Buurtzorg: reinventing district nursing in Scotland

Buurtzorg roughly translates from its native Dutch as “neighbourhood care”. The model, used extensively in the Netherlands, has attracted international attention as a novel way to deliver community based nursing programmes. Its positive reputation and recorded successes in areas of Holland are attributed to its innovative use of locally-based and locally-aware nursing teams to deliver high-quality person-centred, but low-cost, care.

Seeking to improve core health outcomes

In the Netherlands, Buurtzorg was designed to engage three key health priorities:

  • Health promotion
  • Effective management of conditions (in a community setting)
  • Disease prevention

It focused particularly on the elderly, those who move regularly between hospital and home, and those with long term, constant care illnesses. It has also been used with patients with progressive illnesses such as dementia, with some nurses within the teams being given training to become dementia specialists where appropriate.

The model includes the following key elements:

  1. Holistic and personalised care – where assessments of need are integrated into and form the foundation of agreed care plans
  2. Mapping networks of informal care, and assessing ways to involve these networks in treatment plans
  3. Identifying other formal carers and organisations who provide care services and coordinate their input
  4. Taking steps to support the client in his/her own environment
  5. Promoting self-care and independence on the part of patients.

A number of studies of pilot sites across the UK and beyond have identified the positives and some challenges of applying the Buurtzorg model in different contexts. Some of these are outlined in the table below.

Applying the model in Scotland

In a Scottish context, the model has been applied in a number of areas, with the initial pilots making way for a wider roll out of adaptations of the model. In March 2017, as part of a wider research project, nurses and management staff from NHS boards across Scotland met in Perth to discuss learning and exchange best practice around how the model could be adapted and further rolled out in the future.

It highlighted the different stages that many Buurtzorg areas were at in their roll out, with some like Aberdeen and the Borders far more established than Argyll, who were at the time only in the earliest stages of their Buurtzorg journey. The research and learning event gave practitioners the opportunity to engage and further cement both formal and informal learning networks, which have been identified as key to the success of the Buurtzorg model both in the UK and elsewhere.

The importance of information sharing and informal learning

Rolling out the model in test sites highlighted the importance of planning and learning, and of creating a strong sense of trust between practitioners and NHS management, but also between the Buurtzorg nurses and their service users and other professionals. This change in mindset regarding ways of working, and a change in the chain of accountability was something, which, according to those practitioners who attended the Perth event, many sites have found to be a significant barrier to effective implementation.

However it was also highlighted that promoting and facilitating the creation of formal and informal learning networks and learning spaces can be an effective way to generate conversation about best practice as well as allaying some fears that may persist regarding working culture and approaches, including partnership working with other agencies and understanding risk in the working environment.

In Scotland, approaches have varied, from encouraging nursing teams to create videos and then post them to an online forum, employing more formal training plans to incorporate multiple agencies and ensure that everyone is “singing from the same hymn sheet”, or holding informal drop-in or open space events where staff are supported in their role and given advice to alleviate and find potential solutions to issues.

Practitioners also highlighted that it is important to provide a space where teams can examine what did not work well, and why. Learning from mistakes can often be as beneficial as learning from good practice, as these can provide insights into issue management and resolution as well as how to implement the programme effectively.

It is also clear from feedback, that while a strong core network of nurses and other community based practitioners is vital to the success of Buurtzorg care models, the back team support is also just as important. Creating efficient and streamlined processes leaves nursing teams free to care for patients and allows them more time to develop and deliver the person-centred care which is a key element of the Buurtzorg model.

Final thoughts

Learning from the experiences of the trial projects in Scotland has provided invaluable insights on how the model can be applied and some of the challenges that can be encountered because of the differing context. This knowledge can then be used to shelter and steer newer projects away from danger areas toward best practice and innovative collaborative working. Applying Buurtzorg in Scotland gives the potential to create and implement new models of holistic person-centred care, where practitioners with local and specialist knowledge interact at a local level with other care providers, join up approaches and create a better care experience for service users.

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If you enjoyed this blog, you may also be interested in our other articles on health care and reablement care

 

Maggie’s Centres: wellness through building design and the environment

In March 2017, the 20th Maggie’s Centre was opened in the grounds of Forth Valley Royal Hospital in Falkirk. Designed by architects Garbers & James, it is expected to receive 3000 visits in the first year.

Maggies Centre Forth Valley, Garbers and James

Maggie’s provides free practical, emotional and social support to people with cancer and their family and friends, following the ideas about cancer care originally laid out by Maggie Keswick Jencks and co-founded by her husband Charles, who is a landscape architect. Among Maggie’s beliefs about cancer treatment was the importance of environment to a person dealing with cancer.

She talked about the need for “thoughtful lighting, a view out to trees, birds and sky,” and the opportunity “to relax and talk away from home cares”. She talked about the need for a welcoming, reassuring space, as well as a place for privacy, where someone can take in information at their own pace. This is what Maggie’s centres today aspire to.

A number of high profile architects have designed Maggie’s Centres across the UK – from the late Zaha Hadid to Frank Gehry, Richard Rogers and Rem Koolhaas.

The Maggie’s Centre in Kirkcaldy, Zaha Hadid Architects

Promoting wellbeing through the natural environment and effective design

Drawing on research which considers the significant impact that environment can have on wellbeing, Maggie’s Centres are designed to be warm and communal, while at the same time being stimulating and inspiring. The interiors are comfortable and home-like. Landscape designers and architects are encouraged to work closely together from the beginning of a project as the interplay between outside and inside space, the built and the “natural” environment, is seen as an important one.

A building, while not wholly capable of curing illness, can act as “a secondary therapy”, encouraging wellness, rehabilitation and inspiring strength from those who move around it.”

