Living in the face of death: not just a long goodbye.

This past week I have had a couple of conversations which though significantly unconnected have in my mind touched and influenced one another. One had to do with reaction to a television advert from the Alzheimer Society, the second a conversation with a Filippino care worker who is preparing to celebrate Black Saturday today.

The Long Goodbye is a very emotional television advert with a voice over by the actor Colin Firth which shows a son delivering a eulogy at his mother’s funeral and recalling the many moments in his mother’s dementia experience where a part of her ‘died’ ‘again and again’.

The advert created by the Alzheimer Society has resulted in a wide debate on social media and amongst dementia organisations about its merit and what it says about the lives of those who live with dementia. Many have stated that it diminishes the lives of those with dementia by presenting it as a series of deaths and losses.

The CEO of the Alzheimer Society, Kate Lee in response to the ‘backlash’ commented:

“This campaign seeks to tell the unvarnished truth about the devastation caused by dementia and it is very much informed by people affected by the condition.

The loved ones of people with dementia often describe it as a ‘living grief’ as, bit by bit, the disease’s relentless progression causes part of the person to die…again and again and again.

“But there is hope. Alzheimer’s Society, through its support services, is there for people affected again and again as they face the grim reality of the long goodbye.”

The Alzheimer Society has gone on to argue that the advert was created and made with people who have dementia and their families, that it is seeking to raise awareness of the fact that 900,000 people have dementia and that nearly 80% of respondents to a recent survey weren’t aware that one in three people born in the UK today will get dementia. It argues that ‘Many may find the advert upsetting. But the reality is that dementia is devastating.’ They argue that this campaign is not about fundraising but raising the awareness of wider society that current approaches to dementia cannot go on as they are as we move to a situation where by 2040 1.4 million people will be living with the condition.

This past week I have had several conversations with both individuals who are living with dementia but also their family members and allies and everyone has mentioned the TV campaign. It has led many to feel despair and hurt and indeed shock about the way in which it portrays living with dementia.

Having watched the clip myself part of me can absolutely see what the creators were trying to do and achieve, but a huge part of me cannot but feel this is a massive and damaging misstep by a charity which should be focussed on the affirmation of life regardless of diagnosis.

I know just how upset and hurt people have been and how staff in care homes and in the community have had to speak about these issues with residents and clients.

At the centre of the debate about the advert is the issue of anticipatory grief something I have spoken and written about a great deal. What does it mean and how does it feel to live your life in the knowledge that the disease within you will kill you? How do you as an individual and those who are around you in a company of love and compassion deal with the changes which are happening because of the disease? How do you better support yourself for the act of dying and the work of grieving?

For me there are no easy answers to any of those questions and the way in which I have worked through the loss of a loved one has been and will be different to anyone else. But what has been important for me is that every moment mattered, every conversation counted, and that the preciousness of time became an invaluable gift. Far from my losing a loved becoming a series of long goodbyes I tried (and admittedly didn’t always achieve) to have a sense of every encounter being a new beginning or a hello, an introduction to a new part of the person; a realisation that even in barrenness and hurt there was growth and newness, possibility and promise even in pain and emptiness. That the person I loved was still the person before me, just different, still wanting and reaching out for love and touch, for a renewed sense of being held by my humanity.

I mentioned another conversation I had this week.

This was one I held with a nurse who was working in a care home and who comes from the Philippines. We were chatting about the upcoming holiday weekend, and I asked her what she was planning. She told me that she would be celebrating Easter Sunday but that first she would be recognising Black Saturday which was so important to her, her culture and to many other people from the Philippines.

I discovered from her that Black Saturday was a day of fasting for Catholics in the Philippines and that it commemorated the day that the crucified Jesus lay in his tomb after he had died on Good Friday. It was the day in between deep sadness and celebratory joy. I was told that Black Saturday is a significant day for people in the Philippines. It is recognised in diverse ways including the famous healing rituals in Siquijor where traditional medicines using herbs and roots are created. It is a day of quietness, limited noise, peace and solemnity.

But importantly my partner in conversation said that it is a day when you are meant to spend time thinking about how you are living your life in the face of your own death; how you are healing the relationships which might be fractured or broken; how you are using your voice to speak peace and healing; how you are using your hands to bring solace and purpose. It is an active day of contemplative preparation. It is a central requirement between loss and hope to be open to listening, active in preparation, and instinctive in being with others.

It struck me as she spoke to me and as I reflected later on the real upset caused by the Alzheimer advert that Black Saturday was all about anticipatory grief.

