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26th August 2016

A New Approach to Domiciliary Care

A new system of delivering health and social care in the community has developed in several countries. It originated in Holland, and is called the Buurtzorg model, developed by Jos de Blok. It has been briefly characterised as 'self managingself-managing teams working with self-determining individuals in care systems whose key focus is the person and their community.' The word 'Buurtzorg' simply means neighbourhood care. Perhaps it is wrong to call it new: -district nursing in years gone by followed almost the same organisational pattern, before 'progress' introduced other ways of working.

What is it?

  • Local, de-centralised, self managingself-managing teams
  • Devolution of control of care to people themselves and professional district nurses
  • Using and building local knowledge and relationships to provide care when and where needed.
  • Preventive approach through early detection
  • Outcomes focussed, with the person at the centre of setting these.
  • Person- and community -centred.
  • Fewer organisational costs with increased job satisfaction.

Recent UK interest

The services in Holland have been visited by consultants from the Scottish Government, to assess whether the model would be useful in the current funding pressures.

The Royal College of nursing Nursing have also studied the method and visited services. It concluded that 'It is the view of the RCN that this ‘fresh look’ can only achieve meaningful results if the central plank of the Buurtzorg model – its emphasis on nurses as self-managing agents of change – is maintained throughout.'

The Health and Social care Alliance in Scotland has invited its founder to meetings, and overall approves of making progress to implementing the model here.

Crisis in Present Services

Unison has recently issued a report to claim that current home care services in Scotland are in crisis. Support visits are very brief because of pressures on services, preventing whole person care; travelling time between locations is not considered, and work breaks, including meal times, are not taken.

All of this suggests the person is made to fit the available service, rather than the service being personalised to them. The Buurtzorg model promises an alternative to this, with each person getting the time and early care they need, minimal travel time and reduced overall costs through minimal management structures.


Despite major organisational change and refocussing which will be needed, the Alliance concludes: "let's do this! Buurtzorg offers a rich seam of learning, a sense of hope in the face of a current system under huge pressure and a tangible way of working that at it’ss heart is simple and absolutely person centred. And its cost effective too."

Could we rewind the system to the earlier neighbourhood care which used to prevail here? Clearly major change would be needed: health and social care is now more often delivered by centralised services with fixed and expensive management structures. Changing professional hierarchies would take much time and effort. But change must be possible in the current context of a funding and demand crisis which shows little sign of reducing.

*All information is correct at the time of publishing. Use of this material is subject to your acceptance of our terms and conditions.

Tony Clarke

Scottish Care Inspectorate Specialist

Tony began care work as a care assistant in care of the elderly here in Scotland in the 1970s. He very much enjoyed promoting activities, interests and good basic care. After a gap to gain a social work qualification, he worked in management of care services, latterly as a peripatetic manager which gave him experience of a wide range of services.

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