Innovation at the heart

Legislation to implement Health and Social Care Integration came into force on 1 April this year. This brought NHS and local council care services together under one partnership arrangement for each area. In total, 31 Health and Social Care partnerships (HSCP’s) have been set up across Scotland.

At its heart, Integration aims to ensure that those who use services get the right care and support whatever their needs, at any point in their care journey. This brings a greater emphasis on enabling people to stay in their homes, or another homely setting, where possible, sharing their lives with their family and friends, doing the things that give life meaning and value.

The independent sector, being the biggest provider of social care in Scotland has a significant role to play in this programme. Though the largest provider of health and social care, our sector is not always associated with service excellence or seen as a true and valuable partner.

In order to change this I have recently set up The Learning and Innovation Group within Scottish Care. This will take the lead on sharing good practice, promoting the range of services provided by our sector and to support learning, improvement and innovation. I am joined by seven Local Integration Leads, all of whom are directly involved in innovative tests of change in their areas, by Becca Gatherum and by Jamie McGeechan. Jamie is our newly appointed Communications and Events Officer.

Those of us close to the sector see, on a daily basis, the commitment of our workforce, the high levels of skills and expertise within our teams, innovative practice, strong leadership and an absolute commitment to service excellence. This is a sector I am very proud to be part of.

The Learning and Innovation Group met for the second time yesterday and as anticipated, there was a really positive energy in the room. Given the significant challenges facing our sector just now, it was heartening to focus on the success stories and to remind ourselves why we do what we do.

Over the coming months we will share the learning from tests of change and innovative approaches to the delivery of health and social care. A variety of platforms and approaches will be used in order to reach as wide an audience as possible. These will include digital stories, publications and reports, presenting at conferences and events, videos, formal research, the development of a resource library and social media.  Jamie’s skills in communication will be evident to all! We plan to develop a section dedicated to innovation on the Scottish care website which will hopefully become a first stop for those interested in developing services. Whether looking at small tests of change, a major development or have an experience to share, we are interested in hearing from you.

I have many hopes in life, one being that the independent sector will get the respect and response that we deserve from our partners, the media and the public. We all have a role to play in this, I hope that my part in sharing the good news will help towards this.


Margaret McKeith

13 July 2016

Iriss: Bring Your Own Enquiry project


Iriss are seeking partners to work with around an explorative approach to organisational enquiry and action.

This Bring Your Own Enquiry (BYOE) project will support cross-organisational teams to collaboratively address and act on an issue that they have identified as a group. The project will initially be using a Community of Enquiry (CoE) approach to explore the experiences of those taking part and to build and develop a shared way forward. This approach is one that helps people go from sharing their own knowledge, to very quickly being able to develop consensus on an issue to be explored and acted upon. Iriss view this process as a way of blending their approach to innovation and evidence:

“Iriss sees innovation and evidence as being interwoven and engaged with through a reflective learning process. This weaving of innovation and evidence involves a ‘remix’ of ideas – ideas that have been copied, transformed and combined”

The BYOE project aims:

  • Support participating organisations to embed an enquiry-based approach
  • Encourage evidence use, gathering and creation
  • Develop and deliver individual action plans
  • Share lessons from the approach and the actions to a wider audience

Read more about BYOE on the Iriss website.

Note that the deadline for registering interest is Wednesday, 27 July 2016.

Stroke education survey for care managers

Chest Heart & Stroke Scotland are facilitating a survey to identify the perceived training needs of staff working in care homes or care agencies who care for people who have had a stroke.

This survey has been developed following a request from members of the Scottish Stroke AHP Forum (SSAHPF).

The survey will run until the 5th of September 2016 and results will be shared with the SSAHPF and Scottish Care.

It would be appropriate if senior managers or people with responsibility for education could complete the survey, which will take no longer than 10 minutes (one response per home or agency). If you have any questions please contact  [email protected]

The survey can be accessed at:

Scottish Care Front Line Support Worker Strategy Forum

Scottish Care is committed to progressing front line workforce engagement and involvement in local and national discussions and consultations.

Following on from the launch of ‘Voices from the Front Line’ in February, we have been identifying how we can progress the recommendations made in this report.