Each of the centres incorporates an open kitchenette where patients can gather for a cup of tea, airy sitting rooms with access to gardens and other landscape features, and bountiful views. There are also private rooms for one-on-one consultations; here Maggie’s staff can advise patients on a range of issues relating to their condition, whether that is dietary planning, discussing treatment options (in a non-clinical setting) or delivering classes such as yoga.

Spaces to promote mental wellbeing as well as physical healing

Maggie’s Centres are also about offering spaces to people to help improve their mental wellbeing. As well as quiet tranquil spaces for reflection and meditation, there are also central areas, focused on encouraging the creation of a community between the people who use the centre. Wide-open spaces, high ceilings and large windows, with lots of opportunities to view the outside landscaping and allow natural light to enter are a key feature of many of the Maggie’s Centres.

The locations also try as far as possible to provide a space free from noise and air pollution, while remaining close enough to oncology treatment centres to provide a localised base for the entire treatment plan of patients.

Fresh air, low levels of noise and exposure to sunlight and the natural environment, as well as designs that provide spaces that promote communal interaction to reduce feelings of isolation and loneliness, have all been shown to improve mental as well as physical wellbeing. In this way, the physical attributes and design of the Maggie’s buildings are helping to promote mental as well as physical wellbeing of patients and supplement the care being given by the cancer treatment centres located nearby.

Interior of the Maggie’s Centre in Manchester, Foster and Partners

Award-winning architecture and design

In 2017 Maggie’s Manchester was shortlisted for the Architects’ Journal Building of the Year award. And many of the individual centres have won regional design awards for their innovative use of space and incorporation of the natural environment into their designs.

A Maggie’s garden was also featured at the 2017 Chelsea Flower show, highlighting the importance of environment, and the role of the natural environment in rehabilitation and promoting wellness among those who are ill.

Final thoughts

How design and landscape can aid and empower patients is central to Maggie’s Centres. They are a prime example of how people can be encouraged to live and feel well through the design of buildings and the integration of the surrounding natural environment. These environments are the result of a complex set of natural and manmade factors, which interact with one another to promote a sense of wellness, strength and rehabilitation.

They demonstrate how the built environment can contribute to a holistic package of care – care for the whole person, not just their medical condition. Other health and social care providers can learn from them in terms of supporting the wellbeing of patients, carers and their families.


You can find out more about Maggie’s Centres though their website.

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Creating sustainability in health and social care

The question of the sustainability of funding for health and social care services has been in the spotlight recently. The Conservative Party manifesto contained proposals around making individuals pay for more of their social care costs, to deal with the “challenges of an ageing society”. Meanwhile, figures suggest that NHS Trusts in England overspent by £770m last year despite a focus on efficiency savings.

However, creating and maintaining sustainability in health and social care is much broader than financial sustainability. It means considering other factors, including environmental, training and project management issues. This takes planning, commitment and an understanding of the aims and expectations of staff and senior management.

A research symposium earlier this year (hosted by Healthcare Improvement Scotland and partners) explored these issues further, looking at the evidence underpinning ways to create sustainable health and care systems.

Environmental sustainability

Environmental sustainability is something which all organisations are being asked to address and improve. The issue of climate change has led to a focus on behaviour change and a more sustainable use of resources.

  • Buildings – This includes the planning of new healthcare buildings, as well as adaptations to existing structures to make them more energy-efficient. Alternative building materials and designs have been used in new projects to improve energy efficiency, with some buildings even incorporating wind turbines, solar panels and geothermal capture centres. Reducing waste water and improving temperature regulation through heat capture and insulation techniques are also being adopted. While these may be costly initial spends for many, the long-term cost savings are also significant, as well as ensuring that the buildings meet minimum national requirements for energy efficiency and contribute to emissions reduction targets.
  • Resource, waste and recycling management – In many offices and clinical centres, individuals are encouraged to be personally responsible for their own reduction in waste and improved use of recycling facilities; however, this must also be facilitated at an organisational level. Clearly labelled recycling bins, promoting reduction in of the use of disposable water and coffee cups, and encouraging employees to use less paper when report writing (printing double sided for example, or going paperless where possible) are all simple ways in which environmental sustainability can be promoted in health and social care settings. Innovative techniques such as reusing water in internal plumbing, or creating bespoke recycling facilities to help reduce the amount of clinical waste incinerated, are being developed.
  • Remote monitoring and the use of technology – There have been major advances in the use of remote technology to host meetings, video-conferences, follow up appointments and assessments for those in receipt of reablement care via tele-health. Remote monitoring of patients, as well as the use of tele-health and other digital platforms can allow consultations and routine check-ups to take place without either party having to leave the house or office, thereby reducing vehicle emissions used in transport. In social care, remote meetings and cloud-based reporting can allow front-line social workers to remain out on visits instead of having to return to the office to fill out reports, again reducing vehicle emissions.

Sustainable resource management

In the face of more limited funding, joint working between health and social care is being heralded as a new way of cost saving, making the most of ever-depleting resources in the face of ever-greater demands. Being efficient with resources, through effective planning and management is one of the key ways to ensure resource sustainability in the long term, especially for the NHS and local authority social care teams.

Approaches include:

  • Making full use of the entire health and care ecosystem – This means using the entirety of the health and social care ecosystem, its capacity, expertise, resources and the end-to-end care it can provide. It means engaging carers, GPs, nurses, and pharmacists to improve efficiency, make better use of resources, spread the workload and improve satisfaction levels and outcomes for service users.
  • Using careful and well-managed commissioning models  This means making good decisions about commissioning and outsourcing to make best use of funding and other available resources. It also means allocating to appropriate projects, being mindful of the possible consequences of payment by result frameworks, and getting the best value possible.

Sustainability in practice

The final level of sustainability in relation to health and social care practice involves the sustainable implementation of programmes. This means finding ways to ensure that implementation is carried out in ways that ensure long term success and positive outcomes. It involves understanding context, and the culture of the organisation and makes reference to something discussed previously in our blog on implementation science.

