On Wednesday 1^st March I was delighted to be able to attend the virtual launch of the Scottish Care led social care campaign which runs the month of March. It is a campaign which whilst led by Scottish Care is involving a range of others – its primary purpose is to raise the profile of all the key issues facing the social care sector at the present time. In a week which has witnessed so much debate and discussion around social care the need for this campaign has never been more necessary and urgent.

There are several main themes in the campaign and one of them is to help us all have a greater understanding of what social care is. Regular readers of this blog will know how much I bemoan the way in which social care is continually – not least by the media and by our political leaders – seen through the lens of the NHS. Yes social care when it is functioning at its best is able to reduce the demand on our acute and secondary health services. Yes, social care can help to address the huge number of people who are unnecessarily delayed in hospital. But in truth if you only see social care through an NHS lens then you will effectively be blind to its extent and to its promise.

Social care is many things but at its heart it is a set of services and supports, whether for children, adults or older people, which enables people to live to their fullest; allows them independence, purpose, control and choice and helps all our communities to flourish and thrive.

To achieve this, we have some of the most progressive policy and legislation anywhere in the world but have sorely failed to implement these in practice. This week we have heard that the plans to create a National Care Service are now on pause which in itself was an attempt to address the gaps between aspiration and implementation, rhetoric and reality.

But in truth social care in Scotland has not been reaching its potential for a very long time – the patient has been in intensive care and in need of resuscitation – and the major reason for that is the lack of appreciation and value which has for years resulted in a woeful inadequacy of financing and investment in not only the workforce but in the organisations that employ them. It is reflected in the fact that there are hundreds upon hundreds of individuals living in our communities who have social care needs, some assessed , many not. The high level of unmet need is just as critical and dangerous as the delayed discharges in our hospitals but receives a tenth of the attention and focus it deserves. The inadequacy of treatment is especially seen in the way in which we reward, recognise and pay our frontline social care staff. I think it is frankly obscene at a time when the massive recruitment challenges facing social care are talked about so openly and so frequently that we have in the last few weeks created such a chasm between social care and the NHS.

The pay offer which has been negotiated for NHS colleagues and which has been much lauded (even if to date not formally accepted) has rightly valued our nurses and health care workers. But what might have escaped those patting their own backs is the real world effect which means that from April 2023 a social care frontline carer will be paid nearly 20% less for doing the same job as a frontline healthcare assistant in the NHS. This chasm is shameful. What about all the talk of integrated services – of one system – of co-dependency, and an appreciation that the NHS without social care is like a one-sided coin? What are we going to do about this arithmetic of disgrace?

We find ourselves in the midst of a leadership battle within the SNP and in the weeks up till the 27^th March we seem to have entered into a no-man’s land of decision paralysis – meanwhile social care organisations are losing staff hand over fist and frontline workers are looking over at colleagues in the NHS and wondering why is there such unequal treatment. After all social care staff are registered, regulated and require to be qualified. Why no equality? Why no level playing field?

And lest someone reads this and falls foul of the easy trap of blaming charitable or private providers they need to be reminded that over 70% of social care is paid for by the public purse at rates of contract that make it impossible to pay staff what they deserve and still remain sustainable as a charity or a private provider. That is why every week in the last few weeks I have had owners and directors of charities, care homes and home care organisations in tears telling me that they will have to close, hand back work, refuse to accept any more Council funded residents because they pay at least 40% less than what the true cost is, or indeed stop receiving any new residents. You cannot ever reach the land of fair pay for workers if you do not have fair contracts and commissioning. We are reaping the harvest of fiscal neglect and a lack of strategic priority.

The responsibility for the enduring long-term crisis in Scotland’s social care system is the culpability of national and local government. What else can you call a 20% differential between the NHS and social care? What else can you call the reality that in-house local authority care homes on average spend £1,200 plus a week to support a care home resident and yet the same authorities pay private or charitable care homes around £830 a week for nursing care and support which is about £5 an hour to care for some of our most valuable citizens.

There is a deadening hypocrisy which has for years corrupted the social care landscape and we have now reached a stage where unless central Government funds an adequate pay reward for frontline social care staff, invests resource in meeting the energy and cost of living crisis, works with the sector to make Scotland’s small often family run private care businesses and smaller care charities sustainable, then we might as well say goodbye to any local social care provision, forget about economic growth because families will have to give up their jobs to support their relatives, and start accepting the reality of an unsafe NHS. And let us not forget the neglect of the thousands of unpaid family carers for so many years.

Everyone will rely on social care at some point in their lives, and it is a truism that the sector only becomes important when that happens. But in truth the urgency of this hour means that there might not be a sector around to provide the support you and I might need in the future unless we act now. We want to see action taken to tackle the social care crisis.

