This has been an unprecedented and horrendous year. This very latest chapter in the story of care has for many turned out to be the hardest as new strains of the virus stole our chances of remobilisation.

Yet, when I think of those who work in social care, 84% of whom are women, the feminist phrase ‘nevertheless she persisted’ comes to mind. March 8th is international women’s day. This year’s theme is #ChooseToChallenge making it a good time to consciously recognise and raise the role that gender politics have played in the long-term under recognition of social care and the pernicious effect of paternalistic structures and systems on all those who provide, work in, and access care and support. Pandemic response has been a microcosm of that experience, leading to scrutiny, division and blame at a time when what is needed is respect, collaboration, and support.

The voice and expertise of skilled social care professionals, when listened to, offers routes to manage the pandemic in situ. We have seen this in the embedding of the most recent guidance, finally co-produced with sector experts.

In the Engender report ‘Sex and Power in Scotland 2020’ we read that only 2 out of every 50 people who head up the top Scottish Companies are women. This is quite a comparison to the 2 out of every 3 who hold CEO and Director level posts in social care. There are two ways that we must look at this. First, we must celebrate a sector which has championed and supported so many women into leadership roles. This is not purely down to statistics, but because of a sector which very often applies its expertise in person-centred and person-led care and support to workforce development. There is much that other sectors could learn from this approach.

Secondly, we must note the vast difference in the number of men in senior rather than frontline roles. Diversity is a greatness, and this highlights the need to welcome more men to frontline social care. But also, not to rest on our laurels, 2 out of 3 is impressive, but not representative of the 84% in frontline roles. There is still more to be done about that proverbial glass ceiling.

I recently heard Dame Stefanie Shirley speak and she said that ‘you can tell ambitious women by the shape of their head – it is flat by being patted patronisingly’. Now my first reaction was to laugh out loud, but this was quickly followed by a sharp intake of breath as its accuracy hit home.

So many assumptions are made by those outside of the sector about what social care is and does. We have no better spotlight than now to showcase our expertise, skills, and professionalism. I ask my fellow flat headers and those that they work with, to #choosetochallenge by sharing a story about what you do in social care. We have an opportunity to change perception, it is our responsibility to take it.

Thanks to the SSSC for providing social care workforce data.

 

Karen Hedge

National Director

@hegeit

I was walking along thinking about what I would say in this blog, aware of the fact that it is National Intergenerational Week from the 8^th-14^th March, when my 6-year-old companion opined – apropos of nothing – “Ladybirds are different from caterpillars. They don’t look like, but they are the same; they are family; I like them both.” Now I suspect that this observation has arisen from an over-abundance of David Attenborough and Adam Kay’s Anatomy –(which if you have not read you should! ) – but it is so apposite.

Intergenerational Week is this year an online campaign backed by many organisations and is all about celebrating the times when people of all ages come together, make friends and work, learn, relax and change one another. In the year that has passed we have so missed those moments of connection and togetherness as lockdowns have separated old from young, generation from generation, and the absence has ached and hurt. Perhaps those who have missed the connection between different ages the most have been residents in care homes and even though in Scotland indoor visits are now starting again we all long for the day when children can see grandparents and great-grandparents.

The organisers of Intergenerational Week also point to a pre-pandemic reality which I know for countless folks rings true and that is that for many of us being connected across the generations has changed over the years. We are a long way off from the times when most families lived together across the generations, or at least in close proximity. Many of us live our lives a distance of time and travel away from our older generation not least because so many are having family later in life. Busyness, older parenthood, changing leisure patterns as well as mobility have all affected family generational connections.

Last week I wrote about the impact of loneliness and isolation during lockdown on the mental health of all people, but perhaps especially the old and the young. The pandemic has taught us a painful lesson about the risks of loneliness and isolation, and the importance of connections which previously we might have taken for granted. The pandemic has also in a positive sense shown us the ability of human individuals to reach out, to cross divides, to make the effort to get to know, to be concerned for, and to connect with those who are different from us regardless of age or circumstance.

Moving forward we need to work hard at not just restoring the inter-generational connections and opportunities we used to have before the pandemic, but we also need to put effort into making sure that we can create new opportunities for the age divide to be removed and shattered.

We need to, I believe, do much more at creating spaces and places where the generations can work and relax, live and simply be together. There is a real risk that we create divides in the name of infection prevention that limits our capacity to be close to others and to form new and meaningful relationships across the generations. One of the worst legacies of our pandemic response – though I know a health necessity- has been the idea of social distance. To be social you can never be distant, you have always to be close and proximate, alongside to touch and be changed by interaction.

