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

 

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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Secure care in Scotland: measuring outcomes and sharing practice

By Rebecca Jackson

There are five centres which offer secure care in Scotland, with around 100 of Scotland’s most vulnerable children and young people placed within these units. Placements happen if they are deemed to be a risk to themselves, or others, within their communities, and it is felt that they can only be managed effectively within a secure care setting. These placements are arranged via the courts or the children’s hearing system.

 

National Secure Care Project

In 2014 the Scottish Government granted funding to the Centre for Youth and Criminal Justice (CYCJ) for a fixed term project to build on the work of the Securing our future initiative (SOFI) report in 2009. The SOFI report was a comprehensive analysis of the secure care estate in Scotland. It made recommendations for future practice in secure care and also suggested ways that the system could be made more efficient and young person centred. These included implementing and embedding the Getting It Right for Every Child approach and making full use of the Children’s Hearing and Early Years frameworks, including the SHANARRI indicators on well-being.

A scoping study was completed by CYCJ in 2015 which considered the current legislative and academic frameworks, as well as current practices of the 5 centres of secure care in Scotland. This followed the streamlining and takeover by Scotland Excel in 4 of the centres and Edinburgh City Council in the other.

The scoping study report, along with the project plan, highlights the aims and objectives of this new national programme:

  • identifying and promoting current best practice
  • identifying and exploring alternatives to secure care
  • building capacity within the secure care sector to draw comparisons and learn from the rest of the UK (and from each other)

Other key issues that the studies identified as needing to be addressed included:

Outcomes in secure care

One of the key issues raised by academics, policy makers and practitioners within secure care is the concept of outcomes. It’s been suggested that there is a need for both individual outcome targets for each child within secure care but also for a wider framework of general agreed outcomes to allow for better comparison between centres, which it is hoped will help raise standards of practice.

It is also recognised that long term, as well as the immediate, outcomes need to be assessed and researched. This ties in with the need for more emphasis on transitionary care and support. Although there is an expectation that local social workers will follow up on behalf of the secure care units, this isn’t always the case.

Key questions also have to be addressed from within the sector itself with regards to:

  • what are the aims of the centres
  • what exactly is meant by positive outcomes
  • what counts as an outcome
  • how can we look at a child or young person and say that a certain objective has been met, and can this be attributed to any one particular event, intervention or placement

These questions are not unique to the secure care sector but they do need addressed. Similarly there needs to be a wider acceptance that there are multiple outcomes and that these can be in terms of quality of life, process or change outcomes.

Sharing best practice and using staff as “knowledge brokers”

There is concern among practitioners and academics that, as a result of the changes to secure care provision implemented in 2014, secure care units are now reluctant to collaborate and share best practice.

The nature of the new secure care framework agreement means that, despite being referred to as a “secure care network”, the five centres are now in effect “in competition with one another” for individuals to be placed with them.

There is a risk that this constrains the sharing of best practice, ultimately reducing the collective standard of all five centres and therefore reducing the standard of care afforded to some young people. This was particularly highlighted in the 2015 CYCJ scoping report.

One of the key ways to share information and best practice is to allow the people who work within the centres, working with residents on a day to day basis, a platform to discuss and contribute to a wider discussion of best practice outside of their own individual centre.

Another potentially useful strategy would be to integrate approaches from traditional social work with regards to sharing ideas and information. This may also make it easier for social workers within and outside the secure care context to liaise with one another. Using staff members as “knowledge brokers” could be an efficient and effective way to allow staff to communicate best practice. Tools such as a digital platform, interactive app or online forum could help staff to share their experiences.

With the project scheduled to run until 2017, some of the issues highlighted here were discussed at an event hosted by CYCJ and WithScotland at the University of Strathclyde in April 2016. The hope is to increase collaboration and move the provision of care and creation of successful and useful outcomes frameworks forward as part of the wider National Secure Care Project.


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Telecare in the UK: lessons from Barcelona

By Rebecca Jackson

Telecare is technology to help people live independently, usually in their own homes, for longer. Usually delivered as part of a package of care, telecare devices can include things like: bed sensors, to detect if someone is out of bed at an unusual time; fall sensors; medication reminders; and alerts on screens or over loudspeakers. Such devices have led telecare to be heralded as a new dawn in patient-centred, independent living.  However, despite initiatives  to drive its application forward, not everyone in the UK is convinced about the benefits of telecare.