So I will spend some part of this Saturday thinking about how I can better support those who wait upon death. I will do so not thinking that every moment has to be strained of joy and purpose but in honesty being prepared to accept that the tears of living are made with joy and sadness. I will remember those moments when my heart panged with a sense of loss caused by the changes of a look that did not remember me or a memory lost into time, and I will reflect on my truth that despite all the absence that there was an astonishing presence of love and touch, of togetherness and being.

And yes, I will in the days and weeks ahead try to convince others of the importance of being more aware, more committed, more energetic in righting the wrongs of a society that displaces dementia and those who live with the disease, that treats them with financial and care discrimination, one that is so unequal.

I do not and cannot believe that a life facing a dementia death is calculated by a series of losses, but rather I have to and will continue to believe in the immeasurable arithmetic of presence and positivity.

I am reading a lot of Rupi Kaur these days, and this poem ‘funeral’ spoke to me this week, a week of anticipatory grieving for so many.

when i go from this place
dress the porch with garlands
as you would for a wedding my dear
pull the people from their homes
and dance in the streets
when death arrives
like a bride at the aisle
send me off in my brightest clothing
serve ice cream with rose petals to our guests
there’s no reason to cry my dear
i have waited my whole life
for such a beauty to take
my breath away
when i go let it be a celebration
for i have been here
i have lived
i have won at this game called life

[POEM] Funeral by Rupi Kaur : r/Poetry (reddit.com)

Donald Macaskill

Photo by Rebecca Matthews on Unsplash

Enhancing the lives of older people in our care homes

The following is based on part of an address given last Tuesday at an online conference organised by Faith in Older People and Anna Chaplaincy.

To begin with I have to acknowledge that any talk of care homes has to address the problem of image and stigma. Even before the pandemic but certainly since the very understanding of care homes is one that is too often associated with the negative.

But I want to start from the perspective of challenging the stereotypes that care homes are places where people (to use the language that is often used), are places that people are  ‘put in’, or ‘end up in’ … or even worse the idea that they are ‘prisons for older age,’ ‘locations of last resort’.

Yes, it is true that for the vast majority of people moving into congregated or shared living in older age is a decision which is not ideal, and it might be one taken as a result of a decline or deterioration; we acknowledge that most of us would want to remain independent or in our own home for as long as possible.

Yet whilst many more people are living longer, they are also living with multiple conditions or co-morbidities. Another truth is that people are entering residential care much later in their illness or ageing journey. We are therefore talking about a more frail and fragile population, the majority of whom are living with some degree of cognitive decline such as dementia and the majority of whom are on a palliative and end of life care pathway in one way or another.

For many residents their care home is likely to be the place where they end their days. Most care home residents today will be in the home for between 14 and 18 months rather than the 3-5 years which were commonplace a decade ago. In many senses therefore care homes have become ‘hospices in the heart of our communities.’

That awareness has changed the dynamic of many care homes yet paradoxically that has not made care homes places of quietude and sadness but quite the opposite – for many they have become even more places of enjoyment and life affirmation, of living life to the fullest possible extent.

In my experience many care homes are places where individuals flourish, where they thrive, where they come alive, where they discover an energy which they felt they had lost in the years of past memory; where some find a new direction and sense of purpose that they might have yearned for in the past.

It is no exaggeration – at least for me – to state that care homes can be places that change lives and bring a new dimension to the remaining days of life.

In other words, care homes are not places where the task is to exist but rather, and with compassionate support and skilled professionalism, they can become places where people grow until the end of their lives, changing and moulding their days to the new rhythm of their experience.

They are places where individuals are enabled to ‘tell their story’.

Care homes can in the words of this talk be places to enhance life rather than to simply survive – and the role of spiritual care in that enhancement is critical and central.

Enhance is a lovely and intriguing word. It first came into English usage in the 13th century and literally meant ‘to raise something higher.’

When it was first used enhance meant to mak something physically higher, but quickly it became a word used to describe making someone feel recognised, more valued, or attractive.

I love the image that the word suggests. How are we in our relationships and actions, in the dynamics of our happening times and in our silence, in the exchanges of our conversations and encounters – enhancing or raising higher those who we are privileged to spend time with?

Care homes should be about enhancing older age, about raising up, making attractive, bestowing value on age and individual and all that comes with it. They should be about scattering to the four winds the stigma and stereotype of being old, of becoming frail, of losing memory, of developing dementia, and even of dying. Because all of these experiences can each and every one be enhanced – be raised up, to the point at which someone feels heard and valued, affirmed and wanted, celebrated and seen.

Care homes are about creating spaces and places where people can discover who they are even in the last hours and moments of living and loving; they are about raising up older age as something worthy of being affirmed, as valuable in its own right, regardless of activity or ability, capacity or consent.