I dearly want the leadership candidates for First Minister to start telling us what they are going to do to rescue social care because it is going to be, whether they recognise it or not, a top priority in the early weeks and months of their time in office. I want them to tell us beyond campaign soundbite how much they value social care staff – and let it not be £10.90 an hour. I want them to show me how much they value social care away from the shadow of the NHS? I want them to show me they really understand why hundreds and thousands of talented professionals are leaving the sector and to commit to working with  with us to support the organisations that employ them. If a factory closes or a major employer ceases to operate we set up a Task Force – we urgently need such priority in virtually every community across our land. A slick paid-for TV campaign to recruit people to work in a sector that cannot afford to retain them won’t cut it.

Now is the time to #careaboutcare. Now is the time to #shinealight on the social care sector; to get beyond the myths and discover the amazing women and men who are the cradlers of compassion within all our communities. They deserve so much more than Scotland has given them. They and the charities and private organisations that have kept social care afloat in Scotland are weary, tired and exhausted but they know that now not a future land of promise, is the time to save social care in Scotland.

Join our campaign and find out more at https://scottishcare.org/social-care-campaign/#1669210952025-1e98646a-819e

Donald Macaskill

It’s been a busy week in the world of technology, data and social care in Scotland. I managed that rare thing of attending the whole of a conference event and to listen to some insightful and interesting speakers. The event was the annual Holyrood Digital Health and Care Technology event. It brought together hundreds of delegates from the health, social care, technology, and data sectors to talk about the priorities of the moment, hear about some amazing innovations and be suitably challenged to think creatively and with imagination. It also combined an Awards evening which celebrated the cutting edge of excellence across Scotland in health and social care. I was honoured to have been one of the judges at an occasion where every nominee really was a winner.

Inevitably one leaves such an experience with a head full of thoughts and feelings, some of which were conflicting and contradictory. I want to share a few of them in this brief blog.

One of the key moments in the two days was the launch of the Scottish Government’s latest data strategy.  In many senses the title of this joint document with local government body COSLA says it all – ‘greater access, better insight, improved outcomes.’ The aims are clear and aspirational and are well articulated within a strategy which hopes to enable a better health and social care experience by the means of an ethical and human rights based use of data. The focus on autonomy and citizen ownership is laudable. The conference contained a lot of debate around data and how valuable our personal story through data was in our achievement of change and progress and yet along with many I was uncomfortable about the extent to which the disparity between the worlds of social care and health were highlighted in much of the debate around data and its use. My colleague Nicola Cooper who was also at the event articulated this in a succinct and prescient manner in a tweet yesterday where she said:

“‘Something has been troubling me. Data, data, data…….mentioned 10,564 times (felt like) at #digihealthcare2023 Conference… So are we saying that Social Care is less mature in its use of data, compared to health?’ The premise being it is…I’m not sure I agree. Here’s why.Social Care data is collected over & over, in different formats, to please different masters, and shared routinely for scrutiny & oversight, scrutiny & oversight (yes, I know I am repeating myself). It invokes negative + disempowering associations…Task driven, de-professionalising, risk averse, overwhelm – get it? Good data, often qualitative, helps with person-led high-quality care. It’s there but buried under the weight of reporting + regulation…. Data is the new gold at the end of the rainbow – always out of touch.

This is where maturity lies. In data driven innovation. Grass roots, by those closest to the challenge who are the most likely to know how to do better – improvement, service redesign, innovation… Will social care achieve data maturity is less of the question than IF social care in its current state is sustainable? (hint, the answer is NO).”

The social care sector has an abundance of rich often qualitative data, and this is immeasurably useful for the improvement of the individual experience of citizens and for the benefit of the whole health and care system but it is only useful if there is an adequacy of priority given to social care providers and staff to enable them to be the harvesters and users of such data in a way which is sustainable and beneficial to the rights and lives of the individual. It is only useful if the data tells the whole story and if social care is enabled to be autonomous and unique in its articulation and not be forced to utilise a data dialect which is not fit for context or purpose – thus the huge significance of the narrative as well as the number within data. Qualitative data matters as much to the outcome of a story as quantitative measures! Yet again the imbalance in strategic priorities between health and social care illustrates the failure of a whole system approach within Scotland.

My second observation of the conference was the extent to which there was a continual reference to the need to develop a digitally trained and competent workforce. At Scottish Care we are no strangers to the necessity of equipping our frontline carers with the tools to enable them to maximise the benefits of technology and digital in order to achieve the best possible outcomes and lives for the people who are supported in their own homes and in our care homes. The Care Technologist programme is an adventurous and innovative approach to ensuring that frontline social care is at the forefront in the challenge of championing that people are enabled to use technology to maximise their personal control and choice in their lives and in their care support. But if such innovation is to become mainstream, it demands an adequacy of resource priority to ensure our care workforce of the present and future is properly equipped, supported, and encouraged to undertake these progressive approaches. And all this at a time when social care providers are struggling to recruit and to retain frontline staff because of the embarrassingly shameful rates of pay which are predicated on inadequate Scottish Government pay awards. You cannot build and equip a technologically confident workforce on the deficit scale of reward and remuneration. There is a massive risk that the future of social care technology and digital usage in Scotland will be a shameful lost opportunity because of a lack of investment in and priority for the care workforce.

