I have had some challenging and hard conversations and encounters in the last few days. Indeed, I would go so far as to say that they have been some of the most difficult conversations I have had in many a while. In reflecting at the end of the week on each of them I cannot but conclude that there was a common thread running through the experience of the folks who shared their stories and insights with me – and that was the fact that each of the people were experiencing trauma.
My first conversation was with the manager of a care at home service who informed me that officials at his local Health and Social Care Partnership had told him that they required to make substantial budget savings and because of that they would be reducing the number of packages of care at home which would be available for him to put his name forward for. He reflected that for the council contract staff that this was just about budgets, and finance and numbers but for him it was a change which put the sustainability of his very organisation into question. And that ‘turned his blood cold’ in his own words because he had been in business for nearly two decades, providing what was considered to be high quality care (according to the Inspectorate) and that he had employed a loyal, dedicated and professional staff. He was hyper-anxious when I spoke to him about the limited options he had available; he was desperate to keep things going not only because he was a key local employer in an area where there were few but critically because what broke his heart was the thought of telling customers and staff that things were going to have to change – dramatically. He was in every sense traumatised by what he saw as a short-sighted decision to make savage cuts to local social care and support. He wasn’t sleeping, felt manic, his blood-pressure was through the roof, and he had an overwhelming sense of hopelessness.
My second conversation was with a frontline care worker whose homecare organisation had like so many in the last few weeks been told by their HSCP that cuts were having to be made. However, in this case the organisation would keep going because it was in an area where the folks were able to buy their care even when the local authority had withdrawn packages of care and support. But the reason the worker was in tears was that she had spent that morning on her round saying goodbye to people she had known for months and in some cases years. She recounted one instance where a lady in her eighties who had declining sight and was virtually housebound had up till then been receiving a daily care and support package but after a ‘review’ this had been cut back by a massive degree. The lost relationship, the friendship, the familiarity and knowledge built up between the pair counted for nothing as the HSCP and its ‘reviewers’ (who had not visited her to tell her of the change) cut her service. The carer was in tears as one by one relationships were fractured not because (in her estimation and professional opinion) the care was no longer needed but that someone, somewhere, had decided it was no longer affordable. She was so very upset… she told me she had been traumatised by her morning.
And in a week which has been the national annual Carers Week with lots of photo opportunities for our politicians, I spoke to the wife of a man who had received care and support for many years because of a degenerative neurological condition. Like hundreds across Scotland, she had been told that her husband’s package of care and support was being reduced ‘after re-assessment’. She was at her wits end as to how she could cope. She was getting frail and older herself and the thought of having to do more for her husband was draining her. She had no family nearby and all her neighbours were either older than her or had their own issues. She desperately needed the support to continue, to get time for herself, to have some respite from caring. Yes, she had an increased allowance, yes she had accessed all the financial support she could, but what she really needed was the daily relief of someone else who knew her husband being present, being there, being for her. Someone else to share her burden and questions and exhaustion. She feels utterly and completely abandoned.
Each of these conversations left a mark on me because it is clear to me in their own way that each person was traumatised and going through trauma because of what was happening in their lives.
I know the response to what I have written will be – especially during an election – to posit understanding and then to cast the blame and responsibility to another – the lack of UK Government funding; the lack of resource from Scottish Government given the level of increased need; the failure of the local decision makers and so on. But to be frank I am tired of the pass the buck mentality and lack of honesty, the failure to own up collectively as a nation, as political leaders, as social care and health leaders, that the system is well and truly broken. And more than that that the decisions to cut care packages, to review and stop, to reduce the number of care beds being occupied or the number of care packages being contracted – all of it has and is traumatising some of the most valuable and vulnerable people in our communities. It is not fair. It is not just. And it is not the Scotland I want to live in.
I am familiar with trauma both as a concept and as a lived reality. We hear a lot of talk in the world of social care about trauma and what has become known as trauma informed practice. Indeed, the latter is now a core element underpinning the latest professional standards from the regulator. More than that Scottish Government guidance states that all social care and related practice should be understood and responded to through a trauma lens.
Trauma can be variously described but a simple definition states that:
“Trauma results from an event, series of events, or set of circumstances that is experienced by an individual as harmful or life threatening. While unique to the individual, generally the experience of trauma can cause lasting adverse effects, limiting the ability to function and achieve mental, physical, social, emotional or spiritual well-being.”
And our trauma informed practice in social care and social work is that which:
“is an approach to health and care interventions which is grounded in the understanding that trauma exposure can impact an individual’s neurological, biological, psychological and social development.”
Social care practitioners and services know what is required to support those who have been traumatised. At the heart of such attention is their physical, psychological and emotional safety and attempting through all means to prevent re-traumatisation for the person being cared for and supported.
Now I recognise that the concept of trauma and trauma-informed practice is not universally accepted and there does indeed need to be safeguards as brilliantly delineated in the recent work of Mark Smith and Sebastian Monteux who have suggested caution in its application ‘lest a predominant focus on trauma may construct the kind of psychological conditions it professes to respond to.’
But at a very human level what is happening in Scotland to our social care services and supports at this time is resulting in very real trauma, harm and suffering. Perversely those charged with fostering the delivery of compassionate trauma informed practical care and support are now the agents of re-traumatising a damaged and vulnerable citizenhood.
For the staff and managers I have spoken to there is clear evidence of the trauma they are experiencing resulting in burnout, emotional and compassion fatigue; they are being overwhelmed by resource limitations which are resulting in very acute conflicted values. This level of chronic stress is leading to exhaustion, anxiety, depression and acute self-doubt. It is also for many resulting in what I can only describe as vicarious trauma where the trauma experiences of supported people and those being cared for create a sense of vulnerability and helplessness in the worker and manager.
We urgently need to address the reality which is a traumatised social care system, workforce and those who require social care supports. We cannot continue to do more harm in the name of fiscal and resource re-allocation and prioritisation. There has to be a more honest way of addressing the crisis of social care in Scotland than traumatising those who deliver, work in and use our services.
Donald Macaskill