Category: Neighbourhood Care

Inspired by the work of Buurtzorg, a number of health and social care partnerships across Scotland are developing, with the intent to test, models of neighbourhood care. These models, such as multi-disciplinary team working are reflective of their local need and context, and will support them in understanding and delivering person-centred care that enables individuals to live well in the community for longer.

The Buurtzorg model of neighbourhood care 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.

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.

The success of any care at home model, Buurtzorg or otherwise, will rely heavily on the connections made to other disciplines, for example to community services provided in the neighborhood, to general practitioners, to a host of AHP services, to pharmacists, to ambulance and other transport services; to other specialist disciplines as required and also third sector partners.

The neighbourhood care workstream is supporting health and social care partnerships from across Scotland to develop and test models of neighbourhood care, as well as evaluating the impact and outcome of this work.

Neighbourhood Care Across Scotland – What Next?

Published on 19 April 201910 May 2019 by Living Well In CommunitiesLeave a comment

Neighbourhood Care Across Scotland – What Next?

On 20^th March the Living Well in Communities team held a national event in Glasgow to mark the end of the first phase of the Neighbourhood Care Programme. It was an opportunity for those involved in the ihub’s national programme of work to come together with other regions in Scotland (and the rest of the UK) that are developing and testing similar models of care. 91 people attended and the roles and organisations present on the day are represented in the two word clouds below.

What is your job role? (n=68)

Word cloud 1

On reflection, an opportunity for improvement would be to facilitate the attendance of more of those directly involved in a care giving role.

What organisation are you representing today? (n=72)

Word cloud 2

There was really good representation from a variety of organisations from all over the U.K. An opportunity for improvement would be to have more representatives from third sector and trade union organisations.

It was particularly interesting to learn that those attending had varied knowledge and experience of Neighbourhood Care in their own areas, with just over half of attendees reporting that Neighbourhood Care teams were currently operating in their place of work.

Are there Neighbourhood Care teams currently operating in your organisation? (n=35)

Poll 1

This poll was over lunch time and responses were lower than other polls.

The aims of the day were:

Meet, network, share and learn from each other and leave with an improved awareness of models of Neighbourhood Care and similar activity being tested throughout Scotland
Consider how the learning and challenges in adopting models of Neighbourhood Care can inform the design and working of integrated health and social care teams of the future
Consider the implications for future local / national policy

The full agenda can be found here, and the slides that were used on the day can be downloaded from the Neighbourhood Care Knowledge Hub (Khub) website. You will have to become a member of the Khub website first before following this link and downloading these, but we’d encourage you to join, as we hope that this website will become a platform for those from different health and social care backgrounds to network, chat and also share resources, experience and data. Just ‘request to join’ online by following the link above, ‘sign up’ and searching for Neighbourhood Care on the Knowledge Hub, but if you have any difficulty, please contact the team on hcis.People-LedCare@nhs.net.

The audience participation tool, ‘Slido’ was used for delegates to ask questions throughout the day and to engage with each other. It was new for the majority, but most people mentioned that they liked using it in their evaluation forms, so we look forward to using it more at future events.

Have you used Slido/similar before? (n=59)

Poll 2

In the first part of morning, we heard from a variety of presenters in national roles: Chris Bruce, National Advisor, Neighbourhood Care Programme, Maria McIlgorm, Professional Advisor, CNOD, Scottish Government, Joanna MacDonald, Chief Officer, Argyll & Bute HSCP, and Jane Johnstone, Professional Social Work Adviser, Scottish Government.

They discussed what Neighbourhood Care meant in Scottish/integrated care context. We then heard from a mixture of sites from all over Scotland that are implementing models of Neighbourhood Care in their Health and Social Care Partnerships (HSCPs). This included South Lanarkshire HSCP, Greater Glasgow & Clyde HSCP, Angus HSCP, Cornerstone, Aberdeen City HSCP, Western Isles HSCP, Clackmannanshire & Stirling HSCP, NHS Highland and Argyll & Bute HSCP.

Generally it was acknowledge that there is definite merit in working in this way both for staff and people that receive care, but there are common challenges too.

After lunch, delegates had the opportunity to discuss the top five voted questions in the room and then the ‘barriers’ and ‘enablers’ to delivering models of neighbourhood care in different settings (with a particular focus on ‘what are the current/required solutions?’) as part of a world café session.

