Let’s make 2018 the Year of Social Care

In one of the most famous broadcasts since the start of radio, George VI used the words of the poet Minnie Haskins to start the New Year in 1939

‘And I said to the man who stood at the gate of the year:
‘Give me a light that I may tread softly into the unknown.’

These words were uttered at a point in history of great uncertainty, fear and alarm at the start of the year which would see the horrors of the Second World War start to unfold.

They are also words which over time became synonymous with the start of the year, with the sense of journeying into a future which was undetermined and full both of potential and challenge.

To some degree every New Year message from politician and commentator alike has combined a mixture of reflective analysis of the year that has past and a consideration of both the challenge and the potential of the year that is to come. The recent flurry in the last few days of such messages from Scottish politicians has tended to concentrate on the extent to which 2018 is a year which because it is the Year of Young People will enable us to focus on the contribution of the young to moulding our modern Scottish society.

In this message at the start of 2018 I would like to suggest that 2018 should be the Year of Social Care – regardless of the age of those who might be in need of the essential life enabling support and care which social care offers.

I do so well aware that in 2018 we will witness the 70th anniversary of the NHS in the United Kingdom. That celebration will help us to focus on the amazing contribution which the NHS and those who work in it have made to ensuring the health and wellbeing of our communities. Over the last 70 years we have seen extra-ordinary advances in care and treatment which have helped eradicate many of the diseases which formerly scarred society, control many others and result in astonishing progress in life expectancy and the quality of life for countless millions. So, 2018 will indeed be a year to celebrate the NHS.

But we are increasingly aware of the interdependency of social care with the clinical health system represented by the work of the NHS. The integration of health and social care in Scotland underlines a reality that we have long been aware of – namely that a failure in one part of the health and care eco-system, including a failure to adequately resource, has profound impact on another connected area. At the present time, the impact of the flu epidemic which is putting strain on the NHS, stretching A&E services, and impacting on delayed discharge is evidenced in the related struggles to arrange packages of social care to enable people to be discharged and to be supported at home or in a homely setting.

The celebration of the NHS reaching 70 will be somewhat hollow and vacuous if it is against a backdrop of the sounds of a disintegrating and deteriorating social care system.

Social care in Scotland is at a crossroads as we move into 2018.

Regular readers of these blogs will be well aware that throughout 2017 I have been warning of the ‘crisis’ facing social care. We have 9 out of 10 home care providers struggling to recruit staff and in the last few weeks faced with increased staff illness, the challenge of the better-paid retail sector, and ever shortening time-slots in which to deliver dignified care – home care providers have been really challenged to keep the show on the road and deliver urgent care and support at the point of need, no matter how isolated those locations might be.
Our care home providers faced with a vacancy level of 31% for nurses, nearly a quarter of care staff leaving the sector last year and with the already real living nightmare of Brexit, they are continuing to deliver increasingly high-quality care to some of our most vulnerable citizens in palliative and end of life contexts and to individuals living with the challenges of advanced dementia.

We have, in Scotland, so much which is full of potential and promise. Staff who are quite simply astonishingly professional and multi-skilled despite being paid basic wages. Legislation around Self-directed Support which has the potential of giving real choice and control to the individual citizen, which builds support around the person rather than the needs of the system. We have the start of the Health and Social Care Standards which have human rights at their heart and which if properly implemented and supported will help to advance care. We have new legislation which seeks to put carers at the heart of an effective and resourced support system in recognition of their critical contribution. The potential therefore is evident – the challenge in 2018 is to realise that potential.

As I write this piece our politicians are discussing and debating the Budget proposals of the Scottish Government. Despite my own call for a 3-year urgent investment of £1 billion pounds in the whole social care system, that Budget has promised only an additional £66 million to ensure the reforms, developments and delivery of this critical part of our social fabric. I hope the politicians who do have influence hear the urgent calls for further substantial investment in social care in Scotland. We can no longer tolerate the shame of 15 mins visits, where dignified end of life care and support, where the opportunity of personal care, is being crowded out by the budgets of austerity which affect the old, infirm and dying most sharply. We can no longer as we move into 2018 consider it acceptable that your chronological age has become the determinant of whether you get the opportunities to live a meaningful and independent life.

‘And I said to the man who stood at the gate of the year:
‘Give me a light that I may tread softly into the unknown.’

2018 needs to be the Year of Social Care in Scotland. A year when as a society we make the choice to value those who care and the work of care as making an essential contribution to Scotland rather than being a drain on our nation; where we celebrate the astonishing dedication and skill of the 10s of thousands who today care for our fellows in challenging, emotional and draining circumstances by properly rewarding them; and when we adequately resource social care especially for our vulnerable old to enable them to live life to the full and to die well.

Our political leaders have the opportunity of leading us into that future or merely standing still at the gate.

Dr Donald Macaskill
@DrDMacaskill