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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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.


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Coding in Glasgow’s public libraries

by Stacey Dingwall

Last week saw the annual CILIPS Autumn Gathering take place in Glasgow. CILIPS is the Scottish branch of the professional body for librarians and information professionals in the UK (CILIP). The Autumn Gathering provides professionals in Scotland with an opportunity to get together to discuss issues and trends within the sector and share best practice.

The day saw a range of sessions alongside two keynote addresses from Marc Lambert, CEO of the Scottish Book Trust, and Diane Bruxvoort from the University of Aberdeen. One of the most interesting talks I attended was given by Martin Goodfellow, who is the Coder in Residence at Glasgow Life. Martin previously worked on the Future Makers project, providing 5-17 year olds in Glasgow with the opportunity to learn digital making skills. The project was made possible due to the city winning Innovate UK’s Future Cities Demonstrator competition, and £24m in funding to explore ways to improve the city and the quality of life for its residents through technology.

For the uninitiated, Martin explained that coding=programming. It’s a form of computational thinking: something we all use in everyday life, e.g. in deciding when to stop looking for something, be it when shopping or looking for information.

Coding in Libraries

Martin’s remit is to support the creation of coding clubs in Glasgow’s public libraries. Glasgow is the first library service in the UK to have a Coder in Residence, and Martin is based at the city’s Mitchell Library, which has its own Digital Making Space and recently opened Scotland’s first Google Digital Garage.

In partnership with CoderDojo Scotland and Virgin Media, the first Glasgow coding club was set up in the Mitchell’s Digital Making Space. The club hosts regular CoderDojo events, and the clubs have started to roll out to several of Glasgow’s local libraries.

The events are aimed at young people aged 8-17 and operate democratically, in that there is no set curriculum in place at the clubs. Instead, participants work on their own projects or suggest ideas for the club to take part in. Martin described some of the projects the club have been involved in, noting that these are sometimes in collaboration with other cultural events in Glasgow. For example, during the last Celtic Connections festival, some of the young coders were involved in building a program that saw Scotland the Brave remixed using various different effects. He also showed off a 3D printed Mitchell Library created by the club in Mindcraft as part of the BBC’s Build it Scotland event, which is to be included in a forthcoming visual map of Scotland.

Making not consuming

Martin explained that club had used Sonic Pi in order to create the music program. This is just one of the software packages that participants can access at the clubs, alongside tools including Raspberry Pi and Scratch. He also demonstrated one of the outcomes of the club’s use of Twine, which had resulted in the creation of a ‘choose your own adventure’ style game, which sees players either going from the Mitchell to a secret Biffy Clyro gig, or missing out on the gig, depending on their choices.

Here, Martin placed an emphasis on public libraries being seen as not only a space where people can use technology to access resources, but also learn how to use technology: digital making, not just digital consumption. This is similar to the makerspace movement in libraries, which we looked at on the blog last month.

Teaching children how to code is part of the gamificiation of education trend, which takes concepts that children are used to in video games and uses these to support educational attainment. Gamification in general is a key trend at the moment, as seen in apps like Pokémon Go which is suggested to produce physical health benefits for players.

Martin highlighted that the clubs have worked with the STEMnet Ambassador programme, in which people volunteer to support and encourage young people to participate in, and enjoy, STEM subjects, both in and outside of the school setting. With the UK facing an estimated shortfall of 40,000 STEM workers per year (often blamed on societal stereotypes which can discourage certain groups  particularly girls   from studying STEM subjects), the work that the programme and initiatives like the coding clubs do is vital.

The future

The fact that there has been no real need to promote the coding clubs in Glasgow beyond using social media shows that young people are interested in STEM subjects, if they are presented in a way that is enjoyable and accessible to them. Martin spoke about Glasgow’s participation in National Coding Week last month, during which the clubs hosted a range of events including intergenerational sessions, which saw parents come in and learn from their kids about coding. The idea of ‘teaching an adult to code’ is one that is hoped to be continued in the coding clubs. The other key aims include having a club running in every one of the city’s public libraries, expanding the clubs into schools, and ensuring their sustainability.

