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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Denmark’s digital ambassador: should the UK be following suit?


By Steven McGinty

On 26 January, the Danish Ministry of Foreign Affairs announced that they would be appointing the world’s first ‘digital ambassador’ to act as the nation’s representative to major technology companies, such as Google, Apple, Facebook and Amazon.

At a conference on the future of the Foreign Service, the Foreign Minister, Anders Samuelsen, explained that:

Denmark must be at the forefront of technological development. Technological advances are making such a great impact on our society that it has become a matter of foreign policy. I have therefore decided to announce the appointment of a digitisation ambassador.

In a follow up interview with Danish newspaper Politken, Mr Samuelsen expressed his belief that multinational technology giants “affect Denmark just as much as entire countries”. He highlighted the examples of Apple and Google whose market values are so large that if they were countries they would only narrowly miss out from inclusion in the G20 – the global forum for cooperation between the world’s 20 major economies.

As a result of this economic strength, together with tech firms’ impact on the everyday lives of citizens, Mr Samuelsen argues that the technology sector should be treated as a form of ‘new nation’, which Denmark must develop closer relationships with.

Cooperation between nation states and the technology sector

Technology companies are becoming involved in activities that were once reserved for nation states. For example, Mr Samuelsen’s Liberal party accepts donations in Bitcoin – an online currency which challenges the state’s role as the only issuer of legal tender. And Microsoft have signed a partnership agreement with the French Ministry of Education to provide teacher training, in order to prepare teachers for running special coding classes.

The technology industry argues that it is better placed than national governments to provide effective digital services, at cheaper prices. In terms of national security, computer engineering expert and academic, Jean-Gabriel Ganascia, argues that this is probably the case. Mr Ganascia highlights that Google and Facebook have vast image databases that enable them to use facial recognition software far better than any national security service. Therefore, countries have started working with technology companies on a variety of crime and public safety issues.

Citizens are also spending greater amounts of time on social media platforms. In an interview with The Washington Post, Mr Samuelsen stated that more than half of the world’s data has been created in the past two years (much of this from major platforms such as Facebook). This trend has implications for the privacy of citizens and the spreading of false information, a phenomena that has been labelled ‘fake news’. These issues are fundamentally important for citizens and nation states, and are likely to increase cooperation between countries and the technology sector.

Australia’s Ambassador for Cyber Affairs

Although Denmark will be the first country to introduce a digital ambassador, another government has made a similar appointment. In January, Dr Tobias Feakin was appointment as Australia’s Ambassador for Cyber Affairs. His role focuses on cyber-security, but also includes issues such as censorship and promoting internet access. At this stage, it’s unclear whether Dr Feakin will have direct contact with technology companies and whether this relationship will involve discussions over economic issues such as taxation.

Is a digital ambassador necessary?

Not everyone, however, is buying into the appointment of a government representative focused solely on digital issues. Technology journalist, Emma Woollacott, believes that it’s a ‘terrible idea’.

According to Ms Woollacott, Denmark already has a good relationship with technology companies, highlighting that Facebook has recently announced plans to build a new data centre in Odense, creating 150 new permanent jobs. These views may have some merit, as Mr Samuelsen has confirmed that the deal between the Foreign Ministry and Facebook was the result of three years of behind-the-scenes work.

Ms Woollacott also argues that Denmark is setting a worrying precedent by equating a private company to a nation state.  In her view, the importance of the technology sector could have been acknowledged through hiring knowledge staff, rather than granting it a ‘unique political status’.

However, Professor Jan Stentoft, who researches the insourcing of technological production to Denmark, believes creating the ambassadorial post is a good idea. He explains:

We have much to offer these companies, but Denmark is a small country, and we obviously need to make ourselves noticed if we are to attract them to the country.

Marianne Dahl Steensen, CEO of Microsoft Denmark, also welcomed the creation of a digital ambassador position, but did acknowledge that the company ‘can hardly be equated with a nation’.

Should the UK introduce a digital ambassador?

By introducing a digital ambassador, Mr Samuelsen is taking a pragmatic approach to ensure Denmark is a key player in the international digital economy, as well as attempting to manage the impacts of an increasingly digital society.

Although appointing an ambassador for the technology sector poses philosophical and ethical questions, the UK should closely monitor how this new role develops and the potential benefits (and challenges) it brings for Denmark. In particular, if the new role is able to improve dialogue between technology companies and the security services on matters such as privacy, or help address the sector’s need for digitally skilled workers, then maybe introducing a digital ambassador is something worth exploring.

