Redesigning health and social care
Redesigning health and social care

A highly successful Dutch model of care at home – known as BUURTZORG - will be explored in West Suffolk through a “Test and Learn Site”, one of only a handful in the England, in partnership with West Suffolk CCG, West Suffolk Councils and Suffolk County Council, with support from the East of England LGA and the UK Buurtzorg partner, Public World.

The population of the UK is ageing.  Life expectancy at 65 is now 21 years for women and 19 years for men, and the number of people aged over 85 has doubled over the past three decades.  By 2065, 26% of the population of England and Wales would be more than 65 years old, up from 18% today.

Our ageing population represents a victory for standards of living and the huge strides in healthcare, enabling society to benefit from the experience, perspectives and a wide range of skill sets and capacities older people bring. However, it also represents a huge challenge for our social care and health services – particularly because healthy life expectancy is not increasing as quickly. In simple terms the health and care system is heading for a crisis, unless it radically changes the way it works.

Redesigning health and social care
In redesigning health and social care the focus has been on keeping people healthy and independent for longer. This is not only key in reducing the strain on already stretched services, but provides a better outcome for us all as we age.

Integration has become the buzzword of choice in recent years, supported by all of the main political parties, it has ambitions as the panacea to the challenges of an ageing society.  However, there are still many barriers, operational, societal and cultural, to the implementation of integrated care and it will take real innovation to see ambitions realised. 

The BUURTZORG Model of Care at Home
And this is where Buurtzorg – a Dutch model of care at home - could provide a possible solution.

In 2013/14 there were approximately 405,500 people over 65 in residential care.  Given the choice, the vast majority of older people would opt to stay independent and in their own homes for as long as possible.  But most need a more person-centred model of care in order to do so.

In the Netherlands, nurse Jos De Blok felt an all too similar challenge, where years of reform had resulted in what he felt was a disconnect between carer and patient.  In 2006, he and three other nurses in the small Netherlands town of Almelo decided to set up their own social enterprise, Buurtzorg - “Care in the Neighbourhood”- to better look after older people in their own homes.

Buurtzorg is built on a foundation of small, self-managed teams linked to neighbourhoods where they provide a wide range of services for older people.  Since its inception it now has 9,300 nurses in 800 locations across the Netherlands and patient satisfaction is the highest for any care organisation in the country. 

Essentially the model empowers individuals – in this case nurses - to deliver all the care that patients need.  This has resulted in higher costs per hour but fewer hours in total and a significantly reduced back office with 30 people to support 7,000 frontline nurses.   The cost per client is 35% less than the Dutch average.  It has almost no middle management, no HR, legal, estates, communications, finance, IT or procurement.  Not surprisingly the non-profit making Buurtzorg has overhead costs of 8% compared to the typical 25%, leaving more money to invest in care and innovation. 

Can the BUURTZORG Model of Care at Home work in an English context? 
This is a key question that the coalition of health, social care and housing partners in West Suffolk are seeking to answer.  The partners are establishing a Buurtzorg “test and learn site” in the area, one of only a handful in the country, with the support of the East of England LGA and the UK Buurtzorg partner, Public World. 

With the current Buurtzorg enterprise delivering better, more personalised outcomes at lower costs it is unsurprising that the initial response to trialling the model in the East has been hugely enthusiastic.  But we now need to get into the detail of how the model might transfer to our own context – England has significantly different organisational frameworks and regulatory arrangements to the Netherlands.

On 22 March partners came together for the first step of investigating the model and the opportunities it might bring in greater depth but also to consider the challenges — institutional, regulatory, financial and cultural — that could stand in the way.  Needless to say many challenges were identified, but so were the opportunities, and scepticism gave way to a light of optimism and excitement of what this approach could potentially achieve.

In West Suffolk we are right at the start of the journey, but the primary aim will be to identify a way to adapt the model to our own context without losing the essential features of the Buurtzorg experience - the focus on mobilising and strengthening the capabilities of the client and the networks around them through self-organised teams of autonomous responsible professionals.

Follow our journey
We will be blogging about our experiences and journey on the East of England LGA website regularly as the test and learn site progresses, so keep checking back to follow progress.  For further information you can also get in touch with Hannah.shah@eelga.gov.uk.