Doing something unpredictable in the year to come: a reflection.

One of the best-known New Year poems is ‘The Year’ written by the American poet Ella Wheeler. She wrote:

“What can be said in New Year rhymes,

That’s not been said a thousand times?

The new years come, the old years go,

We know we dream, we dream we know.

We rise up laughing with the light,

We lie down weeping with the night.

We hug the world until it stings,

We curse it then and sigh for wings.

We live, we love, we woo, we wed,

We wreathe our brides, we sheet our dead.

We laugh, we weep, we hope, we fear,

And that’s the burden of the year.”

Wilcox’s rhyming couplets have a real ring of truthfulness about them in their description both of the year that is passing tonight and the one that is dawning tomorrow. There is a natural predictability of patterned time on this day. As we gather with friends or family, or sit on our own, no doubt some of us will have much that we will gladly say goodbye to and have much to desire to pull us into tomorrow; there will be those not with us whose absence will ache and those we will meet in the days to come whose presence we will yearn. The ‘burden of the year’ is the constancy of continued humanity for good and ill for there is in truth nothing new under the sun.

However, the sense of the immovability of the things that challenge us, a sense that there is nothing we can do, that the barriers to progress and the obstacles to change are insurmountable is one that I have heard mentioned and felt with increasing vigour in the last weeks and months. These last few days have been no exception with the media full of stories of the very nightmarish challenges facing our health and social care systems across Scotland not least of which have been heartfelt pleas from frontline A&E staff on social media. It has never been this bad is the common litany of despair. It is important that we name these challenges for what they are and do not seek to delude ourselves or mask the reality of what is being felt and experienced. Owning the truth and avoiding the lie is the first step to positive movement. Although I am not always convinced we have done so with real authentic honesty in the last few months when we have talked about the real critical and life-damaging challenges facing social care in Scotland nevertheless I remain convinced of the necessity of such articulation as a first step to moving forward.

I have long rehearsed an argument in these blogs which is that you cannot seek to address the health and wellbeing of our nation without accepting the inextricable connection and inter-relationship between the NHS and wider social care systems. That attending to the major faults of one without an equal focus on the ruptures within the other only serves to design even more instability and weakness into the whole. The analogy I have often used is that if you repair or replace a broken part in a machine without looking at the rest of the machine then you make the whole less efficient and less workable and actually more than that you make a breakdown or fault in the part you have not repaired much more likely to occur. Whole system solution is the only effort that prevents whole system dissolution and breakdown.

Another constant and I suspect tedious observation of mine is that you must also recognise the uniqueness, the distinctiveness, the particularity of each part of a whole system in order to understand the ‘machine.’  Treating social care services as primarily an aid to the health system is to wholly fail to understand the unique and distinctive value and role of social care. Care homes and homecare services are there and in existence to enable people to achieve the fulness of a possible life and to live to the dignity of a life of potential. They are not there as the help maiden, the rescuer for a health system with delays in discharging people from hospital or which has run out of beds to accommodate those who could more healthily be supported in their own home or a homely setting. Reactive rescue is always an emergency response to a system that is failing, preventative collaborative innovation is always the solution for long term challenge and change.

Having made those two observations like others I am alarmed at the current state of health and social care, but I suspect my analysis would not be the same as that of others and my prognosis would be distinct.  Primarily I have always stated that the solution to our NHS set of crises is not going to be achieved within that system alone but from an increased collaborative working with the social care system and its providers.  There are too many people engaged in a revolving door of continued admission and discharge into our NHS acute settings; too many individuals capable of being supported both clinically and in terms of social care in their own homes for so much longer; there are too many folks not benefitting from the potential of technology in their own homes which acts as preventative support and enhances personal independence; there are too many frontline staff moving around like pawns between different providers in a system of inequity and unequalness which does not benefit the individual worker in the long term and certainly does not benefit the system as a whole; there is indeed increased financial resource but much of it is in the wrong place, targeting the wrong priorities and all too often wasted.

2023 must be a year of building on collaborative efforts to work together and to move beyond siloed solutions for whole system problems. You cannot address the workforce challenges in social care by continually improving the terms and conditions of healthcare staff and ignoring the in-work poverty of home carers for instance; you cannot meet the rising demands within ‘paid’ social care without addressing the crisis of exhaustion and lack of resource in informal care; you cannot create a sustainable care home sector by continuing the disparity between those who the State chooses to pay for and those it does not; you cannot continue to address the major healthcare need which is dementia by not creating equivalence with other long-term conditions; you cannot continue to justify unequal treatment between in-house local authority provision of care at home and the hypocrisy of contracting third and independent providers at lower rates, poorer terms and worse conditions. We have all of us across all sectors in the NHS and social care and beyond, to do the unpredictable and start working seriously with one another because we know the truth that where it has been happening in 2022 there has been real benefit to patient and resident, the fostering of real trust, reciprocity, innovation and creativity.

The challenge at any time but especially as we enter a New Year is that we blindly and uncritically accept the constancy of a predictable patterning of the future, or we seek to do something different – to contradict the rhythm of the same with a new direction and by the disturbance of disruptive innovation and practice. That surely has to be the year of 2023.

We need not to dwell on the actions and aspirations which lie crumpled up in used papers of regret in the year gone by – rather as we pin the calendar to the wall and turn a picture to January we need to find purpose to be the promise agents of all we want to achieve which has yet still to be fulfilled. We are the ones who change our morrow because there needs to be an urgency and an impatience of hoping and a demand for ever stronger loving and commitment to others.

The winter clouds are starting to move apart, the challenge for all of us in the worlds of health and social care is to help in their dispersion and to replace a scene of challenge with one of promise and potential. I truly believe it can be achieved– together.

Poem for a New Year

By Matt Goodfellow

Something’s moving in,

I hear the weather in the wind,

sense the tension of a sheep-field

and the pilgrimage of fins.

Something’s not the same,

I taste the sap and feel the grain,

hear the rolling of the rowan

ringing, singing in a change.

Something’s set to start,

there’s meadow-music in the dark

and the clouds that shroud the mountain

slowly, softly start to part.

From A Poem For Every Day Of The Year

Happy New Year.

Donald Macaskill