Working for Wye - past, present and future

About "that little bit of help"

Often, as people age all it takes to preserve their independence, health, wellbeing and quality of life is 'that little bit of help' from time to time. The Older People's Enquiry (2005) Joseph Roundtree Foundation

"The places where we live have a fundamental impact on our quality of life. The services that we access, the environments that we live in, and the connections that we have with our neighbours and with the wider world are of critical importance to our well-being."Carnegie Trust

A recently blind man stands on the pavement outside Wye Surgery and learns how to cross the road with the aid of a white stick

Our Place Wye recognises that older people can need, and value low-level practical assistance to enable them to live in comfort in their own homes, and to enjoy a better quality of life.

As a nation we are living longer. The population is ageing, and growing in size, but NHS budgets for health and council budgets for social care are under increasing pressure, and tightening every year. Consequently, the social care system that supports us in our later years is changing. What can Wye do as a community to help itself in this situation?

Image: Outside Wye Surgery, a recently blind man learns how to cross Oxenturn Road with the aid of a white stick.

In essence, Our Place Wye is a practical, preventative response to the adage that 'prevention is better than cure'. However, while the effects of this approach are easy to recognise and understand, they are hard to measure. The benefits of 'that little bit of help' are cumulative and will probably show themselves gradually.

Wye is most fortunate to have many informal volunteer-led networks, and a culture of active neighbourliness. These established, but ad hoc networks continue to do a good job of supporting older people and countering loneliness with social engagements, meals and a variety of activities. However, budgets are under increasing pressure, and dedicated carers, friends and neighbours are getting older.

Our Place Wye aims to support and reinforce these voluntary networks, and help them to counter the serious negative impacts that loneliness and social isolation have on health and wellbeing. Carers, people who are in good physical health, but isolated, and those who have few health problems or social care needs will also benefit.

Financial pressure

Cllr Paul Carter CBE, the former leader of Kent County Council and the County Councils Network Spokesman for Health and Social Care Integration said:

"At the risk of sounding over the top, we might just be standing on the cusp of new era for health and social care integration, with Counties in the vanguard of establishing a new way of working for the sole purpose of delivering better health and social care services for residents at a time of reduced funding.

The unprecedented financial pressures facing local authorities and the demand-led pressures created by an ageing population mean we fundamentally have to change the way care and support is provided..."

"...All over the country, in places like Surrey, Dorset and my own authority of Kent, we are proving the validity of radical care integration and cross sector collaboration as a way of improving services for our communities whilst simultaneously reducing costs."

Foreword, Delivering the Better Care Fund in Counties (May 2014)

Our Place Wye: local action

Wye already shows signs of financial pressure, hence the need for urgent action.

Accordingly, Our Place Wye is developing several complementary local initiatives and activities that will make a difference to people's lives. These aim to promote aspects of health, wellbeing and care, and work together to sustain a good quality of life.

Action at the community level also makes good economic sense: every person who can be helped to remain active, healthy and independent until late in life, will need fewer GP appointments, and have less need of hospital beds and other health and care services.

As a way forward the Carnegie Trust proposes that the role of the state needs change from provider to enabler, and to change its approach "from:

  • target setting to outcomes
  • top-down to bottom-up
  • representation to participation
  • silos to working together
  • crisis management to prevention
  • doing-to to doing with
  • state to the third sector"

"The state should continue providing the public services that it excels at. It must also take on a new role that of the 'Enabling State' empowering and supporting communities, individuals and families to play a more active role in improving their own wellbeing."

"The healthiest people, physically and mentally, are those who manage their own activity levels, eating and drinking and social activities most fully. People also derive great benefit from the support and advice of others, often those who understand particular health issues from direct personal experience. Day to day the state does most to help us by facilitating those behaviours, rather than by taking responsibility to itself."

Extracts from A route map to an Enabling State, (2014) Sir John Elvidge, Carnegie Trust

The Buurtzorg home and community care programme

The Buurtzorg Nederland (home care provider) model | Observations for the UK

Extracts: 'Founded in the Netherlands in 2006, Buurtzorg is a unique district nursing system which has garnered international acclaim for being entirely nurse-led and cost effective. The latter point has sparked particular interest in the UK where a key challenge is meeting the needs of an ageing population increasingly susceptible to co-morbidity and complex long-term conditions. The Buurtzorg model comprises six key services. These are:

1. Holistic assessment of the client's needs which includes medical, long-term conditions and personal/social care needs. Care plans are drafted from this assessment

2. Map networks of informal care and assess ways to involve these carers in the client's treatment plan

3. Identify any other formal carers and help to co-ordinate care between providers

4. Care delivery

5. Support the client in his/her social environment

6. Promote self-care and independence.

The aim of this approach is to engage three key national health priorities:

Health promotion, Management of conditions, and Disease prevention.

Buurtzorg was set-up by Jos de Blok (himself a former nurse) who envisaged a reformed district nursing system in the Netherlands. Prior to Buurtzorg, home care services in the Netherlands were fragmented with patients being cared for by multiple practitioners and providers.

Ongoing financial pressures within the health sector led to home care providers cutting costs by employing a low-paid and poorly skilled workforce who were unable to properly care for patients with co-morbidities, leading to a decline in patient health and satisfaction.

Buurtzorg's answer to this problem was to give its district nurses far greater control over patient care – a factor which it attributes as key for its rapid growth. In 2011, Buurtzorg employed nearly 4,000 district nurses and nurse assistants across 380 teams. By 2013, this had risen to 6,500 nurses (an increase of 62.5 per cent) across 580 teams

Nurses lead the assessment, planning and coordination of patient care with one another. The model consists of small self-managing teams of a maximum of 12 professionals (comprising both nurses and other allied health professionals). These teams provide co-ordinated care for a specific catchment area, typically consisting of between 40 to 60 patients.2

The composition of these teams in terms of specialty and level of practice varies according to the needs of each catchment area.

In the Netherlands, integrated care has been cited as easier to deliver because district nurses tend to be well known in the small neighbourhood/community they work in. This has helped them to build good working relationships and strong dialogue with GPs, home doctors, police, paramedics and social care providers.'

Last updated: Sun, 02 Feb 2020 21:18