Buurtzorg: reinventing district nursing in Scotland

Posted on July 5, 2017 by Rebecca Jackson

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:

Holistic and personalised care – where assessments of need are integrated into and form the foundation of agreed care plans
Mapping networks of informal care, and assessing ways to involve these networks in treatment plans
Identifying other formal carers and organisations who provide care services and coordinate their input
Taking steps to support the client in his/her own environment
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

World Social Work Day: promoting community and environmental sustainability

Posted on March 20, 2017 by Rebecca Jackson

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.

We regularly write on social work topics. Check out some of our previous articles:

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What is Reablement in healthcare and how is it done?

Posted on March 9, 2016 by Rebecca Jackson

By Rebecca Jackson

Reablement, or enablement is the process of rehabilitating people to allow them to regain some or all of their independence. Often promoted as a form of intermediary care, reablement programmes are recommended for patients who have had a stay in hospital, in order to reduce dependence on the local social care system or traditional ‘care at home’ programmes.

They often result in longer periods of one-to-one contact than ‘care at home’ programmes – trained professionals work with patients and their family to encourage and promote the achievement of personal goals. It also provides an intermediary stage between health care and social care, which can help the patient transition. Effective reablement programmes are an example of health and social care bodies working together to deliver holistic, person-centred care.

What makes an effective reablement programme?

Reablement programmes cover a range of everyday tasks such as how to tackle stairs, how to wash and dress and how to prepare and cook meals. It encourages service users to develop the confidence and skills to carry out these activities themselves in order to continue to live at home.

The programmes are planned and delivered by trained reablement professionals – they involve home care staff working in tandem with physiotherapists, occupational therapists and other health professionals.

Much of the literature around reablement (enablement) practice centres on core issues which are vital to ensure success:

focus on early intervention and prevention;
a positive, enabling, co-productive approach adopted by all;
a workforce with an ethos of working with people, rather than doing something to them;
the active participation of the service user and their family in reablement;
ongoing training for staff;
information and support for families and carers;
integration and collaborative working between health, housing and social services;
strong leadership in commissioning, and adequate funding of services to deliver sustainable outcomes;
evaluation that incorporates both social and financial service outcomes to demonstrate value;
good quality assessment by a practitioner with the right skills and abilities to determine an effective programme.

Reablement in local authorities

Research has shown that these intensive programmes are effective. A 2007 study for the Department of Health’s Care Services Efficiency Delivery Network found that up to 68% of people no longer needed a home care package after a period of reablement, and up to 48% continued not to need home care two years later.

Almost all of England’s councils are planning, implementing or running a reablement service. One driver is that it is seen as a tool for managing the costs of an ageing population. In the UK, reablement programmes usually last for 6 weeks, at which time care is either passed to a social worker, adult social care team, or patients are asked to pay for the continuation of the programme themselves.

Reablement has been criticised as expensive, and time- and resource-intensive. Like any service working with vulnerable people, it can also be difficult to demonstrate value as there are differing success rates for different patients. However, interviews conducted with people who have received reablement packages have suggested the emotional and long term benefits are significant as are potential savings to care budgets in the future. This is especially the case in terms of the cost of readmission to hospital, which studies have found is reduced in cases where people received effective reablement care.

The local authority in Croydon was recognised in 2013 for its work in promoting and expanding reablement practices. They also developed a programme of pre-ablement, which saw training delivered to vulnerable people before they became unable to carry out tasks. By showing them alternative ways to do tasks, they were able to change things before being forced to. This preventative approach worked within the local authority and is something which could be considered more widely as pressure increases on local authority funding and care capacity.

There is a growing consensus that properly funded and effective preventative services, such as reablement, can deliver cost-savings to health and social care services, as well as improving the lives of patients.

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Budget cuts hit research in councils’ adult social care departments

Posted on November 4, 2015 by morwenj

Image by Innovate 360. CC BY 2.0

By Morwen Johnson

The news that budget pressures have affected councils’ ability to carry out research in adult social care won’t come as any surprise to those working in the sector. Councils have cut £4.6bn from adult social care budgets since 2009-10, equivalent to almost a third of net real terms spend, according to Adass. And with research seen as non-essential, it will always lose out in favour of frontline services and care packages.