Practitioners and carers are sceptical about the potential of replacing traditional care with digital models to save money and the impact that this could have on standards of care. In addition, many patients themselves are uncertain about the use of telecare and digital health solutions, with many who have telecare systems within their homes choosing to continue to interact with primary and home care services in the same way as before. Much of the academic and expert-led research and evaluation of telecare programmes in the UK by organisations such as the Nuffield Trust and the Kings Fund has found little to no improvement in service, reduction in cost or reduction in workload for care teams in areas where telecare has been deployed.

While telecare in the UK appears to have stalled, elsewhere digital health solutions are not only successfully integrated into traditional care models, but are having a positive impact on the people in receipt of care, and reducing the burden of work on care providers.

Lessons from Barcelona

In Spain, the law has guaranteed access to telecare since 2006. Economic austerity has led to individual local authorities in Spain being given control over their budgets and therefore their provision of telecare. The approach in Barcelona has been highlighted as an example of best practice in telecare.

The system there – a cooperative venture between an independent provider and the local authority – sees carers take a proactive approach to telecare. The system does not just monitor and provide assistance in times of distress, but proactively engages with service users at regular intervals to help carers provide reassurance and build relationships.

As well as the emergency measures, such as fall sensors (typically the primary use of telecare in the UK), calls are made to check up on service users, provide reassurance, deliver general public health information and to mark important occasions, like birthdays. This can help to reduce feelings of isolation and loneliness, which in turn can lead to better general health and wellbeing.

Calls can also be made to highlight important information, such  as weather warnings; safety alerts and local events which the service users may wish to attend. These calls are backed up by visits from the care team, who work for the telecare provider. These visits supplement visits from municipal care and social workers and the two teams communicate and share information via digital platforms.

Digital healthcare as an enabler

The case of Barcelona shows us how digital healthcare solutions, and more specifically telecare, can be used as an enabler – a tool to allow the local authority to pursue a joined up and preventative approach to healthcare which has positive benefits for recipients.

Such approaches could also have a significant impact on the UK’s 3.8 million unpaid carers. Telecare has the potential to reduce some of the burden and stress of caring for a relative, which in turn can have positive effects on the health of the person in receipt of care. It can also  form an effective part of reablement programmes – supporting people as they leave hospital or return to independent living.

However the approach to delivering telecare in Britain is as much about culture as it is about the technological infrastructure. Using telecare as part of a preventative, person-centred approach should produce better outcomes. In this sense, implementation of telecare in the UK still lags behind other countries. Key lessons could also be learnt from programmes in Norway and the Netherlands in relation to telecare in dementia settings.

Generally, the targeting of telecare services also differs – in the UK it tends to be aimed at elderly people with complex and diverse needs, while in Norway and the Netherlands the focus has shifted to those suffering from chronic illnesses.

Local solutions

In the UK, some local authorities have been experimenting with digital healthcare, although local authority budget cuts have meant that in many cases these have been cut back to focus delivery on the most vulnerable clients.

The lessons in digital healthcare that Britain can learn from places like Barcelona could be key to the successful roll out of digital healthcare solutions in the future. The Barcelona example highlights the enabling role that telecare can play in joining up health and social care and promoting a more preventative approach to healthcare.

Opportunities to develop telecare strategies and deliver them in partnership, as in the Barcelona model, show that it cannot be delivered in isolation, or be used as a replacement for existing carer-led services. Instead telecare has the potential to be a supporting tool to ensure effective care outcomes. It could also help care services in Britain to tackle the increasing demand of an ageing population.


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Digital technology in social work practice

Using social media in social work practice was the topic of conversation at a recent conference, held at the University of Stirling. With a delegate list including academics, researchers, practitioners and representatives from the public and private sectors the conversation topics were broad and wide ranging from how to use social media, what to avoid doing and how to integrate digital technologies and systems into everyday practice for social workers.

social media infographic photoPartnerships to deliver digital solutions

In March last year we told you about the partnership between a local authority and Idox who teamed up to deliver a digital case management tool to support the council social workers in their day to day practice. The ideas that were promoted during the conference not only emphasises the innovative nature of that partnership when it was developed, but also the continuing possibilities to pursue innovative digital solutions within local government to allow Idox to continue deliver efficient and positive outcomes for service users.

Avoiding social media pitfalls

Aside from poor infrastructure, like a lack of wifi, and seemingly impenetrable work computer firewalls, both of which came up regularly in discussions, one of the main reasons social workers did not use social media was fear, uncertainty and worry of the repercussions should something be posted or liked which was deemed inappropriate.

