Person centred care—from rhetoric to reality
NHS England chief executive Simon Stevens was refreshingly candid recently when he told leaders of NHS provider organisations that they would have to manage without more money.
That disappointed many of them, and their staff, especially those employed in the two out of every three trusts that finished the last financial year in deficit. But few will doubt the truth of his warning, especially after last week’s Brexit vote.
However, their disappointment should not prevent them from hearing the other half of Stevens’s vital message: that it is social care that has the greater need for whatever new funds are available.
On one level, of course, Stevens is simply making a sound business case. Everyone knows that strengthening social care will reduce demand on NHS services.
But he was also demonstrating the ‘system leadership’ so badly needed if we are to take person-centred care from rhetoric to reality — and that is what we must do if we are to make the best use of whatever funding is available.
This will involve many changes to existing mindsets, such as an assumption that good care is more expensive than bad care. In fact, by fragmenting care into tasks assigned as cheaply as possible, we have added costs not cut them.
We know from the Dutch example of Buurtzorg — which Public World is supporting the introduction of in the UK — that enabling well trained care givers to exercise professional autonomy responsibly can reduce costs as well as improve quality.
In the ten years since Jos de Blok and three colleagues founded its first self-managed nursing team Buurtzorg has grown to 850 teams and more than 10,000 caregivers. It has done it by consistently delivering on three fronts: higher standards of care, more satisfied staff and lower costs.
Crucially, Buurtzorg staff provide holistic care, uninhibited by the arbitrary barriers that confront district nurses, social workers, home care workers, phystiotherapists, occupational therapists and GPs as they strive to co-ordinate their efforts for patients.
No wonder there are system leaders up and down the country who are trying to integrate across their organisational boundaries, but many such efforts are frustrated by another faulty mindset: that to achieve integration around the person receiving care we must first integrate organisations.
Buurtzorg has shown that professionals can be more effective when they are empowered to co-ordinate with each other across organisational boundaries and co-create solutions with clients and their families.
That has enabled Buurtzorg to grow and to command sufficient respect in the Dutch system to successfully promote reforms aimed at securing a more favourable institutional and financial environment for its successful model.
Looking enviously over the Channel at Buurtzorg’s success, many UK policy makers and practitioners tend to assume that there are too many structural, institutional and regulatory barriers in the way or replicating it here.
But the truth is that Buurtzorg had to demonstrate from the very start one of the core characteristics displayed by its nurses: an ability to engage all stakeholders in finding solutions to whatever problems inhibit good outcomes.
The more we enable frontline professionals to co-create solutions with the people they care for the more we will learn how to overcome the barriers preventing them doing even better.
Interested? Come and hear Jos de Blok and I explore the challenges of bringing Buurtzorg to the UK at the King’s Fund conference on the future of social care.