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 Public World Consulting,
the Royal college of Nursing and the UK Homecare Association for leaders in
health and social care. There may be a few tickets left.
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!
James Archer and Tamsin Fulton - Public World Consulting