If you liked this, you might like our other posts on STEM and digital participation:

Improving basic skills levels in England

a conference

by Stacey Dingwall

At the end of last month, the OECD published its review of adult skills in England, Building Skills for All. The review was commissioned by the Department for Business Innovation and Skills (BIS) after a 2013 Survey of Adult Skills in 24 OECD countries ranked England at 22nd and 21st in terms of young adults’ (aged 16-24) levels of literacy and numeracy respectively. For all adults (aged 16-65), the country was ranked in 11th position for literacy, and 17th for numeracy.

England’s skills levels reviewed

The latest review produced similar results, estimating that there are around nine million adults of working age in England with low levels of numeracy and/or literacy. This represents more than a quarter of adults aged 16-65 in the country. The lower levels of basic skills among young people are also noted again: while older adults (aged 55-65) in England have basic skills levels broadly similar to their peers in other OECD countries, the same cannot be said for younger adults. As the older generation reaches retirement age, this obviously raises concerns over the skills levels of the current and future workforce.

The findings prompted the OECD to recommend that as universities in England are “failing to develop quite basic skills” among their students, some students would be better suited to enrolling in further, as opposed to higher, education. If universities didn’t allow students to enrol without at least a GCSE C grade in maths, for example, or graduate without achieving a reasonable level of basic skills, the think tank believes that this would allow a rebalancing of the country’s education system, by targeting resources in areas where they are best suited.

Who or what is to blame?

Higher education bodies did not agree with this assessment of the current system, contending that the survey involved too small of a sample of students to support such a large reform. However, research conducted with employers on their experiences of recruiting young people has found evidence of a basic skills issue. Surveys carried out by the CIPD and Education and Training Foundation both heard from employers who were particularly concerned about young employees’ (current and potential) literacy and numeracy skills, as well as their ability to communicate in a professional manner, i.e. not in text speak.

Following the publication of the OECD’s 2013 report, the president of the International Council for Adult Education, Alan Tuckett, blamed England’s poor results on constant changes to the curriculum, arguing that this had distracted attention from adult education. He argued that there needed to be more investment in lifelong learning, highlighting that South Korea had achieved second place in the rankings, following such an investment. The country enacted its second Lifelong Education Act in 2007, defining lifelong learning as including “all types of systemic educational activities other than traditional school education”, including basic adult literacy.

Despite Tuckett’s criticism, the 2015 OECD review concludes that while it is still too early to evaluate the success of the government’s education reforms, including making maths and literacy courses a requirement in most 16-19 education, their objectives are the correct ones. In terms of funding for adults skills and education, however, recent news of a leaked memo suggesting that BIS agencies including the Skills Funding Agency are at risk of abolition due to further budget cuts is a cause for concern. It has already been confirmed that funding for the UK Commission for Employment and Skills (UKCES) is being withdrawn in 2016-17; supposedly as part of the government’s commitment to protecting core adult skills participation budgets in cash terms.

Good practice: the Citizen’s Curriculum

In 2014/15, NIACE developed the Citizen’s Curriculum approach, with the aim of ensuring that everyone is equipped with a core set of skills required for the 21st century:

  • English;
  • maths;
  • English for speakers of other languages (ESOL); and
  • digital, civic, health and financial capabilities.

The approach was piloted in 13 areas, delivered by a range of organisations including local authorities, colleges and charities. This initial phase sought to understand adults’ motivation for learning, as well as ensuring that they are being provided with opportunities for learning that are suited to their particular needs. This co-production aspect of the approach is seen as key to its success. With a particular focus on disadvantaged groups, including the homeless and ex-offenders, the pilots provided insight into what works in engaging disadvantaged learners. For example, the pilot carried out by the homeless charity St. Mungo’s Broadway found that embedding skills such as maths and English within independent living skills was particularly important, and helped to adequately prepare learners for moving on and progressing in life.

Following an impact assessment that saw 92% of participants indicate that they were motivated to progress to further learning opportunities, the second phase of the pilots was launched in October 2015. This will see previous participating organisations returning to build on their work in the previous phase, alongside new pilots testing the approach in different settings, or with different sets of learners.


 

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Further reading: if you liked this blog post, you might also want to read our other article on STEM skills in the UK.

‘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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Taming the information jungle

TonyphotoIn the latest of our series of posts looking at the work of housing associations, Tony McLaughlin explains how managing information supports activities across the Wheatley Group.