The engagement in these conversations was really worthwhile and produced a lot of valuable intelligence that will help guide the future national direction of this programme of work.

As there wasn’t enough time on the day to answer all the pertinent questions posted on Slido, the LWiC team decided to pose these questions to the most appropriate individuals/teams and collate the responses. Thank you to all who have provided the questions and the answers. The response document can be found by following this link.

The world café session provided information that was particularly useful. The full transcription of the flipchart notes from the twelve individual tables is here, but the world cloud below that has been generated from combining all discussions highlights the key themes really well.

Word cloud 3

Within the Healthcare Improvement Scotland’s Improvement Hub (ihub), the Neighbourhood Care programme will move from the Living Well in Communities (LWiC) team to the Person-Led Care team from April 2019 as it enters a second phase. Chris Sutton, Portfolio Lead for the Person-Led Care team, introduced herself to the room on the day and will use the outputs from these valuable discussions to inform the future actions needed to support the delivery of the Neighbourhood Care Programme going forward. For any further information or to find out how you and your team can engage, please contact the Person Led Team on: hcis.People-LedCare@nhs.net.

Fiona McQueen, Chief Nurse, Scottish Government rounded off the day with her reflections. Fiona discussed the great impact stories that were shared earlier in the day and stressed that working together in an integrated manner is the only way to provide truly person-centred and holistic care.

‘We still have a long way to go, but it’s a very worth-while journey’

Thank you to everyone who attended. Here are a few short ‘Vlogs’ that captured your general experience and learning on the day.

Future general enquiries/information requests should be directed to hcis.People-LedCare@nhs.net

Thought bubble

Thought by Nociconist from the Noun Project

Neighbourhood Care Steering Group

Published on 3 December 20183 December 2018 by Living Well In CommunitiesLeave a comment

Our recent Neighbourhood Care Steering Group took place on 21^st November at The Studio, Glasgow. This session focused on measurement and provided an opportunity for our test sites to update each other on their progress and any challenges encountered since our last meeting.

NC pic 1

Care Experience Measurement

Our public partners, recently attended training on Care Experience, delivered by the Person Centred Care team in the hope that each public partner will link up with an active test site and assist them in capturing care experience in their local area. A further training session will happen in the New Year and those from the HSCP pilot sites are welcome to attend.

The group was shown an example of a “Care Experience Map” and asked if this would be helpful in developing one for each active site, with 1 or 2 patients being interviewed (Aberdeen City, Scottish Borders and NHS Highland). The Care Experience Maps would be used to capture the current care received from Neighbourhood Care teams, and could highlight opportunities for quality improvement work for local teams.

Knowledge Hub

The Steering Group have previously expressed that they would like to have a platform to share information around Neighbourhood Care in between the Steering Group meetings. As a result, the Living Well in Communities (LWIC) team have created a Knowledge Hub site. It provides a chance for those interested in testing similar models to network and share ideas and will be open to all roles in all areas.

The LWiC team had brain stormed these folders and suggested some sub folders, as well as uploading a few examples of documents that sites may find useful to share. Everyone was invited to “test” out the page and offer suggestions that would help improve the page before it gets shared more widely with local test site teams. Sites were asked to feedback their suggestions to the LWiC team and nominate a member of their team as ‘administrator’ who will be responsible for updating and uploading documents to their site’s folder.

Measurement

A small NC Measurement sub-group formed on the back of the last Steering Group and met to develop a set of common measures for all sites based on the 7 common themes of measurement:

Re-ablement
Customer satisfaction/experience
Staff satisfaction
Procedures
Workforce
Professional Autonomy
Community impact

The steering group was briefed on the 10 suggested measures and asked if they would be both useful and easy for Neighbourhood Care teams to measure. Some of the measures included:

“The percentage of time spent by nurses and carers that:

is directly person facing time or Involves person centred activities”

“The average number of team/staff members visiting each person per day/per week”

“The percentage of attendees who join the regular team meetings that discuss and plan care/case load”

“Number of steps in a process that require approval to be sought [before a neighbourhood care team/control group and with a neighbourhood care team”? I.e. “How many barriers removed?”

All suggestions were useful and would be of particular interest to team members, but some may prove challenging to capture. Neighbourhood Care Test Sites will now test ways to capture some of these measures and have been asked to help define them more precisely.