My next observation relates to the criticality of cyber and data security. After landing home after the event, I got an alert along with many parents at my local school around on-line security and threat. In this instance it was related to concerns which had been raised around the potential for cyberbullying, grooming or unwanted contact through the Roblox chat functions.  Roblox allows users to create and share their own games, as well as play other users’ games. As any user can create a game, an individual may create or invite a user to join a game that contains adult themes that will expose the child to content inappropriate for their age. No-one with a young child in their family will be unfamiliar with such warnings, and concerns – the world we inhabit is as full of technological threat as it is with digital promise and positivity. To ensure that those who work in and use social care are properly protected and aware both at an organisational and individual level is a massive challenge. This coming week (27^th February to the 5^th March) is Cyber Security Scotland Week which is an important initiative to make sure that we are all much more aware of the critical issues of cyber and online security. This is a fundamental element of ensuring our futures are one of positivity rather than abuse. The future promise of technology not least in the sensitive arena of health and social care will rise or fall on the extent that we prioritise both awareness of and investment in the protection of data and the development of our cyber security.

My last technology observation for the week relates to something which might seem antithetical to everything that has gone before and to a generally positivist approach to tech. It is simply that we must recognise that technology and digital are tools and not destinations. Like many people since the pandemic my world has become dominated by online meetings and Teams calls. In a very real sense attending a physical event is a rare treat and pleasure – it has become unusual for many of us to be out there with people in the way in which we used to be. This has had many benefits – we probably get more work done, we are more inclusive of those who live and work at a distance and we have managed to maximise participation and engagement in so many diverse ways. But – there is a cost. That cost is one I think we increasingly both individually and collectively need to challenge until we get to a point of healthier balance. The cost is personal interaction, dialogue, and honest communication. Online meetings allow those who organise and chair, those who lead and manage to control what happens, they drive out the directness of eye contact, the positivity of physical presence and the benefit of side exchange and networking. I am convinced in most meetings and group interactions they stunt innovative contribution and creativity. We have- not least in some governmental and statutory circles – reached a stage at which I am very worried about the way in which honest and healthy exchange and debate are being shut down by the dominance of virtual meetings and the absence of physical in-person interaction. It would be unfortunate in the extreme if the benefits of technology ended up leading to a situation of disingenuous exchange and the loss of freedom for speech and robust and honest contribution. I just wonder if that is the direction in so much of our working lives in which we are moving.

Enjoy your tech week.

 

Donald Macaskill

There are times when you might feel the struggles and obstacles you are enduring are unique to your own circumstances and situation. To be honest it sometimes feels like that in the world of social care in Scotland – that our challenges are unique and peculiar. But they are not. And both this week and in the last month it has become even clearer that there is a shared global set of concerns around social care and ageing but equally important a collective international desire and focus to do something about them. My reason for saying so is because of two reports which have been published in the last month.

The first is from the United Nations Department for Economic and Social Affairs (DESA) which in mid-January published its biennial flagship report that ‘aims to assess the world’s social situation by identifying emerging trends of international concern ‘. The World Social Report 2023 focuses on population ageing and the challenges and opportunities it brings as countries strive to achieve the 2030 Agenda for Sustainable Development.

It is called ‘Leaving No One Behind in an Ageing World,’ and takes its title from the commitment that as the world strives to achieve environmental sustainability that no-one especially the most vulnerable would be left behind. For the purposes of this report, it focuses on older age. It does so by celebrating the reality that we have made huge global strides in advancing health and older age but states quite baldly that there is much still to do to reap the benefit of this ‘demographic dividend.’

The report argues that older persons should be able to continue working for as long as they desire and are able, and it calls for ‘flexible retirement policies with guaranteed universal minimum benefits; eliminating barriers to older people’s participation in the workforce; and supporting learning and skills development throughout the life course.’

But it also advocates for a robust renewal of social care and health supports for our ageing population, stating that:

‘So far, public spending in most countries has not been sufficient to cover the growing demand for long-term care. The average expenditure by countries of the Organisation for Economic Co-operation and Development (OECD) was 1.5 per cent of GDP in 2019, down from 1.7 per cent in 2017. Insufficient funding means caregivers are undervalued, underpaid, and inadequately trained and often work in difficult conditions. A shortage of well-trained caregivers leads to poor quality care. Many countries, even wealthy ones, continue to rely on informal services by paid or unpaid caregivers.’

The report is well worth a read as it articulates a clear link between the economic success of a country and the degree to which it robustly addresses age discrimination and disadvantage. And when it talks about age discrimination it is explicitly referring to the discrimination against older age which is a global shame.

The second report which has highlighted for me our shared global challenge and potential came out a few days ago. It is entitled ‘Long Term Care: A Call for Action on a Global Scale.’ I know this work much better because I had the privilege over the last year of being part of the international group of writers who contributed to its development. That process and the conversations and discussions that were involved showed me first hand just how many shared concerns and solutions we share with one another across the world.

