In early October a team of health and local government representatives from Suffolk, supported by the East of England LGA and Public World, visited Wijk Bij Duurstede in the Netherlands to see the Buurtzorg model in action. The visit involved shadowing nurses and meeting clients, exploring the support system and meeting with those who have transitioned to the Buurtzorg way of working.
Here Cecilia Tredget, Managing Director of the East of England LGA shares her reflections on the visit.
On our first morning we were immersed in the work of the Buurtzorg nurses, each going out with a nurse on their morning rounds. I went out with Selma a Buurtzorg nurse working in the Doorn team about 10 km from Wijk Bij Duurstede. We visited a number of different clients that morning, but I wanted to share one particular experience that really reflected what Buurtzorg means to me.
This visit was to an apartment in the town where a couple in their early 70’s had lived for the past year. The husband had been a German teacher, and his wife a radiologist. They have 2 children but neither of whom live nearby. The wife has had MS for a number of years, and as a result they moved from a house in the countryside into the apartment which has been adapted for the wife who is now unable to walk and has very restricted movement – just the ability to raise her arms.
As a Buurtzorg nurse, Selma has cared for the wife for the last 5 years and clearly knew the couple very well. This was evident from the empathy between nurse and patient, and partner. Time was taken to talk to the couple and encouragement was given to the wife ask her to do the little things she could still do despite the extended time this took.
The wife has a catheter, and is fed slowly through a tube by a machine throughout the day. Selma washed and dressed her and helped her wash her teeth, before using the hoist to put her into her bed. When she was sitting up in bed she gave her ground up medicine in apple puree as she cannot swallow easily. Her husband would get her up when he returned from tennis later that morning, and she would spend the rest of the day in her wheelchair, with her husband, in their lovely large living room. In the evening the Buurtzorg nurse would return to help put her to bed.
The trip provided real insight into why this model has developed and grown so quickly across the Netherlands. Here are some of my own reflections from the study trip:
- The visits to the clients never felt rushed, and the nurses had time to care and to focus on prevention and independence. Despite having lower caseloads, the nurses deliver lower hours of care overall.
- The client’s families worked as a team with the nurse, preparing for the needs of the nurses before her arrival.
- The nurses focus on proactive rather than scheduled care. In the case I describe above, special attention was paid to ensuring the catheter was cleaned out and the bag was changed for a new one even though it was not scheduled. This proactive care has meant that, although the nurses are available 24/7, there has been no need for calls out at night.
- The nurses operate in small self-managed teams, but with a focus on providing a primary carer for each client to ensure continuity. The relationship this enables also means that they can develop a strong connection to the formal and informal networks around the client to deliver better care.
- The nurses were empowered to take professional decisions about the care of the clients and this was supported by the self-management principles that are embedded in Buurtzorg. One of the challenges of adopting this model in the UK will be around the need for need for a cultural shift to this non-hierarchical structure and a need for a ‘heat shield’ to protect the teams from, and provide an intermediary with, the wider system.
- The IT system enables the models ethos of simplicity over complexity, enabling the nurses to update records quickly and easily review care plans. It also provided a clear mechanism to support nurses to self-organise and self-manage.
The Buurtzorg model offers an exciting opportunity to radically look at the way care is delivered in the UK to truly put the client at the heart of the system. The first Buurtzorg team was set up in The Netherlands ten years ago and there are now over 850 teams employing 10,000 people. This person-centred approach is now the preferred way of working across the system and is being introduced in countries across the world, including Sweden, Japan and the USA. We look forward to supporting Suffolk and other partners in the region to explore how we might test this model here in the East.
A report of the study trip has been written as an account of the key areas explored through the trip to enable wider sharing of learning beyond the study group itself. It is available for download here.