Scottish Care Statement Stands Against Racism and Supports Affected Communities

In light of recent abhorrent violence in parts of the UK, Scottish Care stands united against all forms of racism, hate and xenophobia and condemns these actions in the strongest possible terms. We express our solidarity with all communities affected, including those working in or accessing care who have been impacted.

In terms of Black, Asian, and Minority Ethnic (BAME) social care staff in Scotland, your dedication, compassion and professionalism in providing care and support to some of the most vulnerable members of our society do not go unnoticed, especially during such challenging times.

We celebrate your role in the social care sector and invaluable contribution to Scotland. It is the responsibility of all of us to stand with you, to listen, and to act in ways that promote equity, inclusion, and respect for all.

For people in the Scottish social care sector whose support or work has been affected by this unrest, please reach out to your care organisation, Health & Social Care Partnership or Scottish Care for support.

The poverty of holidays.

I travelled to and from Manchester at the end of this past week. As usual I went by train and to say the least the stations in Glasgow and Manchester were busy – if not mobbed. I wasn’t surprised because it is of course holiday season and whether it’s English schools now being closed meaning visitors coming to Scotland or Scottish families getting away in the last few weeks before the schools re-open, as is always the case the period of late July and early August is very busy.

As I was travelling I couldn’t but recall a passing conversation I had with a care worker last weekend on the very topic of holidays. She had spoken to me of the fact that in her own words she ‘hated’ the holidays because as the sole parent of a couple of children it meant that an already challenged situation was made a lot worse because of trying to organise and pay for care and support for her young family given that she had no relatives living close by and that she, whilst she said she was paid more than some in the care sector, she was still not able to pay for the support her kids would like. Worst of all she said she hated not being able to give her children the holiday experiences that their friends had. It was for her a stressful and depressing times.

The reality of what has come to be termed ‘holiday poverty’ is nothing new. This past week a new study has shown that 39.7 million workers, 14% of the EU’s population, couldn’t afford to go on holiday for a week in 2022.

Importantly this research underlines that holidays are not or should not be something which only those who can afford them should have the right to take – holidays are fundamental for our emotional, psychological and physical health and wellbeing, not least for children. As the European Trade Union Confederation General Secretary, Esther Lynch stated a few days ago:

“It’s also unsafe for workers, they need to have time to recuperate… it is important for addressing burnout and making sure that you come back to work restored and refreshed… a holiday is not a luxury, having time away with family is key for protecting the physical and mental health of workers along with providing valuable experiences for children.”

As the report highlights one of the very real social developments which has benefited millions in the last century has been the recognition that vacations and holidays were a fundamental importance for the whole of society and not just for those who can afford them. We need the benefits of switching off, of de-escalation and relaxing, to re-charge our batteries and help us live and work better. In some sense we seem to be going backwards rather than moving forwards in regard to the health and wellbeing of our workers and society as a whole.

Sadly, there is nothing new in such reports – as long ago as 2017 in a significant report called ‘Hungry Holidays’ a Westminster Cross Party groups of peers and MPs warned that the life chances of up to three million children in the UK were under threat due to their risk of going hungry during school holidays. The children’s charity, Children in Scotland stated at the time that this reality was influenced by high childcare costs, and that:

“Going to school hungry and struggling through the long school holidays not only impacts children’s happiness and wellbeing, it severely limits their mental and physical development with long-lasting and wide-ranging consequences. They are most likely to suffer from type 2 diabetes, obesity and to have a healthy life expectancy of 23 years less than their most affluent counterparts.”

Data from various surveys and research indicate that the prevalence of food insecurity among families with children rises notably during school holidays. For example, a survey conducted by the Food Standards Agency highlights that food insecurity affects various demographics and has led to increased reliance on food banks and other emergency food provisions especially during the holiday period.

Whilst the care worker I spoke to last weekend was focussed on the summer holidays, holiday poverty is not just something which happens during the summer because school holidays make up around a quarter of the year – that is a significant amount of time for someone to be stressing about how her children are cared for and supported.

As well as the impact on individual workers and employing organisations who try to be as flexible as possible in re-organising shifts and patterns of work, there is a wider impact of holiday hunger upon the social care sector which often goes unrecognised, namely an increased demand for care and support. And all this is happening at a time when local support initiatives and projects are being bled of funding because of austerity and cost-of-living pressures.

Overall, the lack of systematic, widespread support during school holidays exacerbates existing inequalities and places a significant burden on Scotland’s social care sector, highlighting the need for comprehensive policy interventions to ensure all children have access to adequate nutrition year-round.