But the pandemic has also shown us the risks of creating false divides across the generations. There have at times not least in media and popular dialogue, been the risk of creeping age discrimination. The prioritisation of the welfare of the young should never be seen as an opposite to caring for and the focus upon those who are older. Community cannot be created by binary choices or by accentuating the value of one group against another. Community is always nurtured when all peoples regardless of status or role, culture or origin, and critically regardless of age are included, valued and heard.

We can do many more things to work at promoting and advancing inter-generational activity and opportunity. We can resist the temptation to create older age into ghettos- in villages separate from the living of youth; we can create care facilities for those who require support in the heart of our communities and cities. We can resource better models such as student and older age co-operative living, which enable the generations to live, move and have their being in connection one with the other.

A couple of weeks ago I was in a meeting where representatives of Young Scot shared their issues in relation to technology, including the challenges of digital poverty and exclusion. On hearing these issues I was aware of just how similar the challenges they spoke of are for those of an older generation. In an era of increased dependence and reliance upon technology and digital, the risks of technological exclusion and digital poverty don’t discriminate on the basis of age alone. However the benefits of inclusion equally cross the age divide. The potential of those who are  young who possess the skills, confidence and familiarity with technology to share these with those who are older in order to enable technological and relational connection across the generations are immense.

The potential of inter-generational connection is immense; it is so often untapped and rarely prioritised, but in essence it is what creates truly inclusive communities, with or without technology.

The motto for the week ahead is Say No to the Age Gap – it is one grounded in the age-old insight that we are all of us so inter-connected that a focus that does not prioritise and attend to the needs of all, fails all. We need to learn to recognise beauty, flight and freedom in the caterpillar as much as we do in the ladybird. Age is but the outer skin of reality which hides the real person.

I love the insight of the continuous flow and connection between all ages and generations French poet Antoine de Saint-Exupery depicts in his poem Generation to Generation. His words also carry with them an injunction and encouragement to us all that it is our task and responsibility to be the both the teachers of tradition and those who learn from all ages:

In a house which becomes a home,
one hands down and another takes up
the heritage of mind and heart,
laughter and tears, musings and deeds.

Love, like a carefully loaded ship,
crosses the gulf between the generations.
Therefore, we do not neglect the ceremonies
of our passage: when we wed, when we die,
and when we are blessed with a child;
When we depart and when we return;
When we plant and when we harvest.

Let us bring up our children. It is not
the place of some official to hand to them
their heritage.
If others impart to our children our knowledge
and ideals, they will lose all of us that is
wordless and full of wonder.
Let us build memories in our children,
lest they drag out joyless lives,
lest they allow treasures to be lost because
they have not been given the keys.
We live, not by things, but by the meanings
of things. It is needful to transmit the passwords
from generation to generation.

Donald Macaskill

One of the saddest consequences of the Covid pandemic has been its impact, not least through lockdowns, on the mental health of tens of thousands of individuals. There is thankfully a wide and extensive acceptance of these impacts and a shared resolve across politics and society to do something about it.

I am also pleased that there is a growing recognition of the mental health impacts of the pandemic upon older people. This last week has seen an excellent article in the British Medical Journal on this very subject. But in a general sense, both societally and politically, the mental health distress and damage on older people has unfortunately been a lot less written and spoken about and yet it is, I would suggest, of equal criticality as the mental health impacts upon children, young people and those of middle age.

I was reflecting on these realities in preparing for a contribution this coming week at a roundtable organised by Voluntary Health Scotland and the Open University. The session is entitled Falling Off a Cliff at 65: serious mental health issues in later life. It is painfully clear in their work that the mental health of older people have been significantly impacted by the pandemic and lockdowns.

Undoubtedly, there has been in the last decade a growing awareness of the significance of dementia and delirium in the mental health of older Scots. The problem is, as those of us who work in older people’s care and support, know only too well, mental health and distress in older age goes way beyond these two conditions.

I wrote a blog on this subject some four years ago and sadly not a lot has changed. There has always been a risk that the focus on dementia has taken our eye off other mental health and life enduring challenges faced by older Scots. The absence of a distinct focus on older people’s mental health issues in the 2017 national strategy was particularly disappointing.

I remember speaking to someone who had lived with chronic depression most of their adult life and had received good supports until they got to 65 years of age. Then almost overnight, he told me, it felt like the system was abandoning him and the supports he had been used to changed and disappeared.

“It was like standing at a window and seeing everything and everyone who had helped you live your life, especially in the down times, walk down the street and wave goodbye. I felt really alone.”

