be a champion and advocate for the human rights and equal treatment of older persons. Older Scots should not be the victims of discrimination in employment, in accessing public services, in social care or in hospital treatment.

The time has come for us in Scotland to join the campaign to create a framework of rights which recognises the distinctive discriminatory experience, both at societal and personal levels, which all too many older Scots endure and experience.

We need to take off the heather-tinted glasses and face up to the reality that Scotland is as ageist a nation as many others in the world but rather than just recognise this we need to act and both a Convention and Commissioner for Older Persons would be positive steps to take. Human rights do not have a use by date – they do not diminish with age.

 

Dr Donald Macaskill

Chief Executive, Scottish Care

 

The caring side of data

I have become a victim of data or at least I have succumbed to the world of fitness data. Last year I was given a Fitbit and started using it in the autumn. I wasn’t aware of the massive advertising campaigns behind the Fitbit which is basically a cloud-based fitness-tracking device. But according to the advertisements this small device – with a little help from myself in the form of walking and sleeping more (though not together) – will enable significant life-quality changes. I will leave for others to decide the truthfullness of that statement viz-a-viz my waistline. But what I have been astonished by is the sheer amount of data that I am sent every week from this small device which sits on my left wrist everything from my average heart rate, my calories burning, my steps walked etc.

There has been an obvious shift in the data available to us about our own health in the last few years. I remember the early devices which enabled you to track your blood pressure or heart rate but what we now have is an empowerment of the individual, what some specialists have called the ‘democratisation of self-care.’ My device can now be used to adjust, alter and direct my behaviour – I have control and choice in its applicability and use. There is therefore huge potential in the realm of preventative health and self-care.

 The accumulation of statistical data indicates a shift of legitimacy and power from the medical expert to the individual.

 Many of you will be familiar with the concept of Big Data – defined as:

 extremely large data sets that may be analysed computationally to reveal patterns, trends, and associations, especially relating to human behaviour and interactions.

 But it is not the size so much as its applicability to determine trends, behaviours and patterns for whole populations that has become significant for social scientists and planners. This has especially become the case in the world of health. In some senses the data information I get and which is produced by my Fitbit gives me ‘Small Data’ –

 ‘data in a volume and format that makes it accessible, informative and actionable. … Small data connects people with timely, meaningful insights, organized and packaged – often visually – to be accessible, understandable, and actionable for everyday tasks.

So what is the place of such Data, Big or Small, in social care?

One of the issues facing those of us who work in social care is that we need to take a greater degree of ownership of the data and the debate about data – we cannot leave this to technicians and data analysts alone but must increasingly work in partnership to enable a shared determination of what data can do to enable better outcomes for individuals who use and seek to access services. Data has a tremendous potential to advance care and improve health but it is one which has to be managed and to some extent controlled.

So much of our world is being increasingly defined by an analysis of numbers, statistics and data. Are we making the right decisions from that data? Is the picture of our health and wellbeing which is painted, a true one? Just as we get suggested reading from an Amazon account or Tesco might determine what it offers us in our shopping trolley from what we have bought before – are we sufficiently aware of the streamlining of choice as a result of someone else’s analysis of our data? That may be an issue for my shopping but it becomes a critical one if data becomes a key determinant of health and social care choice.

There is therefore an important ethical debate to continually be held about the use of both Big and Small data which necessitates an awareness of the ethics behind not just the use of technology which has been much articulated but the ethics of the use of health and social care data both individually, at community levels and wider society.

Other fields are much further ahead in exploring the use of Big Data in transforming the way we do things, especially education. There is clear potential but we have to guard against a whole-scale adoption of approaches that will serve to unhelpfully alter our care landscape.

Next month sees the first ever conference to be held in Scotland which will explore some of the ethical and social science questions behind the use of data in Scottish society.  This Edinburgh Data Summit is part of DataFest17 and will hear from international thinkers. But its debates and the messages which come from the conference will doubtless shape our response to data. Those of us involved in policy development, in preventative care, in empowering choice and control over health and care; those of us working or caring in care homes and in communities need to be alive to and aware of these debates.

 

Donald Macaskill (Dr)

 

 

 

 

 

Challenging the Sex Taboo:

One of the privileges – and challenges – of doing my job – is being invited to speak at a range of events and conferences. Yesterday I was taking part in a seminar in East Dunbartonshire Health and Social Care Partnership on ‘Capacity,
Sex & Relationships.’ I was asked to reflect on the issue of older people’s sexuality in care settings.

My preparation for the seminar highlighted for me the relative dearth of literature and academic study on what is one of the most fundamental parts of what constitutes our identity and what it means to be human. There are some good pieces of work not least from Alzheimer Scotland, the Terence Higgins Trust etc. but not a lot.

This might be because there are still massive social taboos around the issue of older people and sexual expression. Its almost as if older people and sex is for our age ‘the love that dare not speak its name.’ But people are living longer and healthier lives and why should sexual expression end when we reach a particular age, almost as if our sexual selves have a use-by date attached.

But pervasive negative attitudes serve to consolidate the taboo. People consciously and unconsciously suggest that sex is unimportant to older individuals; that it is somehow abnormal for older people to be interested in sex; that older people have no desire for intimacy; that older persons are not physically attractive and are not desirable. And of course the endemic cultural presumption is that sex is for the young and fit.

Nevertheless for many individuals sexual expression remains an important part of their quality of life. According to a 2013 Saga survey, 71 per cent of over 50s reported having a healthy sex life. Such expression is a basic human right.

Some 18 months ago Taylor-Jane Flynn and Alan Gow, professor of psychology at Heriot-Watt University in Edinburgh, carried out research on sexuality and older Scots which was published in the journal Age and Ageing. They interviewed and spoke to 133 Scottish adults aged 65 and over. Half of these lived with a spouse or partner.

What they discovered was that between 75 and 89 percent said they’d engaged in kissing, hugging and holding hands or touching. Men and women scored about the same for frequency and importance of sexual behaviours overall, and for quality of life.

Participants reporting more frequent sexual behaviour rated their social relationships as higher quality, while people who found sexual activity to be important had higher scores for psychological quality of life.

Critically they found that older adults who value sexual activity and engage in it have better social lives and psychological well-being.

So if that is a given there are clear challenges and implications for providers of care and support and for those who work in supporting older individuals.

So how important is sexual expression within the care sector?

There are obvious challenges not least with individuals with declining and reduced capacity and physical abilities in ensuring that there is a balance between protection and safety on the one hand, and enabling expression on the other. But beyond this – and there are good guides already available to help staff work with individuals who might have dementia and portray disinhibited behaviour or language – beyond that are we doing enough?
Are we able in care homes, for instance, to create places and spaces for people to be intimate and private?

Do we manage well those situations where the wishes of family members might not be the wishes of an individual resident who desires to form a new relationship?

Do we train and resource our workforce in such a way that they have confidence in dealing with what can be a challenging issue and to do so in a manner which is non-discriminatory and respectful of individual rights?

Is the regulatory framework and work of scrutiny too restrictive in this area?

Do we commission in such a way which would enable the provision of facilities to enable couples to live together or someone to initiate or form a relationship whilst in a care setting?

Do our services have sexuality policies whether in the community or in a residential location?

Do we properly understand issues of consent and capacity in the sexual relationships of the old?

Are we aware of the growing issue of sexually transmitted diseases amongst our older population, in and out of care environments?

 

All of us who support and work with those who are older need to not only start challenging the conspiracy of silence which surrounds this issue but proactively to start working to address some of the challenges I have just outlined.

 

Donald Macaskill

@DrDMacaskill