A society that allows children to go hungry in front of our eyes, a society which makes a mother feel useless because she cannot provide what she wants to for her children, despite working and giving of herself in a social care role, has a lot to ask of itself. And yes, at the risk of constantly repeating myself it is a society that needs to recognise the fundamental value of care and support through proper pay, terms and conditions for those who care and that such recognition has to be the foundation of any action.

As I watched the crowds at the train stations queue and jostle to ‘escape’ on their holidays I could not but think of those left behind, with too many adults and children hungry and stressed in a time of ‘holiday.’ Holiday poverty is a reality that seems not to have departed.

The poet Edwin Morgan as I have mentioned before in this blog used to come to my school in Glasgow and read some of his poetry to the classes. All his poems were direct and spoke to many in the room about the realities they knew only too well. As the city of Glasgow struggled to re-design and re-build itself the realities of those left behind were never lost to Morgan, and sadly today whilst the scenes may be different, I think there remains a sad resonance to today’s poverty in his poem Glasgow Sonnet i

A mean wind wanders through the backcourt trash.
Hackles on puddles rise, old mattresses
puff briefly and subside. Play-fortresses
of brick and bric-a-brac spill out some ash.
Four storeys have no windows left to smash,
but in the fifth a chipped sill buttresses
mother and daughter the last mistresses
of that black block condemned to stand, not crash.
Around them the cracks deepen, the rats crawl.
The kettle whimpers on a crazy hob.
Roses of mould grow from ceiling to wall.
The man lies late since he has lost his job,
smokes on one elbow, letting his coughs fall
thinly into an air too poor to rob.

From Collected Poems (Manchester: Carcanet Press, 1990). Taken from Glasgow Sonnet i by Edwin Morgan – Scottish Poetry Library

Photo by Niklas Ohlrogge on Unsplash

Donald Macaskill

The illusion of partnership: what real collaboration looks like.

This was my first full week back at work since I took annual leave this summer and as is often the case I have been catching up on meetings and reading reports. With your indulgence I want to reflect on some of the event(s) and meetings of the week because they each had a common theme, namely what is real partnership like.

I got around to reading the first report from the UK Covid Inquiry which was published last Friday 19th July. Baroness Hallett and her team did not miss their targets. The first Module was an examination of the extent to which as a country we were or were not prepared for a pandemic. The resounding answer was that we singularly were not but more than that that there was a complacency that we were better prepared than most. As the public health specialist Prof Devi Sridhar from Edinburgh University opined last weekend:

“the UK government failed in its basic responsibility to its citizens of keeping them safe. The UK had too many preventable deaths, not only from Covid, but also from the shutdown of health services and a long lockdown that would have been unnecessary had public health systems been in place.”

We prepared for the wrong pandemic and the Inquiry has called for ‘fundamental reform of the UK government and devolved nations’ preparedness for civil emergencies.

Anyone involved in the world of social care before and during the pandemic cannot but agree with Lady Hallet and her findings. We saw the consequences first hand. Her recommendations make it clear that co-ordination, communication and critical whole system planning, and engagement are necessary to avoid any future disaster from happening.

Since her report there have been a number of articles considering the extent to which we are better or worse prepared for another pandemic and the likelihood of which we may need to face that reality. If some, like Sridhar are right, not least around avian flu (H5N1) and its growing threat to human health, then preparing for the future is critical. And that’s what worries me.

Hallett makes 10 clear recommendations and at their heart is a call for the simplification of pandemic planning and response. Planning exercises should be held every three years, and their results reported to the public, as well as the criticality of identifying at risk groups and to avoid a sense of ‘group think.’ All absolutely spot on, in my opinion.

The extent to which frontline social care providers and organisations from the independent and third sector were kept away from the planning table was appalling before and in many instances during the pandemic. I have said as much during evidence I have already given to the UK and Scottish Covid Inquiries. But far from learning those lessons I fear we continued and are continuing to embed poor practice which is at risk of repeating the errors and tragedies of the recent past.

The Scottish Government set up a body called the ‘Standing Committee on Pandemic Preparedness’ in the spring of 2022 to learn the lessons and to better prepare and plan for any future pandemic.

Its terms of reference stated that its membership would:

‘include scientific and technical experts from fields including public health, epidemiology, virology, behavioural sciences, global health, medicine, veterinary medicine, zoonoses and statistical modelling. In addition to independent experts, members may be clinicians and officials from the Scottish Government and associated agencies, selected for their role in pandemic preparedness and response.’

This body has met on numerous occasions and published an interim report late in 2022.

At the time of its establishment, I bemoaned the fact that yet again who was missing from the table? – the social care delivery sector. How can we possibly identify risk and embed lessons unless those most impacted are present? With due respect to the distinguished scientists, clinicians, medics and academics – they are the same groups of individuals (in some cases literally so) who were engaged in the planning processes which Hallett has highlighted as inadequate.