The paper makes many of the same arguments as the UN report but is primarily focussed on the aged care and social care sector and its condition across the world. It is a direct call to the governments of the world to act to address what is effectively an ageing emergency – one just as significant and challenging as our environmental emergency. It is a call to action to ensure that growing old is something which continues to uphold dignity, human worth and value, that celebrates individual autonomy and choice, and which enshrines the human rights of all regardless of age or capacity.  It states quite clearly that positive ageing does not happen by accident but through a clear strategic focus, prioritisation and planning which values ageing at its heart.

It especially states that we are globally, not just in Scotland, faced with very real challenges in terms of the declining numbers of caregivers and insufficient government support for services for older adults at the very same time as there are more and more older people requiring a greater level of support to remain independent, autonomous and valued. It also calls for a radical re-imagining of how we support people in older age, how we value them and how we provide care and support to those who may require it:

“As the aging population grows, there are too many challenges to keep doing things the way we have been doing them in the past decades. Informal family caregivers, who, in every country worldwide play a fundamental role in ensuring older adults’ well-being, are struggling with exhaustion, deteriorating quality of life, and loss of income that feed into negative macroeconomic impacts. We cannot leave this to families alone,” said Jiri Horecky, president European Ageing Network and board chair, the Global Ageing Network. “As the numbers of older adults grow, governments will have no choice but to invest in the supports older adults need, to give them agency and to protect their rights, including the right to long-term care.”

I consider that this international report is of real significance to those of us who care about older age in Scotland. It shows that many of the challenges we are facing in Scotland are global in nature, but it also suggests that the solutions of a better recognised and rewarded workforce, investment in older age care and support, and the innovative use of a human-rights based use of technology are ones we need to build on in Scotland and elsewhere.

If we are to truly ensure that no-one is left behind, we have to raise our heads from the horizon of our local and national concerns to work internationally on shared responses – this is as true of ageing and its potential as much as it is true of the environment and its challenge. Dozens of governments across the globe were presented with the report on Tuesday and I really do hope that they, ours included, will act on its call.

That is why I am delighted that Glasgow will welcome delegates from around the globe in this coming September to debate, talk, share, campaign, create and become active around the issues of ageing and care and support. The Global Ageing Conference will be taking place in the exact spot where COP26 happened – sustainable care and support for our growing ageing human population is as critical to ensuring a sustainable environment as perhaps any other issue. You can find out more details of this event at https://globalageing2023.com/

Both these international reports are appearing at a time when increasingly there is an acceptance of the intimate relationship between ageing and the environment, between celebrating and valuing older age and economic sustainability and success of communities and nations. Sadly, I think Scotland has some way to go to recognise older age as full of potential rather than cost. Scotland’s social care system and its very acute and real challenges can learn much from the insights of other places because there is much more that unites than divides our commonality. But wherever we are in the world the future is one where inescapably older people will increasingly find voice and agency, will demand change and innovation, will demonstrate new ways of being old – I very much hope we have the courage to listen to international voices and learn from global insights because those who are ageing will not allow themselves to be left behind.

Donald Macaskill

Today is the International Day of Women and Girls in Science. As someone who is much more comfortable in the world of arts and literature it may seem an odd theme to reflect upon in my weekly blog. But throughout my life I have come across some amazingly gifted women and girls who have contributed through their careers and writing to the advancement of our scientific knowledge. Yet in virtually each of their stories and careers they have done so despite the barriers and challenges placed in front of them both in terms of attitudes and behaviours, and more explicitly in terms of bias and discrimination. Theirs has without exception been a journey of struggle against the prevalent societal, academic and industry prejudices.

In some senses I belong to a generation where there was an unhealthy presumption when I was at school that science was for the boys and that the arts and other subjects were for the girls.  And I am not that old! This myth of male scientific primacy could not have been more visibly negated than in my own classroom where the girls romped ahead of any male in their environment and to my knowledge at least three of whom went on to do science-based PhDs and have excellent scientific careers. Yet I can still remember a female teacher standing in front of the class and stating without fear of contradiction or embarrassment that “science brains were always ‘male brains because of the way in which we were made”. The pseudo-science of presumption.

Wind on the years and I am sitting in a care home with an older lady who by that stage was in her nineties and bar from some real physical challenges as the result of hip replacement surgery which had not worked as it should have, she was intellectually active and her mind was dynamic and creative. She recounted to me her own experience of frustration with her schooling because despite being the undoubted brightest in a family of three brothers, she never got her chance at pursuing education until she had left school and working all hours and with the support of her young husband, she put herself through university education. She went on to become one of the foremost specialists in her field of immunology. We got to know one another really well but in almost every conversation we had there was both an anger at the barriers she had faced not just at school but in her clinical career simply because she was a woman, and this was combined with a determination that girls and women in the future should not have to endure similar experiences.

Undeniably we have come a long way and there are more women in positions of scientific prominence and as leaders in science and technological industry, but we have considerable distance still to go. The UNESCO and UN-Women led day we celebrate today illustrates the distance to ending such discrimination. It states:

• Women are typically given smaller research grants than their male colleagues and, while they represent 33.3% of all researchers, only 12% of members of national science academies are women.
• In cutting edge fields such as artificial intelligence, only one in five professionals (22%) is a woman.
• Despite a shortage of skills in most of the technological fields driving the Fourth Industrial Revolution, women still account for only 28% of engineering graduates and 40% of graduates in computer science and informatics.
• Female researchers tend to have shorter, less well-paid careers. Their work is underrepresented in high-profile journals, and they are often passed over for promotion.

