New Year Promises for social care: to break or to last?

Over the last few days I have had the chance to get out and walk a bit more. I am fortunate to be only a couple of minutes from a beach that goes on for miles and with the coming of much colder and frostier days it has been a quieter place. As I walked along the pristine, settled and perfect sand marked only by the currents of the cold sea I was reminded of Jackie Kay’s New Year poem, The Promise:

Remember, the time of year

when the future appears

like a blank sheet of paper

a clean calendar, a new chance.

On thick white snow

You vow fresh footprints

then watch them go

with the wind’s hearty gust.

Fill your glass. Here’s tae us. Promises

made to be broken, made to last.

At the start of 2021 after a year which has brought much trauma and heartache there is indeed a sense of a ‘clean calendar, a new chance.’ There are still inordinate challenges to face in terms of Coronavirus not least in terms of the roll-out of the vaccines and ensuring equity of treatment and response. But the opportunity for a new chance, has perhaps never been more the case than it is for social care services and supports in Scotland. We have the findings of the Independent Review of Adult Social Care due later this month, combined doubtless with significant debate as the political parties gather their policies together to present to the Scottish electorate in May. There will be a lot of talk and chatter about care. So, after decades of political obfuscation and silence, the time has finally come for social care to become a central actor rather than a small walk-on-part on the political stage. This will be a critical year for the future of social care in Scotland. I hope it will be a year where we do not miss the opportunity of making a real difference and where we can also avoid the pitfalls of party-political wrangling where ambition is placed ahead of reality and truthfulness. I hope it will be a year of promises made to be kept not to be broken.

Yesterday Scottish Care launched a further contribution to that debate. It is an encouragement to folks to make it a ‘new year resolution’ to shape the positive future of social care. Back in November 2020, Scottish Care developed the concept of a ‘Social Care Garden’ through its Collective Care Futures programme as a way to imagine and share our vision for the future of social care in Scotland. This was included as part of the ‘What If & Why Not’ submission to the Independent Review of Adult Social Care.

Scottish Care is now taking this a step further by inviting people to be part of this collaborative vision for the future to capture our collective aspirations. To do this they are curating a ‘Social Care Mosaic’ for the Care Futures Garden.

Through the ‘Social Care Mosaic’ they aim to capture the imaginations of the people of Scotland to better understand the values of social care and generate collective action to support the wishes and dreams people have for this context for the future. You can share your ‘tile’ for the mosaic by sending a virtual postcard to  https://scottishcare.org/social-care-mosaic/

So, what would I put on my tile? What are my hopes and aspirations for social care in 2021? What are the promises I want to see lived out?

A promise to people. Social care is first and foremost about people. It is not a series of transactions and tasks; it is not about services and supplies. It is not about ‘doing to’ but working alongside. It is not telling and instructing but listening and adapting. It is not about creating a service and expecting the person to fit into the shape of what you offer and allocate, but changing the system and the services to be shaped around the needs and wants of the individual. This is a huge challenge – this is not person-centred care but person-led care. It is a disempowering of the centre in order to empower and enable the individual to flourish.

A promise to communities. Social care at its best is about creating conditions where communities of people can flourish through the individual contribution and insights of the individual. It is all about relationship – keeping people connected, independent and autonomous whilst reducing loneliness, isolation and despair. It is an authentic working through of problems rather than an illusory attempt to solve marginal concerns. That is why commissioning 15-minute visits for someone which deny them the ability to relate, to talk, to be and which instead treat them as functional units to be attended to, are so abhorrent to me. Relationship can never be achieved by a timepiece it can only be fostered by the freedom of respect and dignity.

A promise to listen. We have as a society become too accustomed to the voice of ‘informed’ commentators who have not walked in the shoes of those who live their lives receiving support and care, those who work at the care face and those who manage and support. I hope that whatever is designed in 2021 originates from, is resonant with, is consistent to the lived experience of those who are most important, the people who are impacted by social care and the systems politicians, commissioners and organisations create. And let us be careful that we do not just listen to those whose voice is loudest and most articulate, it behoves us to search out those whose silence and diffidence resonates with truth, who are not often included in what we have come to create as an industry of consultation and engagement.