A recent survey carried out by the Social Services Research Group (SSRG) and commissioned by the Personal Social Services Research Unit (PSSRU), highlighted the scale of the problem though, finding that there were fewer staff to do research, and those who were left had fewer resources and less support.

Dr Chris Rainey, one of the report authors commented: “In-house research is critical to finding out what, how and why services are delivered and what difference they make. The survey points to the need to reinvest in local research capacity to ensure sound evidence is used”.

Barriers to the use of research

As well as low capacity to undertake their own research on local needs, the survey also identified restrictions on training and professional development.

Like other professions, those working in public health and social services face barriers to keeping up with the latest evidence and commentary. This includes lack of time but also the accessibility of much research (both in terms of knowing it is out there and being able to understand how research relates to practice).

The report highlighted the risk that “reliance on internet-based training and information … may result in a lack of exposure to critical debate and an over-reliance on ‘received wisdom’”.

What our members say

The findings reflect our own experience in meeting the information needs of council staff. We’ve a number of adult social care departments who use our Information Service and once staff realise the time savings we offer, they become champions of the service to colleagues. As our team is made up of information professionals and researchers, we offer experience that can be lacking internally. Resources include peer-reviewed journals, grey literature, books and practice-based case studies and evaluations – which won’t be found by searching Google.

Staff also use us for CPD purposes – nowadays spending on event and conference attendance is unlikely to be approved, but our briefings and current awareness services can help keep them up-to-date with essential topics. We also have a lot of resources on general management issues, such as managing teams, benchmarking, performance, equalities and communication.

“From time to time, we review this service and our last review showed that those who use it regularly either in a corporate capacity or in our major strategic services value it highly, describing it as quick, easy, and comprehensive. It gives staff access to a wide range of information and keeps them up-to-date across many areas that are of direct relevance.”

“I recently completed a Post Graduate course and used it as my first reference point at the beginning of each module. The service saved me a lot of time in searching for articles and books and the staff were extremely helpful. The library is well stocked and I didn’t need to purchase any books for the course.”

“Having access to the on-demand research service is a real plus, and most of our staff see real advantage to that. It saves them time in the long run and frees them up to do the day job.”

The threat of short-termism

With resources in social care departments likely to remain very tight, but with practitioners under more pressure to deliver than ever, the question is how can local authorities retain and enhance the evidence base it needs to make decisions effectively?

And how can practitioners engage with the research and analysis on key developments in policy that affect social care services, such as demographic change, housing need, and independent living?

It’s worth remembering that local authority social services researchers were introduced as a result of a recommendation of the 1968 Seebohm Report. This report stressed the need for research and evaluation to be ‘a continuous process, accepted as a familiar and permanent feature of any department or agency concerned with social provision.”

But as we approach another Spending Review, it’s likely that adult social care services will face more cuts. This is despite national organisations representing the sector issuing a statement in October arguing that the sustainability of the sector has now reached a ‘crunch’ point.

Focusing on efficiency savings and short-term interventions may seem the only option at the moment, but we risk just patching up problems rather than delivering services which take a holistic and long-term view of outcomes. And that’s why recognising the value of research and evidence should be a key part of decision-making in every part of the public sector.

We are currently offering a free trial of our service for local authorities. Contact us for more information.

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Can the Care Act really provide the transformation in adult social care needed for modern society?

Posted on October 7, 2014 by heathercameron25

By Heather Cameron

The legislative framework for adult social care in England has been described as out-dated by the Department of Health (DH) as it is focused on crisis intervention rather than prevention and early intervention, and on the provision of services, rather than enabling the system to be centred around the health and wellbeing of people and carers. The DH has therefore highlighted the need for government intervention to reform the legal framework so it better fits the purpose of modern care and support.

The government’s objectives for adult social care are to improve people’s quality of life, delay and reduce the need for care, ensure positive care experiences and safeguard adults from harm. The Care Act 2014 was passed into law on 14^th May 2014 with the aim of transforming adult social care in England to meet these objectives. Although the Act is generally concerned with care and support matters in England, some provisions extend to the devolved nations. The main focus of the Act is on promoting individual wellbeing and preventing the need for care and support. In particular, it makes provision:

to reform the law relating to care and support for adults and the law relating to support for carers;
about safeguarding adults from abuse or neglect;
about care standards;
about Health Education England;
about the Health Research Authority;
about integrating care and support with health services; and
for connected purposes.

