A startlingly simple approach to health and care integration in the Netherlands is striking the right note with patients and staff alike, raising one simple question: could it work on this side of the pond? Kate Ling takes us on a tour of the pioneering Buurtzorg model.
The challenge of delivering quality health and social care services to a rapidly ageing population – many with long-term conditions – is one that England shares with most countries across Europe.
Another common challenge facing health systems in Europe is ensuring we have the right workforce to deliver these services; one equipped with the appropriate clinical and leadership skills to cure and care for patients with compassion and dedication.
To respond to these challenges, a number of innovative approaches have been developed across Europe, and the NHS European Office and NHS England’s New Models of Care team are working together to capture their insights, promote some of their approaches, and encourage peer support and learning between sites in England and Europe.
NHS leaders have a lot to gain from looking at these international experiences when considering which models produce the best experience for patients, the best value for money, and the highest level of satisfaction for its workforce.
Take the Buurtzorg (Dutch for neighbourhood care) experience in the Netherlands, for example. Like England, the Netherlands faces big capacity problems owing to demographic changes, with a predicted shortfall of 400,000 nurses within the next ten years. Both patients and nurses have been dissatisfied with the quality of care delivered in the community: service users found themselves confronted with too many caregivers; services were fragmented and providers were incentivised to process a lot of activities at low cost.
Against this backdrop, Jos de Blok, a Dutch nurse, started the Buurtzorg organisation in 2007, with a single team of four nurses. Eight years on, Buurtzorg now employs 9,500 nurses working in 800 teams and is the fastest growing organisation in the Netherlands.
The Buurtzorg principle is startlingly simple.
Teams of up to 12 nurses covering a neighbourhood of 5,000 to 10,000 people plan and deliver integrated health and social care for – and with – patients, in collaboration with GPs. The teams are independent and self-managing, usually with a caseload of 40 or 50 people. Typically, service users:
- are elderly
- have multiple pathologies
- may have symptoms of dementia
- may have been discharged from hospital recently
- may be chronically or terminally ill.
Patient satisfaction and involvement in care planning are prioritised, and Buurtzorg consistently scores highly in feedback from patients and patient advocacy organisations.
The entire Buurtzorg organisation has a back office of only 45 staff who deal with admin and bureaucracy, freeing nurses to get on with their jobs. Nurses from teams across the country can easily network with the back office, and with each other, using IT systems to share information, problems and ideas, and 15 nurse coaches offer professional support.
Job satisfaction among Buurtzorg nurses is high: they report appreciating being able to work in small teams with a strong team spirit, have a high degree of autonomy, and can focus on doing what they are trained to do – caring for patients. Sickness among Buurtzorg nurses is only two-thirds of average nurse sickness levels.
The success of this model is evidenced by Buurtzorg having been awarded the accolade of 'best employer in the Netherlands' for three years in a row, and by the fact that nurses are flocking to join the organisation.
Not only are patients and nurses happy, but costs are no higher – and may well be cheaper – than care under the pre-Buurtzorg system. Owing to the very flat structure, overheads are only 8 per cent compared with an average of 25 per cent elsewhere – saving money that can be ploughed back into care and innovation. Evidence so far suggests that patients are less likely to need admission to hospital, and spend less time as inpatients.
Is this something for the English NHS?
This all sounds, and is, impressive. But can Buurtzorg, or something like it, be replicated in the English health system, which is very different from the Dutch? How would integrated health and social care budgets be used to purchase community-based care along similar lines?
Various NHS organisations have already approached Buurtzorg to see whether the Dutch model could work in an English context. Some NHS organisations, such as Guy’s and St Thomas, have even gone further and decided to pilot the scheme locally after working with Public World, Buurtzorg’s partner organisation in England, to assess its feasibility.
Can we dare to hope that Buurtzorg’s Dutch courage will inspire NHS colleagues to take brave steps towards empowering staff and patients to do things differently in England too?
Kate Ling is a senior policy manager at the NHS European Office, part of the NHS Confederation. Follow the organisation on Twitter @NHSConfed_EU.
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