A quiet revolution

Pictured with Cllr Ian Hudspeth and Dr Kiren Collison, Chair and Vice Chair of Oxfordshire’s Health and Wellbeing Board

Last week I was asked by Oxfordshire’s Health and Wellbeing Board to co-facilitate a discussion on their future working arrangement and how to move their board forward. Their board has the most senior Officers, Clinicians, Councillors and Chairs from across Oxfordshire’s Health and Social Care system and their passion for leading change for their residents was palpable.

My fellow facilitator, Dr Julia Simon is a senior NHS advisor and has sent many years in the NHS with a profound understanding of that world.  As we sat on the train going over our slides and how we would help the board in the session ahead design things for themselves, we got to talk about the origins of the Health and Wellbeing Board.  We realised we were both at the same launch conference after the 2012 act that created the boards. For the next year, I sat in one cohort designing aspects of the governance arrangements and Julia sat in another looking at how the boards would work, small world sometimes!

Over the years you eventually learn that all the training, reading, meetings, discussion and undertaking various roles from Chairmen of an Adult Social Care Scrutiny Committee, to being Cabinet member for Adult Social Care, then Finance and later Leader of a County Council which spends over £200 Million on Adult Care.  As well as sitting on the LGA Community Wellbeing Board and becoming a member Peer, through which I have undertaken many Corporate and Adult Social Care Peer Challenges and reviews, eventually you get to have a reasonably good knowledge of how a system works and what ‘good’ should be.

I think we are all coming to realise there is no future for the NHS unless we significantly improve the care we provide in our communities.  Clinicians are skilled at the medical interventions we will all need from time to time. But Local Councils are good at community and it’s in our communities where we have to deliver the solutions to the health care needs of an ageing population. Not in, dare I say the glamorous world of shiny hospitals and technical innovations, albeit we all need those from time to time. But for the vast majority of people services delivered in their homes and their communities as residents cope with slowly increased care and health needs as they live their lives.

In Suffolk, I commissioned a body of work last year from our Public Health team to look our data and make some predictions about Suffolk in twenty years’ time.  I was going to call it the ‘Suffolk Blueprint’, but apparently, that’s too Tory and so had to change its title to ‘Suffolk Plus 20’.  One of its starkest facts is the prediction, based on the current rate of admissions to our local hospitals times the rate at which our population is ageing; we will need an additional 792 acute beds in twenty years, in essence, a doubling of the number we have now and that’s not going to happen, is it?

So we need to find solutions in our primary health care and our communities. Often the debate is centred around how to integrate Health and Social Care or perhaps we should have massive organisations change, which I think would be a mistake. Of how to better pool our budgets which I believe is the right approach. But the good news is that Health and Wellbeing Boards across the country are getting on with the business of integrating and providing services to our residents. Focused on how we design a system of health and social care support not shunting people from silo to silo but having a health and social care pathway whether that be urgent or longer term, a system wrapped around residents and not the other way around.

A new Council


As you may have read Forest Heath District Council and St. Edmundsbury Borough Council have held their first few joint shadow meetings as we head towards a merger in May 2019.  I was there to take part in the historic first meeting, and it felt like the next logical step on the reform journey we set out on in 2011 when we decided to share a Chief Executive and cut staffing numbers by merging the officer teams to serve the two councils and save money.

The critical point for me has and will always be the same, organising the councils differently we can save back-office costs to protect frontline services. Regarding Council tax, the merger will mean that it will rise slower than if we did not merge because by merging we can save even more back-office costs. So, on both of my acid-tests, this merger is the right next move.  Lakenheath will still have two Councillors, and we will continue to work hard for our community at the Shadow Council.

One of the differences between the councils has always been that Forest Heath is a District Council with a Chairman who chairs the Full Council meeting and represents the Council at official events and functions.  Whereas, St Edmundsbury is a Borough Council with a Civic Mayor, who does much the same role but there is a more ceremonial aspect to it and thus higher costs associated with the office. What we want to do is get your views on the type of formal role the new Council should have.

The differences and pro’s and con’s of both approaches are explained in far greater detail by having a look at


and then taking part in the survey


The survey is open until Sunday 2nd September.

Alternativity you are very welcome to contact me to share your views, which we can then feed in. It will be interesting to learn what you think and to have a strong representation from our area would be great.

Postcard from the LGA Conference in Birmingham – BUURTZORG!




Last week at the Local Government Association’s annual Conference I spoke at an event in the Innovation Zone about the work I have championed, as Chairman of the EELGA Improvement and Efficiency Board looking at the Dutch care system called BUURTZORG which is a successful Dutch model of care at home.

This is being explored in West Suffolk through a “Test and Learn Site”, one of only a handful in the England, in partnership with West Suffolk CCG, St. Edmundsbury Borough Council, Forest Heath District Council West Suffolk Councils and Suffolk County Council, with support from the East of England LGA and the UK Buurtzorg partner, Public World.