That sense of abandonment is evident in the research undertaken by the VHS and the Open University and sadly it is the experience of too many once they have reached the age of 65 that it is like ‘falling off a cliff’ in terms of service provision. By March 2020 both organisations had gathered a level of evidence, but then paused their work due to Covid-19. You can read their initial report here. I am pleased it is starting again not least because the problems remain and have undoubtedly been exacerbated by the pandemic.

When I speak to frontline staff in the community and from what people tell me the pandemic has resulted in a worrying deterioration in the mental health of older Scots. Whilst there has been an understandable and appropriate focus upon the impact of lockdown on people in care homes, there has been less focus on the impact upon older people in the community.

People who might before have developed routines which enabled them to be connected to others and therefore to maintain their mental health have had those connections limited or severed. There has been an exponential growth in loneliness and isolation; self-help groups and therapies have stopped or become limited; and the reality of digital poverty for older people has meant on-line and virtual equivalents have not been an option for many.

Speaking to community nursing staff I hear stories of significant dehydration as people have neglected their nutrition and wellbeing, of increased confusion, loss of memory and motivation, increased frailty and depression. There is a growth in the number of people falling and losing weight. I have heard too many stories of older people separated from family contact, disconnected and downcast, alone and empty, isolated and too often ignored.

The mental health impact of Covid on older age is profound and shaming. This was already a population more likely to experience health inequalities, more likely to be socially isolated for longer periods of time and to suffer more profound impacts from the requirements to shield and protect.  All that we developed as tools for connection and protection have been used less by those of older age. This is a population much less likely- partly through frailty but also through fear, to exercise and self-motivate, to fight the black dog of the night through the light of activity and exercise. Depression has clearly increased to worrying levels and reports of self-harm at anecdotal level are deeply worrying.

Before Covid we needed to get much better at supporting people who have life enduring mental health challenges to transition from adult to older people services. This includes properly resourcing the older people care sector to train and equip staff to both recognise and to deal with mental health issues and challenges beyond dementia and delirium, and also to give greater priority to enable the development of new models of support which can cater for individual and particular mental health needs in older age. With age comes so many losses over which the individual has little control but around which it behoves society to provide support.

But much more than that we have to as a whole society take older people’s mental health seriously. We have to accept the crippling reality of hurt that is the daily grind of too many and has been for decades. Mental ill health is sadly not solely the experience of youth.

We need to get better at finding those who need to be found, naming the hurt and answering the plea. We need to remember deep inside that agony has no date by which it is spent, distress no destination at which it departs, depression no age by which it is managed. For too long we have swallowed the myth that age conquers the mind and its ravages, that with experience comes coping and with chronology challenges diminish. Mental illness has no use by date, it does not lessen as bone and muscle decline, it merely changes its whisper to shout louder in another tongue. What age seems to do is to increase absence and heartache for too many at just the time that some in society seem to consider that the expense and effort of support is best offered to others. Scotland has the opportunity to put the mental health of all our citizens first and foremost in our recovery from Covid, and a focus on older people’s mental health issues has to be central to that effort.

The model and actor Cara Delevingne beautifully captures the necessity that is the challenge to all of us – to be open to find, regardless of age, those who need accompaniment to journey through the landscape of the mind.

 Who am I? Who am I trying to be?

Not myself, anyone but myself.

Living in a fantasy to bury the reality,

Making myself the mystery,

A strong facade disguising the misery.

Empty, but beyond the point of emptiness,

Full to brim with fake confidence,

A guard that will never be broken,

Because I broke a long time ago.

I’m hurting but don’t tell anyone.

No one needs to know.

Don’t show or you’ve failed.

Always okay, always fine, always on show.

The show must go on.

It will never stop.

The show must not go on,

But I know it will.

I give up. I give up giving up.

I am lost.

I don’t need to be saved,

I need to be found.

Depression by Cara Delevingne

 

Donald Macaskill

I originally wrote this piece in November 2019, but for a variety of reasons, it was never published. There always seemed to be a greater emergency in social care which took precedent; supporting the social care workforce, promoting human rights, challenges of financial sustainability and of course now, a global pandemic.

However, I have decided to go ahead and publish today. Not just because this afternoon I am on a panel at the Health and Social Care Alliance, as they publish their report: ‘Sustainable Health and Social Care: Climate Change and COVID-19’ in which they call for £25 million to support a climate change innovation fund for social care, and the forthcoming hosting of COP26, but also because it is becoming increasingly obvious that the right time must be now.