For any further information on any of the above, please feel free to contact one of the team:

hcis.livingwell@nhs.net

Neighbourhood Care Steering Group, 3rd October – Challenges and Support

Published on 23 October 201826 October 2018 by Living Well In CommunitiesLeave a comment

On the 3^rd October we held our latest Neighbourhood Care Steering Group at the Edinburgh Training & Conference Venue. There was great representation from the Neighbourhood Care test sites [including Western Isles, NHS Highland, Aberdeen City, Scottish Borders, Stirling & Clacks and Cornerstone] as well as national supportive partners [Scottish Government, Buurtzorg Britain & Ireland, SSSC, Care Inspectorate and NES].

The aim of the day was to openly discuss the challenges and support that National Partners and test sites can offer each other.

Defining our Measures

Thomas Monaghan (HIS) and Fee Hodgkiss (Scottish Government) revisited the vision set out in 2016 for Neighbourhood Care, in a letter from Scottish Government. Both discussed whether the principles are still relevant today, and what they mean in a Scottish context. They offered the opinion that as a set of principles, they were solid and aligned with the pillars of providing person-centred, ‘good, old-fashioned’ care. The group agreed that the principles still applied in a Scottish context and there was a general consensus that the principle of person-centred care was most important.

Logic Model-Measurement Mapping

The group were led through a cross mapping exercise carried out by the ihub team that links the original desired outcomes and impact of the programme’s logic model with the current measures being undertaken in local test sites.

The measures were themed into six categories:

Re-ablement
Person satisfaction/experience
Staff satisfaction
Procedural tasks
Workforce structure
Professional autonomy/self-management

The exercise highlighted that there may be areas of measurement that were not currently being recorded. Key to this part of the morning was to facilitate agreement on potential measures for Neighbourhood Care Teams at a national level, and the group discussed this and what measures could potentially ‘fill the gaps’ if necessary.

There was consensus within the group that the themes were good. The group also highlighted the need for “Third Sector/communities capacity building contribution” to be added as a 7^th theme for measurement.

The group agreed that further discussion focussing on the measures within the document would be of benefit, and a small sub-group will be formed to carry this out. This group will meet and develop a set of common measures for all sites based on these (now seven) highlighted themes before the next steering group in November. If you have any suggestions, please get in touch with your local lead or contact hcis.livingwell@nhs.net

Challenges and Support

The group was asked to reflect on the nine common themes of challenges that sites were reporting and were asked to consider opportunities for peer support and/or offers of support from national partners.

The group selected three themes and spent the remainder of the afternoon discussing these:

Number 4: Ability to empower teams to be self-managing

Number 2: Competing Priorities and Communicating

Number 7: Lack of platform / regular reporting structure

“Self-organising” came up as a key challenge being faced by the test sites. The group agreed there is potential for some rich learning that could be shared from Buurtzorg Britain and Ireland and Cornerstone’s approach and experience with this.

HIS will work alongside Britain Buurtzorg and Ireland and Cornerstone to develop a series of recorded WebExes that will provide further information on this (and other fundamental topics) and will share these on our website. Watch out for a programme of dates for these, which we’ll communicate soon.

Care Experience Tool

In order to support sites to measure ‘experience’ (versus satisfaction) a Care Experience Tool (developed in collaboration between the LWiC and Evidence and Indicators team within HIS) was shared in a draft form. The tool is a set of open questions that aim to explore compassionate care, and are directly related to the new Health and Social Care Standards. Aberdeen City, Stirling and Clackmannanshire and Cornerstone were interested in testing out the tool. It’s great that our public partners have agreed to support sites with this work.

The group also discussed the practical use of the tool and further training and development dates will be planned.

Having a platform for regular sharing/reporting

The Steering Group expressed that having the opportunity to meet, chat and share ideas, knowledge and offers of support is always extremely valuable. Steering groups only happen every 6-8 weeks, so the LWiC team agreed to set up a webpage for the group on the Knowledge Hub. This will be a platform for sites to share information around Neighbourhood Care in between meetings and will be open to all roles in all areas. We look forward to sharing more details around this in the future.

For any further information on any of the above, please feel free to contact one of the team:

hcis.livingwell@nhs.net

Neighbourhood Care Steering Group – 22 August Blog

Published on 16 October 2018 by Living Well In CommunitiesLeave a comment

On the 22^nd August the newly formed Steering Group met for the first time.