That is no more the case than when I reflect about dementia. A diagnosis of dementia deserves not to be a full stop in the story of your life, but rather with support and resourced focus it can become the start of a new chapter whose ending is still to be written, whose richness of experience has still to be encountered.

Too often we have both in care home and community limited people by diagnosis and labelled them by siloed response and action. Person led care and support is recognising the particularity and uniqueness of each individual – it is about changing the dynamic of the cared for and carer so the power, autonomy, control and choice rests with the person being supported (perhaps especially if the individual lacks capacity to ‘know’) – it is about not treating the condition but caring for the person.

The role of spirituality and spiritual care in the whole process of enhancing older age in care homes is simply inescapable and undeniable. In a real sense enhancing – raising up older age in care homes – is about recognising that the very dynamic of care and support is at its essence an act of spiritual care. And for me it focuses on several characteristics:

Firstly, that spiritual care which enhances older age should seek to discover and use a language that can be the means of real communication for the person being supported.

Many years ago, I was privileged to spend some time with Phoebe Caldwell who for many is the mother of modern speech and language therapy, not least because of her development of intensive interaction approaches. I have seen with my own eyes how Phoebe worked with individuals who had been ‘locked in’, who had never or had stopped using words as their means of communication. Phoebe used to say that every human being has a unique language and communicates in a unique way. I am on one side of the river- you are on the other – the art of communication is the building of the bridge of understanding from one shore to the other. It is arrogance and hubris of the highest order to assume (as we so often do) that in order to communicate you must come over to my world, use my language, my words. It is much better for us to garner the humility of encountering one another in the middle of that bridge where I learn what your sounds, or eyes, or motion, or jerks say to me and vice versa. Real communication happens when there is a mutuality of encounter. For me that has always been an essential part of spiritual care – I am about learning your language, being humble enough not to assume I have all the insights or answers, all the knowledge and sense.

Dr Maggie Ellis from St Andrews University has done so much to use Phoebe’s approaches in communicating with individuals who have lost the power of speech in the latter stages of dementia. I would commend her work to you not least because now and in the years to come there will be so many more who because of their dementia will lose the power of speech and communication – we can either dismiss them as used to be the case in the way we labelled people with disabilities and autism as ‘non communicative’ or we can enter a new world of self and mutual discovery and learn a new language of spirit, compassion and care. Learning a new language and new ways to communicate is key to effective spiritual care.

My second characteristic of care that enhances older age is a spiritual care that seeks to address the whole of a person rather than the elements that can be simply determined, recorded, and recognised.

In the words of the Scottish Government’s Spiritual Care Framework

‘We all have a part of us that seeks to discover meaning, purpose and hope in those aspects of our experience that matter most to us. This is often referred to as “spirituality”; informing our personal values and beliefs, and affirming that tears, laughter, pain, and joy are all part of the human experience.

 I believe that part of enhancing older age – of raising it up – is to acknowledge that questions of meaning, purpose and hope are as real and valid in older age – and whilst living with conditions such as dementia – as at any other age. These are spiritual questions which we need to give space to – and ignoring them, not encouraging them, or worst still avoiding them is a limiting of the person.

That might take us into uncomfortable territory because I fear that our risk averse attitudes to age and frailty have led us sometimes to treat older people as children, to avoid the totality of being human, to try not to be unsafe or take risks, or fail and not succeed; to somehow think all older people are like one another; to presume that older age has no capacity for the novel or new, has no appreciation of the desire to do learn or discover possibility. Caring for the totality of a person requires spiritual care but is in itself an act of spiritual care. I just wonder if we sometimes limit the shocking potential of spiritual care by being predictable and safe?

Lastly, for me a critical component of enhancing, of raising up older age in care homes is the spiritual art of being honest and real and raw in accepting the uncertainties of the unknown and in giving sanctuary to the deepest fears of individuals.

Care homes are much better at walking with people on the journey to dying than perhaps they used to be. Living in and through dying is a critical component of ageing.

Care homes are in an often-unique position in enabling the giftedness of encounter and relationship formation to build a sense of belonging that can heal the deepest wounds even beyond the tears of grief.

There is perhaps no greater act of care for the person than to allow them to die well, with choice and autonomy and control as much as is possible.

Enhancing the last moments of life, raising up the latter days of an individual, creating space for there to be acts to raise the value and worth of a life lived to the full are all surely the core of spiritual care.

So spiritual care is essential to enhancing – to raising up the lives of all who are older, but not least in our care homes. At its best it is an art that allows the person to become who they have the potential to be, to flourish and to thrive into wholeness.

