The invisibility of loneliness: an opportunity to change – a blog from our CEO.

Like many others working in social care I receive invitations to attend events and conferences. This week I have received notification of no less than three conferences in the next two months looking at the issue of loneliness and isolation both during the pandemic and before/beyond it. Loneliness seems to be an issue of real concern at the present time.

I don’t suppose any of us would have imagined in March that as a society we were going to be starting a process of months of social isolation and social distancing, being physically apart from those who matter to us and distant from those we know and love. For many of us that has been very hard indeed but the slow return to connection and relationship has been one of the few positives over the last few weeks of summer. But this sadly is not the case for everyone.

In a world and at a time when relationship and connection seem to be all the more important there are those in our communities who are dis-connected and alone.

At the height of the pandemic I received a call from someone who before Covid19 led an active life contributing to a diverse range of organisations and groups. To do so they required the support of a carer because of their own life-long disabilities. With the start of the pandemic all that disappeared as their social care package was reduced and then frozen. Virtually overnight they became disconnected, deeply impacting on their sense of self and identity. For this individual isolation meant a loss of more than simply being able to be out and about, it stripped them of their confidence and self-esteem. Incidentally like so many this person’s package of care and support has still not been renewed. They have been told that they seemed to have ‘managed’ without paid care!

Coronavirus and the imposed lockdown has deeply impacted thousands of individuals and created for them a sense of loneliness and isolation. In June an ONS Opinion and Lifestyle Survey found that about 1 in 4 people aged 55-69 and almost 3 in 10 people aged 70+ felt lonely in the preceding week. There have also been a range of academic papers and studies highlighting the degree to which people of all ages have felt lonely and isolated during the lockdown.

It is clear even at this early stage that this has and is having a profound impact on mental health and wellbeing. What might surprise some is that those most impacted by loneliness have been those in younger and middle years. Sadly, for those working in social care this may not be a shock – mainly because we have known that older people have experienced loneliness and isolation for many years!

In a world which presupposes relationship as being intrinsic to well-being years of research have shown us that loneliness is the day to day, week by week, month by month experience of older people in Scotland. One survey by the National Campaign to End Loneliness undertaken a couple of years ago found that of the older population of the city of Glasgow, it is estimated that 10% can go days or weeks without having any contact with anyone. It stated that loneliness and its impact can have such negative health determinants that it is the equivalent of smoking fifteen cigarettes a day.

With over 1.4 million people in the United Kingdom reported as being lonely, the issue has been known for years. During Covid19 an estimated 6.1 million people were living on their own, of whom around 2.2 million people are over 75. For millions Covid19 lockdown was a time of real loneliness and deep isolation.

As we come out of strict lockdown and as we prepare for winter and the challenges which it will bring in our management of Coronavirus I think it is urgent that we address now issues of loneliness and the hugely negative impacts that isolation can have on the health and wellbeing of people. It is clear that this has been the case in our care homes. However, the impact of isolation and loneliness in our wider community has not received the focus and attention that it urgently requires. Without any sense of hyperbole loneliness can kill.

Now lest I get accused of over-simplification. I recognise that for many being on your own is not intrinsically negative and admittedly much of the recent debate has ignored the benefits of solitude. There is a world of difference between social isolation and forced loneliness over which you have no control and which you do not desire, and the reality for many which is a decision to be single and alone. There has been an automatic presumption of the negativity of aloneness in much of the consideration of these issues. So, what we need rather is a serious debate about what loneliness is and what interventions are needed, which will be beneficial for both the individual citizen and society as large. That is a debate we urgently need to have in these mid-Covid times.

I hope as we consider the impact of loneliness we also reflect on what social care can bring to that debate. Social care in essence is not about engaging in a set of transactions and functional tasks rather it has at its heart the enabling of individual citizenship and the fostering of relationship. In decades gone by the person who used to be known as the ‘home help’ was an individual who not only carried out daily tasks but much more importantly spent time with and gave time to those they cared for. They were the eyes and ears of protection and prevention, they were the carrier of community insight and gossip, they were the ear to listen to and the person to unburden upon.  When we stripped out this element of care in the reforms of homecare in the 1990s we lost not just individual characters, but we lost a sense of connectedness and cohesion. Care is about a relatedness which reduces isolation and fosters connection by creating community.

Moving into the autumn and winter I hope as we restore packages of support and care in our communities, as family members return to work and ‘paid carers’ take over, I hope we use this time to address the challenges of loneliness. Now is the time to change our view of what homecare is all about. Now is the time to restore time, relationship and connection.

For years people like me have criticised the way in which as a society in Scotland we have apportioned and commissioned social care for our older citizens. Before the pandemic Scottish Care estimated that at least a third of Scottish councils commissioned 15-minute visits for the provision of personal care. Despite all the political rhetoric to the contrary we still have thousands of people experiencing the indignity of the degrading practice of flying visits. For many individuals receiving support at home, 15-minute personal care visits barely allow for tasks to be completed, let alone to develop a positive relationship between the individual and their carer. Never mind the battery care-hen pressures they place on the worker by electronic call monitoring and checks.

We must surely use the opportunities presented by Covid19 to invest more in the care of our older citizens in the community. Whatever happens with a second wave or with outbreaks and lockdowns we have to do better by those who require care and support in our communities. One way of addressing loneliness is to stop treating people as a problem to be solved but rather to empower them to be in control of their packages of care. That is what we have already in legislation (the Self-directed Support Act) but the system and vested interest and mantra has prevented real control and power being given to those who require care. Let us end 15-minute visits, let us pay for people to spend time with our older citizens, to be present rather than to be clock-watchers for the next call.

A society where loneliness becomes a political policy priority, but not where the same political system is prepared to allocate resource to address the issue is less than it should be; a community where contact is reduced by the arithmetic of affordability does not in any sense value those who it should care for; and a place where older age is considered to be beyond contribution – such a society needs to rediscover the essence of a love and regard for others, which would be a true pandemic legacy.

Loneliness is not just the absence of others rather it is that emptiness created by absence which reaches inside a person and holds them. It is the sense of physical and emotional abandonment and complete aloneness; the sense that no one is there for you, no one is listening to you, and no one is truly hearing you. That tragically is what too many feel today. A social care system worthy of its name should seek to support and uphold not just by care but by being ‘social.’

Donald Macaskill

@DrDMacaskill