Pandemic response has in many ways improved our environments, we have reduced our travel for instance and while this should be celebrated and even maintained, we must also consider the impact of increased use of chemicals and disposable equipment such as PPE. These items are of course essential but will have a long-term impact on our environment. Additional to that is the theory that with our natural resources now struggling to maintain balance, we will experience an increasing number of pandemics. Horrific to conceptualise proving to me that the time is indeed now so here is that piece from 2019, perhaps even more relevant today than ever:

In the last few weeks, the plastic cotton bud ban came into force in Scotland.

Over the last 25 years, the Marine Conservation Society has collected 150,000 plastic cotton buds from beaches in Scotland. This legislation follows the microbeads ban in 2018, with further climate environmental related legislation expected in 2021. Scotland’s Government initiative ‘Action Against Plastics’ is in line with the EU Single-use Plastics Directive, in an attempt to reduce the use of single-use plastics and the impact they are having on the planet.

The climate change issue is no more pertinent to me than on seeing the findings from a childhood friend and climate change expert who has recently returned from an expedition to East Greenland where she documented some of the irreversible changes resulting from climate change. Melting glaciers which can never be replaced, whole ecosystems disrupted. It’s funny how more real things seem when they happen to someone you know.

Originating from a perspective of infection control, single-use plastics are everywhere in social care, from cotton buds to protective equipment, to packaging for our medicines and food. There is a real opportunity for the care sector to play a role in leading the way to reduce waste, but also to find other ways to uphold safe high-quality care, in a more environmentally sound way by changing practice, and exploring new materials. The mantra of ‘Reduce. Reuse. Recycle’ has much to offer in this space and some care staff have been involved in adopting and embedding such a culture in their organisations. Via the Scottish Care Strategic Nursing Group, we will also ask the ‘Infection Control’ team at NES for suggestions and resources that they may be able to share.

However, single-use plastics are not the only contributors to the increasing climate change crisis. Health Care Without Harm estimates that measuring the greenhouse gas emissions solely related to heating and cooling the worlds healthcare providers (using the WHO definition so including social care) would make it the fifth-largest contributor in the world. Their report ‘Towards Sustainable Healthcare’ outlines 5 areas where change can be made for the sector as a whole. It covers energy, procurement practices, chemicals, pharma and food, all of which have implications and opportunity for social care. Whilst we can choose how and where we draw our energy, the chemicals we use and the food we buy, but overall, the biggest implication is currently outwith our control. Where external agencies have authority in terms of commissioning and procurement practice, it more often favours cost over quality and sustainability in all definitions.

Across the UK and beyond, organisations have been making eco-conscious changes, but this can often be more achievable at scale. Given that most care providers in Scotland are SMEs, despite desire this can seem a more daunting task.

For care homes and housing support, there are many options that providers have been implementing for over a decade – better insulation, water and lighting efficiencies such as eco taps and aerators, and LED lighting installed where they meet the expectations of creating a homely environment. Last week I met an architect with whom I discussed ‘smarter design’. They have particular expertise in optimising natural light in care homes thus reducing electricity use, but they also described to me the effect this can have on regulating body functions such as your heartbeat and even when you urinate. Design affects the widest definitions of the environment. Structural change is of course more difficult if you have an older property, as to retrofit can present challenge and cost. However, as some of these changes are cost saving in the longer-term, they may also be financially worthy of investment. Whilst access to such resource can be compromised because of the prolonged underfunding of the sector, it is clear that issues of environmental sustainability are just as important for our Commissioning Authorities as for providers and staff.

Whilst some of this also applies to homecare offices, the opportunities for care at home providers lie more in clinical consumables and PPE, and in travel. Smarter route planning can reduce emissions, as well as reducing travel time for employees and reduced vehicle costs.

Indeed, digital and technological developments such as care planning tools may be a significant answer to a range of challenges as they have the opportunity not only to reduce paper waste but also to develop into citizen-owned and controlled systems, making data sharing and data analysis much simpler to experience and access. Projects such as medicines waste reduction which can be enhanced by using digital systems such as E-MAR not only reduce waste, but significantly reduce costs, not to mention the impact of reducing the transport required to issue and deliver scripts.

Scottish Care’s Executive Committee recently revisited the communique written at the Five Nations Care Forum over a year ago, on the role of a sector already renowned for its impact on humanity in extending its activity to include sustainability. We discussed the actions of some providers towards achieving this and would like to hear from you on what you have been doing to support the sharing of good ideas across Scotland. Whilst a culture of environmental audits can help organisations to regularly review their practise, access to a resource full of ideas may offer suggestions to enable other providers to identify and act on areas for improvement. It is also a fantastic way not only to showcase your own work but to positively showcase the sector as a whole in actively addressing the challenge head-on.

I look forward to hearing from you.

Aware, Awaken, Action.

Karen Hedge

National Director

@hegeit