By Catherine Needham and Judith Smith
The Buurtzorg model of home care appears to be the innovation of the moment in community health and social care. Self-managing teams of nurses provide high quality care to over 10,000 people in the Netherlands. The model evaluates well: it is cost effective, in part because the lack of management keeps administration costs very low. The Buurtzorg model is now being adopted in parts of the US and Japan and there are attempts to implement it in the UK.
At a recent two day Anglo-Dutch Dialogue conference held in Utrecht with senior policy makers, practitioners, academics and user/carer organisations from the two countries, we were able to find out more about what works well in long-term care for the elderly in the Netherlands and to share learning from experience in England.
Many of the Dutch indicators are much more auspicious than our own. They have a smaller population, higher spending on care services and fewer older people living in poverty. Yet like England they are struggling to provide high quality care services that are personalised and support wellbeing, rather than just addressing functional needs. Cure, i.e. the health system, is privileged over care, and efforts to achieve more integration do not appear to have advanced very far.
There were also points of difference. Rates of residential care home usage in the Netherlands are higher than in the U.K. The Netherlands is moving towards a more localised approach to care provision, with the recent Long Term Care Act giving municipalities more control over care. In England, city regions, Sustainability and Transformation Plans, and the introduction of national eligibility criteria for social care may suggest a weakening of municipal control.
Over the two days in Utrecht we saw a robot that could do the dance moves to YMCA (being used to run fitness classes in a care home) and an ageing suit that allows trainee nurses and social care staff to experience the mobility challenges of people in old age. The technologies were impressive but the two models that may have the most to offer the UK were not in fact high tech.
The first was Wijkzorg, an existing care company which has used the insights of Buurtzorg to rebuild its care model from within. New teams of staff were recruited by Wijkzorg using the Buurtzorg model of self-management. The new team was kept entirely insulated from the wider staff team to avoid them adopting the existing organisational culture. This new approach proved so effective and popular with staff that now the whole company has been rebuilt on this model. It was not without its challenges - it took several years to enact, and some staff were not able to make the transition to the new way of working. This is not an innovation so much as the successful borrowing and adaptation of someone else's idea (Buurtzorg, with whom Wijkzorg shared a platform, did not seem to mind). It does however highlight that you do not have to be a start-up company to work in significantly new ways.
The second new approach that caught our eye was Humanitas Deventer - a care home which reserves some of its rooms for students. Six students live rent-free alongside the 160 care home residents in return for each student giving 30 hours a month of support for residents. Like Buurtzorg the approach is light on rules. The students told us they can really do what they and the residents want - cook together, go to the football, do beauty therapies, and go shopping. The student residents are carefully selected and older residents have a say in their selection. The students we met enthused about living with the older people, and a video of interviews with residents highlighted how much they enjoyed the company of the students.
Again this is an initiative that could be adopted by existing social care providers. Some English care home providers at the Apeldoorn conference felt it might not be possible to get past the legal and reputational risks to adopt such innovations. Another however said they were going to straight back to England and start giving it a go. We will follow these developments and let you know how they shape up. A theme at the conference was 'steal ideas with pride' and we left Utrecht feeling that was what in fact we were all about to do.
Dr Catherine Needham is Reader in Public Management and Public Policy at the Health Services Management Centre, University of Birmingham. Professor Judith Smith is Director of the Health Services Management Centre.