Ensuring sustainability in practice requires multiple efforts including:

  • Making sure that practice becomes embedded into everyday work
  • Sharing best practice
  • Maintaining motivation among your workforce
  • Using robust, local evidence in a way that is clear and concise.

Understanding what kind of evidence leads to sustainable programme implementation is also important: economists prefer cost-based strategies, chief executives want one-page summaries, professionals want examples of other organisational based programmes and what was required to implement effectively, and councillors want case studies based around the positive impact on services users. Case studies can at times actually be the least helpful because even in a failing programme there is usually one example you can use to find positives.

Another issue with evidence is the reluctance to report on issues or challenges, or failed projects, when actually some of the greatest insight can be gained from this. All of the learning that can be gained from failures could be useful when trying to make programmes more resilient so they can be more sustainable.



Final thoughts

The concept of sustainability in health and social care cuts across many areas of organisational management and personal practice and behaviour. Encouraging and participating in sustainable practice can mean anything from being more environmentally friendly by digitising reports, recycling paper or changing to energy saving lightbulbs to promoting sustainability of resources through efficient and effective management, utilising the skills, expertise and resources of the entire health and social care ecosystem.

These approaches to sustainability should not only help health and social care as a profession to be less impactful on the environment but will also allow organisations to save money, improve efficiency and ultimately improve outcomes for patients and service users as a result.


* The 5th Annual Research Symposium: Evidence for sustainability – exploring the current evidence underpinning ways to create sustainable health and care systems was held on 16 March 2017. It was jointly hosted by Healthcare Improvement Scotland, Health Services Research Unit and the Health Economics Research Unit at the University of Aberdeen, and the Nursing, Midwifery and Allied Health Professions Research Unit at the Chief Scientist Office.

If you enjoyed this blog, you may also be interested in other articles on implementation theory and commissioning in health and social care.

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Learning from mistakes: reflective learning in social work

No one likes to talk about their own mistakes. They are an inevitable part of the human condition, highlight our flaws, inabilities and limitations and can place a spotlight on what happens when resources and people are stretched too thinly.

In certain professions, including frontline social work, mistakes – however innocent or unintentional – can have potentially life-changing effects for service users. Keeping them to a minimum is of paramount importance. And it’s important that if mistakes have been made that they are not only rectified but also analysed to consider what went wrong, and what can be done to avoid the same thing happening again. For social workers the stakes could not be much higher – people’s lives are in the balance. So how can social workers not only recognise, reduce and rectify mistakes, but also use them as learning opportunities to improve performance and decision making in the future?

Making the most of our mistakes

It is important that practitioners and their managers know which strategies are most effective for them and their team when it comes to extracting valuable insight from mistakes. This only comes from having a strong and secure working relationship, where people feel able to talk openly and reveal insecurities and inadequacies, as well as recognising the positives within their practice.

Working out the correct strategies for each occasion and for each team member will take time. However, some tools and strategies include:

  • learning how to generate effective questions to explore not only how a mistake happened, but why and what steps can be taken to prevent it from happening in the future
  • adopting a strengths-based approach, rather than a deficit-based approach to staff and any mistakes they made
  • reflective frameworks that can be formally incorporated into everyday practice
  • encouraging staff to find a “critical friend” to offer an external perspective and extend personal reflective capacity
  • encouraging staff to take up reflective writing (in everyday life, not just at work) including journals and diary entries
  • training staff on creative models of reflection and on how to give and receive constructive feedback
  • finding ways to feed back to an entire organisation regarding the lessons learned from mistakes and how they can shape practice in the future.

The reflective cycle

One of the traditional models of reflection for social workers is Gibbs’ cycle of reflection (1988).

Among social workers, reflective practice is often promoted. Personal experience and participation should be seen as a positive and an opportunity to develop new skills, learning or approaches. Reflection should be focused on professional errors, asking questions like “why”; “what went wrong”; and “what did I do wrong.”

Reflection can happen at three levels:

  • personal
  • one-to-one with another person (a supervisor, colleague or family member)
  • in groups (at organisational level)

It can be useful to reflect at all levels, where possible, in order to get the most out of the experience and have the biggest impact with regard to what can be learnt from mistakes and how this can be passed to others to avoid them making the same ones.

Taking and giving constructive feedback

Although it may be uncomfortable at the time, social workers and people from other professions should welcome feedback from colleagues and service users as they can be powerful sources to drive professional growth. However, it is important to distinguish constructive feedback from blame. Highlighting helpful advice and using it in a constructive way is not the same as finger pointing and fault picking, and managers must develop the ability to distinguish between the two.

Final thoughts

Mistakes happen, and although we don’t like to talk about them, they can sometimes provide some of the most useful insight for learning and improvement within an organisation. Beyond the organisational level, personal reflection on practice and taking time to consider how you approach certain situations is a vital aspect of the self-aware, continual improvement that social workers must strive towards, even if they don’t always meet the exacting standards all of the time.


If you enjoyed this blog post, you may also find the following article of interest:

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Zero suicide cities: learning from Detroit in the UK

Suicide is the biggest killer of men under the age of 45. Yet people still experience stigma when seeking help for mental illness, despite high-profile discussions of mental health issues such as those by members of the royal family and sportspeople. And a report into the Government’s suicide prevention strategy in March 2017, suggested that although 95% of local authorities now have a suicide prevention plan, there is little or no information about the quality of those plans, or whether adequate funding is available to implement them.

The lack of progress made on improving suicide and general mental health provision has led to a growing frustration among professionals and resulted in attempts to create new approaches to tackle mental health issues, and in particular to improve access to support for people in crisis or at risk of suicide.

The idea of a “zero suicide city” was first adopted in Detroit in the late 2000’s, with others following its lead in subsequent years. With reports finding that around 14 Londoners a week took their own life in 2015 (735 in total), an increase of a third from the 2014 statistics, a report in February 2017 by the London Assembly Health Committee suggested that London too should take this approach.

