Buurtzorg Tests for Scotland: 1st July first gathering of tests co-production community from Nick Wilding on Vimeo.

Video highlights from the first Buurtzorg workshop

In this article we look at Buurtzorg, a Dutch model of community care, and talk about the work that we are supporting to test the principles of Buurtzorg in Scotland.

Where did Buurtzorg come from, and what does it involve?

Buurtzorg, which means neighbourhood care, is a delivery model for community care which was established in the Netherlands in 2007 to improve quality of care and outcomes for people. It puts the person at the centre of care and promotes staff autonomy and the provision of holistic care in the community.

Care is delivered by skilled generalist registered nursing teams, with a maximum of 12 nurses in a team. The teams organise themselves, and have a structure that promotes self-management, which gives nurses more freedom to respond to the needs of individuals. Regional coaches are available to support teams, although they work with a number of teams and do not act as managers.

The model was developed in response to a fragmented landscape of home care provision in the Netherlands, in which people were receiving care from multiple practitioners and providers. Rather than carrying out fixed tasks for people in isolation, the Buurtzorg model takes a holistic approach and looks at what patients and service users can learn to do for themselves again, reducing the need for care in the future. Its focus on neighbourhoods allows teams to use informal networks and work together with a range of professionals, such as GPs and pharmacists, and to engage in preventative activities.

What are the benefits?

Analysis by KPMG has found that Buurtzorg methods lead to:

Greater

• Productivity
• Work satisfaction
• Supply of professionals
• Revenue
• Quality
• Motivation

Reduced

• Costs
• Resources per patient
• Cycle time
• Unplanned care
• Absence through illness
• Staff turnover

Buurtzorg uses digital technology to provide information that directly supports the care process and reduces administrative overheads. A 2015 KPMG study (in Dutch, but cited in this Commonwealth Fund article) found that Buurtzorg ranked among the best home-care agencies in the Netherlands when assessed on patient-reported experiences, and delivered considerably fewer care hours than the average home-care organisation.

What are we doing in Scotland?

The Living Well in Communities team at Healthcare Improvement Scotland’s Improvement Hub (ihub) is working with the Scottish Government and Health and Social Care Partnerships to test the principles of Buurtzorg. We held a workshop on 1^st June 2016, which brought together people and organisations interested in testing Buurtzorg in Scotland to consider how we could best undertake a Scotland-wide experiment inspired by the Buurtzorg approach. Participants heard from Madelon von Tilburg, a Buurtzorg nurse, and Public Word’s Brendan Martin, who is supporting the testing of Buurtzorg in England. The presentations generated a lot of discussion and debate around how to test the Buurtzorg model in Scotland. A later event on 27^th June developed a plan of action to test the Buurtzorg approach.

There was a consensus that Buurtzorg involves a significant cultural change, and there are challenges around budget pressures, information sharing, freeing up staff to work autonomously and thinking through the reporting, governance and scrutiny arrangements. While the Buurtzorg approach resonates with much of the work that is going on in Scotland to develop person-centred care and transform health and social care, combining all of its principles is a radical change to organisational structure and service delivery. It was felt that an incremental approach would be necessary  to allow services to test new ways of working  and give staff time to adjust.

There was clearly a great deal of interest and excitement about the model and its potential, and participants were eager to engage with frontline staff and generate enthusiasm about the model. Some felt that the model could help to address difficulties with recruiting carers and building a team approach, while others were keen to learn how to make their organisations less hierarchical. There was reflection on nursing qualifications and career paths, and how to best support people to self-manage. Pooling personal care and community nursing care budgets and allowing local testing to be creative in spending that budget was also a subject of discussion. While partnerships and organisations are grappling with a number of issues, there is a clear will and energy to create something that is genuinely transformational.

Next steps

Teams from across Scotland will be progressing with testing the principles of Buurtzorg at a pace which is appropriate for their local areas and reflects local priorities. We intend to build on the first two workshops to establish a learning network across all the different tests, and hope to include the three Scottish tests of Community Led Support, another innovative approach to neighbourhood care that has sprung from the world of social work and social care in England.

You can access resources from our work on Buurtzorg so far from the Buurtzorg page on our community site.