The Canadian poet Rupi Kaur writes:

“it was when I stopped searching for home within others and lifted the foundations of home within myself I found there were no roots more intimate than those between a mind and body that have decided to be whole.”

Donald Macaskill

Photo by Alexander Grey on Unsplash

Restoring the essence: the role of social work in changing times.

Tuesday coming, the 19th of March is World Social Work Day.

I have spent a lot of my life surrounded by social workers both in terms of being colleagues of them, working alongside them, and even sharing office space with them. But I have also been very aware of the role of social work through relatives and family connections who were and are social workers. It is a profession, therefore, with which I am very familiar and for which I have over the years developed a deep respect, no less so than when I trained hundreds of social workers in Self-directed Support legislation, around issues such as grief and loss, and adult protection.

I am saying all this because I want to evidence a regard for a role and a profession which I feel to be increasingly marginalised and ignored and one which I fear may be losing sight of its essence and energy. I was sharing some of these reflections the other day with a social worker friend who had just retired after decades of service and whose reflections and insights challenged me a great deal.

The international description of World Social Work Day states that it is :

” a celebration that aims to highlight the achievements of social work, to raise the visibility of social services for the future of societies, and to defend social justice and human rights.”

It goes further and points out for this year’s theme:

“World Social Work Day …is rooted in the Global Agenda and emphasises the need for social workers to adopt innovative, community-led approaches that are grounded in indigenous wisdom and harmonious coexistence with nature.”

Social work happens the world over and whilst there may be cultural and geographic distinctions, the essence or core of the profession is largely similar regardless of location. For me a social worker has always been the person who works alongside an individual, community, or group to help them find solutions to their problems and challenges. They are about enabling people to find the resource and energy, the route and strength to empower them to thrive, and achieve their full potential. Regardless of the age of the supported person, social work is grounded in an advocacy for the person at risk of rejection and discrimination. It is a profession steeped in ethical and moral principles with a concern for those marginalised, ignored and at risk. It is a role which literally defends, intervenes to ensure safety, and directs toward independence, self-control and personal autonomy. Knowledge of law, awareness of policy, ability to manage systems are all social work skills directed to enabling the supported person to take control, be autonomous and live as independently as they can. This is all about the maximising of human potential.

The Global Definition of Social Work from the International Federation of Social Workers expresses it well:

“Social work is a practice-based profession and an academic discipline that promotes social change and development, social cohesion, and the empowerment and liberation of people. Principles of social justice, human rights, collective responsibility and respect for diversities are central to social work.”

My social work friend and I reflected on the passionate originality and strength of the Social Work Scotland Act when it appeared in 1968 – which whilst I was a babe in arms – in the years after I began to appreciate was a dramatic game-changer in the world of social work in this country. It posited a very different approach to social work which attempted to change the traditional power dynamics of the era. It grounded in law the commitment to provide a community based social work service which ijn the words of a recent report was:

‘focused on providing early help, working in partnership with the communities served, and prepared and empowered to act to protect the vulnerable and those in crisis.’

My friend and I reflected on the extent to which the social work profession in Scotland was reflective of the original intent. Now straight off the bat I am not one of those sideline commentators who consider that social work has sold the pass and has lost its integrity, but it is difficult to ignore the reality that policy, political and legislative changes have altered the nature of social work over the years. Chief amongst them was the Community Care Act and the introduction of the concept of care management which to my friend, “turned us into bean counters, door blockers and system protectors.”

This change has been described in the following terms:

‘This shifted the onus from social workers as therapeutic resources towards practitioners as navigators of an increasingly complex landscape in which their professional values, methods and identity were eroded. Inevitably, social workers looked for areas within an ever more bureaucratic workplace to retain identity and purpose by trying to steer courses between policy intention, management systems and professional judgement.’ (see 3. Historical context – National Care Service – social work: contextual paper – gov.scot (www.gov.scot) )

So it was perhaps not surprising when the Self-directed Support Act (SDS) was introduced in 2013 with its emphasis on enabling the supported person to identify what would enable them to live to the fullest rather than what they needed, its principles of independent living, its emphasis on control, choice, autonomy and dignity – that virtually all the social workers I met and trained in the Act spoke about it in terms of a return to core values and about being what they had entered the profession to do in the first place, i.e. to be an advocate for those who needed a voice and to enable people to fulfil their individual potential and live their lives as they wanted and needed to.

Derek Feeley’s report and the work of Social Work Scotland in its numerous reports have well and truly described the ‘implementation gap’ between legislative aspiration around SDS and the on the ground reality, but chief amongst them must surely be the frustration and disappointment of the social work profession that the management of cases, the supervision of budgets, the emphasis on resource constraint and needs assessment has remained dominant and prevented a return to the essence of social work.