So what can London, and other areas of the UK, learn from Detroit’s approach? And how can services act to reduce the number of people taking their own lives?

Zero-suicide cities

Poverty and high unemployment in Detroit are contributing factors to high levels of depression among city residents. As a result of these high rates of depression and very high suicide statistics, Detroit-based mental health professionals adopted a new approach to tackle the stigma around mental illness and use identifiers to highlight cases of crisis, or potential crisis. The focus is on preventative care, encouraging professionals to act upon signs of mental illness before a suicide or attempted suicide takes place.

Patients attending health clinics for other illnesses, including diabetes or heart failure, are also now screened for depression and other mental health issues before they are released. This allows people deemed to be ‘at risk’ to be identified as soon as they come into contact with medical professionals, who can then refer the patient to a mental health specialist if needed, rather than reacting to mental illness once it reaches crisis point.

In order to support this approach, a centralised IT system was created which means results are traceable, and surveys and information are standardised so they can be used and accessed across clinics throughout Detroit. Coordination with non-medical practitioners, including social workers, employers and family members, has also been key in identifying people at risk and signposting them to help at every possible opportunity. There has also been additional training for staff to improve recognition of identifying factors. Patients can email their clinicians or liaising staff directly and attend regular drop-in appointments. Up to 12,000 patients using mental health facilities are tracked each year in the city and some statistics suggest that the clinics reduced suicides by over 80%.

There have been some criticisms of the system however, despite the reduction in the number of suicides in the city. Critics highlight the fact that many of the poorest and most severely in need of help are not reached as they do not have health insurance and so do not attend those clinics involved in the scheme.

Ultimately, however, the scheme seeks to provide better preventative, coordinated and targeted care to those who are at risk or show some signs of mental health crisis. And some in the UK have suggested there are lessons that could be learned from this approach.

Whole system approach to suicide prevention in the East of England

Four local areas in the East of England (Bedfordshire, Cambridgeshire & Peterborough, Essex and Hertfordshire) were selected in 2013 as pathfinder sites to develop new approaches to suicide prevention based in part on the Detroit model.

Since then, Mersey Care, Cambridge and Peterborough Clinical Commissioning Group and Teesside councils have also become aligned with the programme and are continuing with their approach towards improved suicide prevention. The Centre for Mental Health evaluated the work of some of the sites during 2015.

The evaluation found there were a range of activities that had taken suicide prevention activities out into local communities. They included:

  • training key public service staff such as GPs, police officers, teachers and housing officers
  • training others who may encounter someone at risk of taking their own life, such as pub landlords, coroners, private security staff, faith groups and gym workers
  • creating ‘community champions’ to put local people in control of activities relating to promoting positive mental health and signposting to help services
  • putting in place practical suicide prevention measures in ‘hot spots’ such as bridges and railways
  • working with local newspapers, radio and social media to raise awareness in the wider community
  • supporting safety planning for people at risk of suicide, involving families and carers throughout the process
  • linking with local crisis services to ensure people get speedy access to evidence-based treatments.

However, subsequent research also highlighted some of the challenges. The marketing of the pilots was seen to be damaging and misleading with regards to creating “zero suicide areas”, rather than suicide prevention areas. It has also been suggested that although the campaigns serve to raise publicity and awareness, there is little evidence that the schemes actually reduce the number of suicides in an area any more than “traditional campaigns” to better signpost people to available support.

In addition, many of the projects struggled past the initial implementation stage to have long-term impact, as the buy-in from local GPs and other service professionals was not as high as was expected.

Final thoughts

Widening and improving access to support and services for people at risk of mental ill health or suicide is a big challenge for health and social care professionals. Identifying those people at risk is one of the key barriers and taking inspiration from schemes like those trialled in Detroit is one way for professionals in the UK to adapt their approaches in order to overcome these barriers.

Providing more opportunities for people to get help, and better training for professionals who may come into contact with people with mental illness are some of the ways that current schemes are trying to address mental health and suicide in particular.

However, as many of the evaluative studies from test sites in the UK have found, going beyond that to take mental health into the community, in order to create whole system pathways of care across multiple settings and professions, remains a challenge.

As the London Assembly report pointed out, another key aspect is creating an open environment for people to talk about how they are feeling. This week is Mental Health Awareness Week 2017 and the theme is ‘surviving to thriving’ – and emphasising that good mental health is more than the absence of a mental health problem. Whether in the workplace or in the home; with friends, family or colleagues; it’s important that everyone feels that they have a space where they can talk, and to cultivate resilience and good mental health.


If you enjoyed this blog, you may also be interested in our other articles on mental health in the workplace.

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“Business is an act of citizenship”: using BIDs to promote inclusive economic growth in communities

The key to inclusive place based economic growth?

The principle of Business Improvement Districts (BIDs) is pretty straightforward, and the legislation in Scotland is flexible enough to ensure that pretty much anyone can create and act on a BID-based idea. There are currently over 30 live BID projects in Scotland, with BIDs Scotland stating in their latest annual report that they believe this number could almost double to 65 by the end of 2017 if upcoming and scheduled BIDs are also taken into account. The report found that, despite continuing tough economic conditions, there appears to be little evidence of a decline in interest in the BID model. If anything, more people are turning to BIDs as a way of improving local high streets using limited local funds, private investment from local businesses, and other local assets.

BIDs themselves can be seen as a cross section – a mix of the entire economic ecosystem of a place. They can encompass economic, business, local, political and social elements and bring them together in a strategic way to build revenue to support the different aspects of the BID area, including aesthetics, security and commerce. They are locally developed, locally managed, locally financed and locally delivered, giving a sense of authenticity which is becoming increasingly popular among consumers. This popularity is evidenced by the successful renewal of all of the BIDs in Scotland who have gone to reballot to date, with many actually increasing their majority in favour of the BID model.