Sadly, I am convinced that we are less prepared in Scotland to deal with a pandemic in the future than we even were in 2020 – and I know I am not alone in that analysis. I say so because amongst other reasons if frontline social care delivery voices are not present at the table, the voices of those who support and care for our older citizens and people who require care and support, and indeed informal carers and those supported individuals themselves, then we are only ever going to get part of the picture and at a distance. We are walking blindly but even more shamefully deliberately into a new chaos.

Hallett’s insights must be fully heard and at their core is the critical engagement and involvement of all not least the social care sector and avoidance of the dominance of the usual suspects and exclusionary governmental practice in planning and resilience – a theme which I have no doubt will become repetitive in all her future reports. Partnership does not happen by proxy it requires presence.

The second area I want to reflect on was my attendance at two meetings to contribute to the surge and winter planning process in Scotland.

Last October in a blog I bemoaned the fact that the third and independent sector had not been included in the planning for the Scottish Government Winter Plan. Positively at least someone has heard and in the week that has passed I have attended a deep dive with colleagues and also a fuller meeting which Scottish Government hosted with a range of providers and stakeholders from the care home and homecare sector. Listening and a desire to include was certainly present albeit that we still have concerns that the planning is premised on a myopic concentration on issues relating to the acute NHS sector such as delayed discharge and avoidable admissions, rather than the critical issues facing the social care sector. But credit where it is due, and I hope Scottish Government and most importantly Ministers will listen to the constructive contributions from the third and independent sector as we approach winter and periods of ‘surge’. Real partnership certainly involves listening but it requires hearing resulting in action rather than avoidance.

The reason why such listening and partnership working is all the more urgent as we prepare for winter was laid bare on Thursday.

On that day a report from the Audit Commission was published. I have read many a report from the Commission and its sister body Audit Scotland over the years, but few have been as direct and damning as this one. It is an exploration of the financial robustness of Scotland’s Integration Joint Boards and the fiscal working behind our integrated health and social care partnerships. Its sections review the workforce, commissioning and performance. It makes it clear that community health and social care face rising unmet need and that ‘managing the crisis is taking priority over prevention due to the multiple pressures facing the bodies providing these services.’

Its findings resonant strongly with the experience of social care providers in care home and homecare services across Scotland around which I have often commented in this blog.

We particularly recognise the analysis which highlights that the workforce is under immense pressure, and organisations are facing acute challenges of recruiting and retaining staff.

The experience of constricted budgets, the demand to make savings and the consequential impact this has had on the ability of citizens to access necessary care and support are all mirrored in the report’s findings.

The Report rightly illustrates the way in which private and third sector providers find that council commissioning rates are insufficient to deliver social care and support and residential, personal and nursing care, and pay expenses such as staff, training and overheads.

The social care sector in Scotland is in a deep and unsustainable crisis, and this Report highlights why that is the case.

More positively the Report contains some case studies which evidence innovative and more effective ways of commissioning and procuring services, even in straightened economic circumstances. To name but two the Granite Care Consortium and the Fife Care Collaborative show how we can do things better.  What these new ways of working have in common is an emphasis on trust-built relationships, all professionals listening to one another, and all stakeholders actively involved in sharing mutual priorities.

The time ahs long passed whether in pandemic planning, winter preparation or the actual day to day delivery of social care in an integrated system for us to play at partnership and conjure up the illusion of collaboration. We urgently need to remove the shackles of self-interest and defensiveness, move away from the ‘it’s aye been done like this’ mantras and to seriously roll up our sleeves and work together for all the citizens of Scotland.

That only happens when the third and independent sectors and their representatives are in the room, at the table and empowered to contribute, rather than being kept outside.

Unless we all get around the table and spend as much time working together rather than seeking to cut an already vulnerable social care sector and its services to the bone, we will continue collectively to fail our citizens.

As the advocate and author Helen Keller once wrote: : “Alone we can do so little; together we can do so much.”

Donald Macaskill

Photo by Toa Heftiba on Unsplash

Care Home Conference 2024: Tickets Now Available!

Get ready for the Care Home Conference 2024!

We are thrilled to announce that tickets for the Care Home Conference 2024 are now officially on sale! This event will be held on Friday 15 November 2024, at the Hilton Hotel in Glasgow.

Why Attend?

The Care Home Conference 2024 promises to be an insightful and enriching experience, bringing together a diverse group of professionals, caregivers, and stakeholders from the care home sector. The conference will focus on key issues and developments within the industry, providing a platform for sharing knowledge, best practices, and innovative solutions.