And in these last few weeks when the hidden crisis and breakdown of the social care system in Scotland has become ever more apparent to me, I cannot help but think how far that essence of advocacy and human rights protection that social work once enshrined seems to have become even more remote.

When I sit and hear as I have this last week of social workers in one authority visiting service users who have had packages of care and support lasting 45 minutes to inform them that after a ‘review’ that their care would be delivered in 15 minute visits (to include getting up, being bathed, and having a meal prepared) then I cannot but feel that the essence of social work is slipping away.

When I hear a social worker in another authority stating that a body wash should replace a shower (to save time); and that a local day service needs to shut because of resource constraints, I sense a slipping away of social work.

When I listen to the family of a man with a significant neurological condition, who had been used to four visits a day to support them, now being reduced to two, and the social worker saying that the family will just have to help out more – I see the essence of social work slipping away.

Now lest you suggest these are exceptions to the rule then sadly I would contend they are not rather they are the tip of the iceberg.

Undeniably I know that there are hundreds of women and men who are fantastic passionate social workers, and I know when I speak to them, how massively frustrated they are by the fiscal and managerial shackles they have to operate within. Every day they try their best to hold back a soulless system which is increasingly inhumane and disrespectful of the dignity and human rights of some of our most vulnerable citizens. Every day they voice their despair to managers and leaders for it to be ignored and set aside.

My old retired social worker friend remarked to me that with an increasingly overt emphasis on clinical care and assessment focussed on making sure people are safe and well but not much more, that the uniqueness of social work (and I would add social care) is being increasingly crowded out and pushed to the edge. The social, community dynamic of social work, which used to see connection and neighbourhood, community and relationships as intrinsic to wellbeing is being sacrificed by the bean counters and political expedients in our towns and villages. Life is more than maintenance.

I hope against hope that on this year’s World Social Work Day the strong voice of social work advocacy, the shout of defending the human rights of all, and the proclamation of the worth and dignity of the least is heard again in loud calls to change and challenge actions which are happening up and down Scotland today.

Someone a bit like Anna Wigeon’s social worker:

Mosaic
by Anna Wigeon

The study, work placements and exams are all done,
And now it is the hour for the clients to come.

Practice process explained and values declared,
Those attending may feel it’s now easier to share.

Hurting hearts, tell unique tales and words,  about need,
Words, they hope,  will be heard. ‘Loss’ is oft a core seed.                    

Those who want  to feel ”whole’ and who yearn to ‘belong’.
The rich gent and poor rogue, might recite common song’.

What change might occur, if a skilled helping hand,
Could give timely support to assist them to stand.

Many stories depicting a myriad of need.
Common circumstance  bringing so many to heed.

The homeless, sleeping on concrete sheets while their wits,
Go to waste and wither down the cracks in the streets.

Then there are those who just want to ‘Be‘.  Be free of,
Societal labelling and that online melee.

No-one’s is excluded from these hardest of roads,
Caused by abuse, violence; into slavery sold?

Thank-you for caring; choosing a social work role,
For giving  solace to those needing consoled.

Your compassion; open mind towards those in ‘chains’,
For your seeing anew and believing in change.

As you give of yourself and your social work skills,
Remember Self-Care and your support team’s good will.

And barring emergency……do try to leave at a reasonable hour!’

From Poems by and for Social Workers – Scottish Poetry Library

Donald Macaskill

Photo by Anne Nygård on Unsplash

Visiting Angelz earns accolade as Scotland’s First Living Hours Accredited Care at Home Service

In a groundbreaking achievement for Scotland’s social care sector, Visiting Angelz, a Renfrewshire-based nurse-led care at home service, has secured Living Hours accreditation, marking a significant milestone in fair employment practices. They are the first social care employer in Scotland to achieve this accolade.

Established in 2012, Visiting Angelz specialises in delivering personal and domestic care services throughout Renfrewshire. By meeting the rigourous criteria for Living Hours accreditation, including the payment of the real Living Wage, providing advanced notice for shifts, and ensuring minimum weekly working hours, the company has demonstrated its commitment to fair compensation and secure working conditions for its employees.

Angela Magee, the Service Manager and Owner of Visiting Angelz, said:

“In these times of hardship in our communities, it is important to not only pay people fairly, but to provide them with stability and security at work and the opportunities that come with that through secure working terms. “Hard-working, dedicated people should have the opportunities to realise their full potential in all areas of their lives.”

