Opinion

We need more than cash to fix social care

Adrian Brown, Executive Director at the Centre for Public Impact

In the spending review in August, Chancellor of the Exchequer Sajid Javid announced an additional £1.5bn funding for social care in the next year. The announcement was welcomed as a much needed but temporary lifeline for a sector which, for years has been battered by funding shortages and in desperate need of long-term reform. The spending review followed Prime Minister Boris Johnson’s pledge to ‘fix social care once and for all’.

With the ageing population and continuous staff shortages, social care reform is one of the biggest and most complex challenges facing governments across the world today. It is becoming apparent that modern governments are increasingly ill-equipped to deal with such levels of complexity. Cash alone, albeit desperately needed, cannot bring into fruition effective reform that would cause real, long-term impact.

What’s needed is a holistic approach to health and social care – one which realises that top-down bureaucratic methods might not be the best way forward. Governments can achieve more through a ‘shared power’ mindset; rather than focusing on improving delivery of services directly, this mindset recognises that that there are limits to what can be achieved when power is aggregated. It asks instead, what can be achieved through collaboration and cooperation? This cultivates the conditions that can bring about positive public impact.

When it comes to public services, this means that, wherever possible, local actors should be empowered to shape solutions, including frontline professionals such as doctors, nurses and social workers.

It’s the shared power mindset that helped transform home care in the Netherlands. Following decades of inefficiencies, plummeting quality of services, rising care bills and patient and staff dissatisfaction, a new approach emerged in 2006 that represented a radical breakaway from the traditional model of care delivery. The Buutzorg (Dutch for ‘neighbourhood care’) model handed control to small, self-managing teams of nurses, with each team providing both medical and supportive home care for 50-60 patients in a community.

The system includes a sophisticated IT infrastructure, which relieves nurses from the administrative burden, leaving more time to care for patients. The management structure is flat, with nurses fully responsible for the decisions that concern their own patients, and with regional coaches offering advice and support when needed.

The introduction of the new model resulted in a 40% reduction in the care costs and far higher patient and staff satisfaction. At the same time, the length of patient hospital stays and hospital admissions were reduced by a third. There are now more than 10,000 Buurtzorg nurses in 900 independent teams across the Netherlands, caring for more than 70,000 patients a year.

There are a number of lessons that the UK health and social care system can draw from the success of Buurtzorg. As Jos de Blok, architect of the Dutch model, said “the basic problems in Britain are the same as those we set out to tackle a decade ago in the Netherlands: top-down command and control instead of professional freedom and responsibility; systems that are far more complicated than they need to be; fragmented services instead of holistic care”.

Last year, the Health Secretary Matt Hancock pointed to Buurtzorg as a model which should be considered when thinking about health and care delivery, as the UK looks for ways to better integrate care and social care. The model is already being piloted in various parts of the UK. One of the examples is Guy’s and St Thomas’ NHS Foundation Trust, who began rolling out the community nursing system in 2018. This followed a successful trial which saw levels of patient and staff satisfaction increase, and the quality of care improving over the period.

As the UK considers options for long term social care reform and the integration of the health and social care sectors, it’s important that we look at those issues holistically and innovatively. Proper funding is vital – but pouring money into an outdated system is inefficient and it risks repeating old mistakes. Buurtzorg radically shook up management structures and foundations of care delivery in an effort to put humanity above bureaucracy and provide better outcomes for both giving and receiving care. Changemakers in the UK should learn from their example.

Centre for Public Impact

The article first appeared on Open Access Government.

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