Let care flourish… reflections on primary and social care

I read probably more than my fair share of reports and official research and if truth be told I often struggle to get beyond the Executive Summary for most of them and probably hold very few in my memory. There are exceptions and one was ‘Let Glasgow Flourish’ a report in 2006 describing the health inequalities of the city of Glasgow and what was needed to address these. Written by Prof Phil Hanlon and colleagues it was an articulate, impassioned, reasoned and convincing argument of what needed to be done to address that city’s health and social care woes. Sadly, a lot of what was called for is still resonating as an echo.

As a former citizen of Glasgow, I have always treasured the motto of the city ‘Let Glasgow flourish ….’ The idea of flourishing resonates with the sense of springing into life, of growth and renewal, of resurgence and success. Its organic positivity is at the heart of all human health and care. Clinical and social care have a shared desire to see the individual grow and develop, become whole and achieve potential; in other words, to flourish to the fullness of their humanity. Something of this is captured by the idea of thriving which I know is now much beloved by public health thinkers. But there is something about flourishing that appeals to this west coaster!

The concept of flourishing may seem a strange one to reflect upon as we are struggling to still deal with a pandemic which has destroyed so much in its wake, and has brought havoc and despair, loss and death to tens of thousands. But I think it is important in the days, weeks and months ahead to start reflecting on what it is that will help individuals, communities and organisations start to flourish again.

This week we received the thankful news that slowly and safety we will see the start of care homes enabling family members to visit their relatives. The abnormal exclusion of contact and presence is coming to an end boundaried by the need to protect and keep safe. But alongside this is the urgent requirement to support residents and staff to start to flourish again. Work is ongoing and has a new urgency to address the very real deterioration and decline that has occurred as a result of measures designed to protect, through self-isolation and social distancing during lockdown. This will not be easy either on a personal level or for organisations, but we must give as much energy to coming out of lockdown as we have to protecting it. The role of our Allied Health professionals, physiotherapists, podiatrists, nutritionists, speech and language therapists, optometrists and so many more will be critical and central as we seek to let care and people flourish again. I have often heard folks say that people got a new lease of life when they went into a care home and were cared for, met others and felt as if they belonged. We all have a lot of work to do to restore that sense of joy at the heart of our care homes and to let them flourish once again.

But care also needs to flourish by restoring the well-being of nursing and care staff who are understandably spent and exhausted by the struggles and demands of the days and weeks which have passed. Without the traditional routes for relaxation and renewal offered by a flight to the sun, we will need all of us to support staff and frontline nurses and carers to be able to deal with the emotional and physical challenges of the last months.

On a wider front we have a real opportunity to let care flourish. Yesterday I took part in a webinar with hundreds of primary care colleagues which was both a reflection of the lessons learned during the pandemic and the real positive work that has been underway. I have written elsewhere that over time we have fragmented the critical interface of how primary care and social care relates. If there is one thing we need to do better after Covid it is to ensure that we get this right. Part of that is the painful acceptance that we did not get it right all the time, in every place and in every way,  at the start of the pandemic to the extent to which social care staff have voiced a sense of abandonment. There is little point dwelling on this – but we have to learn from it and need to move forward to recognise that where we got it right it was of immense benefit to resident and professional alike. The tremendous examples of GPs, palliative and end of life practitioners, pharmacy colleagues, community nurses working alongside social care nurses and social care staff should be the ultimate memory that changes things in the future.

I believe we need to develop a real partnership of mutual respect, professional understanding and reciprocal awareness that wraps primary and secondary care around our care homes and our homecare services. In some parts of Scotland, the pandemic has helped us to walk in each other’s shoes for the first time and has helped to create real mutuality and respect. We need to build on this systemically, strategically and with sensitivity. These conversations and pieces of mutual work will be essential to enable care to flourish.

To flourish is to have a sense of positive renewal. Now is the time not just to open the gardens of care homes to visitors but for the community to take care homes into their centre; for us to create a system where all citizens, regardless of need or location, of residence or age, of disease or condition, receive equal treatment and care which is built around the needs of the person, enhances the humanity of the individual, and enables them to flourish, and our society to become renewed. We will do that by binding secondary, primary and social care together not so tightly that the distinctiveness of each is diminished, but in a way that each has voice, contribution and creative ability to grow and change.

So, let care flourish.

Donald Macaskill