Rachel Morrison-McCormick, Projects Coordinator at Living Wage Scotland, commended Visiting Angelz for their dedication to fair work practices, saying:

“We are delighted to welcome Visiting Angelz as our first social care Living Hours employer.

“There are over 3400 Living Wage employers in Scotland and it is great to see Visiting Angelz take further steps to protect their workers from low pay and insecure work.

“The values that led them to commit to the real Living Wage are the same values that have led to their expanded commitment to fair work at a time when workers need it most.”

According to research by the Living Wage Foundation, over 9 per cent of Scottish workers are in insecure work and earn below the Living Wage, accounting for approximately 250,000 workers.

As Scotland grapples with a significant portion of workers facing insecure employment and earning below the Living Wage, initiatives like Living Hours are crucial in promoting stable incomes and predictable working arrangements. Through Living Hours accreditation, Visiting Angelz exemplifies the values of fair employment and strives to provide its workforce with the means to lead fulfilling lives.

This story was featured on the Gazette, have a read here.

Being a shepherd: a reflection on the characteristics of leading.

A couple of days ago I had the very real pleasure of being invited to give a Fireside Chat to the participants in one of the Queen’s Nursing Institute Scotland Leadership Development programmes. The Queens Nursing Institute is an amazing organisation and (in their own words):

‘supports, develops, and inspires Scotland’s community nurses and midwives to become agents for health improvement and catalysts for social change. Together, we are building a healthier, fairer, kinder Scotland.’

My ‘chat’ and conversation was centred around what I considered to be the key characteristics and marks of leadership. Having written more than my fair share on this topic over the years, not least in this blog, I tried to distil some of the main things I have learnt and experienced about leadership wherever that may be held or focussed. Here are some of my reflections:

For me the critical mark of all leadership is the need to be authentic, to mirror the reality of your self, ‘warts and all’. To be the real and raw ‘handmade’ person you are. Too often leaders and managers seek to mould themselves into the likeness of another, and that includes a mentor, or to shape themselves to what they expect the organisation or system demands and wants from them. That is not authentic – it is wearing a mask of pretence and usually (especially when the going gets tough) the masks slips and falls. Authentic leadership requires us to develop an honesty which allows us to be open, transparent and truthful with both ourselves and with others. In my experience such authenticity is what brings people in a team or organisation alongside a leader and strengthens the ability of all to be who they are. We need more people who walk their talk.

A mark of that authenticity for me is that it requires vulnerability. Vulnerability is often perceived as a negative characteristic or quality, but I very much believe that being vulnerable and being open to vulnerability are marks of essential humanity, not least in relationship to others. Vulnerability in itself is not negative; it is only when that vulnerability is mis-used or abused by another that it can become harmful and damaging. Being vulnerable is an openness to the unknownness and sometimes pain of encounter and the risk of losing your protection of self in order to achieve a greater self-discovery. In vulnerability there is a strength beyond the cracks and the brokenness.

A leader who can be strong enough to be emotionally mature and grounded, who is able to show emotion and empathy, to demonstrate the limitations of their own knowledge and skill is one that others can see something of themselves within.

Another element I reflected on was how important it is that leadership has a sense of purpose and direction about it. This is all the more important when particular context or circumstance is taken into account. In emergency situations for instance we do not look for a laissez fair attitude, a consultative engagement as primary, but rather when the chips are down, we want someone to be inclusively directive whilst appreciative of the diversity of those they lead and the requirement to shape action or response to the capacities of an individual. Occasions and contexts matter and whilst a leader should not be dominated by them a failure to be sensitive to the realities of the world around and an inability to be practically pragmatic helps no-one.

Over the years I recognise that the best leaders I have been privileged to work and be alongside, are individuals who whilst they have a clear purpose, direction, and vision, have invested in the people around them rather than just the achievement of particular goals. It used to be that being described as a ‘people person’ was considered something of lesser worth and value than someone who was influenced and dominated by process and models, outcomes, and outputs. Thankfully leadership and management approaches now recognise that the greatest asset in any organisation or system are the people and that nurturing and developing them is an essential task of team and group leadership.

There are other qualities I could add, such as the importance of determination and the ability to keep going despite obstacles or circumstance; the development of a resilience which isn’t just a springing back to doing things the way you have always done them but an openness to the new and innovative. I think of the ability to get to know the landscape and environment around you and to appreciate that the world we live in changes continually and often dramatically; or the recognition that we all change and need to adapt and be open to our own physical, mental, and emotional journeys.

I shared with the nurses I spoke to that over the years I have found strength in some of the metaphors and models for leadership, including the maieutic which considers a leader from the perspective of a midwife. But more recently, and in no small part, from reflecting on the life of my late uncle I have started to consider the metaphor of the shepherd as resonating with me in terms of what it conveys about leadership.