In order to achieve full and equal access to and participation in science for women and girls, and further achieve gender equality and the empowerment of women and girls, we must recognise the challenges we see all around us.

I have written and spoken a lot about technology and how it impacts the world of social care – I hasten to add from an amateur and non-scientific expert stance! As a result, I attend many science and technology conferences and events and what often strikes me is that without exception so much of the most dynamic, original and humanistic inventions and initiatives originate from the work of female developers and scientists – yet so much leadership, presentation and articulation of these is led by men. What is going on there if not healthcare and social care’s own glass ceiling operating against the creativity and imagination of women? As the UN states women remain a minority in ‘digital information technology, computing, physics, mathematics and engineering. These are the fields that are driving the digital revolution and so, many of the jobs of tomorrow.’

Of all the Nobel laureates awarded in physics, chemistry, physiology and medicine 587 (97%) have been given to men and only 20 to women. That strikes me as the arithmetic of bias rather than the science of sense. It is time for those of us in our own spheres of influence such as social care and health care to ensure we continually address the ongoing discrimination against women and girls in technology and science. If we do so we not only work to right an error but to benefit the whole of society by giving space and voice to creativity, innovation, discovery and insight from those who have so much to give. As my old friend in the care home said to me, she had spent her life “dreaming and working to be herself.”

And what better way to end this blog but with the challenge and creative brilliance of Neil Gaiman and his poem ‘The Mushroom Hunters.’:

“The Mushroom Hunters,”

Science, as you know, my little one, is the study

of the nature and behaviour of the universe.

It’s based on observation, on experiment, and measurement,

and the formulation of laws to describe the facts revealed.

In the old times, they say, the men came already fitted with brains

designed to follow flesh-beasts at a run,

to hurdle blindly into the unknown,

and then to find their way back home when lost

with a slain antelope to carry between them.

Or, on bad hunting days, nothing.

The women, who did not need to run down prey,

had brains that spotted landmarks and made paths between them

left at the thorn bush and across the scree

and look down in the bole of the half-fallen tree,

because sometimes there are mushrooms.

Before the flint club, or flint butcher’s tools,

The first tool of all was a sling for the baby

to keep our hands free

and something to put the berries and the mushrooms in,

the roots and the good leaves, the seeds and the crawlers.

Then a flint pestle to smash, to crush, to grind or break.

And sometimes men chased the beasts

into the deep woods,

and never came back.

Some mushrooms will kill you,

while some will show you gods

and some will feed the hunger in our bellies. Identify.

Others will kill us if we eat them raw,

and kill us again if we cook them once,

but if we boil them up in spring water, and pour the water away,

and then boil them once more, and pour the water away,

only then can we eat them safely. Observe.

Observe childbirth, measure the swell of bellies and the shape of breasts,

and through experience discover how to bring babies safely into the world.

Observe everything.

And the mushroom hunters walk the ways they walk

and watch the world, and see what they observe.

And some of them would thrive and lick their lips,

While others clutched their stomachs and expired.

So laws are made and handed down on what is safe. Formulate.

The tools we make to build our lives:

our clothes, our food, our path home…

all these things we base on observation,

on experiment, on measurement, on truth.

And science, you remember, is the study

of the nature and behaviour of the universe,

based on observation, experiment, and measurement,

and the formulation of laws to describe these facts.

The race continues. An early scientist

drew beasts upon the walls of caves

to show her children, now all fat on mushrooms

and on berries, what would be safe to hunt.

The men go running on after beasts.

The scientists walk more slowly, over to the brow of the hill

and down to the water’s edge and past the place where the red clay runs.

They are carrying their babies in the slings they made,

freeing their hands to pick the mushrooms.

From https://allyourprettywords.tumblr.com/post/160240301193/the-mushroom-hunters-neil-gaiman

Donald Macaskill

I’ve never been the victim of racism but have sadly witnessed it and its impact all too often over the years. For over a decade I was involved in delivering programmes of learning and development for organisations and their staff on the issues of equality and diversity. With the distance of time, I often reflect on that experience which frequently felt as if I was pushing a boulder up a steep hill. Often when I was delivering a training course the first period of time involved me engaging in what felt like an evangelical argument to convince folks that what they were about to experience was not the latest fad, was not a tick box exercise and was not pandering to ‘political correctness’ whatever that was understood as meaning. In other words, it was important, meaningful and that it mattered just as much as Health and Safety to Child Protection training. On occasion I had to engage in a more robust and strident defence and set of arguments on how understanding the way you relate to people who might be different to you, whose behaviours, beliefs, or attitudes you may disagree with – was a fundamental part of working in a modern public facing service and indeed being a part of contemporary society. Whether it was a training course delivered to the police or social workers, to a charity or private business, the challenge and resistance to race equality training was almost predictable and sadly familiarly frequent.