Key Highlights:

  • Engaging Keynote Speakers: Hear from leading experts and influencers in the care home sector who will share their perspectives on current challenges and future opportunities.
  • Interactive Workshops: Participate in hands-on sessions designed to provide practical insights and strategies that you can implement in your own practice.
  • Networking Opportunities: Connect with peers, industry leaders, and potential partners to exchange ideas and forge valuable relationships.
  • Exhibition Hall: Explore the latest products and services from top suppliers and learn how they can enhance your care delivery.

Who Should Attend?

The Care Home Conference 2024 is perfect for anyone involved in the care home industry, including:

  • Care Home Managers and Owners
  • Healthcare Professionals
  • Policy Makers
  • Service Providers
  • Researchers and Academics
  • Anyone passionate about improving care for the elderly

Early Bird Special:

Early bird tickets are now available for this conference! Buy your tickets before the close of play on Monday 30 September to take advantage of the discounted rates. Ticket prices are as follows:

  • Early Bird Members: £70 + VAT (£84)
  • Early Bird Non-Members: £115 + VAT (£138)
  • Standard Members: £80 + VAT (£96)
  • Standard Non-Members: £140 + VAT (£168)

We recommend booking early to secure your spot and benefit from these savings.

Ticket Information:

Tickets can be purchased through the Scottish Care website here. Ensure you book your tickets before the early bird deadline to enjoy the discounts.

We look forward to welcoming you to Glasgow in November for what promises to be an unforgettable conference!

Scottish Care responds to Integration Joint Board Finance & Performance Report

Scottish Care welcomes the study and report undertaken by the Account Commission on the finance and performance of Integration Joint Boards. Its findings resonant strongly with the experience of social care providers in care home and homecare services.

We particularly recognise the analysis which highlights that the workforce is under immense pressure, and organisations are facing acute challenges of recruiting and retaining staff. Factors such as Brexit, Covid-19 and the cost-of-living crisis have all served to exacerbate these pressures.

Our experience of constricted budgets, the demand to make savings and the consequential impact this has had on the ability of citizens to access necessary care and support are all mirrored in the report’s findings.

Perhaps the most challenging part of the report is when it talks about commissioning, procurement and contracting services. It rightly calls into question our current systems which focus on competition and price, highlighting the political vested interest at local level. It rightly argues that providers in the private and third sectors are expected to take too much of the risk on within contracts, which is unsustainable. For instance, it cites a scenario where the cost of energy makes a service more expensive to deliver than the contract provides for, and yet the provider is still required to provide the service, bearing the loss.

The Report rightly illustrates the way in which private and third sector providers find that council commissioning rates are insufficient to deliver social care and support and residential, personal and nursing care, and pay expenses such as staff, training and overheads. These providers say they cannot compete with councils where pay and terms and conditions are better than they can provide due to the flat cash settlement local government receives from the Scottish Government.

The social care sector in Scotland is in a deep and unsustainable crisis, and this Report highlights why that is the case. Some of the responses to address this are within the hands of national and local Government and these need to fully utilised, not least of which is an urgent need to develop non-competitive, fair and ethical approaches to commissioning and contracting for providers.

More positively we are pleased to see case studies which evidence innovative and more effective ways of commissioning and procuring services, notably the Granite Care Consortium and the Fife Care Collaborative.  What these new ways of working have in common is an emphasis on trust-built relationships, all professionals listening to one another, and all stakeholders actively involved in sharing mutual priorities.

Dr Donald Macaskill, CEO of Scottish Care stated:

“This is a hard hitting report which lays bare the real challenges facing our social care sector in Scotland and why we are falling short. It is clear that significant investment rather than cost savings are needed to give women and men the services and supports they need. We all know how we can make things work better. We need to get on and do it.

It is also clear that it is possible to work in new ways which make integrated working and services successful. This can only happen when all involved in the delivery of health and social care are around the same table and working together. It will not happen – as occurs in many parts of Scotland – where providers who deliver most of the care and support, namely the independent and third sectors, are kept at arm’s length. We need all partners to be prepared to work together and as this report shows, even after many years, this is still not happening.

Unless we all get around the table and spend as much time working together rather than seeking to cut an already vulnerable sector to the bone, we will never make integrated approaches work and we will continue collectively to fail our citizens.”


The Audit Commission report is available on: https://audit.scot/publications/integration-joint-boards-finance-and-performance-2024

Blog: Back to the Day Job – State of the Nation’s Care

It’s been a busy General Election period, where Scotland has seen many of its frontline Holyrood politicians campaigning on behalf of their Westminster colleagues during the past month. With social care being a devolved matter, the needs of those accessing care and support in Scotland have taken a back seat in public discourse. With the commotion over, Scottish Care remains firm in its contention of the pressing need to return closer to home in order to achieve sustainability across the adult social care sector. This must be top of the Scottish Government’s agenda.