I have mentioned my late uncle Donald before. He was by modern descriptors someone who had a learning disability and who struggled with verbal communication, though those who knew him well could converse with him easily. A man of quiet behaviour and few words but of determined focus and comfortable routine, like many of his island age, he was a crofter-shepherd. In his case this was an art he carried out in the barren though colourful moorlands of north-west Skye.

Over the days and weeks, I spent with him I began to understand what the life of a shepherd was and much of it strikes me as descriptive of the essence of modern leadership in any context. It wasn’t a syrupy or romantic image or reality. it was hard and real. It included the need for preparation and planning, making sure you were appropriately dressed and prepared for the weather to change at any minute; a humility that recognised that you can never do things on your own but that shepherding is always a collective act even if alone; the appreciation of the need to know your environment and the limitation of your own knowledge; an openness to be moulded and changed by circumstance and terrain; a willingness to take your lead from those who ostensibly you are there to lead; to be able to read the happenings of the moment and to listen with a silence where sound can be heard in all its subtle invitations. It was a life which sought to become attuned to the rhythms of nature and which was rooted in the humble awareness of human insignificance in the face of the elements and the rawness of death and birth, grief and renewal.

But being a shepherd then was always about creativity and ingenuity, especially in the absence of easily accessible modern technology; it was a practised art where skill was developed over years of practice and the insights of failure and error as much as the moments of success. You had to be adaptable and innovative and able to use what you had around you.

Whatever your model of leadership, whatever metaphor speaks to you, there is a sense of dynamic movement about leading – ours is the task both as leaders (in whatever way) or as those who are led, to move towards the creation of communities and organisations, teams, and societies, where the voice of all are heard and the value of everyone is upheld, and where together we can all flourish and thrive, which is the daily task of social care.

Donald Macaskill

International Women’s Day 2024 – Spotlight

This International Women’s Day, we shine a spotlight on the remarkable achievements of past female winners at the Care Home Awards 2023 and Care at Home Awards 2023, celebrating their invaluable contributions to the social care sector.

With over 80% of the Scottish social service sector workforce being women, we extend our heartfelt gratitude to all the women tirelessly serving in various roles, enriching lives and fostering compassionate care across Scotland.

#IWD2024 #InternationalWomensDay #shinealight


Care at Home & Housing Support Awards 2023

Care Service Coordination/Administration Award – Karrie Henderson, myCare Grampian

Care Learning Award – Sharon Barton, Plus Homecare

Leadership Award – Liz Cassidy, Altogether Care Services

Positive Impact Award – Rachel Shepherd, Call-In Homecare

Strategic Contribution Award – Anna Houston, HRM Homecare

Care Home Awards 2023

Ancillary & Support Award – Maureen Cameron, Manor Grange Care Home

Meaningful Activity Award – Benore Care Home Wellbeing Team

Emerging Talent Award – Brogan McKay, Manor Grange Care Home

Outstanding Achievement Award – Sharon Findlay, Benore Care Home

Leadership Award – Kirsty Cartin, Rashielee Care Home

Nurse of the Year Award – Vany Thomas, Benore Care Home

Care Worker of the Year Award – Tracy Libby, Four Hills

Care at Home & Housing Support Awards 2024 – Deadline Extended!

Care at Home & Housing Support Awards 2024

Entry deadline extended – 18 March
Great news! We’ve extended the deadline for nominations to our annual Care at Home & Housing Support Awards until 5:00 pm on Monday 18 March 2024.

Don’t miss out on the chance to nominate deserving individuals and organisations in the homecare sector across Scotland. With 10 award categories, there’s ample opportunity to celebrate exceptional skills and commitment.

Before submitting your nomination, please review the guidelines carefully to ensure compliance with judging criteria.

Judging will take place in March/April, with the Awards Ceremony set for Friday 17 May, at the Radisson Blu Hotel in Glasgow, following the 2024 Care at Home & Housing Support Conference.

Don’t miss out on early bird tickets for the conference and book your place before the end of March here!

Join us in recognising the outstanding contributions of our dedicated homecare professionals and enter the awards now!

Find out more and enter here.

Media Statement: Concerns over North Ayrshire Homecare Support

Scottish Care Media Release

For immediate release

Scottish Care voices concern over North Ayrshire homecare support

Scottish Care is the representative body of care at home providers who are charitable, not for profit, private and employee owned. Our members deliver most of the care and support for adults and older adults right across Scotland. As an organisation we very rarely make public comment on local actions, but we find ourselves unable to remain silent about what is happening in North Ayrshire at the present time.

