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.



Things have to change

Last Monday in my role as Chairman of the Improvement and Efficiency Panel of the East of England Local Government Association (EELGA) I chaired a conference at the Cambridge Genome Campus Conference Centre, probably the most impressive venue in East Anglia.  The conference was entitled Positive Ageing and co-convened by the Eastern Academic Health Science Network (EAHSN), which is an organisation within the Health system dedicated to new learning and bringing technology to the fore in the Health world, the other co-sponsors were NHS Confederation and Public Health England.

About 200 people from across the region’s Health and Social Care system gathered to hear speakers and life experiences of older age and how we, as a system, can help shape a positive vision and reality for people as they age in our communities.  An ageing population is often talked about but just living to a ripe of age is not enough it has to be a positive experience or what the point and that is the point I made in opening the Conference.

Here is conference brochure summary of what the day entailed:

‘With a significant ageing demographic the East of England is well positioned to be at the leading edge of accelerating the testing and scale up of self-care technology and health services in a way which can help make ageing work better for everyone.

This conference, led by Eastern AHSN, the East of England LGA, Public Health England and the NHS Confederation, will bring together NHS, local government, industry and academia stakeholders and aims to strengthen emerging solutions, new ways of working and shared plans for achieving healthier and happier ageing across the region.

In particular it will look to:

  • support the STPs to meet their ambitions on this agenda
  • identify opportunities to work collaboratively to further positive ageing agenda
  • position the region at the forefront of the UKs research and innovation communities.

The conference will be structured around six themes which include:

  • Defining successful ageing – What are the real demographics of ageing?
  • Sowing health habits – What can we do to ensure our own health and increase the chance of both a long life and a healthy life?
  • Rethinking work – How can society ensure the health and economic benefits of work for more people into older life?
  • Breakthroughs in technology – How can new research and innovations radically change our concepts of what old age means?
  • Connecting with others – How can we develop caring communities and multi-generational social networks?
  • Preserving purpose – How can health and social care systems focus on maintaining quality and purpose of life above the drive for extending life?’

And here is the link to the presentations from the day and if you have a look please look out for the Buurtzorg Health Care Model as that is a programme I am championing here in Suffolk and is a part of our contribution to the national debate about how we re-shape the healthcare system to better serve the changing age profile of our communities.




Continuing Problems, new thinking required!

PrintA few Friday’s ago I had the opportunity to attend a morning at West Suffolk House with David Hall from the Ideas Centre Limited who talked about and then lead a workshop on how to think differently in problem solving. I enjoy these sessions as they are a blue sky thinking opportunity to use different tools and techniques to see problems from different angles and how to then find new ways of thinking about them that are often not apparent when you are right up against the intractable problems on a day to day basis.

The morning was most timely as that afternoon I travelled to Cambridge for a meeting of the EELAG’s (East of England Local Government Association) Improvement and Development Panel of which I am a member and we pondered the coming Autumn Statement from the Chancellor of the Exchequer George Osborne and how, over the next few years, it will be those Councils who look at their issues from new and different perspectives that will flourish. Those who do not innovate and simply salami their way thought the cuts Agenda that will prevail until at least until the 2020s will have missed a considerable opportunity to have an open and honest debate with resident as to which services they value and wish to keep and which can simply slip away as being of a different era.

If the last few council elections have been about council tax track records and future pledges, as important as such things are to the vast majority of residents, cuts in services are inevitable however well organised, stream line and cost efficient a council is. So how you go about cuts in one service whilst protecting another is vital, not only to make the right decisions and be proportionate but to take residents with you. Those councils that simply plough on cutting services as they go with the fig leaf of ‘Statutory Public Consultation’ will see the ruling parties sweep aside and lose control as people become more dissatisfied with their councils. Seems to me those in control now who survive will be those that actually co-produce changes with their residents, someone one said ‘culture eats strategy for breakfast’ and of course co-production is a cultural thing not a strategy.

The Networked Councillor – The next steps

Late last week I went along to the East of England Local Government Association Strategic Leaders Meeting at the fine offices of South Cambridgeshire District Council in that impressive new town just outside Cambridge called Camborne. I was there to represent Suffolk County Council, and to present one of the Agenda items – the Networked Councillor Report, commissioned by the East of England LGA and written by Public-I; and to talk about the launch of its next steps – the Networked Councillor programme, which aims to tackle the challenges and opportunities that face elected members operating in an increasingly networked and digital society.

As I have previously blogged the report lays out the evidence to support the idea that we need all our elected representatives to be comfortable and effective in the online space and recommends the need to develop new models of training, mentoring and support to help councillors be effective in a digital and networked world.

Essentially to make sure it’s not just another one of those reports that get read and then popped on a shelf to gather dust, the team are now in the process of implementing the report’s findings and are looking to identify two pilot areas to trial an action learning programme. The pilot will be funded by the East of England LGA and pilot areas should encompass a whole county area, including representation from both tiers (where applicable).

Of course while many of the skills and issues are common, councils will approach this process differently and with a different idea of how they, as councillors, want to achieve online and the type of relationship they want to have with the public. This programme is designed in order to provide the opportunity for each council to shape its own response to this new landscape and not simply learn by rote.

All of us involved in this work are focused that the programme will introduce the concept of a Networked Councillor and encourage a discussion about the kind of relationship they will have with the public in the future, based on the scale of communicative to co-productive that formed the central thrust of the report. The key will be that the approach will revolve around practical examples and will model the practice of leading councils and already prolific social media members.

At the end of the programme hopefully a member should have an understanding and considered digital footprint and network which reflects their needs.  Underpinning all of this will be a series of supporting materials that will develop practical technical skills

Suffolk will be the first place its rolled out and the programme will work with a cohort of around 20 members and run over 3 workshop days each concentrating on a different theme: ‘Understand your digital footprint and current network’, ‘Develop skills to shape that network and manage debates online’ and then ‘Develop skills to influence your network and lead effectively in this context’.

Broadly the sessions will cover issues such as:

How will you manage your privacy – what do you want to share?

Which channels suit your communicate style and how do you reach them?

Who do you need to influence?

Understand your own reach and closing the gaps

Crisis management – compare how messages go out with current and ideal reach

Maintenance of networks

So by the end of the programme it’s hoped that participants are, able to integrate social media into their workflow, be able to measure and understand their digital footprint and have made informed choices about the tools that they are using, actively influencing others online, actively managing their online networks and reach. The further to this a peer mentoring programme will be created in order to provide access for participants to more experienced social media using politicians.

If you know nothing about the tools not a problem as there will be a  programme of technical skills training opportunities supporting these workshops so you can get started with things like Twitter, Facebook, blogging, web sites and understanding your metrics.

So if you are a Councillor and want to get involved look out for the email coming soon to be a part of the first group.

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