The steering group combines the Delivery Group (members of national organisations that support the Neighbourhood Care programme) with the Learning Network (project leads from the health and social care organisations that are testing the Neighbourhood Care principles (inspired by Buurtzorg). The steering group will meet every six to eight weeks and work in a Break Through Series Collaborative. By working in this way it’s hoped that there will be more opportunities for closer working, easier sharing and increased opportunities for support.

The 22^nd was an opportunity for all members of the Steering Group to share their current progress, challenges and support required. You can read more about the day’s activities in our flash report. Please feel free to share this with your teams.

Our next Steering Group meeting is on 3^rd October. Between now and then the LWiC team and National Partners will have met to discuss how best to plan the support that is required in order to assist local teams to develop their own local models of care to deliver the principles. This will be discussed further with the Steering Group on 3^rd October.

Scottish Borders HSCP, Aberdeen City HSCP, Argyll & Bute HSCP and NHS Highland have live case loads and so will continue to be supported by Buurtzorg Britain and Ireland (previously Public World) and a plan of training events has been developed from now until the end of the year that is tailored to their needs.

As well as the Steering Group, the Scottish Social Services Council (SSSC) are supporting 10 individuals (including representation from HIS, Scottish Government, Care Inspectorate and Cornerstone) from the steering group in Action Learning Sets (ALS). ALS are a structured method of supportive coaching that helps the participants deliver outcomes that are important to them and the overall aim of the programme.

At the last steering group meeting test sites shared their current/planned measures that they will use to evidence their team’s improvements and outcomes. The LWiC team has collated this information and cross-mapped the measures to the original outcome framework/logic model. The next steering group meeting will provide an opportunity to discuss and define these measures in more detail, as well as discussing why sites have chosen these specific measures and whether there is an opportunity to develop a common set of measures between all sites.

We look forward to keeping you further informed after the next steering group meeting J

Highlights from the Neighbourhood Care Learning Network Event

Published on 30 May 2018 by Living Well In CommunitiesLeave a comment

On 11 May 2018 we held our latest neighbourhood care learning network event at the Care Inspectorate Offices in Hamilton. The session was well -attended by representatives from the neighbourhood care test sites, national organisations and third sector organisations. The purpose of this meeting was to discuss neighbourhood care and regulation, with a focus on questions raised by the test sites before the meeting. We also took the opportunity to discuss measurement ideas and learn what plans were already in place for local evaluation.

Sharing learning from the test sites

After introductions, staff from each test site provided an update on the neighbourhood care work in their area. There has been a lot of activity across the test sites with positives discussed on this way of working, offers of support and an eagerness from sites to arrange visits to learn from one another. Common challenges faced by the sites include those around culture and shifting perceptions, but the passion for the concept and success stories continue to drive this work forwards and motivate the teams.

Care Inspectorate – from enforcers to enablers

Catherine Agnew from the Care Inspectorate gave an informative presentation about the role of the Care Inspectorate in supporting services as enablers of innovation, rather than the traditional perception of enforcing regulation. There is acknowledgement that services for the public are evolving with the integration of health and social care. In support of this, the Care Inspectorate have developed regulatory sandboxes, where normal regulatory requirements are waived to support innovation which has the potential for public benefit.

Attendees discussed the new health and social care standards in Scotland and were pleased to note that the principles of the Buurtzorg model mirror these standards (Dignity and respect; Compassion; Be included; Responsive care and support; Wellbeing).

Evaluation

We facilitated a group discussion on evaluation and undertook an exercise to look at measures, how important these are and how easy they are to use. Representatives from the test sites rated examples and entered them into a prioritisation tool, which could help the teams to look at work priorities and measurements in their areas. They highlighted difficulties with measuring face-to-face contact time, although this is an important measure to show effectiveness of this model and the test site representatives acknowledged that this is a measure that is important to care givers: ‘more time with the person needing care’.

They are aware that while test sites will have different measures and there will be local variation, there is a need to have some standardisation for comparisons. Evaluation should be meaningful in a local context for individuals, their carers and staff. However, an element of evaluation will be required for national interest to look at areas such as cost saving, avoiding hospital admissions and reducing length of stays, etc.

The King’s Fund has recently published a paper on transformational change in health and care in response to the growing pressures and demands on the health and care system. The paper highlights four case studies that have been recognised as successful transformation initiatives, led by staff that directly provide care and service users. One of these successful initiatives is the Buurtzorg Nederland model.