In a recent statement North Ayrshire Health and Social Care Partnership (NAHSCP) has stated that they have decided to take all homecare support ‘in house’ and to end the contracts of existing non-Council providers from June 2024.

Scottish Care is concerned that actions of the NAHSCP endangers the care and support of those who are at the moment receiving services in the North Ayrshire area and which in the future will limit the legal rights and choices of residents in the area.

Scottish Care has several major concerns:

  • The NAHSCP has stated that their decision to bring all homecare services in house is for reasons of quality and that they have ‘invested’ in this decision. The NAHSCP has not published the costs of in-house services although precedent suggests they will cost more than double the cost of outsourced care and support it is possible therefore that in a time of austerity and service cuts that this decision will result in fewer people in North Ayrshire receiving the care and support they deserve and require, in an effort to balance books.
  • Whilst the NAHSCP has sought to reassure individuals that they will have the right to remain with existing providers and staff, we have no confidence of the independence of information and support being given to people. Will citizens have real choice and an independent support to allow them to make the decision which is right for them rather than what suits the NAHSCP?
  • Every person who requires social care and support, anywhere in Scotland, has the right to choose a provider (whether the Council or not) to provide that care. Scottish Care is concerned that in the future residents of North Ayrshire will be denied this legal right. We need assurance from the NAHSCP that they will continue to make available the services of other providers and that they will give independent information about their availability, and that they will comply with their legal duties in terms of the Social Care (Self-directed Support) (Scotland) Act 2013 (SDS Act).
  • The SDS Act places a requirement upon a local authority or HSCPs ‘to promote a variety of providers of support and a variety of support’ (sections 19 of the Act). This means that people have a range of providers to choose from. Scottish Care does not believe that anyone (whether a public, private or charitable provider) should have an effective monopoly in any area. The right to informed choice which the SDS Act enshrines requires there to be real choice. How can that be the case if the Council delivers all services? We would like North Ayrshire HSCP to communicate with ourselves and more importantly to the citizens of North Ayrshire as to how they will fulfil their legal requirements and how they intend to ‘promote a variety of providers.?
  • Scottish Care also highlights the report on the National Care Service (NCS)(Scotland) Bill (Stage 1), in relation to ethical commissioning. Recommendation 86 emphasises a “personalisation agenda as established within self-directed support legislation, ensuring choice and control for individuals to ensure the best possible outcomes”. This is achieved through a “plurality of provider to ensure that local care meets the needs and preferences of individuals”. Given this, Scottish Care seeks clarification surrounding the NAHSCP’s decision to conflict with the recommendations of the Scottish Parliament’s Health, Social Care and Sport Committee, and the subsequent legislative direction of Scotland in regard to ethical commissioning.
  • Lastly, the NAHSCP believes that most of the workers employed by existing providers will want to transfer to their employment. We already know many will not because they simply do not want to work for the Council. This will mean an even greater shortage of workers at such a critical time. Scottish Care would like to know if the NAHSCP has undertaken an equality and human rights risk assessment on their decision especially as it affects the rights of this predominantly female and older workforce. Sadly, we do not believe the rights of frontline workers have been respected.

In conclusion every citizen in Scotland who requires social care and support deserves to be treated in a manner that respects their individual dignity and the right to have control and choice over their lives. The SDS Act came about after years of campaigning by disability and older people groups who were tired of a situation where there was a take it or leave it approach, where people had no choice or control over the social care and support they receive. Scottish Care is very concerned that these hard fought for human rights are effectively being denied by the actions of the North Ayrshire Health and Social Care Partnership. By their actions NAHSCP have taken a step back in time rather than a step forward. Local residents and users of services both now and in the future, urgently need the NAHSCP to answer some fundamental questions.


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Deeside Care Home Charity Walk

Deeside Care Home in Aberdeen is taking part in the ‘Walk 100K in March Challenge 2024’ for Scotland’s Charity Air Ambulance.

Staff from the care home will be walking this March for a good cause and to help raise much needed funds to keep our air ambulance crews saving lives in Scotland! We wish them all the best of luck for this challenge!

Digital & Data Skills Resource Hub – Pilot launched

The Digitally Enabled Workforce (DEW) Team from NHS Education for Scotland has recently launched the Digital and Data Skills Resource Hub. Colleagues across health and social care (including housing, charities and third sector) are invited to join the pilot phase, running throughout the month of March.

Anyone working or volunteering within the sector can register to receive a link to the hub, where they’ll have a chance to browse and access over 200 free resources, before leaving feedback via a short online evaluation form.

Please register for this here.