Personal experience inspired Brendan Martin on a journey to find new ways of caring for people. He is now the managing director of Buurtzorg Britain & Ireland, advocating a system of care that focuses on the individual within their community.
“Towards the end of my mom’s life I was her principal carer,” Brendan told C2. “And I got a close look at the way that home care services operate in Britain.
“What I concluded was that they were crying out for local, self-organised and self-managed teams that could build relationships with the people they support and with each other to enable them to provide great care, instead of the dysfunctional systems and organisations that they work in now.
“I decided once my mom had died, I was going to devote a lot of time and effort to try to tackle that challenge.”
Brendan came across the Dutch organisation Buurtzorg. The name derives from Buurt meaning neighbourhood, and zorg for care. It was developed by Jos de Blok in responses to a commodified approach to community care that had prevailed in the Netherlands.
“In very practical ways they were making it succeed,” said Brendan.
A trip to see them in action was followed by a meeting of minds and Buurtzorg Britain and Ireland was born.
At the core of Buurtzorg is the needs of the person requiring care. One defining characteristic is that the nurses operate through self-managed teams. These enable the professional practitioners to build relationships with people and their social networks to create a fully rounded environment of care.
What rings through is respect: for the individual, for the professionals, and for the community.
“We see the professional practitioner’s role as being not only to provide elements of care, but also to act as a sort of a care coordinator and facilitator. To enable the person needing support, to help them navigate the formal system of health and social care,” said Brendan.
True to their name, those self-managed teams of professionals work on a neighbourhood level. The aim of Buurtzorg is to help build neighbourhoods that care for themselves more effectively.
“We see ourselves at the interface between public service and community development. It’s clear that the future of care needs to be about building strong, self-caring neighbourhoods. That doesn’t mean that public services or the professionals in them aren’t required,” said Brendan. “It’s the interface of those professions in public services and the creation and development of caring neighbourhoods that we see as being the solution.”
That solution includes doing things with people rather than to them.
As an added bonus, it reduces some of the costs. too.
To work in that relationship-based way with a community development, self-management approach, the last thing you want is central office telling people how to do their jobs.
“Layers of administrators, management, performance indicators and all this nonsense, not only inhibits the human relationships, but it also gets in the way of the professionals doing their jobs,” said Brendan.
“It creates a low trust environment, where we need high trust environments.”
Those high trust environments are transparent, open and not without robust conversations. The teams learn how to resolve conflicts and give feedback, which enables them individually and collectively to learn and improve.
“You get much better care and much better working lives for the people providing it,” said Brendan. “One of the significant reasons that Buurtzorg succeeded since it was founded, is that it’s reduced the number of hours of professional input per client on average by half. That’s not because it’s reduced quality – it’s improved quality – it’s also created more favourable conditions for people to live as autonomously as possible with the support of the people around them.”
There’s a whole pile of anecdotal evidence and a growing body of independent evaluation backing that up. An assessment of their impact at Guys and St Thomas’ Hospital (NHS FoundationTrust), found ‘patients and carers reported high levels of satisfaction. With one patient saying: “The care the neighbourhood [nurses] are giving is first class”.
The report goes on to say, ‘Patients and carers were able to report a positive change in the nursing practice they experienced compared to previous experience of district nursing. Individual patients could describe how this change had resulted in direct improved clinical outcomes.’
The Buurtzorg response to the coronavirus situation has been notable, too, which echoes our findings in C2 communities.
“During the COVID crisis, those teams were better able to get on with what was needed because they were less reliant on being told what to do,” said Brendan.
That experience combined with an agility of thinking has led to the creation of Buurtzorg Care UK.
“I’ve realized that we were trying to do two things at once, which seemed to be the same things, but really aren’t,” said Brendan.
Buurtzorg Care will be a social enterprise providing neighbourhood-based health and social care within the wider public system. It will provide clinical and personal care to all in partnership with NHS and local government organisations.
“There’s some obvious overlap,” said Brendan. “If we can be true to ourselves, we have to be willing to support organisations to do what they can, providing their values and vision is sufficiently in line with ours. We can do both, but they’re not the same thing.”
One of the reasons for this development has been the resilience of the bureaucratic mindset. “Leaders are often unable to bridge the gap between what they say they want and what that requires in practice and in terms of a different approach to leadership,” said Brendan, who is nevertheless buoyant with positivity.
“I get my optimism sustained both by the people I work with each day and seeing the change we’re making. That’s the most satisfying thing in my working life.
A growing coalition for change
“We feel we’re part of a growing coalition for change,” he said. “I think history’s pointing in our direction.”
As long term advocates of the healing powers of relational approaches and self-organisation for communities we couldn’t agree more, Brendan!