Over the coming months we are progressing the following:

  • Front Line representation in ALL Scottish Care consultation groups and forums, including the new Care at Home/Housing Support Reform Group and the Care Home Reform Group
  • Reviewing the critical role of the front line support worker and promote their contribution in an integrated health and social care setting
  • Involve front line support workers in Scottish Government forums
  • Exploring successful career pathways and design to support recruitment and retention
  • Undertake a study designed to promote the image of social care as a career

We also want to grow our learning network and are currently inviting more organisations and stakeholders to get involved in this important group.  Please contact [email protected] for more information.

We have also planned two engagement events this year.  The first will be taking place on Wednesday 21st September 12.15pm – 4.30pm at the Renfield Centre, 260 Bath Street, Glasgow, G2 4JP.

The event is entitled ‘Exploring the Wellbeing, Skills and Ambitions of the Front Line Workforce in Scotland’.

More information about how to book your place at this event will be coming out over the coming weeks.  We would very much encourage you to send members of your front line support workforce to this important event.

Voices from the front line of nursing in social care

Over the next few months, the Workforce Matters team will be working closely with colleagues in Scottish Care on a piece of research exploring the experiences of front line nursing in social care settings.  We are acutely aware of the challenges providers face recruiting nurses, and the damaging implications of long term reliance on agencies.

We anticipate that this research will start in August, with a report and key findings launched at Scottish Care’s Care Home Conference on 18 November.

More information will be shared with our members over the coming weeks where we will be looking for organisations to express interest in getting involved in interviews and discussions.

For more information please contact [email protected]

End of Life & Palliative Care resources

Katharine Ross, Scottish Care’s Workforce Lead, was recently invited to speak at a Scotland Policy Conferences Keynote Seminar at the beginning of June.

The title of the event was  ‘Next steps for palliative and end of life care: access, delivery and integration.  

Katharine’s presentation is available here.  We hope this emphasises the importance of involvement and integrated co-production that Scottish Care place in the development of end of life and palliative care.

Scottish Care has recently been invited to participate in the development of end of life and palliative care learning and educational material.  Although this project is in the initial stages of development, we will soon be inviting Scottish Care members to engage in discussions with NES and SSSC.  More information will be coming out soon.

If this is an area you or your organisation would like to get involved in please contact Katharine directly – [email protected]


Bringing human rights home

Over the last nine months Scottish Care has published two human rights documents, the Convention on the Rights of Residents in Care Homes for Adults and Older People and two weeks ago at the annual Care at Home and Housing Support Conference, the Convention on the Rights of People receiving Care at Home and Housing Support Services. Both were products of collaborative work where individuals who used support services articulated their sense of what constituted for them basic rights and quality in service provision.

Nearly two decades ago the Human Rights Act incorporated the European Convention of Human Rights into domestic legislation enabling individuals if they felt that there had been a breach in their human rights to take their case to a local court without having to have recourse to a court distanced from them in Europe. The whole process was badged as ‘Bringing Rights Home.’

In some sense that is what both of the Scottish Care Conventions have sought to do. They have sought to bring ‘human rights’ into the homes of individuals who use social care support whether they live in residential care or in the wider community. They have sought to make human rights something which spoke to their needs and aspirations, something which was real rather than a set of abstract concepts used by the media and politicians to score cheap points in a debate. As one of the participants said:

‘Human rights are ours.’

The First Minister in a speech in the Pearce Institute in Govan in September 2015 in addressing attempts to repeal the Human Rights Act spoke of the need to see the Act as a floor rather than as a ceiling beyond which one could not go or aspire.

“When the Human Rights Act was passed in 1998, the intention was that the Convention would provide a floor for human rights across the UK. That’s because it would be incorporated within the domestic law of all nations of the UK – through the Human Rights Act, and the different devolution settlements.

But the Convention was always intended to be a floor, not a ceiling. Devolved governments have the flexibility to go further, if we choose. And so complying with the Convention should not be the limit of our ambitions.”

(First Minister Nicola Sturgeon, Pearce Institute, Govan, 23 September, 2015)

The First Minister challenged civic and public society in Scotland to attempt to work together to achieve a context where human rights were at the heart of all we do in Scotland. In a small way the Conventions seek to contribute to that process.

