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

 

Why resilience matters for social workers

By Heather Cameron

A recent storyline in the BBC’s Silent Witness programme graphically illustrated the emotional pressures that social workers operate under. Troublingly, this was not a case of dramatic license. Stress is damaging the ability of a significant number of social workers to do their job. This is often compounded by a lack of workplace support, particularly with regard to difficult cases such as child abuse.

In a recent Community Care survey of more than 2,000 frontline staff and managers, more than 80% of social workers felt stress is affecting their ability to do their job.

A third were trying to cope with stress by using alcohol, while 17% are using prescription drugs such as anti-depressants. Despite almost all respondents (97%) stating they were moderately or very stressed, only 16% said they had received any training or guidance on how to deal with work-related stress, and less than a third had been offered access to workplace counselling.

Social workers need high levels of confidence and resilience when dealing with safeguarding issues. And these are worrying findings, given the serious emotional impact more challenging cases can have.

Lack of support

New research for the NSPCC in six local authorities, highlights that social workers are finding it difficult to deal with the emotional impact of child sex abuse cases.

Adequate support and supervision is key to moderating the negative impacts of stress and burnout. The Assessed and Supported Year in Employment (ASYE) – introduced in September 2012 – provides a support framework for newly qualified social workers. However, the research found supervision for experienced social workers continues to still be lacking, with many having to find their own informal support networks.

With reports on child abuse a regular occurrence in the media, the public pressure on social workers and other professionals involved in such cases is unlikely to subside. It’s even been suggested that politicians and the press have a common agenda in presenting ‘bad stories’ about social work to the public.

So what can be done?

With nearly 1 in 10 social workers considering leaving their jobs, its clear that addressing stress is a priority. But they are working in an environment where local authority budgets are being cut and the numbers of children subject to child protection plans increased by 12% between March 2013 and March 2014.

Back in 2009 the Laming Report emphasised the need for social workers to “develop the emotional resilience to manage the challenges they will face when dealing with potentially difficult families”. Research at the University of Bedfordshire has explored what resilience means in practice, and how individual resilience can be improved. It suggests that resilience can be learned, and is supported by reflective practice and self-awareness.

Active listening by line managers or supervisors can be an effective tool for identifying and dealing with the onset of stress within their team. And qualitative research in Scotland suggested that with the right support, social workers can retain the sense that their work is worthwhile and satisfying.

Let’s hope that Community Care’s next annual survey of social workers will show an improvement in work-related stress.


 

Further reading

Some resources may only be available to Idox Information Service members.

‘Heads must roll’? Emotional politics, the press and the death of Baby P, IN British Journal of Social Work, Vol 44 No 6 Sep 2014, pp1637-1653

Social Work Watch: inside an average day in social work – how social work staff support and protect people, against all the odds (2014). Unison

‘Bouncing back?’ personal representations of resilience of student and experienced social workers, IN Practice: Social Work in Action, Vol 25 No 5 Dec 2013

Inquiry into the state of social work report (2013). British Association of Social Workers