Scottish Care’s recent myth-busting report detailed the current sustainability crisis facing the independent sector, with insufficient funding borne from unfit-for-purpose funding models.

Independent care homes are suffering the greatest level of closure across all sectors, bearing the largest decrease in publicly funded care. Rising running expenses, agency staff costs, and the continued impact of high inflation have highlighted the insufficiency of the National Care Home Contract, and its inability to meet the unique requirements of varying models of care, and in varying (often rural) locations across Scotland. Funding for publicly funded residents (particularly those requiring nursing care) is below the level of sustainability, and burdens care homes with the intolerable choice of increasing fees to residents or risking closure. Compounding this is a growing restriction on purchasing care beds in several local authority areas, thwarting any opportunity to offset losses for existing care with new service users.

Compared to other devolved administrations and English Government regions, rates for homecare services in Scotland have failed to increase to the level required to sustain service provision. In all too many cases, rates have either stagnated or decreased. Given an inability to sustainably deliver services, care at home packages are being returned to local authorities at an increasing rate.

Given this trying financial climate, the relationships on which commissioning is based are also fraying. Scottish Care has become aware of cases throughout the country, of the ongoing pressure on care at home and housing support providers to reduce package costs for providers currently delivering services. The possibility of package withdrawal, or the denial of further opportunities to tender, looms large.

Mutual respect and trust is imperative across the commissioning process, and urgent reform to funding models is required as a means to support both providers and commissioners, and to halt the deterioration of the relationships between them.

Ultimately, those who require care and support are impacted, with a postcode lottery reducing choice to larger services that can manage economies of scale and funding shortfalls. In accordance with the Social Care (Self-directed Support) (Scotland) Act 2013, every person who requires social care and support has the right to choose a provider for their care. The current dearth of sustainable independent services and subsequent choice for individuals has seen the continued denial of this legal right. A sustainable mixed market model is the essential prerequisite to choice and control, realising of the rights of those accessing care and support.

These issues occur in the shadow of the ongoing development of the National Care Service (NCS). On Monday 24 June, the Minister for Social Care, Mental Wellbeing and Sport, Maree Todd released draft Stage 2 amendments of the NCS Bill. The Health, Social Care and Sport Committee will consider these amendments, alongside responses to the public consultation, over the course of the coming months.

The NCS represents an opportunity to cement a fit for purpose funding model as part of long-term systemic reform to the adult social care sector. Scottish Care remains committed to a vision of a shared national framework as part of the upcoming NCS, with flexibility for local funding solutions to unique care demands, and non-negotiable conditions for commissioning agencies to meet the true cost of care. Such a framework is key to cementing reform that supports the independent sector’s sustainability and commercial viability, and the importance of their care to communities across Scotland.

A central part of this reform, and Scottish Care’s subsequent advocacy, is the continued drive towards ethical commissioning. Scottish Care recognises the potential of ethical commissioning across Scotland as a means to address this crisis in sustainability. This is through an end to the emphasis on price and competition which has led to this crisis in sustainability.

There are no quick fixes to these systemic problems, and direct engagement with the independent sector should be the first step in achieving proper understanding of the vital role the independent sector plays in the delivery of social care and support, and how the sector’s current plight jeopardises such delivery.

It therefore must be back to the day job for our elected representatives in Scotland, to achieve the sustainable adult social care sector that communities across Scotland deserve.


By Fraser Smith
Policy Lead (Ethical Commissioning), Scottish Care

Mental health supports for older people in Scotland: time to listen.

Samaritans Awareness Day is on 24 July and the following day sees National Schizophrenia Awareness Day. These are two important days in the mental health and awareness calendar and come at a time when the issues of mental health and wellbeing are more prominent than ever.

Samaritans Awareness Day continues their focus on a campaign which has been running for 8 years. The ‘Talk To Us’ campaign aims to highlight the charity’s work and the help it can offer. With events being held throughout July by the Samaritans the aim is to highlight the organisation’s availability at any time of day or night to listen to anyone who is struggling to cope. According to Mind, one in every four people in the UK suffers from a mental health condition each year. Those who are experiencing challenges or discomfort have somewhere to turn in the Samaritans.

National Schizophrenia Awareness Day aims to shine a light on the everyday challenges the millions of people living with a diagnosis of schizophrenia face and how we can tackle the stigma and discrimination around it. It is estimated that one in 100 people will experience schizophrenia. Despite being so common, the stigma surrounding schizophrenia remains stubbornly high due to a lack of understanding.

‘Schizophrenia is a very complex condition that can affect how a person thinks, feels, and experiences the world around them. While the word is made up of schizo (to split) and phrene (the mind), schizophrenia does not mean split personality.

