To solve Britain’s social care crisis, follow the Dutch example

More than a decade ago, four Dutch nurses decided something needed to be done about their country’s care in the community. Back then, it was almost as bad as it is in Britain now — where a recent report found that at least 400 pensioners a week sell their homes to pay for social care. Nursing in the Netherlands had taken a terrible turn in the 1990s, when the government decided healthcare should be more ‘professional’. The ensuing bureaucracy and management doubled the cost, and the quality plummeted. Nurses were forced to spend more time on paperwork and, for want of help, elderly patients ended up in hospital when they could and should have been at home. The solution the four nurses, led by Jos de Blok, came up with was a revolutionary model that they named ‘Buurtzorg’, ‘neighbourhood care’. They had three aims: better care for patients, happier staff and lower costs. And I can tell you that they succeeded because when both my parents, who live in the Netherlands, were seriously ill last year, I experienced Buurtzorg in action.

The big idea was that each team of nurses would have complete autonomy, supported by a central office for administrative matters. So Buurtzorg nurses would not only control how and when they treated patients, but also their budget, who they employed and their own planning and organisation.

Buurtzorg started with a pilot of ten teams in 2007, which has grown to 950 in the Netherlands (employing 10,000 nurses) with successful expansions in 23 other countries. Each team has a maximum of 12 nurses to ensure there is no hierarchy or manager needed to lead them. The central office is run by 50 people, with some administration, such as payroll, outsourced. There are 20 ‘coaches’ to help set up new teams or to help teams that are failing to solve a specific problem on their own.