Next steps

The test site representatives agreed to try a new approach to the learning network, with an option to move to the IHI model of a breakthrough series collaborative alongside action learning sets facilitated by the Scottish Social Services Council in the future. Once logistics have been further discussed, options will be presented to the group to take forward. Members of the group were happy to share their plans for evaluation with the Living Well in Communities (LWiC) team and there are steps to visit each site. Further information will be available soon.

Putting the Buurtzorg Principles into Practice: our third learning network workshop

Published on 16 January 20173 July 2017 by Living Well In CommunitiesLeave a comment

by Ben Lukins, Programme Manager, Healthcare Improvement Scotland. Follow Ben on Twitter at @blukins1

Our third learning network event took place on 13^th October and allowed test sites to share their progress to date and further explore applying the principles of Buurtzorg. It was well-attended, with representatives from health, social care and the third sector and from across Scotland taking part in a lively day of discussions. You can view the Twitter highlights from the day in our Storify.

Sharing early learning from the test sites

Staff from the test sites shared their reflections on developing models of neighbourhood care and their motivations for change. The strong desire to deliver the best care possible to people resonated with everyone and fuelled the enthusiasm for the day. The discussions which followed reaffirmed the importance of this, and people acknowledged that it was acceptable to apply the principles of Buurtzorg in different ways across the different sites.

Enablers and challenges

Discussion about the enablers and challenges of progressing the work highlighted the strength drawn from the common goals of the work: improving care for individuals, and empowering staff. Groups discussed the importance of protecting the test sites and the challenge of doing so, in particular regarding regulation and inspection. People also felt that it was necessary to address misconceptions about obstacles which in fact may not exist, or may be easily addressed. Continue reading “Putting the Buurtzorg Principles into Practice: our third learning network workshop” →

Evaluating the application of the Buurtzorg principles in Scotland

Published on 16 January 20173 July 2017 by Living Well In CommunitiesLeave a comment

evaluation

by Ben Lukins, Programme Manager, Healthcare Improvement Scotland. Follow Ben on Twitter @blukins1.

At the start of December we held a workshop exploring the evaluation of neighbourhood care at a national and local level. The workshop was well-attended and included academics with evaluation backgrounds, staff from some of the Scottish test sites, representatives from Buurtzorg, staff from the Public Health Agency in Northern Ireland and individuals from our national partners.

The importance of reflecting the local context was recognised and it was acknowledged that there was a richness in the qualitative information, drawn from staff’s experiences. The group reflected that the evaluation was about looking at how the principles of Buurtzorg had been applied and not about evaluating the principles themselves.

Buurtzorg principles in Scotland

We spent time determining the principles that were being applied in Scotland and agreed on the following:

Putting the person at the centre of holistic care.
Building relationships with people to make informed decisions about their own care, which promotes wellbeing and independence with active involvement of family, neighbours and the wider community, where appropriate.
Everyone, including support functions, enabling person-centred care at the point of delivery.
Small self-organising, geographical-based teams.
Professional autonomy.

Continue reading “Evaluating the application of the Buurtzorg principles in Scotland” →

Meet Ben Lukins!

Published on 16 January 20173 July 2017 by Living Well In CommunitiesLeave a comment

ben_bw I would like to take the opportunity to introduce myself as the Programme Manager with Healthcare Improvement Scotland, responsible for coordinating the work on applying the principles of Buurtzorg to develop Scottish models of neighbourhood care.

I have been reflecting on how quickly time has flow by since coming into post in September. From the offset I was keen to immerse myself in Buurtzorg to understand the model, and to think about how we as a national body could best support the local work in Scotland. A key part of this has been meeting with a number of people from different organisations, backgrounds and professions who have been part, or are keen to be part, of this work.

This has been a great opportunity to listen to myriad perspectives and thoughts. I have been struck by the enthusiasm of those I have talked to, many of whom are motivated by achieving the best possible outcomes for people, as well as making the role of those providing care truly fulfilling. The Buurtzorg model resonates so powerfully for so many, as it brings to the surface the reason they came into the caring profession, drawing from the richness that comes from building and sustaining meaningful relationships. Continue reading “Meet Ben Lukins!” →

Testing an innovative model of care in the community: Buurtzorg

Published on 24 August 20169 April 2018 by Living Well In Communities2 Comments

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.