By Tony McLaughlin, Research and Policy Officer, the Wheatley Group

Comparing the volume of information we come across as a ‘jungle’ may seem a little hyperbolic, but for my colleagues and I in the Research and Development Team at the Wheatley Group, Scotland’s leading housing, care and community regeneration organisation, it can certainly seem that way.

Managing information on behalf of our colleagues in other parts of the business to ensure that they have the data and information they need at their fingertips is a core part of what we do. However, keeping on top of the information we are bombarded with can be a task in itself.

In keeping with the jungle analogy, the sources where we get information from can be quite different beasts. A quick survey of our team found that collectively we are on the mailing lists of over eighty organisations, including many specialists beyond our core business of housing, care and regeneration. These mailing lists are just the tip of the information iceberg. If you take into account social media, the number of information sources would be likely to multiply several times.

We are responsible for supporting activities across a large organisation which provides services to over 100,000 people, and employs more than 2,100 people across Central Scotland. With a team of seven people, and many competing demands on our time, we have to be smart about what we focus on. We appreciate services that cut down the amount of time we have to spend identifying useful resources. It’s important for us to provide information that is specific to the needs of our business and which supports excellence in everything that we do. We do this in a number of ways, two of which are given as examples below.

We produce an ‘Insight’ bulletin, which is aimed at leaders and is a short themed think-piece which informs strategy and service development. Recent editions have focused on diverse topics such as customer segmentation, value for money, working with communities and employment trends. We are planning editions on digital inclusion, care and support, challenging poverty, and innovative funding.

We also organise a series of seminars for staff at all levels of our organisation and for relevant people from our partner agencies. These are typically hosted at our purpose-built learning and conference centre, The Academy, which is located at our Glasgow headquarters. Our most recent seminars were arranged as part of the corporate partnership which the Wheatley Group has with the professional body for housing, the Chartered Institute of Housing (CIH).

The first of these was a visit by CIH Chief Executive, Grainia Long, to address our leadership team on the challenges faced by the housing sector in the coming years. The second was a presentation on our innovative ‘Frontline Futures’ research aimed at frontline staff, which examines the role of the frontline housing professional in light of new challenges facing social housing providers and customers.

These seminars are part of a coordinated approach to supporting staff CPD. Our membership of IDOX Information Service contributes to this, as it allows our colleagues who undertake academic study as part of their professional development to access a range of resources to help them achieve their qualifications.

To sum up, our team should not simply navigate through the information jungle for material that we find interesting – everything we do should have a purpose in promoting excellence within our organisation; the information that we disseminate should always help drive innovation and improvement.

I would be happy to discuss any ideas with other like-minded organisations. Please drop me an email at tony.mclaughlin@wheatley-group.com

For more information about what we do visit www.wheatley-group.com


 

The Wheatley Group are members of the Idox Information Service. For the past 40 years, the Information Service has been the first port of call for information and knowledge on public and social policy and practice.

Our previous blogs on housing associations include:

 

Raising attainment for all, not just some – Scottish Learning Festival 2014

slf

By Stacey Dingwall

On Wednesday 25th September, I attended the first day of the Scottish Learning Festival at the Scottish Exhibition and Conference Centre. Now in its 14th year, the two day event, organised by Education Scotland, saw over 4,000 delegates gather to discuss the latest in education policy and practice.

The theme of this year’s festival was ‘raising education for all, not just some’. This was reflected in some way in most of the sessions I attended throughout the day, emphasising the importance of achieving equity for all students, regardless of their background, in education systems.

The first session I attended, ‘Game on Scotland: the educational impact of the 2014 Commonwealth Games’ got the day off to an exciting start thanks to the presence of Kimberley and Louise Renicks, who had brought along the gold medals they won for judo at the 2014 Games in Glasgow. The sisters spoke about their involvement with the Game on Scotland Athletes Visits Programme, which has seen them visit all the secondary schools in East Renfrewshire since the conclusion of the Games.

Louise explained how part of the talk she gives in schools involves trying to motivate pupils by helping them gain an insight into how the crowd made her feel when she walked out to compete, and she also emphasised the importance of encouraging children to achieve their personal best – not everyone can or has to reach that ‘gold’ standard.

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