The analogy of bringing rights home is a helpful one. To a considerable degree we have indeed brought rights home but I also suspect that we have kept human rights at the doorstep. Human rights have not entered into every room and corner of our ‘house of care’. We have, and are increasingly articulating the role human rights can play in the delivery of quality services which respect and enhance the dignity, voice and choice of those who use services and supports. The new National Care Standards will go a long way to embedding a rights-based approach to care. But if that is all we do – and that’s not to diminish that process – we will still be keeping human rights in one small room, a room about individual relationships and rights.

For human rights to mean more than just platitudinal rhetoric they have to infiltrate the whole of our health and social care system. Put simply you cannot have a human rights based approach to care and support without a human rights based approach to budgeting, to finance allocation and to commissioning.

It is all very well to require providers and those who work in care services to embed human rights at the heart of their work and services, but unless you have a system whereby human rights can direct the decisions we make about spending limited resources, and unless we change procurement processes to properly operate on a human rights basis then we are just tinkering with rights, we are just keeping human rights at the doorstep.

So at the Care at Home Conference we called upon our partners in Scottish Government and local authorities to work with us in building and developing a human rights based approach to commissioning and budgeting. We are partly there with good rights based procurement guidance, but we have a long way to go.

So what might such a model look like? Well it could perhaps be based on the widely recognised PANEL principles, which is an approach to what a human rights based approach means in practice. PANEL stands for Participation, Accountability, Non-Discrimination, Empowerment and Legality.

What might this mean for budgeting, procurement and commissioning?


Participation – People should be involved in decisions that affect their rights. So providers and those who use services should be key partners in strategic and local decision making, not informed or engaged in consultation after decisions have been made.

Accountability – There should be monitoring of how people’s rights are being affected, as well as remedies when things go wrong. If insufficient resource is allocated to enable an individual to be adequately supported then something is done to address this.

Non-Discrimination – Nobody should be treated unfairly because of their age, gender, ethnicity, disability, religion or belief, sexual orientation or gender identity. Is the allocation of public resources discriminatory for older people? Do we enable the same degree of choice and personal budget allocation to those over 65 as to those under 65, to those who live in our care homes and those who live in their own homes?

Empowerment – Everyone should understand their rights, and be fully supported to take part in developing policy and practices, which affect their lives. Do those who use supports adequately understand their right to involvement in decisions around their support and care e.g., in terms of self-directed support?

Legality – An approach like this is about going beyond the minimum legal requirements and mainstreaming human rights in services, policies and practice to make them run better for everyone.

The challenge is to fully bring human rights home, so that whatever part of our system of care and support from assessment to delivery, from budget allocation to workforce support, we have human rights at the heart and core, not rhetoric but a person centred approach that values the individual and gives real choice, control, involvement and dignity.

Scottish Care is committed to embedding both our Conventions and building upon that work in the months and years to come. So feel free to keep visiting us and join us as we bring rights home.

Dr Donald Macaskill, 5th July 2016


This blog builds on a speech delivered to the 2016 Care at Home and Housing Support conference on 23rd June. This can be seen at


The independent sector – full of heart

Welcome to the first blog on our new website. Every month you will be able to read two new blogs, one from our CEO, the other from a guest blogger. Our aim is to inform you about what is happening in the independent sector, to encourage debate on issues of the moment and to promote innovation in the way that individuals are supported and cared for. We hope you enjoy them.

Last Sunday I had the privilege of taking part in the Royal College of Nursing 100th anniversary Congress which was held in Glasgow for the first time.

Together with the Director of the RCN in Scotland, Theresa Fyfe, and Scotland’s Chief Nursing Officer, Prof Fiona McQueen  I was invited to debate the contribution of third and independent sector nurses to care and health in Scotland.

My contribution was to reflect on the question ‘What needs to change for the independent and third sectors to be seen as equal partners in delivering health and care?’

To answer that question perhaps we need to ask something even more basic – What does it mean to be a nurse?

I’m probably not the right person to be answering that but it’s a question I can remember asking from an early age because every summer holiday I spent time with my aunt who was a district nurse in an island community… The archetypal navy-uniformed, Mini-driving, doctor-repelling, straight-talking Highland district nurse!

I remember asking her probably at a precocious ten years of age why she wasn’t a nurse in a hospital and amongst all her responses one thing stuck in the memory –

” I can get to know people, when they are ill and when they are well, I get to know them all, their sons and daughters, their neighbours and friends… And here I have time…  I didn’t have that in a hospital.