Rachel Wardell, the director of Services at Warwickshire council gave a talk on utilising Twitter in an appropriate way and outlined the “7 stages of Twitter” for new and advanced users. She suggested that Twitter was actually a great way for social workers, teams and managers to make connections and share best practice across the profession. She discussed how links initially forged on twitter by a follow or the sharing of an article developed into partnerships and trips to visit areas of best practice to observe and learn from fellow professionals.picjumbo.com_HNCK1814

However for many social workers, and their management teams, social media use can still be problematic, with the BBC reporting earlier in the year that there had been a rise in the number of council workers being punished for misconduct relating to social media. For social work teams the pressures and implications are even more significant. In discussion with Birmingham University’s Dr Tarsem Singh Cooner some of the delegates highlighted examples of colleagues who had been accused of bringing the profession into disrepute and some extreme instances where they had been removed from cases at the request of service users who had seen a post on their social media account which was not secured with privacy settings.

While most were keen to stress that these were individual mistakes and misjudgements there was still anxiety about the increasingly blurred boundaries between public and private, the importance of relationship building and personal experience for social workers interacting with service users, but the necessity to remain professional. The phrase ‘social workers are human too’ was used regularly by those advocating the use of social media and that councils should use a level of common sense and discretion when dealing with incidents involving staff and social media. However, the general consensus appeared to be that social media should be treated with caution:

  • use a separate work and personal account
  • use an alias
  • employ maximum privacy settings
  • don’t post anything that could potentially bring the profession or your conduct into disrepute
An example (from my own Twitter) of how Twitter can be used to document conferences and interact with professionals

An example (from my own Twitter) of how Twitter can be used to document conferences and interact with professionals

Making social work ‘appier

One of the big developments which has become increasingly popular as a tool to engage social work in digital technology is the creation of apps. Many of the conference discussions were on the benefits of using an app, how they can be utilised fully in their roles as training tools and information providers or how they can be used to encourage participation and communication in aspects such as feedback.

Anne Campbell from Queens University Belfast discussed the development of a series of information-based apps which focused on child development. Another app covered the knowledge of social workers and social care teams of drug and alcohol in substance misuse cases, including symptoms, street names for abused substances and the studies which use examples of substance misuse in social work and adult and child protection cases. She discussed the importance of using practitioners and service users to develop the app, to ensure it was fit for purpose and easy to use. She also highlighted the potential for her apps, which currently operate in a Northern Irish context, to be developed and diversified to account for differences in policy in Scotland, the Republic of Ireland and England and Wales.

Screenshot images of the apps

Screenshot images of the apps

There is a potential for software development in the future which would see more secure data files more easily accessible via personalised secure apps and document drop apps, which could be shared across a number of sectors, including health, social care and education. Delivering the digital infrastructure platforms to develop and successfully run integrated systems and sharing platforms such as these would require huge investment from local authorities, and would potentially provide the opportunity to work in conjunction with specialists, such as Idox, to develop software which is supportive, flexible and fit for purpose.

Apps

Iphone apps. Image by Daniel Go via Creative Commons

Using social media to create connections

The final part of the afternoon was characterised by case study style discussions, where speakers presented their own experiences, both positive and negative of using social media and stressed the importance of social media as a way to create connections. The connections spoken about included connections between practitioners, to create a more extensive community of best practice within the social work profession, connections between service users and social workers, many of whom feel more comfortable communicating via social media, and finally creating connections between service users to help them provide support to each other. This was something specifically highlighted by the team from Lothian Villas in East Lothian.

Lothian Villas have been using a closed, invite only Facebook group as a forum to interact with young people staying with them during a period in residential care. Members can post on the page, while others respond giving advice and reminiscing, much like a traditional family would do. That, according to Ewan McKay, is vital for allowing children who have come from care to build and maintain relationships and have happy memories of their childhood which can go on to shape how they behave as adults in the future. They can also then pass their memories and advice onto the children who are coming through the system after them.

Other groups spoke about the use of document sharing sites, digital presentation sites and networking sites like LinkedIn to create and document continuing professional development (CPD), a core part of social workers’ continuing improvement and the maintenance of standards.

 

The conference highlighted the massive steps forward which have been taken and the desire for drive and innovation in digital infrastructure to take public services, and their delivery onto digital platforms. This would allow for greater connectivity between professions such as social work and other service providers in health and education resulting in more efficient services, producing better outcomes for service users. Using digital platforms well, including apps, sharing websites and personal social networking sites such as Twitter will allow practitioners and local authorities to ‘join up’ services to promote more holistic, person-centred care at a local level while allowing professionals to build a network of best practice and document their own CPD. Digital media in social work practice could potentially be a key enabler in improving practice and generating positive outcomes for service users.


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