The Scottish Budget was passed by the Scottish Parliament yesterday evening. So that’s it over for another year. The chance of smaller political parties to get their pound of flesh from a minority administration has passed over the yard arm.

And what’s it done for social care in Scotland? Well pathetically little.

Admittedly we got our £66million, which is amongst other things supposed to cover the increase in the Scottish Living Wage, the effect of changes on sleepovers, Free Personal Care increases and the start of the Carers Act. Mind you last year we had £100 million allocated for the Scottish Living Wage which had then just gone up by 20p- but it’s amazing what £66million is going to stretch to given it’s a 30p increase this year! That’ll be one to watch!

But I don’t want to just dwell on the Budget because no doubt I’ll be back talking about the back of a fag packet economics of it all at a date in the not too distant future. What I want to talk about is that I’m scunnered and getting really quite angry at the whole charade.

I’m scunnered at what feels like standing in the middle of the public square with a begging bowl each year calling for extra funding for some of our most vulnerable watching out for a passing MSP who might hear the need for serious investment in care.

I’m scunnered at saying we need a dramatic serious investment – I called for a third of a billion in December and we got £66million and at the time I was made to feel as if I was dreaming of Utopia rather than the socially just and human-rights based country that I thought I was a citizen of.

I’m scunnered that there seems to be no real debate despite political rhetoric that admits that the sums are simply just not adding up – and that’s a lesson in the arithmetic of austerity that people who are today grabbing 15 mins of rushed care rather than being treated with respect and dignity have learnt only too well.

But I’m also angry…

I’m angry at the wasted opportunity of having a grown up non-partisan political debate about what is the real and not the affordable cost of rights-based dignified social care and not the system we have at the moment where eligibility makes social care the preserve of the few and not the requirement of those who need it.

I’m angry that a week after the Kings Fund published a major report offering a range of proposals for the funding of public social care in England, no political party north of the Wall seems prepared to look beyond the next ballot box to think seriously about how we are going to pay for care into the future, what system will fit us and how we are to create equity rather than accidental access.

I’m angry that we seem to spend so much of our time hiding behind data to show that what we are doing is making an apparent difference to the health and care experience of our fellow Scots, and that we engage in a self-congratulatory back-slapping of what’s going well. Let us hear the good news stories but let’s not pretend everything in the garden is blooming!

And I’m angry that despite the rhetoric of prevention and self-management we are still dominated by the sacred cow of the NHS against whom no critique should be offered and are thus failing to address the fact that we need to transfer resources from the privileged few in that system to the majority in communities who experience inadequate social care provision.

So yes, the Budget may be over for another year but for goodness sake let’s not be here next year arguing over scraps for a crumbling social care system where the word ‘crisis’ is already beginning to sound empty and hollow. Let’s start to work together to transform the woefully inadequate funding and priority given to social care. And that means we all of us have to take charge and control and start talking up the critical importance of social care.

Social care should not just be for an election debate or a budget negotiation – it should be the central characteristic of the society we wish Scotland to be.

 

Dr Donald Macaskill

@DrDMacaskill

 

Love is all around…

The 14th February has become synonymous with love and depending upon your perspective it is either a day for the purchase of over-priced red roses or a day of true romance.
It’s a little known fact that some of the relics of the famous St Valentine, whose day it is, lie in a church in the City of Love. Paris? Rome? Venice? I hear you suggest but No – Glasgow. St Valentine is (at least in part) resting in the unlikeliest of places – in the Church of the Blessed Duns Scotus – in the Gorbals, a part of the city once synonymous with gang violence and searing poverty.

Just like any relationship, expecting the unexpected and challenging stereotype are probably two useful characteristics for this St Valentine’s Day. In that light three stories struck me in the last week that have relevance and challenge for the care sector. They are each about relationship and value, about human contact and dignity.

The first was the news of the growing challenge of loneliness facing our population.

In a world which presupposes relationship as being intrinsic to well-being it was noticeable that last week saw the launch in Glasgow of research by the National Campaign to End Loneliness which found that of the 15,000 older people in the city, it is estimated that 10% can go days or weeks without having any contact with anyone. It is stated that loneliness and its impact can have such negative health determinants that it is the equivalent of smoking fifteen cigarettes a day.

With over 1.4 million in the United Kingdom reported as being lonely, the issue has not surprisingly become one of great significance with both a Scottish Government Strategy and a UK Minister with responsibility for loneliness to name but two political responses.

With around 7.7 million people living on their own, of whom around 2.2 million people are over 75, the issue of loneliness is likely to become of even greater prominence.

But I for one have become increasingly uneasy with some of the loneliness narrative. It is certainly important that as individuals and communities we should try to include, involve, engage and enable participation and contact. But we also have to be careful that we don’t develop some reverse morality when faced with such loneliness data.

