In 2006 four nurses in the small Netherlands town of Almelo realised that years of ‘reform’ had undermined their relationships with patients. The very vocational commitment that had brought them into the profession in the first place was compromised. The four nurses decided enough was enough and Jos de Blok and his three colleagues had a better idea, to set up their own social enterprise, Buurtzorg, to look after older people in their homes, in the way their ethics and craft demanded.
Nine years later they have more than 9,000 colleagues and Buurtzorg, looks after more than half of the Dutch people needing care at home and as been named the country’s best employer year on year, and is not only a magnet for any Dutch nurse that wants to do a better job but also a role model for the rest of the sector.
Yet Buurtzorg has also cut costs to such an extent that an independent evaluation said if every other Dutch provider worked the same way millions more euros would be saved.
That’s because — and here’s the revolutionary bit — all this has been accomplished through nurses managing themselves in 800 small neighbourhood teams that engage more effectively with other local services, voluntary carers and patients themselves.
And we mean ‘’managing themselves”. Buurtzorg has many leaders but no managers. The self-organised teams are supported instead by peripatetic coaches and an IT system designed around care-giving and collaboration.
Otherwise, the whole national operation is run from a small back office that looks after billing and co-ordinates information and learning across the teams — 40 HQ staff for 9,000 in the field.
In 2015 more and more health and social care commissioners and providers in England are talking about how the Buurtzorg model can be adapted to the UK context, because co-ordinated compassionate care demands it.
The two professions that can best support the growing number of people needing support to enable them to live independent, safe and meaningful lives at home are community nurses and home care workers. However both these professions face a growing crisis.
Many nurses, in England and elsewhere, have responded to the same pressures by giving up and leaving the profession, turnover is at an all time high and the number of district nurses has almost halved, from 12,620 in 2003 to 6,656 in 2013, a 47% drop in a decade. Meanwhile home care work is underpaid and undervalued with staff turnover at over 30% per annum and huge recruitment difficulties.
A revolution in England is underway, but it faces formidable obstacles. The Dutch health insurance system enables social enterprises to introduce innovative approaches more easily than our system does, and although the self-management model certainly can produce savings it does involve upfront investment and transition costs.
But the groundswell for radical change is growing among health and social care professionals in England, and the NHS England Five Year Forward View has earmarked several ‘vanguard’ initiatives to plot the way ahead.
In addition, community nursing leaders in Guys and St Thomas’s NHS FT are collaborating with their local authorities and communities in co-producing new neighbourhood services, including scoping the possibility of a Buurtzorg-type experiment.
Jos de Blok founder of Buurtzorg will be leading a workshop there, in support of an initiative by our social enterprise consultancy, Public World, to take inspiration from his experience and support the care revolution here.
Jos is also speaking at an event in London July 16th organised by , the Royal college of Nursing and the UK Homecare Association for leaders in health and social care. .
Some people have said to us, “it’s a great idea, but it won’t work in England.” If those four nurses in Almelo had taken that attitude tens of thousands of Dutch lives would not have been transformed as they have been. If they can do it, so can we!