Collaboration and embedding BIDS within their local communities

As BIDs have been developed, and new models, partnerships and ways of co- operating have been established, BID coordinators and councils in particular are thinking about how to ensure the legacy of the BID within their locality and, more importantly, how to ensure that the economic benefits of the BID are felt across the BID area, not just within the businesses.

This area-wide benefit can be created by for example, re-investing money in security, street lighting, Christmas lights, and flower baskets to improve the feel and aesthetics of a place – actions which are commonplace in BID areas. However, there are some who feel that BIDs could and should go even further in increasing their social value within a community, while not losing sight of the interests of levy payers. This balance, which requires recognition of the wider roles and responsibilities of BIDs, is something which will have to be carefully managed by BID managers in order to ensure that BIDs do not try to do too much, but at the same time act in a way which makes them a key part of their local community and economy. It is an interesting and, at times, difficult place for progressive BIDs to be.

In many areas, BIDs have provided an opportunity for increased community development, and it has been suggested that there could be a formal role for BIDs to play in the wider community development partnerships within localities. BIDs are now being developed to sit alongside existing community anchor bodies, helping to create strong local partnerships and independent communities.

Through collaboration and co-ordination, BIDs are working alongside other services and organisations to help develop sustained community empowerment, helping communities to lobby, providing work experience placements to local young people and acting positively in the form of events to promote increased community cohesion and empowerment, as well as continuing with “normal practice”- increasing footfall in their local area to benefit businesses.

Not all about the money

While generating additional income for the local economy is one of the biggest drivers of support for BIDs in communities, in some instances one of the biggest assets they bring to a community (especially once they are firmly established) is their leverage and collective bargaining power. They have the power to campaign and support other groups in the community on issues that are important to them, as well as offering greater bargaining power with local authorities or other businesses.

As well as commitment to the levy payers’ interest and to improving the local area for people living nearby, another of the potential roles of BIDs is not to act as direct income generators, but as catalysts or facilitators, to encourage new investment and wider growth beyond the BID area – to engage strategically with other partners to encourage investment.

 

Where next for BIDs

As we have already seen, the flexibility of the BID model in Scotland (there are some legislative differences in England) is such that groups may only be limited by their own ambition. Currently Scotland has what is thought to be the world first food and drinks BID and the first tourism BID this side of the Atlantic. Another innovation is the Borders Railway BID, which seeks to maximise the collective benefit to businesses that are located along the railway route.

It has been suggested that the BID model could be used in a more flexible way to generate income for other public service projects, including the suggestion of a BID for health and a BID for schools. Although the intricacies of how these would work in practice are still being considered, there is much that can be taken from how the existing models use community empowerment, and engagement between the public, third and private sectors to create sustainable and inclusive local economic growth in an area.

As well as their commercial enterprising side, BIDs are also realising their potential as agents of community development and improvement beyond that of economic input. The future currently looks bright for BIDs, which will hopefully mean that it also looks brighter for our local communities.


Business Improvement Districts Scotland is the national organisation for BIDs in Scotland, providing support, advice and encouragement to business groups, communities and local authorities considering and developing a business improvement district.

BIDs Scotland held its Annual Gathering on 28th March 2017 at Perth Concert Hall  with the theme of People – Place – Business: Business Improvement Districts – the key to economic growth.

Follow us on Twitter to see what developments in public and social policy are interesting our research team. If you enjoyed this article, you may also be interested in our other article on BIDs.

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World Social Work Day: promoting community and environmental sustainability

Tomorrow is World Social Work Day (WSWD), and this year the focus is on community sustainability. The theme is inspired by the third pillar of the Global Agenda for Social Work, which was created in 2010 to integrate the aims and aspirations of social workers across the world. It stresses the important role of social workers in prompting sustainable communities and environmentally sensitive development.

This includes:

  • working closely with other partner agencies – including those beyond social work – to create communities of practice, particularly in relation to environmental sustainability;
  • promoting community capacity building, through environmentally friendly and sustainable projects, where possible; and
  • responding to environmental challenges, including helping communities to be resilient to and recover from environmental and natural disasters, as well as in relation to “human disasters” which includes refugee families fleeing persecution or war.

But how does this play out in everyday practice?

Supporting integration

Across the world, social workers are being asked to address ‘human disasters’ as they seek to support and integrate refugee families fleeing persecution and war in conflict zones. Some of the biggest challenges for social workers today relate to refugee and displaced communities. As well as dealing with the effects of trauma, they also help integrate refugees successfully into existing communities and build bridges with others to promote cohesion, reduce tensions and help them make positive contributions to society. Social workers also have a responsibility to encourage all members of the community to help with this support and integration process.

However, in a UK context, supporting people to make positive contributions to their community is not limited to refugee families. It also relates to intergenerational work, valuing the experience of older people, developing the skills of vulnerable adults, or encouraging children to feel connected to a place and community so that they might better take care of it as they grow up.

Supporting sustainability

The role of social workers in supporting the sustainability agenda may not be so obvious. The ability of social workers to adapt and respond to the needs of communities which are experiencing environmental sustainability issues is of growing importance in developing countries. However, social workers in the UK can still contribute to this element of the global social work agenda.

This includes behaving in a way that recognises the need to protect and enhance the natural environment. In practice, this may mean social work departments having policies on going paperless where possible, recycling in offices, and reducing the use of cars, or car sharing (for frontline social workers, however, this is often impractical).

Social work practice can also consider how it supports sustainable social development outcomes within a community, and maintaining personal CPD, education and training levels to reflect this. There should also, as always, be an attempt to share best practice and learn from others.

Final thoughts

This World Social Work Day, let’s take a moment to reflect on the positive contributions that social work professionals are making to their communities as well as to the lives of individuals. It’s also a chance to consider what the future might hold for the profession and how it can continue to promote and support the growth and development of sustainable communities.