Being on your own is not intrinsically negative and much of the recent debate has ignored the benefits of solitude. There is a world of difference between social isolation and forced loneliness over which you have no control and which you do not desire, and the reality for many which is a decision to be single and alone. Have we lost the capacity and ability to be alone? There has been an automatic presumption of the negativity of aloneness in much of the consideration of these issues. What we need rather is a serious debate about what loneliness is and what interventions are needed, which will be beneficial for both the individual citizen and society as large. I am not convinced our sometimes guilt-ridden knee-jerk reactions have developed such maturity.

The second insight from last week’s media came from a disturbing report from the Leonard Cheshire charity. This research is not unrelated to the issue of isolation and loneliness we have just considered. The research undertaken as a result of a Freedom of Information (FOI) request has shown that a third of Scottish councils commissioned 15 minute visits for the provision of personal care in 2016/17. This has meant that over 5,000 Scots were being subjected to the degrading practice of flying visits. At least 5,182 people received personal care visits of 15 minutes or less for support with intimate care, based on data from councils that responded to the FOI request.

Freedom of Information responses from councils in Scotland found that one in three – 31% – were commissioning 15 minute visits for the provision of personal care in 2016/17.

For many individuals receiving support at home, 15-minute personal care visits barely allow for tasks to be completed, let alone to develop a positive relationship between the individual and their carer.

Given that in January, the Scottish Government’s Minister for Social Security Jeanne Freeman launched a consultation and draft strategy on isolation and loneliness, highlighting the link between loneliness, poor physical and mental health, one might ask what benefit such short, task-oriented visits are making. They do little for effective mental well-being but then given the Mental Health Strategy hardly mentions older people its maybe not a surprise that there is a priority on loneliness but not on some of the causes of it.

Leonard Cheshire’s Director for Scotland, Stuart Robertson said:

“These damning figures show that many vulnerable people are being failed by the social care system… We have to urgently address this scandal and ensure people receive the person-centred care they deserve. No one should have to choose between going to the toilet or having a cup of tea, and this practice must come to an end.”

I couldn’t agree more with Stuart Robertson and Scottish Care has called over a long period of time for an end to the shame of short time and task oriented visits which leave no room for dialogue and dignity, never mind conversation and relationship. It is really sad that on a day we are celebrating love and relationship, for so many their only opportunity for exchange and interaction is reduced to a fragment of time.

The third media story I remember from last week was the report that the well-known and formerly respected broadcaster Jeremy Paxman, told an audience last week that he is in favour of removing the vote from anyone over the age of 65. This is somewhat ironic in the week we celebrated the 100th anniversary of woman’s suffrage.

Paxman’s easy dismissal of the contribution and role of the over 65s is indicative of the acceptable ageism that is all too prevalent today. Paxman states that the elderly have done very well out of life and that they are now using their voting power to ensure that they, rather than young people, are getting the best out of the state.

On St Valentine’s Day love has surely to be for more than a Hallmark day. A society where loneliness becomes a political policy priority, but not where the same political system is prepared to allocate resource to address the issue is less than it should be; a community where contact is reduced by the arithmetic of affordability does not in any sense value those who it should care for; and a place where older age is considered to be beyond contribution – such a society needs to rediscover the essence of a love and regard for others, which can’t just be for one day.

Donald Macaskill
@DrDMacaskill

2017 saw Angus Health and Social Care Partnership provide funding for care home staff to attend a series of learning and development days. Staff were able to hear speakers on a variety of subjects including – UTI Prevention; Well Being in Dementia Care; Adult Protection; Maintenance of Hearing Aids and Management of Chronic Pain. Events were held locally and care homes sent staff within their own locality. Having secured funded places I felt sure that this would be of interest to all care homes in Angus and the majority of care homes took up this offer. Sessions involved presentations from a range of services. Interestingly, those people who previously had had little contact with care homes would remark on the enthusiasm and knowledge of care home staff.

After the sessions, homes developed action plans for change and then reported back to session presenters as to how they had got on. Many of the homes came up with well thought out plans but for me one home stood out.

The staff of a small home in Carnoustie rose to the challenge and the range of actions was inspiring – from developing posters for families on over use of antibiotics to starting up a “relax shack” for supporting people with chronic pain. Time and again they would come to follow up sessions with their new ideas and brimming with enthusiasm for further knowledge which they would then use to improve the lives of the people in their care.

I would like to say well done to the team at Braehill Lodge in Carnoustie – at a time of worry and concern over funding and the future of care homes they have taken advantage of opportunities offered.

For 2018 we are going to continue our development days but in a different format making full use of new technology in an effort to make the sessions more accessible across Angus. I suppose the message here is to take the opportunity and try to use it for improving the lives of people living in care.

 

Ivan Cornford,

Local Integration Lead, Angus