State of the Nation: Global Perspectives
Series 3 / Episode 4
Episode 4: Navigating the Future of Social Care
“Good care is the embodiment of good human rights practice.”
In Episode 4 of State of Our Nation: Global Perspectives, Kari Gerstheimer is joined by Donald Macaskill, Chief Executive of Scottish Care, for a wide-ranging and deeply reflective conversation about the state of social care in Scotland and what it reveals about the challenges facing care systems more broadly.
Donald brings to the discussion decades of experience across social care, human rights, bereavement, and palliative care. But as he makes clear from the outset, his commitment to social care did not begin with policy or professional titles. It began with people.
A journey shaped by relationships
Like many who work in care, Donald did not “choose” social care so much as find himself drawn into it through family, community, and lived experience. Before he ever named it as a career, he was supporting older relatives, family members with disabilities, and learning from those working in nursing and clinical roles.
His early professional work focused on adult education and learning disability services, including supporting people to move out of long-stay hospitals and into their own communities for the first time.
“That moment,” Donald reflects, “when people were able to live beyond the labels they had been given,” stayed with him.
Later, his work in human rights and equality consultancy helped him articulate what he had long felt instinctively: that care is not simply a service, but a mechanism through which autonomy, dignity, and rights are either realised or denied.
Pride, not in achievements, but in moments
When asked what he is most proud of in his career, Donald does not point to legislation, structures, or organisational milestones. Instead, he returns again to relationships.
The moments that matter most, he explains, are the quiet ones. Sitting with someone at the end of their life. Listening to their story. Removing fear so that a person can die in peace, surrounded by those they love.
“Those relationship moments,” he says, “are what pastoral and social care is about. And ultimately, that is what human rights are about.”
It is here that Donald raises a theme that runs throughout the episode: the need to plan for end-of-life care with the same seriousness and intention that society plans for birth and early life.
“We plan for the first to the nth degree,” he notes. “We do very little planning for the latter.”
The promise and failure of reform in Scotland
The conversation then turns to Scotland’s attempt to create a National Care Service, an ambition that initially generated widespread hope.
Donald speaks highly of the Feeley Review, commissioned during the pandemic, which listened carefully to people drawing on care, families, workers, providers, and communities. Its recommendations were widely supported and grounded in a shared vision of consistency, quality, and rights-based care.
But what followed, he argues, was a cautionary tale.
What began as a collective, values-led process became politicised, centralised, and disconnected from those delivering and receiving care. Providers, workers, and communities were marginalised. What emerged was not the National Care Service envisaged in the review, but a diluted reform that lost its purpose.
“We have the principles,” Donald says. “But we don’t have the implementation.”
For reform to succeed, he argues, three things are essential: genuine co-production with all stakeholders, cross-party political agreement to protect reform from election cycles, and the hard, often unglamorous work of implementation.
Without these, even the best legislation risks sitting on the shelf.
A human rights crisis in plain sight
One of the most powerful parts of the conversation centres on Donald’s assertion that social care in Scotland is facing a human rights crisis.
Despite strong legislative frameworks, many people do not know their rights, cannot access them, or are told they are entitled to care that simply cannot be delivered due to lack of funding or workforce.
“We recognise that you are entitled to X,” he says, describing the system’s response to individuals in need. “But we can’t deliver it.”
Donald speaks movingly about people waiting weeks or months for care assessments or placements, some of whom die while waiting. Their stories are largely invisible, known only to families and local communities.
“These are hidden deaths,” he says. “And they should shame us.”
He is clear that this invisibility would not be tolerated elsewhere in the system, and that age plays a significant role in why it is allowed to persist.
“We are a profoundly ageist society.”
A hopeful future, if we choose it
Despite the challenges, Donald ends the conversation with optimism.
He points to innovation, technology, and ethical approaches to artificial intelligence as opportunities to enhance autonomy and personalise care, provided they are grounded in human rights and strong relationships.
“The future for care is a bright one,” he says. “But only if we change how we value people, how we value care, and how we share what works.”
For Donald, progress depends on collaboration rather than competition, openness rather than defensiveness, and a willingness to share innovation across borders and systems.
“We can’t be precious,” he reminds us. “We need to share our innovation.”
Episode 4 of State of Our Nation: Global Perspectives is out now.
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You can find the series on Spotify Apple Podcasts, or listen to each episode on our website. Just click on the link to the right.
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Promo graphic of Kari for State of our Nation Podcast
Promo graphic of Kari and Andy for State of our Nation Podcast
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