The bridge of care: how should we start thinking about a new way of doing social care in Scotland?

Skye Bridge

Recently the Scottish Government published its consultation on a National Care Service. All of us involved in social care must plan our next steps with care and mutuality – while paying critical and urgent regard to the crisis of the present time

Donald Macaskill

I crossed one of my favourite bridges yesterday – one which has a long resonance within my experience. The Skye Bridge is synonymous with the struggle of a community determined not to have to pay exorbitant bridge tolls and who carried out a successful campaign in the late 1990s, one which belied both court and parliament.

Indeed, bridges have long fascinated me – probably since my late uncle showed me his signature on a bridge over the River Hamara in Glendale, Skye because he had been involved in building it. As a child it seemed to me to be huge, but in truth it was but a few feet in length. The idea of something which brought you from one side to another, something which you could build to provide safety and passage, fascinated me from that moment on.

How do we get from where we are now?

Recently the Scottish Government published their consultation on a National Care Service. I will make further comment on its contents and proposals in another blog or space – but what has fascinated me this past week isn’t so much the vision of the future but the ‘how’: how do we get from where we are now in terms of social care support delivery in Scotland, to the vision or prospect which is held before us in both the consultation and in other proposals which are beginning to emerge in civic society? I think reflecting on that ‘how’ is important because it will either help to achieve the vision, or hinder it.

Speaking subsequently to the AGM of Scottish Care members, I heard the concern of many that the next few weeks, months and years will be ones of real importance. Getting from where we are to where we want to be involves planning and preparation, focus and concentration. I know that all too well. Climbing a Skye mountain is a challenge in itself – obtaining and developing a vision for how you see the future of social care is an equally arduous task – but as with any climb, it is both the preparation for the climb which is essential and also the descent that often causes the most harm and poses the greatest risk. Having a vision is all very well, but moving towards that future vision is where risk and harm can really happen.

That is where I feel the image of the bridge comes in. A bridge is not an incidental or accidental combination of brick and mortar, steel and structure, but the fashioning of materials for a purpose which entails design, calculation and precision. Too often, we rush to get to the other side without thinking about the importance of the route we travel or what we use to get us there.

Stop the blame game

It is critical that all of us involved in social care plan our next steps with care and mutuality – be we people who use support or frontline workers, managers or owners of care services, trade unionists or politicians.

We need to think of how we support and nourish our workforce who are tired and drained, so that they stick with it and continue to dedicate themselves to the art of caring. We need to stop the blame game for care providers and work together to create a future worthy of our communities of compassion. We need to bestow trust upon professionals delivering our care home services rather than hauling them before investigations and oversight, scrutiny and inspection. We have to chase away the falsity of infection prevention practices which negate human living by treating a care home like an acute infection unit. We need to work with every sinew to build confidence and remove fear so that we can urgently return to the normality of care home living. We need to allow people to take risks, including the risk of acting in ways which may harm themselves if it is their choice with capacity.

We need to think about mutuality not as an airy concept but as a practical, day-to-day reality where the professionalism of one group is valued, appreciated and affirmed by another. We need the false dualities of care and health to become entwined in a regard which puts the person at the centre, and treats them not as ‘cared for’ or ‘patient’ but as citizen and director of their living health and wellbeing. We cannot wait for a reform to commissioning, but must end now the obscenity of 15-minute visits and the penalising of frontline staff. And so on and so on …

One of my favourite poets is the American Emily Dickinson. She led a secluded and quiet life, and her poetry was unconventional both when it was written in the 19th century and for some still now. She is considered by many as one of the greatest female poets. One of her commonest motifs and images was that of the bridge. Her most famous bridge poem is this one:

Faithis the Pierless Bridge

Faithis the Pierless Bridge
Supporting what We see
Unto the Scene that We do not
Too slender for the eye
It bears the Soul as bold
As it were rocked in Steel
With Arms of Steel at either side
It joinsbehind the Veil
To what, could We presume
The Bridge would cease to be
To Our far, vacillating Feet
A first Necessity.

Dickinson’s poem is not primarily about religious faith though uses the metaphors of faith traditions. It imagines a sceptical explorer crossing a bridge (possibly the Niagara Falls Bridge). It is a bridge without piers (a suspension bridge) that extends from what we see to what we do not see. It connects what we know to the unknown. It is not a wobbly wooden-planked bridge but, as one commentator has said, is personified as a mother gently rocking her child (the soul) with arms of steel.

A new way of doing and being social care

The way we cross the bridge, the way we move into the future, will determine what is on the other side as much as what we have left behind. So too, I suspect, it will be with the creation of a new way of doing and being social care.

In our creation of a new model or new systems, we have to characterise our behaviour as one of care, bestowing autonomy and choice, nurturing humanity and dignity, and fulfilling rights and equality. We can walk with care and compassion, treading a bridge which brings renewal, or we can ignore the reality of the present. To achieve all this, we must have critical and urgent regard to the crisis of the present time – and social care in Scotland has, I believe, rarely been in such a state of multiple crises.

The making of the future is built upon the changing of the present. You cannot build a bridge you expect to walk over by pulling up and destroying the planks on which you walk.

Dr Donald Macaskill is the Chief Executive of Scottish Care, which offers a voice for care providers and their workforce throughout Scotland.

  • This blog was first published on the Scottish Care website and is reproduced with kind permission.