People with a diagnosis of schizophrenia can often experience very different symptoms, including audio hallucinations (hearing voices), delusions, disorganised thinking and changes in body language or emotions.’

I have written on a number of occasions about the challenges faced by individuals as they age with life enduring mental health conditions and the lack of support which is targeted at their particular needs. Far from the situation improving over the years I am afraid that the context today as we recognise these two significant mental health days is getting worse not better.

We are faced with some particular and escalating challenges, including increasing demand and resource constraints. It is a given though frequently comes as a shock to some that the population of Scotland is ageing. This means on a demographic level alone that this has led to a higher prevalence of mental health issues such as depression, anxiety, and dementia among older adults. Indeed, studies indicate that around 10-15% of older adults in Scotland experience depression, and a similar percentage suffer from anxiety. These conditions often go undiagnosed and untreated, as symptoms may be mistakenly attributed to aging or physical health problems. For regular readers you will see a resonance here with my last blog highlighting the rise of alcohol misuse amongst older Scots. Sadly we have also witnessed a concerning increase in the number of suicides among older men in particular. Although suicide rates are generally lower among older adults compared to younger age groups factors such as social isolation, chronic illness, and lack of support can contribute to this increased risk.

In addition, at the present time we are faced with not insignificant staffing shortages in mental health support organisations and amongst providers of social care and mental health support. This is all accentuated by the increasingly restricted resource many support services are working with because of underfunding or indeed because they have lost their funding.

And as if the demographic and practical support challenges were not hard enough, we still witness and have to live with enduring stigma. Regrettably mental health issues in older adults are frequently stigmatised, both within the community and among some healthcare providers. Older adults may feel ashamed or reluctant to seek help due to societal attitudes toward mental illness, particularly in older age groups.

As a result of the lack of specialist focus, lack of investment and stigma many of those working in the field who I speak to will argue that there is significant underdiagnosis. Symptoms of mental illness are still being mistaken for normal aging processes.

The mental health of older adults in Scotland is a complex and multifaceted issue that requires a coordinated and comprehensive holistic response involving all stakeholders including social care providers and families and those most impacted. These have to be approaches of care and support which meet the social, economic, housing and healthcare needs of older Scots.

Sadly, at the moment growing older with mental ill health in Scotland is an experience of isolation, despair and one where you feel you are simply not noticed, that your life does not matter. Just as I stated last week when I speak about alcohol harm, we urgently need all stakeholders to prioritise this harm and to do so in an inclusive prioritised manner.

There are many poets who have spoken about mental health struggles, but few have reflected on them as a lifelong experience into older and what ageing means for mental health. One who has is the late American poet Anne Sexton who wrote The Room of My Life:

Here,
in the room of my life
the objects keep changing.
Ashtrays to cry into,
the suffering brother of the wood walls,
the forty-eight keys of the typewriter
each an eyeball that is never shut,
the books, each a contestant in a beauty contest,
the black chair, a dog coffin made of Naugahyde,
the sockets on the wall
waiting like a cave of bees,
the gold rug
a conversation of heels and toes,
the fireplace
a knife waiting for someone to pick it up,
the sofa, exhausted with the exertion of a whore,
the phone
two flowers taking root in its crotch,
the doors
opening and closing like sea clams,
the lights
poking at me,
lighting up both the soil and the laugh.
The windows,
the starving windows
that drive the trees like nails into my heart.
Each day I feed the world out there
although birds explode
right and left.
I feed the world in here too,
offering the desk puppy biscuits.
However, nothing is just what it seems to be.
My objects dream and wear new costumes,
compelled to, it seems, by all the words in my hands
and the sea that bangs in my throat.

Anne Sexton. “The Room Of My Life.” Family Friend Poems, https://www.familyfriendpoems.com/poem/the-room-of-my-life-by-anne-sexton

Photo by Kristina Tripkovic on Unsplash

Donald Macaskill

Winter Plan & Surge Planning Webinar with Scottish Government – 25 July 

Dear Members,

The Scottish Government are carrying out engagement activity in relation to the winter plan 2024 and surge planning activity, and would like to hear from you in a webinar on:

Thursday 25 July 2024
10:00 – 11:00 am

This will be held on Microsoft Teams. Please register for this session on the Members Area.

The questions below will form the structure of the meeting. We will provide you with an opportunity to discuss the implications for social work and social care.

  • Thinking about the winter plan 2023/24
    • What do you think worked well and should be retained?
    • What do you think was missing from the plan?
  • Thinking about the winter plan for 2024/25
    • What do you want to see included in the plan?
    • What do you think should be done differently this year?
    • How could we improve the communications around the winter plan?
  • Thinking about ongoing surge planning, preparing for year round surge pressures
    • What are the critical functions in social care that you think should be protected?
    • What interventions do you think should be considered locally to manage pressure periods?
    • What national interventions do you think should be considered to help the system manage periods of peak pressure?