According to Care and Support Minister, Norman Lamb: “the Care Act represents the most significant reform of care and support in more than 60 years, putting people and their carers in control of their care and support. For the first time, the Act will put a limit on the amount anyone will have to pay towards the costs of their care.”

Due to come into force in April 2015, with its provisions related to funding reform to be implemented a year later, the success, or otherwise, of the Care Act’s implementation is as yet unknown.

Nevertheless, there has been much discussion over the potential issues and challenges with regard to implementation. The College of Social Work (TCSW) argues that the implementation of the legislative reforms “will be challenging and demand significant cultural and attitudinal changes, both strategically and in professional practice”.

The Act presents significant changes for local authorities which will be challenging to implement in the proposed timescale. Concerns have been raised by both local authorities and charities over the funding of the Act’s provisions and the sustainability of adult social care services. A recent article published in Community Care highlights such concerns among councils, noting that nine out of 10 councils believe key parts of the Act will be jeopardised if the government fails to provide local authorities with adequate funding for implementing the reforms.

According to London Councils, London is facing double the shortfall in funding to prepare for the Care Act than previously thought with proposed new funding arrangements unveiled by the government to leave the capital with a £36 million gap.

Moreover, a subsequent article in Community Care suggests that local authorities need to consider the training challenge now in order to negotiate the issues raised by the new funding reforms.

The main costs of the Act relate to improved legal rights for carers (rising to £175 million per annum). However, there may be additional costs, for example where local authorities face increased demand for services due to improved information. Greater clarification on the support available to carers could potentially increase the workload for social care professionals as the number of carers’ assessments could also increase.

The additional requirements of providing support to self-funders as well as carers could also take its toll on councils. Caroline May, business partner in finance at Havering LBC noted at a recent roundtable that:

“There are a lot of unknowns out there that will present us with financial challenges. I think culture shift is going to be huge across the board.”

The Association of Directors of Adult Social Care (ADASS), which represents local authorities, is unconvinced that local authorities can implement the changes required in the proposed timescale. In a joint report with the Local Government Association, they highlight the financial challenges local authorities face, particularly at a time of budget cuts and increasing demand for services. A recent inquiry into adult social care in England has highlighted that there was an 8% real terms cut in spending between 2010/11 and 2012/13; and demand for care provided by adults is projected to rise by over 50% between 2007 and 2032, while the supply of this care is projected to rise by only 20%, according to Carers UK.

Despite these funding issues, however, cost savings have also been identified in relation to public expenditure savings of improved support for carers, according to the DH’s recent impact assessment, which also states that these cost savings outweigh other new costs overall. The potential benefits of the Act for people with care and support needs which could also lead to savings were identified as: “improved wellbeing, better prevention of care and support need, greater clarity, consistency and equality of access to care and support and reduction of unmet need.”

It will undoubtedly be challenging to implement the provisions of the Care Act and it remains to be seen whether the funding provided will be adequate.

Only time will tell whether the proposed reforms will truly transform the currently outdated adult social care system.

Further reading

The Idox Information Service has a wealth of research reports, articles and case studies on a range of adult social care issues. Items we’ve recently summarised for our database include:

The Care Act and the care market: conference summary

Adult social care in England: sixth report of session 2014-15 (HC 518)

Using technology to deliver social care, IN Local Government Chronicle, No 7598 17 Jul 2014

Carers’ quality of life and experiences of adult social care support in England, IN Health and Social Care in the Community, Vol 22 No 4 Jul 2014

Transforming adult social care (improving efficiency in council social care services), IN Local Government Chronicle, 5 Jun 2014

Care Act 2014

Understanding personalisation: implications for social work, IN Journal of Social Work, Vol 14 No 3 May 2014

State of caring 2014

Care home top-up fees: research with local authorities

Making our health and care systems fit for an ageing population

N.B. Abstracts and full text access to subscription journal articles are only available to members of the Idox Information Service.