A promise to enable choice. Individual choice and control are at the heart of a human rights-based approach to social care. If you remove them, if you limit diversity, if you create a one-sized fits all, take it or leave it approach, then you reduce the capacity of an individual to take control of their life and to be truly independent. Those who want to keep control and power never want to devolve  choice to individuals. they offer instead the mirage of choice which is limited and safe. real choice is a radical ownership of control by the individual. That is why care is a collaborative activity which upends the expectations of those outside by taking heed of the desires, ambitions, and dreams of those who matter most – the person requiring support and care. That is why the individual has to be the navigator of their own journey, the controller of decisions about their own life. Choice is not the enemy of individual rights, but uniformity just might be.

A promise to resource. Of course, during any election period, perhaps especially one after the trauma of a pandemic, the air will be full of aspiration and promise. But if they are promises and commitments made without costing, without a grip on fiscal reality; if they are sold without a price-tag attached then they are empty, vacuous, dangerous and frankly insulting. We cannot continue as a society to buy care on the cheap and cast blame away from those who originate contracts and allocate budgets. We cannot continue to allow the inequity which sees some have to sell their inheritance to care for their family, and others largely unaffected simply because of the lottery of diagnosis. If we are to truly keep the promise to social care in 2021 then we need a grown-up debate about how we are all collectively going to pay for that care. To do other is to take us all for fools.

A promise to value. Will we get to the stage where the value of those who receive care and support is acknowledged; their contribution as citizens fully enabled , and their role as intrinsic to community recognised? We have still too much passive aggressive dismissal of the central and critical role of those who use support to enable contribution. Will we finally not just ‘clap for carers’ but create systems of properly commissioned contracts which reward workers and value them properly, with terms and conditions that are equal regardless of who the employer is. Will we end the shameful hypocrisy of one part of the system lauding itself for being fair in employment and practice yet purchasing care from others in a way that prevent equality and fair work. Care needs to be elevated from an after-thought to become a mirror of our society at its best.

A promise to be ambitious. Ambition here is not about model or structure, about ownership or system. Ambition is about humanity. Will we seek to create a social care system where the citizen has control and autonomy, where power rests with the individual rather than the State, where the ingenuity of inventiveness is encouraged just as much as the predictability of the routine? Will we create a system where the pathway from home to hospital to home or care home is led by the needs of the individual rather than the professional; will ‘professionals be on tap or on top’? Will we create models where the person most affected is the evaluator of quality and where improvement is an exercise of mutual creativity and reciprocal trust? Will we be pulled and stretched by the creativity of our collective ambition or limited by the constraints of the predictable and familiar?

Lots of promises, lots of hopes and all of them rest on our working together not apart, seeking the interests of the many not the few.

 I finish with the words of someone who to my mind is one of America’s greatest living poets, the environmentalist W.S.Merwin. It is a poem on the importance of keeping hope alive, and I really do trust that the promises for social care keep being fulfilled in 2021. I yearn for a year where  the promise of social care to transform our common humanity grows into fulfilment, rather than have that promise lie shattered in the fragments of our hoping:

To the New Year

With what stillness at last

you appear in the valley

your first sunlight reaching down

to touch the tips of a few

high leaves that do not stir

as though they had not noticed

and did not know you at all

then the voice of a dove calls

from far away in itself

to the hush of the morning

 

so this is the sound of you

here and now whether or not

anyone hears it this is

where we have come with our age

our knowledge such as it is

and our hopes such as they are

invisible before us

untouched and still possible

 

W.S. Merwin, “To the New Year” from Present Company (Port Townsend, Washington: Copper Canyon Press, 2005). Copyright © 2005 by W. S. Merwin.

 

 

Donald Macaskill