Hidden in plain sight – alcoholism amongst older people in Scotland and its impact on social care.

It was Alcohol Awareness Week at the start of the month and during it I was reading some of the latest research and data on alcohol and older age in Scotland. It was both disturbing and yet sadly predictable.

Across Scotland today one of the hidden harms of alcohol is its impact on the lives of older Scots and their families and the relative lack of specialist social care provision to address that crisis. This growing issue is not only a personal tragedy for those affected but fractures too many families and communities. It is also a harm which as I’ve reflected upon last year in this blog space we still remain poor at calling it out and resourcing the change that’s needed.

Alcoholism among older adults is often overshadowed by other public health concerns. However, the statistics tell a worrying story.

Research indicates that alcohol misuse among those over 65 in Scotland is on the rise, exacerbated by factors such as loneliness, bereavement, and physical health problems. Unlike younger drinkers, older adults often face more severe health consequences from alcohol misuse, making early intervention and support crucial.

Health data indicates that a significant proportion of older adults consume alcohol regularly, with a notable segment drinking more than the recommended guidelines.

The 2022 Scottish Health Survey indicated that 24% of men and 13% of women aged 65-74 drink more than the recommended weekly alcohol limit (14 units per week). For those aged 75 and over, these figures are 16% for men and 8% for women.

In addition, data from the Information Services Division (ISD) Scotland reveals an increasing trend in alcohol-related hospital admissions among older adults. In the past decade, there has been a marked rise in admissions for alcohol-related conditions such as liver disease, falls, and cognitive impairment. ISD Scotland reported that in 2021, there were approximately 2,300 alcohol-related hospital admissions per 100,000 population for those aged 65 and over, a significant increase from previous years.

And further National Records of Scotland recorded 467 alcohol-specific deaths in 2022 among individuals aged 65 and over, an increase of 15% compared to 2021. Statistics show that individuals over 65 have higher alcohol-specific mortality rates compared to younger age groups, reflecting the severe health impacts of prolonged alcohol misuse.

Older adults struggling with alcoholism face a unique set of challenges. Physiologically, the aging body is less capable of metabolising alcohol, increasing vulnerability to its effects. This can lead to a range of health issues, including liver disease, cardiovascular problems, and cognitive decline. Moreover, alcohol can interact dangerously with medications commonly prescribed to older adults, compounding health risks.

Socially, older adults may experience isolation and loneliness, which can drive them to use alcohol as a coping mechanism. I’ve known too many times where the loss of a spouse, or retirement, or relocation has led to folks turning to the drink in older age. All this can sever social ties, leaving individuals even more vulnerable and the stigma associated with alcoholism can further isolate them, making it difficult to seek help.

The rise of alcoholism among older adults has profound implications for social care in Scotland. More and more frontline workers especially in homecare are telling of noticing an increase in alcohol addiction. They are often the first to notice the signs of alcohol misuse, such as frequent falls, memory lapses, or neglect of personal hygiene. However, recognising these signs can be challenging, as they are often attributed to aging itself rather than alcohol use.

Care providers face the complex task of managing the immediate health needs of these individuals while also addressing the underlying issue of alcoholism. This dual challenge requires a nuanced approach that combines clinical care with psychological and social support. In other words, the response has to have social care at its heart.

The data underscores the growing need for targeted interventions to address alcohol misuse among older adults. The current system is stretched to a point that it struggles with the majority and is failing to pick up this growing demographic and their acute needs.

Social care providers must be equipped with the knowledge and resources to identify and manage alcohol-related issues effectively. Investment at this level will support preventative work and will thus reduce the growing pressures on hospitals and residential care settings.

However, social care workers require specialised training to effectively support older adults with alcoholism. This includes understanding the signs of alcohol misuse, managing withdrawal symptoms, and providing compassionate, non-judgmental care. Without adequate training and resources, care providers will struggle to meet the complex needs of this population.

Addressing alcoholism among older adults in Scotland I believe requires a multifaceted approach, including:

Awareness and Education: raising awareness about the issue is the first step. This includes educating the public, care providers, and policymakers about the signs of alcohol misuse in older adults and the unique challenges they face.

 Integrated Care Models: developing integrated care models that combine medical, psychological, and social care support is essential. This holistic approach can ensure that older adults receive comprehensive care tailored to their specific needs.

Community Support: strengthening community support networks can help reduce isolation and provide older adults with the social connections they need to combat loneliness. Yet sadly we are cutting back and defunding these programmes at a time of real need and acuity. Community programmes that offer social activities, peer support, and outreach can play a crucial role in prevention and early intervention.

