Statistics on our ageing population have revealed there are now 11.6 million people over the age of 65 living in the UK, with 1.5 million aged 85 or over.
The number of people aged 85 and over has doubled over the past three decades and the latest estimations claim that by 2065, 26% of the population of England and Wales will be over 65 – up from 18% today.
Of course, our ageing population represents a victory for standards of living and the huge strides we have made in medicine and care. But it also represents an enormous 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 for older people in the UK is heading for a crisis – unless we radically change the way it works.
We have been examining the Buurtzorg model of care and believe this could provide a possible solution. It focuses on a person-centred model of care which was designed in the Netherlands by nurse Jos De Blok.
Mr de Blok wanted to tackle concerns that fragmented and bureaucratic delivery of care was resulting in lowering quality, increasing costs and a shortage of providers.
Back in 2006, he and three other nurses in the small town of Almelo decided to set up their own social enterprise, Buurtzorg – which roughly translates as ‘care in the neighbourhood’, with the idea of better looking after older people in their own homes.
A foundation of care
Buurtzorg was built on a foundation of small, self-managed and non-hierarchical teams linked to neighbourhoods where they provide a wide range of services for older people. It now has over 10,000 nurses in 800 locations across the Netherlands and patient satisfaction is the highest for any care organisation in the country.
The model empowers individuals – in this case nurses – to deliver all the care that patients need. The nurses provide a holistic service, delivering both personal and health care to those in their charge. By providing a holistic service the model tackles the challenges of fragmented services, allowing for greater personalisation and enables the nurses to focus on prevention and early intervention.
The use of highly-trained, generalist nurses results in higher costs per hour, but fewer hours in total. The cost per client is 40% less than the Dutch average, but the quality of care is greater and individuals can stay in their homes and communities for as long as possible and avoid unnecessary hospital admission.
Professional freedom with responsibility
The self-managed teams, with minimal bureaucracy, handle every aspect of care and business, from client assessment to staff recruitment. The nurses are supported by coaches rather than managers. This has resulted in a significantly reduced back office with less than 50 people to support over 10,000 frontline nurses. So, unsurprisingly, the non-profit Buurtzorg has overhead costs of 8% compared to the typical 25%, leaving more money to invest in care and innovation.
Staff satisfaction is higher, too, with Buurtzorg winning best employer in four out of the last five years.
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It is hoped that this successful approach can be replicated here in the UK. In West Suffolk, with the support of the East of England Local Government Association, we have worked hard to establish a Buurtzorg ‘test and learn site’ to find out – and the initial response to our ambitions has been positive.
Through a collaboration between Suffolk CC, West Suffolk councils, West Suffolk clinical commissioning group, West Suffolk NHS Foundation Trust and Suffolk Community Healthcare, we are establishing our first Buurtzorg team in the early Autumn.
With sponsorship from the health and wellbeing board, we will be starting close to the Buurtzorg model, adhering as much as possible to the underlying core principles that are so essential to this approach.
Our team of self-managing, non-hierarchical nursing professionals will deliver a holistic service, working closely alongside the local community and other professionals to deliver better, more personalised outcomes.
In the Buurtzorg model, we are ever mindful that we have significantly different organisational frameworks and regulatory arrangements to the Netherlands. Over the course of our 12-month test, tweaks will need to be made to ensure the model is not lost in translation.
The future of care
There is a great deal of optimism surrounding what this approach could potentially achieve – here in Suffolk and further afield.
If we can find a way to embrace the essential features of the Buurtzorg experience to help our ageing population and the network which supports them, the prospects look good. After all, the goals of the model are to bring a holistic, neighborhood-based approach to the provision of services, maximise patients’ independence through training in self-care and create a network of neighborhood resources.
One of Mr de Blok’s oft-stated mottos is ‘humanity over bureaucracy’ and we believe this is the lynchpin to the future of care in this country.
Cllr Tony Goldson is chairman of the Suffolk health and wellbeing board