It was encouraging to read over the weekend research which had been undertaken by Ipsos Mori. It was the latest ‘Ipsos Mori Issues Index – 2018 in review’, which gives a “snapshot” of the top ten major concerns across individual parts of the country. Brexit and its implications was not surprisingly revealed as the most important issue facing Britain, topping the list. However, what it also showed was that Scots worried about the ageing population and social care much more compared to concerns over immigration and crime than the rest of Britain. 16 per cent of people were concerned about social care compared with 11 per cent for the rest of the country. This is at least encouraging considering that ‘Scotland’s population is ageing at a faster rate compared with the rest of the UK, while the population is growing at a slower rate and fertility, life expectancy at birth and net in-migration are all lower.’ When I read the report I was encouraged by the prominence not least because the social care sector as well as facing huge demands in terms of capacity is eagerly awaiting a Scottish Budget that prioritises it rather than provides leftover crumbs from other fiscal concerns. But when people talk about social care what do they really mean? Indeed I am reminded of a senior public official who recently confessed that it isn’t at all clear what social care is and what it’s distinctive role is. There are many definitions, both legal and aspirational, as to what social care is and what it is not. For instance social care whilst it may contain services which are clinical or medical in nature is not primarily about one’s physiological health. For me the role of social care is:

‘The enabling of those who require support or care to achieve their full citizenship. The fostering of contribution, the achievement of potential and the nurturing of belonging.’

That may all sound a bit nebulous but in essence social care is about enabling the fullness of life for every citizen who needs support whether on the grounds of age, disability, infirmity or health. Social care is holistic in that it seeks to support the whole person and it is about attending to the individual’s wellbeing. It is about removing the barriers that limit and hold back and fostering conditions so that individuality can grow and an individual can flourish. Social care is not about performing certain functions and tasks alone for it is primarily about relationship; the being with another that fosters individual growth, restoration and personal discovery. It is about enabling independence and reducing control, encouraging self-assurance and removing restriction, maximising choice and building community. Therefore as many of us have sought to illustrate over the last few years, social care is profoundly about human rights. It is about giving the citizen control and choice, voice and agency, decision and empowerment. All of the above is why social care is critical to Scotland’s future. That is why we need a social care workforce which is valued, well-rewarded and appropriately resourced. That is why we need to undertake necessary reforms and critically that is why we need to properly resource a sector that is a major contributor to Scotland’s economic and national progress. Social care is not the handmaiden of the NHS- there as an adjunct department to clinician care and medical intervention . This why we cannot treat the two as if they were the same. Whilst inextricably linked the healthcare we deliver is vastly different from the social care we should rightly demand. One of the fundamental areas of difference has to do with choice. If I have a medical emergency then personally I want the best clinical care and don’t really want to have much say in who delivers that care as long as they are trained, suitably qualified and supervised. A short term stay in a hospital is very different from the place and people with whom I spend my life. For if I am living with a lifelong condition or need support in any way because of life circumstances or age then I most certainly do want to have more choice and control both over who is in my life as a carer and what the nature of that support and care might be. The critical importance of legislation like Self-directed Support is all about embedding that control and choice, building those rights with the citizen. We are absolutely right to value social care as intrinsic to the fabric of our society and as a marker of the maturity of our commitment to support and uphold one another in community. In the weeks ahead social care will continue to face fiscal and workforce challenge but in those times it will remain critically important that we defend the intrinsic role and distinctiveness of social care rather than acquiesce in attempts to limit choice, control outcomes and thereby restrict individual rights. It is to be celebrated that Scots care about social care and the ageing population and it is incumbent upon all of us to ensure that social care is advanced and protected in the years ahead. Donald Macaskill @DrDMacaskill

The start of a year is always an opportunity to look forward, to resolve to do things differently, to relate in a different way and to change direction. It is therefore a risky time. The desire for the new can risk sweeping away the best of the old; the energy to innovate can risk draining sense from what is commonplace; the urgency for change can risk the loss of the safe and familiar. The necessity of action can risk the way we relate to others. The first few days of 2019 have filled me personally with a growing sense of dismay and on occasion real concern about the cohesiveness of society. There seems to me to be a growing sense of dis-ease and a lack of compassion and care in politics, in many of our communities and in the wider media. This personal unease was articulated by the Queen in her Christmas Message when she said: “Even with the most deeply held differences, treating the other person with respect and as a fellow human being is always a good first step towards greater understanding.” These words were immediately seized upon and considered to be a veiled reference to Brexit. Be that as it may I would suggest they have a wider resonance at the start of this year. Compassion is central to all good and meaningful social care. Indeed compassion is one of the five principles which underpin our Health and Care Standards in Scotland. Sadly what seems to be lacking in recent days is a sense of compassion beyond the context of social care and health. Admittedly compassion can be a bit of a nebulous word but it has some essential elements. Compassion conveys a sense of sympathy, fellow feeling, empathy, understanding, and tolerance. It is not surprising therefore that the concept of compassion is central to good care. We recognise that the best of care in care homes and of care in an individual’s own home requires staff who are empathic, sensitive and able to relate and get alongside others – even when personal feelings may make that relationship challenging. Care involves developing the art of being professionally compassionate. The scenes of angry crowds shouting down politicians outside Westminster in recent days, the vitriol and violence expressed on social media and the horror of several murders in open and public spaces in the last two weeks seem to paint a picture of a society which has lost the capacity to be compassionate. Now I immediately accept that this analysis on its own is too simplistic not least because the tens of thousands of staff in care homes, homecare and in doing jobs in the NHS and elsewhere are daily illustrations of compassion in action. But… I suspect we need to recognise that civil society and cohesive communities do not just happen but that they need to be striven for and built. I suspect that the ability to dialogue with difference and to discover reconciliation and compromise is something that has to be developed and worked at. I suspect that the resolution of the massive political and economic challenges we face in the next weeks and months can only be achieved by shared collective resolve and mutual respect. Compassion needs to become the energy not just of professional carers but all who would seek to lead us politically and economically. If we are to move forward on so many issues whether Brexit or a Scottish Budget, whether reform of social care or education, then I suspect we need to rediscover the spirit and power of compassion in civic and political discourse. I believe it is perfectly possible to hold strongly held political and philosophical beliefs without that requiring the disminishing and devaluing of the views and values of others. I believe that it is absolutely right that anger and passion can be utilised in a way which is righteous and convincing. However when anger becomes dismissive and denigrating of the other then it is destructive and dangerous. The philosopher Arthur Schopenhauer wrote ‘Compassion is the basis of morality.’ It is such a political morality we need to urgently discover. The year that lies in front of us will bring undoubted challenge and in the world of social care as elsewhere the necessity to make hard and sometimes painful decisions – I very much hope that it will also bring a discovery of the power of compassion. Dr D Macaskill @DrDMacaskill