If you would like to follow the events going on to mark World Social Work Day or, share any of your own stories you can do so on twitter using the hashtag #WSWD17.

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#BeBoldForChange and the changing world of work: International Women’s day 2017

As women across the world mark the 106th International Women’s Day (IWD17) they are being encouraged to think about their place in the “changing world of work.” Perhaps by coincidence, only a few days earlier toy giant Lego announced plans for it’s latest toy set based on “real life female scientists, engineers and astronauts”. The design was the winner of the latest “Lego ideas” competition and will feature prominent female scientists including Katherine Johnson, a mathematician and space scientist who worked with NASA and was recently featured in the Oscar nominated film Hidden Figures.

Despite attempts to raise the profiles of successful and prominent women in employment, research consistently highlights the persistence of the gender pay gap, albeit more prominent in some professions than others. The “motherhood penalty” still stagnates, or even cripples the careers of many women, and women are still not present in equal numbers in business or politics. Figures show that globally, women’s education, health and violence towards women is still worse than that of men, and that these factors affect their ability to participate fully in employment.

The scale of gender inequalities

A report published by the charity Engender ahead of IWD17 found that of the 3029 top leadership positions across business, politics, public sector, media, culture and sport in Scotland, only 27% of positions are held by women. The report found that, although women make up 52% of the population, they represent only:

  • 35% of Members of the Scottish Parliament
  • 7% of senior police officers
  • 20% of museum and gallery directors
  • 25% of local councillors
  • 16% of local authority leaders
  • 28% of public body chief executives
  • 26% of university principals

Previous research by Engender also found that women still do the majority of “invisible” work including housework, raising children and caring for vulnerable relatives. According to the 2011 census data, 62% of unpaid carers are women and the UK household satellite accounts found that the value of informal childcare in 2010 was £343 billion – equivalent to 23% of GDP. A report published by the Fawcett Society highlighted that inequalities also exists between women. The report found that the gender pay gap was even more exaggerated in black and ethnic minority (BAME) women than in other groups.

Women in Employment

The most recent employment figures for the UK showed that unemployment stood at 4.8%, the lowest level since 2005, and the proportion of women in work reached a record high of 70%. The latest PwC Women in Work Index measures levels of female economic empowerment across 33 OECD countries, based on five indicators. It reported that the UK had rapidly improved since 2000. However it also said that at the current rate of progress it will still take until 2041 to close the gender pay gap in the UK.

In short the picture is improving, but what exactly is being done to help women enter and remain in employment?

Supporting women into work

Supporting women into work was highlighted as a key policy objective for both the coalition and Conservative governments. A number of strategies have been considered to help different groups of women into employment:

  • Supporting women from disadvantaged backgrounds into employment – this includes women who have little to no formal education, victims of domestic violence, disabled women, and female offenders.
  • Supporting young women into traditionally “non female” roles – this includes encouraging young women and girls to take subjects at school and continue these onto university. It also means making apprenticeships open and inclusive, and marketable to everyone.
  • Supporting women to start up their own businesses – recent research highlighted that the annual revenue of women-led companies in the UK is growing at 28 per cent with an average turnover of £3.7 million. Potential support includes making women aware of specific funding they are entitled to, and helping them with the initial start up process. We’ve blogged before about female entrepreneurs if you want to know more.
  • Incentives and increased flexibility for women with children – For many women, the cost of childcare for young children means that working does not make financial sense for them. Employers have been taking steps to make working hours and conditions more flexible, some even providing crèche facilities or credits for childcare to staff to ease the pressure of childcare on working families. Changes to maternity and paternity leave also allow fathers to take a greater caring responsibility for new babies, and can help make the transition back to work easier for some families.
  • Supporting older women – this group has been identified as having been somewhat neglected by back-to- or entry-to-work schemes. Age related conditions, increasing caring responsibilities for elderly parents or grandchildren, and decisions to retrain or change careers can all impact significantly on the professional careers of older women.
  • Supporting women to progress – Women typically still make up the majority of the low-skilled, low pay work force, with many working part time in order to meet childcare needs. However, research has shown that this impacts significant on their ability to progress. While progression is an issue across the board for women in employment, it is particularly noticeable for this group. Research from NPI showed that there were around 5.1 million low paid employees in 2015. 62%, or 3.2 million of them were women and options for progression were significantly lower than for men, which keeps many women in a cycle of low-skilled, low paid, often insecure work.

Supporting women back to work

Many women take career breaks during their professional lives, most commonly to start or look after family. However, when they decide to return they face a number of barriers. These barriers mean that many returners end up in lower skilled jobs, either because their old job does not accommodate new flexible working needs or because extended time away from work is associated with a loss of skill. The UK government have launched a number of strategies and consultations aimed at encouraging and supporting women back to work after a career break. Individual organisations have also developed their own schemes, including the Back to Business scheme developed by PwC and Relaunch your career from MasterCard.

Many schemes include coaching and mentoring, phased returns to work, flexible working options and job shares, where appropriate. Increasingly, organisations now offer childcare options. Employers are also now allowing more staff to work from home, with the increased use of videoconferencing and online document sharing.

Earlier this week, Vodafone announced that it is launching the one of the world’s largest supported return to work programmes, ReConnect to recruit women who have taken a career break, as well as committing to increasing the proportion of women in management and leadership roles.

Final thoughts

Fully unlocking women’s economic empowerment – one of the cornerstones of true gender equality – is reliant upon unlocking the full potential of women in the workplace. As people across the world celebrate the economic, social and political achievements of women, as well as a growing awareness of their collective power to agitate for change, International Women’s Day also provides the opportunity to reflect on the position of women within society, and the steps that can be taken to improve this in the future.

#BeBoldForChange is the official hashtag for this years #IWD17 celebrations. You can submit your #BeBoldForChange action via the IWD website.

