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The BBC reported yesterday that spending on care is in down by a fifth.  While this puts a figure on the amount that it’s been cut over the past decade, the fact that home care is in crisis is well known.

Demand is up, money to fund it is down, too few people want to do the work and the way it’s run keeps meaningful, caring relationships from forming between workers and those they care for. In response, Labour announced this week that if it wins the election it will integrate services ‘from home to hospital’, helping end 15-minute care slots and incentivising providers to improve social care. Not only that, they’ll also provide 5,000 more home care workers and offer all vulnerable older people a safety check.

While this is all good, there’s something not quite right about it – the whiff of advisors sitting round a table shouting out solutions to someone sticking a stack of post-it notes on the wall. ‘A safety check for everyone’ ‘Free walking sticks for all’ ‘A 1,000 extra homecare workers’ ‘Is that enough?’ ‘Make it 5,000 then’.

Other parties will not be too far behind in their promises, which will be less or more generous, but will all share the same trait. They will be headline grabbing, with this amount of money pledged or that policy change all that’s needed to make the difference. It will lack the sense that they’ve thought deeply about the problem and reached a considered response working in partnership with those closest to the issues.

Here at the RSA we’ve been discussing home care rather a lot recently, more specifically a Dutch home care company called Buurtzorg, due to its pioneering organisational model. It’s a company with 6,500 nurses and 35 back office staff. Yes, that’s right, 35 back office staff supporting 6,500 frontline staff who in turn look after 60,000 patients a year.

The way they work is to arrange nurses into autonomous units of 12 and let them operate largely as they decide. A strong IT system not only makes the finance, HR and other central parts of the business easy to use and efficient, it also provides strong social networking to share ideas and help each other solve problems.

This lack of hierarchical management, replaced by self-organisation and increased trust, has turned the traditional hierarchical model on its head. Care workers decide themselves how to spend their time, choosing to spend more of it with individual clients, building up relationships and trust. In a study of client satisfaction Buurtzorg came top out of 307 community care organisations. It turns out to be cost effective too as the model leads to more prevention, a shorter period of care and less spending on overheads. This is all incredibly impressive.

One of the powerful things about it is that it began with nurses themselves. Jos de Blok, the founder, is a former nurse who didn’t like the way home care was organised in Holland, which was similar to the way it is currently organised here with very short, timed visits and no allowance for the social side of care or the development of a meaningful relationship between carer and client.

Rather than wait for someone else to fix it he decided to do something about it himself, starting his own organisation with three other nurses in 2006. There were no special dispensations from Government, no grants to get it off the ground, he competed with everyone else on equal terms and Buurtzorg is now the leading supplier of home care in Holland by a large margin.

Something similar would be fantastic to have here, not only to improve home care in this country, but also to increase staff well-being and to demonstrate that a completely different type of organisation is possible. You can wait to see if political parties and their pledges can make all the difference, but I wouldn’t hold your breath. Instead, if you are a Fellow working in this area, I’d love to hear from you to see if we can start a Buurtzorg type revolution ourselves.


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