Shirley Cramer CBE, Chief Executive of RSPH, considers how practitioner-led innovation can deliver significant benefits in public health.
At the end of 2017, I was pleased to hear for the second time a presentation from the much-lauded but humble, Jos de Blok, the nurse who has revolutionised home care in the Netherlands and increasingly across the world. This time round, I was listening in the context of the launch of Buurtzorg (‘neighbourhood care’) Britain and Ireland and feedback on the UK pilots of this successful neighborhood care system.
The Buurtzorg system has many tenets of what makes for good support for the public’s health, mainly because we know that people who live and work in local communities can do more than anyone else to boost the health and wellbeing of local citizens, as they understand and listen to their concerns and needs.
In 2006, when Jos de Blok founded Buurtzorg, a nurse-led organisation to promote integrated health and social care, he created self-managed groups of nurses serving the community. Most importantly he shifted the focus from reactive, task-based care to a more preventive, holistic, client-led approach.
The ‘Buurtzorg way’ has been so successful in the Netherlands over the last 10 years, that they now have ten thousand nurses in 850 teams across the country, with increased client satisfaction, reduced costs and happy staff. This is a system that is now being ‘tailored’ for different countries but retaining many of its unique and compelling characteristics.
One of its most vital attributes is the motivated and enthusiastic nursing staff, so critical to good and safe care. I have just finished reading This is Going to Hurt: Secret Diaries of a Junior Doctor by Adam Kay, which in eye-watering detail, depicts a deeply uncaring attitude of the ‘system’ to frontline NHS staff.
We could learn a lot from the Buurtzorg way of self-management and staff satisfaction in delivering better client care. Crucially nurses decide how long they need to spend with each client and can perform a whole range of both nursing and support tasks with the goal of promoting independence and autonomy.
It is good news that Suffolk Community Health and Guys and St Thomas’s Trusts are both piloting the Buurtzorg approach and we will no doubt learn a lot from this initiative. The nurses are in teams of four to 12 and create their own networks in the community to ensure that the needs of clients are met effectively.
By integrating the medical and care needs of individuals, they can focus on preventing future problems and enable older people to stay at home as along as possible. With the smart use of technology providing real time information to the teams, they are able to be flexible but also have minimal administration.
The Buurtzorg approach is now being adopted in Sweden, the USA, China, India and Germany, and I hope that the pilots in the UK show real benefit for both individuals and the community as well as keeping staff motivated and fulfilled. We have a worrying shortage of nurses in the UK and we must do everything we can to retain their skills.
It makes sense in our global economy and with our common health problems to find successful examples of practice from across the world and explore how they might best be implemented in a different setting.
I can’t help thinking that a Buurtzorg model alongside an enthusiastic and well trained wider workforce for the public’s health might make a real and significant difference to the health and wellbeing of the local community.