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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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‘High quality and equitable outcomes for all’ – highlights from the Scottish Learning Festival 2015

By Rebecca Jackson

“High quality and equitable outcomes for all”  – that was the theme of this year’s Scottish Learning Festival held last week at the SECC in Glasgow. A mix of academic and policy based seminars, converged with practitioner based learning during the session on Wednesday.

Out of a packed schedule we chose to attend the launch of a new initiative to encourage more STEM teachers; information on the Scottish Attainment Challenge, delivered by Education Scotland and the Scottish Government; and a promotion of employment partnership learning, showing how schools and colleges can engage more with local business to provide opportunities for students.

A fundamental commitment of the Scottish Government

The keynote speech on Wednesday was delivered by Angela Constance MSP, Minister for Education at the Scottish Government. In her address, she stressed the importance of the key themes of the conference, which were collaboration, best practice and ensuring that no child in Scotland should be unable to fulfil their potential at school because of their background or their ability to pay.

Scottish education she said, would be “driven by evidence of ‘what works’ “ and “education in Scotland must be about ability to learn, not ability to pay, at all levels” and that this was a fundamental commitment on the part of the Scottish Government.

She also launched a new initiative aimed at getting more STEM teachers into the teaching system in Scotland. Teachers, she said, were key not only to teaching but to inspiring students to pursue subjects to a higher level.

She awarded the Robert Owen Award for an Inspiring Educator to Professor Graham Donaldson, the man behind Teaching Scotland’s future report on the education of Scotland’s teachers.

Angela Constance MSP addresses the conference. Rebecca Jackson, 2015

Angela Constance MSP addresses the conference. Rebecca Jackson, 2015

Tackling the attainment gap: the Scottish Attainment Challenge           

The Scottish Attainment Challenge was promoted as an accelerator of change, building on what has already been done in Scotland and using core values and agreed outcomes to create a system which takes a uniquely Scottish approach. The focus is on 4 key areas, and is delivered by a three way framework which uses a national hub, inter authority collaboration and support and the Scottish Attainment Fund.

The four key areas are:

  • Collaboration for improvement
  • High quality teaching and learning
  • Linking with family and community
  • Supporting nurture and well-being.

Speakers in this seminar emphasised that in Scotland, policy needs to be driven by what works. The challenge, they said, could not be delivered in isolation. Kevin Helman from Stirling and Clackmannan provided a local authority perspective. He highlighted the role of head teachers sharing best practice among schools.

The Scottish Attaniment Challenge outlined in Stirling and Clackmannan. Rebecca Jackson, 2015

The Scottish Attaniment Challenge outlined in Stirling and Clackmannan. Rebecca Jackson, 2015

The Girls in Energy Programme

Employment partnerships between schools and businesses could be a key way to promote vocational learning and encourage STEM subjects in schools. We’ve written before on this blog about the need to build STEM skills in the UK and especialy the importance of providing girls with STEM role models.

It was encouraging therefore to hear in another seminar session about the Girls in Energy programme, an Aberdeenshire based project between Mintlaw Academy and Shell.

The project provides a useful blueprint which could be recreated across Scotland. The programme combines:

  • blended learning, of academic and vocational qualifications (2 HNC’s and 1SVQ level 2);
  • industrial visits;
  • a 2 week placement.
Girls in Energy programme. Rebecca Jackson, 2015

Girls in Energy programme. Rebecca Jackson, 2015

There was an emphasis on how the scheme boosted employability skills, including interview technique, presentation skills and communicating with others, equipping the girls involved with practical skills valued by employers.

Practitioners and students who have been through the scheme were keen to stress that the scheme could easily be recreated if strong relationships between education and industry/business are forged. They highlighted the potential in engineering, construction and other industries which could follow the same outline as their model.

All that is good about Scottish education

The conference highlighted all that is good about the Scottish education sector. The stalls and exhibition space were filled with people who are passionate about providing a better, more equal and well-rounded education for children in Scotland.

However the conference also emphasised the core values of what academics and practitioners feel  is needed to drive education forward in the future – an understanding and sharing of best practice and resources, and the ability to integrate multiple aspects of learning to create a better experience for teachers, local authorities and children alike.

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