These memories often come to the surface when I consider annual events like Race Relations Week which this year runs from the 6th to 10th February. It is a week which ‘unites employees, focuses senior leaders and encourages them to continue their activity and drive race equality all year long.’ It aims to be ‘a catalyst for ongoing change’ in order to ‘galvanise and maximise impact through a nationwide collaboration for real change.’

In the world of social care, the dynamics of race are significant and important. On the one hand social care as a sector whether in care home or homecare employs and attracts more people from Black and Minority Ethnic (BAME) backgrounds as an overall proportion of the workforce than many other sectors in Scotland. On the other hand, the sector has frequently struggled with the issues of racism that beset the rest of the population. That is both in terms of direct service experience for worker and resident/service user and the paucity of distinctive provision for minority groups as a report by Rohini Sharma Joshi for Scottish Care argued just before the pandemic.

When I trained people in equality and diversity starting three decades ago, I often used to say that over time the knee-jerk resistance to learning about race or disability, sexual orientation or belief would change naturally and progressively – I really believed that as people encountered difference more often, as fears were allayed, as generations changed then behaviour and attitudes would become more inclusive, non-discriminatory, and mature.

I disappointingly must admit that such optimism was misplaced because sadly I feel the challenge of racism is in some senses as acute in some parts of Scotland today as it has been in the past. It is undeniably true that incidents of overt race hate have become less common, that people who are victims have marginally become more confident in reporting, that previously accepted societal and group racist behaviours and so-called humour are now more likely to be challenged or whispered – and yet there is almost now a subtle underground pervasiveness of outdated attitudes to ethnicity even amongst the young. Racism has become more subtle and calculating but no less dangerous and damaging. And at the same time as I think racism has become more hidden in plain sight the focus of learning, development and challenge has become less critical and much less well-resourced and prioritised by both organisations and government.

That is not to deny or ignore for instance that there have been some good pieces of research and reports in the recent past exploring the disproportionately negative experiences of the Covid pandemic upon the BAME population as a whole and upon health and social care staff in particular. This work should be welcomed advocating as it does for politicians, policy makers, organisations, and leaders to address the inequity of treatment, discrimination in resource allocation and bias within organisations and systems. But I think as well as tackling endemic racism at that macro level as individuals and communities we need to do a whole lot more in terms of personal attitudes and behaviours.

The recent well publicised experience of the acting colleagues of the Scottish actor James McAvoy who experienced direct racism in the streets of Glasgow should shame anyone who cares about that city and its reputation. But the sad truth is – no matter how many carpets we choose to brush reality under – that there are daily experiences of direct racist incidents being perpetrated upon both Scots of long lineage and more recent arrivals every day.

I spoke to a social care provider in the west of Scotland just a few weeks ago – they had successfully recruited staff from Africa and had supported their arrival and transition really well. Yet these young women and men recounted tale upon tale of negative experience – at the hands of the public – bananas thrown at one person on the bus; at the hands of service users – someone point blankly refusing to be supported and cared for by a ‘black woman’ and even incidents where colleagues had ignored or demeaned them. Despite all the support and the best endeavours of managers and supervisors this new workforce were now reporting to peers back home the reality of not being welcomed.

I’ve equally lost count of the number of workers in both clinical and care settings who have recounted to me incidents of subtle and significant racist behaviour both at the hands of patients or residents and from peers and colleagues.

We need to call out racism wherever it exists and to challenge the perfidious nature of it at the hands of those who care and in environments where people should be having their humanity affirmed not demeaned.

It is simply not acceptable to say things are better than they were because they are still not as they should be. As a society as we rightly seek to address and challenge other inequities and disadvantages let us in the week ahead also continue to renew our efforts to challenge hatred and discrimination on the grounds of race and ethnicity. The job is only half done. It is time to care about racism.

The amazing Jackie Kay one of the greatest living poets in Scotland at the current time brilliantly captures the reality of racism in Scotland in her poem, ‘In My Country.’

walking by the waters,

down where an honest river

shakes hands with the sea,

a woman passed round me

in a slow, watchful circle,

as if I were a superstition;

or the worst dregs of her imagination,

so when she finally spoke her words spliced into bars

of an old wheel. A segment of air.

Where do you come from?

‘Here,’ I said, ‘Here. These parts.’

Printed in Scotland’s Makar Jackie Kay: This is still my country, but it needs to change – The Sunday Post

 

Donald Macaskill.

 

As we all know what we say at the start of the year often sets the tone for our expectations, hopes, and promises for the year to come. In looking back at previous first of the year blogs there is a remarkable consistency if not similitude to the comments I have made. I could therefore save myself a great deal of effort and get the copy and paste key working and I suspect it would read with an air of authenticity about what we still need for social care in the year to come. Yet this year feels very different.

The word ‘crisis’ is everywhere I read and hear; it’s the word of alarm on many of the lips that I have heard or spoken to in the last few days. This year feels so very different to the previous winters even the last two which although exceptionally challenging felt for many reasons different to the one we are now going through. I therefore want today – perhaps at a bit more length than usual – to focus on the crisis in social care and why addressing that is or should be a primary focus of political and economic priority in the weeks and months ahead.