Policy and Funding: it’s perhaps stating the obvious but national and local government in Scotland must prioritise funding for programmes and models that address alcohol misuse among older adults. This includes investing in training for social care workers and expanding access to treatment and support services.

Alcoholism among older adults in Scotland is a pressing issue that demands our collective attention and action.

The data on alcohol misuse among those over 65 in Scotland paints a concerning picture of a hidden crisis that requires urgent attention. By acknowledging the prevalence and impact of this issue, we can better support our older population through targeted interventions, comprehensive care models, and robust community support. Addressing this challenge is not only a matter of health but also of dignity and quality of life for our older citizens.

It is a challenge that intersects with the very heart of social care, impacting both those who suffer from alcohol misuse and the professionals who support them.

Let us not turn a blind eye to this issue. Let us confront it with compassion, understanding, and a commitment to creating a social care system that supports every individual, at every stage of life.

Donald Macaskill

Photo by Thomas Picauly on Unsplash

The Power of ‘Thank You’ in Social Care

Whether it’s Efcharisto, Danke, Gracias, Merci, Takk or simply thank you – wherever those who can and choose to travel or holiday this summer doubtless most of us will learn the basics of communication in the native language of the place we find ourselves in.

Saying thank you to show gratitude is an important part of etiquette in almost all cultures. Whilst manners might change and customs will divert there remains a truth that learning the vocabulary of gratitude is the first step to properly showing your appreciation in a new community.

I think the same can be said of the busy world of social care. Amidst the daily routines and pressing challenges, there lies a profound yet often overlooked practice: saying “thank you.” These two simple words carry immense weight, embodying gratitude and recognition, fostering a culture of appreciation that is vital for both care and support workers and those they support.

Saying thank you might sometimes feel like an afterthought, a perfunctory nod to social etiquette. Yet, these words carry an astonishing power. In my years of working in social care and beyond, I’ve seen firsthand the profound impact that genuine gratitude can have on individuals, relationships, and communities.

At its core, social care is about human connection. It’s about seeing the person behind the condition, label or stigma; it’s about understanding their stories, their struggles, and their triumphs. In such an environment, gratitude is more than just a courtesy; it is a cornerstone of human dignity and respect.

For social care workers, the role they play is both physically demanding and emotionally taxing. They provide support, comfort, and companionship to individuals who often face significant challenges.

This work can be deeply rewarding, yet it can also lead to burnout if not balanced with adequate support and recognition. The central focus of that recognition has to be the continued struggle to give people adequate terms and conditions – and I hope all governments and organisations will heed the criticality of improved pay for the social care workforce as the primary mark of saying thank you!

However wider acknowledgment of the work of a carer is crucial for individual mental health and job satisfaction.

The act of expressing thanks does not just benefit the recipient; it also positively affects the giver. Research shows that practicing gratitude can enhance well-being, reduce stress, and increase overall happiness. In a field as challenging as social care, where the emotional demands are high, cultivating gratitude can serve as a buffer against burnout and compassion fatigue. This is true at all levels of organisations and communities.

For gratitude is not just a social nicety; it is a fundamental human need. Philosophers, psychologists, and spiritual leaders have long extolled the virtues of gratitude, recognising it as a cornerstone of human well-being. Saying “thank you” acknowledges the efforts of others, affirming their value and fostering a sense of connection and mutual regard.

In social care, where the heart of the work lies in human connection, saying “thank you” is more than good manners—it’s a vital practice that sustains the spirit and dedication of caregivers. It strengthens relationships, builds trust, and fosters a culture of mutual respect and appreciation.

In our increasingly disconnected society, where digital interactions often replace face-to-face encounters, expressing thanks has never been more crucial. It bridges the gap between us, reminding us of our shared humanity and interdependence.

So I’m pleased that Thank You Day is returning tomorrow.

Thank You Day began with a handful of organisations looking for a way to enable us all to say a huge ‘thank you’ to everyone and everything that helped us through the COVID-19 pandemic.

Since then the campaign has grown to include hundreds of partners and over 20 million people have taken part in Thank You Day celebrations. Last year 74% of those who took part in a Thank You Day event said they felt a stronger sense of belonging to their local community as a result.

The celebrations this year are focusing on giving thanks to our local communities.

At their heart is the act of gratitude which creates and nurtures the wellbeing both of individuals and communities and not least those who require care and support.

Two simple words – thank you – a powerful act that can transform our interactions and relationships. It is a small gesture with a huge impact, fostering a culture of appreciation and respect.

I hope you have a summer where you are able to both receive and give thanks.

Donald Macaskill