Follow us on Twitter to see what developments in public and social policy are interesting our research team. If you found this article interesting, you may also like to read our other articles on women in employment and women in technology.

Eating or heating: tackling fuel poverty in the UK

nastural gas flame

It is a complete scandal that people die because they can’t afford to heat their homes. ‘I, Daniel Blake’ shows the tragic circumstances and daily dilemma of ‘heating or eating’ faced by many thousands of people in Britain today.”

Those were the words of I, Daniel Blake lead actor Dave Johns as he backed a report published in November 2016 by the charity National Energy Action. The report, which looked at the health problems related to fuel poverty, claimed that a child born today may never see fuel poverty eradicated from the UK unless more assistance is given struggling families.

Identifying the “fuel poor”

In England, according to the most recent official government statistics, more than 2.3 million (10%) households are living in fuel poverty. Leeds, Birmingham, Manchester, Liverpool and Cornwall are among the places worst affected. At risk groups include single parent households with dependent children, rural households, and those living in the private rented sector. Research also highlights that those customers who use prepay meters, which include a large proportion of the most vulnerable customers, are more likely to be “fuel poor” as they do not have the flexible tariff options and reduced rate deals which are offered to customers who pay via direct debit.

The picture is not much better elsewhere in the UK. A report produced by the Scottish Fuel Poverty Strategic Working Group estimated that there are currently over 800,000 households (35%) living in fuel poverty, with levels as high as 50% in rural areas. Meanwhile, in Wales the latest estimates suggest that 23% of households are currently living in fuel poverty.

heater gauge

Tackling the causes of fuel poverty

Not being able to afford to heat your home, or having to choose between eating or heating is the stark choice many families in the UK are being forced to make, however it is clear that fuel poverty stems from a number of different factors, including the cost of fuel, the price of energy, and rising energy consumption habits.

The latest Scottish Government strategy on tackling fuel poverty suggests that four drivers of fuel poverty need to be tackled before fuel poverty can be eradicated. These are:

  • Raising incomes  8 out of 10 households (in Scotland) in income poverty are also fuel poor.
  • Making energy costs affordable  in many cases the cost of fuel is rising faster than household incomes.
  • Improving energy performance in housing  people living in a home with low energy performance are 3.5 times as likely to be suffering from fuel poverty as those in a home with high energy performance.
  • Changing habits of energy use  adopting energy-saving behaviours can make a significant difference to fuel bills by reducing overall demand. There is also a need to better understand and increase use of “green energy”.

But what about energy suppliers?

In December 2016, a report from Turn2Us suggested  that two million households suffer from fuel poverty. Subsequently, the “big six” energy suppliers met at Westminster to discuss what they could do to help tackle fuel poverty. At the moment, there is no legal requirement for energy companies to take action to reduce fuel poverty. However, they are coming under increasing pressure to help tackle fuel poverty, by reflecting some of their profit margins in the rates they give to customers. The idea of automatically putting vulnerable or “at risk” customers onto the lowest fuel tariff was discussed. However the bulk of the discussion, according to reports, concentrated on how to increase awareness of existing options, including the government-led Warm Home Discount, individual support grants, the Cold Weather Payment, and practical support from suppliers themselves.warm fire

Practical strategies to tackle fuel poverty

A number of schemes have been developed to try to help tackle fuel poverty, with national roll outs being supplemented by more localised programmes often funded by local authorities or charities.

In November 2016 the Scottish Government pledged an extra £10m to be spent on tackling fuel poverty. £9m was allocated for councils and housing associations to make it easier for tenants to heat their homes. A further £1m is to be made available to provide interest free loans to help people make their homes more energy efficient.

Other schemes have also been introduced by local authorities to try and tackle fuel poverty, including Ready to Switch? Launched in November 2012, Peterborough City Council’s collective switching scheme uses the combined buying power of residents and businesses within the community to negotiate cheaper prices with energy companies. According to figures from Peterborough Council, to date, hundreds of households have switched to save on gas and electricity, with some reducing annual bills by nearly £150.

Boilers on prescription (BoP) is a new funding stream which is being tested in a number of local authority areas, including Sunderland. The fund is managed through NHS Clinical Commissioning Groups, and householders at risk of cold related illnesses are referred for heating upgrades via health professionals. One of the main ideas behind BoP is to reduce a resident’s need for NHS interventions by improving their thermal comfort at home. It is hoped that a warmer, healthier home could reduce the number of GP appointments or emergency admissions.

Energie

 

Altering the design of new homes and subsidising the retrofitting of older ones is also a key policy strategy for tackling fuel poverty. Providing homes which are designed or adapted to be energy efficient through improved insulation, the installation of solar panels or using appropriate lighting or heating systems will allow the government not only to reduce fuel poverty in the present, but should also reduce the likelihood of more people falling into fuel poverty in the future. Reducing the demand for energy by creating homes which use less of it may also help to drive down the cost of energy, resulting in even bigger savings. However, it is not just the responsibility of individual homeowners to carry out these improvements. Local authorities, housing associations and private landlords also need to (and have in many instances) recognise the vital role they play, particularly in relation to more vulnerable customers who are at increased risk of falling into fuel poverty. Retrofitting has been increasingly popular in other parts of Europe, as these case study examples show.

The issue of fuel poverty in the UK does not appear to be going anywhere fast. Despite the attempts of governments across the UK to reduce the figure, in many areas the number of people falling into fuel poverty continues to rise. While there are individual areas of good practice aiming to help some of the UK’s most vulnerable families to heat their homes, it is clear that a wider commitment to combat the underlying causes of fuel poverty is needed, along with a recognition that there is a responsibility across the board to provide help and information to families suffering as a result of fuel poverty.


If you found this article interesting, you may also like to read our blog on the Dutch Energiesprong model and our research briefing on retrofitting (member access only).