But to begin with – that word ‘crisis’ is an interesting one. Allow me a moment for a semantic sidestep if you will. Originally, the word ‘crisis’ meant “the turning point for better or worse in an acute disease or fever.” But nowadays its commonest meaning is “a difficult or dangerous situation that needs serious attention.” There is something in the original that I like not least because in its root in the Greek it has a connotation of opportunity and new beginning. A crisis can become a moment when things change, and a new or different direction is taken. I think we are very much at such a moment of opportunity.

The state of the NHS

The media over the holiday period has been dominated by stories about what is happening in the NHS in Scotland. They make unpalatable and alarming reading with long delays in A&E, very high levels of delayed discharge, exceptional occupancy levels in our hospitals, an exhausted, weary and morally harmed frontline workforce, and continual warnings about not accessing emergency and urgent services unless the need is essential and very necessary. The focus on the NHS and its state of crisis is understandable although I would want to stress that the work of all those at the frontline and behind it over the last weeks  and indeed for months has been exceptional and sacrificial of self and time. In the midst of a narrative of breakdown and chaos  I think it is equally important to recognise the brilliance, the quality and the success of what is being achieved every day by colleagues in our health service – not least of which is the fact that well over 95% of discharges from hospital are consistently without delay – saying that does not devalue the impact of delay on those who are stuck in hospital but it affirms the hard work of the practitioners in social work, social care and secondary care. It is also critically important that we do not deny the impact of Covid19 upon our health system. As we have rushed back to normality and to adopt a societal vow of silence about Covid and its continued existence we ignore its ongoing impacts at our peril – not least of which is the impact of Long Covid. People are entering hospital in a highly deconditioned state and with exceptional levels of frailty. As a result, patients are staying longer with a greater degree of required treatment which in turns increases the pressure on wards and staff. And at the end of their stay more people than ever before are requiring social care packages in either their own home or in a care home.  At a time of real challenge our health services are supporting more and more people with less and less staff.

The ‘crises’ facing our NHS have been well documented and commented upon but there is a remarkable link with those challenges which I have often commented upon as afflicting social care. That is not just that social care has added to the issues of ‘delayed discharge’ – to narrow things to that single lens is a serious error. I would go further and assert that in the year to come unless we address the challenges and ‘crisis’ of social care then we will continue to fail to meet and deal with those facing the NHS – a focus on one without the other will simply not work. They are two sides of that perennial same coin.

Social care crisis is a workforce crisis.

Over the years I have written a lot about the challenges facing social care in Scotland and do not want to repeat all that here – although despairingly its truth remains. In reducing challenges to one single factor there is always a risk towards oversimplification, but I do not think it unfair to argue that the single continual challenge facing social care both in residential and nursing care home provision and in the community is one of workforce. I might hear you say that it was always the same – and to a degree that is true. Social care has always struggled to compete with others not least the NHS because of a lack of an equal playing field – but we are now in a situation where we aren’t even playing the same game such is the divergence between sectors.

Again, it is worth asserting here that the exceptional professionalism of the women and men at the frontline of social care has been breath-taking, not least the thousands who remained at risk in caring for others during the early stages of the pandemic both in the community and in residential care. But the fact is that we have lost thousands of those staff due to fatigue, exhaustion and because we have failed to recognise, reward, and remunerate their professionalism both before but certainly since the pandemic. We have also shot ourselves in the foot with self-inflicted wounds such as over-zealous oversight and lack of professional trust and regard. Then this week I have read of Sainsburys increasing the salary of frontline staff to £11 an hour in recognition of both cost-of-living pressures and of the need to compete against other retailers. This is clearly to be applauded in these challenging times but compare that to the value society bestows on the work of frontline carers. And this is a point which needs to be made regardless of whether the employer is a charity, private organisation, or a local authority because after all most of the contracts and terms and conditions for frontline care are set by the State at both national and local level.

A frontline professional carer is required to be registered, to be qualified and trained over a period, to maintain that qualification through further study, to be regularly inspected and monitored and work under a fitness of practice regime etc. All this to a degree is appropriate and right for those who care for and support some of our most important citizens whether as children or adults. But to do all that and to remain motivated in challenging times requires society and the taxpayer to appreciate and recognise that role as vital to the functioning of a modern society – I ask you (even with the enhanced Real Living Wage) does £10.90 an hour cut it? I think not. Not surprisingly people are leaving the sector to work in retail and hospitality. All this is not even to mention the unequal treatment in regards to terms and conditions for the thousands of nurses who work in social care and who are increasingly being attracted to join agencies where they are able to earn so much more money whilst working alongside former colleagues – though you can imagine the impact on your morale by working alongside someone who you know is perhaps getting paid double what you are earning for doing the same shift!

