Going Dutch

Kate Ling

Kate Ling is the senior policy manager leading on workforce issues at the NHS European Office

The challenge of delivering quality health and social care services to a rapidly ageing population, many with long term conditions, is one that England share with most countries across Europe. 

Another common challenge to health systems in Europe is ensuring that we have the right workforce to deliver these services, 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 to delivering personalised and better integrated services to patients with long term conditions have been developed in some parts of Europe, and the NHS European Office and NHS England’s New Models of Care team areworking together to publish some of the approaches and encourage peer support and learning between sites in England and across in Europe. NHS leaders have a lot to gain from looking at these international experiences to establish which models produce the best experience for patients and the best value for money, while at the same time delivering a high level of workforce satisfaction.

Neighbourhood care

Take the Buurtzorg (Dutch for neighbourhood care) experience in the Netherlands, for example. The Netherlands, like England, faces big capacity problems owing to demographic changes, with a predicted shortfall of 400,000 nurses within 10 years. Both patients and nurses have been dissatisfied with the quality of care delivered in the community because; 

  • 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 up the Buurtzorg organisation in 2007 with a single team of four nurses. Buurtzorg now employs 9500 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 5-10,000 people plan and deliver integrated health and social care for and with patients, in collaboration with GPs. The teams are independent and self-managing and typically have a caseload of 40 or 50 people to care for. Service users are typically;

  • 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 their care planning is prioritised, and Buurtzorg consistently scores highly in feedback from patients and patient advocacy organisations.

The entire Buurtzorg organisation has a back-up office of only 45 staff who deal with admin and bureaucracy, freeing the 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 there are 15 nurse coaches to 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 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 eight 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.

Jos de Blok, Buurtzorg’s founder and director, will speak at the NHS Employers workforce summit in London on 13 October, together with Brendan Martin from Public World. Following this, the NHS European Office will be hosting a two-day study visit to the Netherlands in early 2016 to enable NHS staff from Pioneer and Vanguard New Models of Care sites to see at first hand how the system operates in practice. 

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 is the senior policy manager leading on workforce issues at the NHS European Office, part of the NHS Confederation. Follow the organisation on Twitter @NHSConfed_EU

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