I was joined by Paul Jansen of Public World who are delivering the Buurtzorg project work in the UK and Kathryn Caley of SK Nurses who are delivering the pilot work in West Suffolk and for an hour we presented and debated aspects of the work. Afterwards I was approached by NHS England who were at the event to discuss how we might take the work further within the NHS.

The project is a step on a journey about a different way to delivery health and social care in our community.  I opened my words with the starkest fact I have at my disposal, in a Public Health exercise I commissioned in Suffolk last year looking at Suffolk in twenty years’ time if we do nothing Suffolk will need 792 additional acute beds based on current rate of admissions times its ageing population.  Now it’s clear that event with the £20Billion additional funding announced by the Government we are never going to see a doubling of the acute beds in Suffolk or across the country, so we have to find very different ways to support our residents in the future and this lies in improvement in the NHS, better integration across Health and Social Care, better Public Health, all of which will help but they allow will not solve the problem, the missing piece is a our communities and how services are designed and delivered in communities to better support the needs of an increasing cohort of older people who are living longer, which is great, but who’s needs must be dealt with very locally to stop them dipping into and out of acute NHS services.

The BUURTZORG Model of Care at Home
The Buurtzorg model grew from the vision of nurse Jos De Blok to tackle ongoing concerns in the provision of care, such as: the fragmentation of prevention, treatment, and care; the impact of demographic change; a shortage of care providers; lowering quality and increasing costs of care; and a lack information about the quality of outcomes in relation to the cost of care per client. Buurtzorg started in 2006 with a team of four nurses working closely with GPs and delivering community care services. By 2015 it had grown to over 9,000 nurses working in 800 teams working with 70,000 patients. The nurses are supported by around 45 back office staff.

The key to the approach is that the model empowers individuals – in this case nurses – to deliver all the care that patients need.  Nurses work in self-managing teams of up to twelve professionals who provide care for 40-50 clients in a specific locality. The nurses are ‘generalists’ taking care of a wide-range of patients and conditions. They are highly qualified; 70% to bachelors level. Their role includes:

  • Assessment of clients’ needs
  • Care delivery
  • Mapping networks of informal care
  • Coordination of care between providers
  • Promotion of self-care, self-management of conditions, and independence.

Buurtzorg is a non-profit enterprise and is 90% funded through health insurance, which is mandatory in The Netherlands. It has led to:

  • Overhead costs of 8%, compared to a national average of 25%
  • Lower staff turnover, lower sickness rates, high staff satisfaction
  • Lower costs of care per client, 40% less than national average
  • High patient satisfaction
  • 30% fewer A&E visits for clients
  • A € 9 million profit in 2014

 So can the BUURTZORG Model of Care at Home work in an English context?  
This is a key question that the coalition of health, social care and housing partners in West Suffolk are seeking to answer.  As I have said the partners have established a Buurtzorg “test and learn site”, one of only a handful in the country, with the support of ‘the system’ and its primary aim will be to

identify a way to adapt the model to our own context without losing the essential features of the Buurtzorg experience – the focus on mobilising and strengthening the capabilities of the client and the networks around them through self-organised teams of autonomous responsible professionals.  This last element is perhaps the most challenging, not so much to Local Government who over the past 7 years have started to empower its front lien staff more, but more challenging to the command and control elements of the NHS culture.

Website: http://www.eelga.gov.uk/innovation-programme/buurtzorg.aspx

News: http://www.eelga.gov.uk/news/west-suffolk-recruits-its-first-buurtzorg-nurses/

A very interesting week in Birmingham

Last week Councillors and Local Government officers from across the country gathered in Birmingham for the Annual Conference, with some exciting backdrops on the Agenda.

As always it seems the ‘U ‘ question (unitary councils bids such as Buckinghamshire, Oxfordshire and now Leicestershire lead the way) hangs in the air as it has done for a number of years. There was to be the maiden conference speech by a new SoS James Brokenshire MP and last but not least the previous week a key report was published jointly by the Health and Social Care and Housing, Communities and Local Government Committees. It makes for fascinating reading in the coming debate on Health and Social Care and indeed ahead of the much delayed Green Paper on Social Care now due in the Autumn a whole year after it was promised.

You can download it from the http://www.parliment.uk website by clicking the link below.


Almost as a footnote last week, but no less interesting is an article by Tony Travers for http://www.lgcplus.com. Tony is one of the most respected speakers on Local Government finance and when he rings the warning bell its time to listen. the link to his article which makes for sobering reading is here:


On a personal note, I was delighted to get re-elected to the Conservative Executive of the LGA as what is known as an ‘At Large’ Executive Member rather than as the County Council representative for obvious reasons. I am delighted to join a tremendous senior Conservative team as we work to set out the Conservative Agenda at the LGA for the coming year.

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