But for social care – even more so than the health service – the situation is worsened by the impacts of Brexit and a thoughtless immigration policy and procedure which has been insensitive to the demographic realities of a Scotland that has both not enough workers as well as an ageing population. We lost thousands of gifted women and men as a result of our departure from the European Union, and they have simply never been replaced (and add to that the hundreds who have left social care to remain in Scotland but to work in retail and hospitality.)

Together with an ageing workforce, issues of gender segregation, the enhanced complexity and volume of social care, huge levels of unmet need in the community, the demotivating use of electronic call monitoring and watch systems, the increased use of fifteen minute visits which make it impossible for staff to care and support someone in dignity, and you have a working context in social care in the community which is at best challenging if not impossible.

‘Delayed discharge’

There has been an inordinate amount of media focus – and no doubt political focus once MSPs return next week – on the issue of people being trapped in hospital when they are fit for discharge. All of us who know this world know that remaining in hospital for longer than you need to is not a healthy option. In response to the growing demand and growing number in such a situation the eyes of the system have turned onto social care as the problem. Well, it is and it is not. There are two main targets within the issue of delayed discharge – the first is that we should be doing all we can to stop people going into hospital in the first place and the second is that as soon as they are in, we should be preparing to get them back to their own home or a homely setting as quickly as possible.

Dealing with the issues of avoiding unnecessary admission is critical. An empty hospital bed will be filled by a patient by the very existence of its presence. Ultimately, we need to be using hospitals less not more and that necessitates treating people as close to their home as possible. An emphasis on local treatment and prevention has been talked about for years and works in some places but requires a massive re-orientation in focus from hospital focussed healthcare to community primary care and social care provision. We have a considerable distance to go down that road, yet it is a journey that is essential if we are to become a healthier community. Too many people are unnecessarily admitted to hospital which not only endangers their lives in the long-term but also lessens their wellbeing in the short term. We need to urgently invest resource in shared social care and primary care models of local support. Care homes which are adequately resourced and staffed are for instance ideal locations for people to be supported for brief times rather than in large institutional acute settings.

At the other end of the spectrum the vast majority of people in hospital today who require a social care package of support are needing to return to their own home but the parlous state of homecare, care at home and housing support means that many charitable and private organisations have handed back care packages, cannot recruit staff and are exiting the sector en masse. There is need for an urgent review of homecare because if we do not get the system right which supports people to remain independent in their own homes then they are unnecessarily admitted to hospital putting yet more pressure on an already strained service. It is worth stating that such reform which requires fair commissioned services, contracts which are equitable and which offers real choice to citizens rather than a one-size fits all model, will require significant resource – the question is as a society are we prepared to finance a preventative approach that values personal choice and independence or to continue to fund an emergency response which is primarily focussed on acute and secondary hospital care?

Lastly in terms of delayed discharge. I have heard it said in recent days that we need to see a return to the old cottage hospitals. Those of us old enough to remember them should be appalled at such a suggestion. There were very good reasons we closed down such units and places and that was that despite the dedication of local staff in many of them that there were too many which had become places to maintain and house older people with degenerative illnesses such as dementia. When we began to focus on care homes as places of long term care for our citizens the emphasis was on creating non-institutional settings and places where people could be rehabilitated and supported in a better environment more conducive to personal care and support and shared living.  At their best care homes have become such places where if adequately resourced and staffed an individual can live a much better quality of life than they could ever achieve in a hospital.

In addition, there has been a huge change in the nature of care homes in the last decade and a half to the extent to which many have become effectively local hospitals and hospices in everything but name. This is especially the case in those homes which offer interim care places which allow someone to be discharged from hospital and to be supported and re-abled to continue their journey home after a few weeks stay in a care home or indeed to move onto another care home of their choice. Believe you me being supported in such an environment in your journey of care is a much better choice than being stuck in an acute hospital with stretched services, exhausted staff and a constant flow and change to say nothing of the risk of infection and deterioration because of lack of mobility and movement.

 

We need I think to have an emergency and urgent response to the whole health and social care crisis that we are facing. There is a moment – even a passing one – for opportunity and collective and collaborative change. I get tired as frontline managers, staff and practitioners struggle with the issues facing them of reading and hearing the constant political fighting over these issues. I’m not naive – I know the role of political parliamentary opposition is to hold government to account, to challenge and persuade the electorate that things are not working. But when does the role of a politician become one of civic responsibility which overcomes party political interest, and which necessitates working in collaboration with others with whom you strongly disagree? I think that that moment has well and truly come for the health and wellbeing of our nation. And so, my most forlorn New Year 2023 wish is that in the spirit of a national emergency (regardless of the reasons for it or from whence it has come) we can work as politicians, policy makers and practitioners in a spirit not of mutual one-upmanship but shared solidarity to address the real concerns of life and limb our health and care systems are now enduring. And yes, I still believe in Santa Claus.

We are at a truly critical phase in the dis-ease affecting health and social care services in Scotland, will we use this crisis to collectively work together to achieve lasting change or rather will we be back here next year with a similar blog spouting the same concerns and challenges? I very much hope it is the former because one thing is clear and that is that these are not simply winter pressures but a crisis for all seasons.

Donald Macaskill