Maybe that’s a romanticised recollection of a ten year old but I remembered those words when recently I spoke to a nurse in a care home I was visiting. I was asking her what was different about nursing in a care home compared to a hospital. She said:

“Here I have time to get to know people, to sometimes become a friend, to nurse to the whole of the person and their family… It’s especially important at the end of life to be able to have known the person whose hand you are holding and who is spending their last moments with you.”

Time, relationship, being with, are some of the characteristics which mark out the especial circumstances of nursing in social care, whether in a care home or in someone’s own home. That’s not to say that they are alien to an acute environment but they are just more possible in non-hospital settings.

As we increasingly hear of the importance of people remaining at home or in a homely setting for as long as possible; as we read new policy initiatives such as the National Clinical Strategy or the Review of Out of Hours Provision, the potential and role of social care in achieving better health outcomes for people becomes a real one. In that regard nursing in social care settings becomes all the more important. There is real potential for those who want to nurse in care homes and in community locations to become a key ally in achieving the outcomes that people want for their lives. But to get there things need to change.

What needs to change for the independent and third sectors to be seen as equal partners in delivering health and care?

Perhaps not a lot for the person who is cared for at home and in a nursing home… but for the nurses themselves – the answer is that equality seems so very far away…

Do we really have equality when nurses in a care home setting are worse off (in terms and conditions) to the degree of around £6,500? Do we really have equality when nurses aren’t given the same opportunities for shared learning and development that colleagues in the NHS have? Do we have equality when countless nurses have told me about how lecturers in college dismissed care of the elderly as not ‘real’ nursing? Do we have equality when frontline nurses feel they have to justify working in a care home or in social care to their fellow professionals?

We need to give value to those who work in non-traditional settings, we need to honour and celebrate nursing staff in care homes and in the community as an essential contributor to the care and support of our communities. And yes value is in part by financial reward but its much more than that. It is about respect, being given a place, being listened to, being heard, having your contribution noticed and indeed celebrated.

The more nurses I have the privilege to speak to the more I know that despite the suffocating amount of paperwork and procedure that gets in the way- I might say unnecessarily so – it is the ability to form relationship, to nurture contact and to be with people that marks out nursing in an independent sector care home or care at home organisation as something which attracts.

In some essential truth nursing in the independent sector is authentic – it is genuine, honest, hard graft but at its best it is relational, human and valuable

What needs to change?  – we all do, society does, Scotland does. We need to change into a country that values those who have been labelled and limited by being described as old; we need to recognise contribution beyond location and value beyond number… Only then will nursing our older citizens be truly celebrated for the critical art it is.

Dr Donald Macaskill  Twitter: @DrDMacaskill

New palliative care awareness bulletin

A new monthly current awareness bulletin is being produced by Healthcare Improvement Scotland.

A new monthly current awareness bulletin is being produced by Healthcare Improvement Scotland to help keep up to date with publications across the range of topics in the Scottish Palliative Care Guidelines. These include pain, symptom control, end of life care and medicines information.

The bulletin can be found here and is generally published mid-month.

Gusset Grippers’ – Edinburgh Fringe show about the mysteries of continence and the pelvic floor

Elaine Miller, physiotherapist, comedian and recovered incontinent is bringing her show, “Gusset Grippers” from the international speakers circuit to the Edinburgh Festival Fringe.

A shocking 1 in 3 women and 1 in 9 men wet themselves.  Leaking is common, but never normal, and most cases of stress incontinence can be cured.

“There is a perception that it’s an inevitable consequence of ageing or parenthood, but that’s not true.” Elaine challenges this assumption.

The aim of “Gusset Grippers” is to break down the taboos which surround incontinence and sexual dysfunctions to encourage people to ask for help.

The show is free and is evidence based and entertaining – “the audience leaves the show knowing what a pelvic floor is, what it does, why having a good one is smashing, and where to take theirs if it

The show counts as Continuing Professional Development for Healthcare Professionals, GPs, midwives, nurses, physiotherapists, urologists, gynaecologists, speech therapists, health visitors and fitness professionals.

Packs with references, reflective questions and a CPD certificate are provided.

This event is free. Please see the show flyer for more information.