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Talking to children about poverty: why education needs to get in on the act

boy with bear

1 in 5 children in poverty

Scotland has one of the highest rates of child poverty in the UK. The latest figures from the Joseph Rowntree Foundation estimate that 1 in 5 children in Scotland live in poverty, with the figure rising to 1 in 3 in the urban centre of Glasgow. With more and more families falling into relative poverty and the numbers of working poor rising, the newly branded “JAMs” (just about managing) are, in some cases not managing, having to decide between heating their house or feeding their families.

People are affected by poverty in many different ways. For adults it can lower self-esteem, increase levels of stress, and can have consequences for mental and physical health. However, it’s sometimes forgotten that many children can feel these same effects from growing up in a family living in poverty.

In the same way as adults, many children suffer from low self-esteem and feel the invisible burden of the stigma that the label of “poverty” places on them. In addition, children affected by poverty:

  • are more likely to be victims of bullying;
  • tend to have lower attainment at school;
  • have fewer social networks or groups of friends;
  • suffer from poorer physical and mental health;
  • have less chance of leaving school with a full set of qualifications and going on to further or higher education (despite the best efforts of various governments to change this); and
  • are more likely than “affluent children” to spend their adulthood in poverty too.

How children understand poverty

Many children have an understanding of poverty as meaning “poor” or lacking in money. Concepts such as heating a home, building personal debt or not being able to afford to travel to work are not things they yet associate as being part of the cost of living, despite many of them seeing their own parents face these struggles on a weekly basis.

They associate poverty with foreign, particularly third world nations, as well as with homelessness, loneliness, a lack of familial support and a reliance on donations. Many children, even from the poorest backgrounds do not recognise themselves as being in poverty. This is something highlighted in research conducted by the Scottish Universities Insight Institute (SUII), which looked at child perceptions of poverty, and expressing these through alternate methods such as art.

In the study, children from schools in less affluent areas of Glasgow and Aberdeen were surveyed and many regarded notions of poverty as a distant, “third world” concept. However, when they were engaged in more creative methods, such as drama, or art, expressions of their experiences of poverty became more acute.

School children raising hands. View from behind.

Engaging education professionals in the poverty discourse

In Scotland, the overarching framework of Getting it Right for Every Child (GIRFEC) is designed to bring services and professionals with whom children come into contact closer together to create a complete model of care for a child. It is interesting that in the latest commitment to tackling child poverty in Scotland there is no commitment to including teachers or education in general, in the same way as health professionals or social workers.

We know that poverty can have an adverse impact on wellbeing and on learning, and that children who live in poverty are more likely to be absent from school. However, education professionals are largely excluded from the discussions which child welfare officers, social workers, doctors and third sector colleagues are already having around the health and wellbeing of children who are living in poverty.

In a practical sense schools do, to a degree, already engage in reducing the impact of child poverty by providing financial and practical help. This could include subsidies for school meals or trips, the donation of free uniforms, breakfast clubs and tutoring after school classes. There have even been cases of individual teachers giving children clean clothes, meals or allowing them to sleep in the staff room at break and lunchtimes to allow them to catch up on sleep lost because of a disruptive lifestyle at home. However, talking about poverty with children is often neglected. This is something that academics are keen to see schools do more of – use their position to engage children in talking about poverty in order to help identify children at risk, but also to help raise the issue with other children who may not have experienced it or know what it is.

Using creative methods in schools to talk about poverty

Many academics argue that statistics on attainment can be misleading – while poverty has a significant impact, it does not correlate directly to cognitive ability. As one researcher at a seminar suggested, “just because you were born poor does not mean you were born without the ability to learn”. While there is evidence to suggest the slower development of children who live in poverty is acute in the early years, there is also evidence that the attainment gap is closing – what children in poverty miss out on is opportunity, variation and experience, and a chance to develop, rather than having lower overall cognitive function. This is one of the reasons, academics argue, it is so vital to engage teachers in wider discussions on child poverty.

For example, the vocabulary of children in poverty is often smaller in range than that of their more affluent peers. But, rather than this being the result of reduced cognitive function, researchers have found that this is primarily because they have not had the need to learn new words. Unlike children from more affluent backgrounds, they tend to remain within their community unit, using more colloquial language and a more limited number of words; they also often have less access to books or exposure to cultural experiences. That is not to say that they could not learn or have learnt all of the words that a child from a more affluent area knows; it’s just that they have not had the need or the opportunity to learn them yet. With this in mind, alternative methods of communication such as art, dance and storytelling could prove useful in explaining poverty to children, and helping them to discuss their experiences and understanding of what it means to be in poverty.

künstlermaterial

Using creative ways of communicating and engaging with children has already been found useful in helping them to talk about other issues personal to them, such as trauma or abuse. Researchers from the Scottish University Insight Institute-funded research team employed similar methods, using art, drama and play to help children express their feelings on poverty, and how it could be tackled in their communities. Children acted out scenarios, wrote poems, and created a number of pieces of tactile artwork, including sculptures and drawings. It was thought that these same methods could be used by teachers as a way to allow children to communicate their feelings about poverty and express issues relating to their own personal experiences without feeling stigmatised or singled out by other members of the class.

It is clear that the education profession has an important role, not only in helping to alleviate the effects of poverty on children through schemes like breakfast clubs, but also in a teaching and learning role. Many teachers and schools are averse to raise issues of money or poverty with children for fear of placing unnecessary distress onto children. However, sensitive and context-aware teaching on the issues around poverty should be seen as an opportunity, not a burden to teachers.

Effective discussion could go a long way to helping children to open up about experiences of poverty and also help them to be more understanding of other children who are living in poverty, reducing stigma and encouraging positive action within their local communities.


This blog reflects on research from the Scottish Universities Insight Institute and seminar participation at the Centre for Child Well-being and Protection at the University of Stirling.

Follow us on Twitter to see what developments in public and social policy are interesting our research team. If you found this article interesting, you may also like to read our other article on arts based practice with children.