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Why Buurtzorg social care doesn’t work in the UK – yet!

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John Seddon wrote to all those people listed as interviewees in the report A Blueprint for Children’s Social Care. Every reply John received stated clearly that the interviewee did not concur with the report’s recommendations.

Dear Interviewee

I’m writing to you because you were listed as an interviewee in A Blueprint for Children’s Social Care: Unlocking the potential of social work. Your listing as an interviewee suggests you might concur with the report’s recommendations, but I am aware some of the interviewees do not.

I read the Blueprint owing to reading about the controversy surrounding its authorship in Private Eye. My first concern was that the Blueprint portrayed the UK pilots of Buurtzorg as successful. If Buurtzorg Netherlands sets the standard, then the UK results are negligible, even nil and dysfunctional. The most important lesson learned was that senior management of the UK pilots had no idea of the change in philosophy – and therefore their behaviour – and frequently served to undermine what they regarded as ‘projects’.

I shared these findings with Brendan Martin (Buurtzorg UK) and Jos de Blok (Buurtzorg Netherlands) last summer. It was in the form of a podcast. Brendan was reported by Private Eye to have withdrawn support for the Blueprint arguing that structure is the wrong starting-place. He’s right. Jos is aware that the problems the UK pilots have experienced are evident in other countries.

No surprise. Many counties copied the UK’s New Public Management agenda and have similar specification and inspection regimes. My colleagues in Scandinavia report the same issues with the Buurtzorg pilots there.

The Blueprint represents a manifesto for training people to operate in a new structure. If this goes ahead, we will waste millions. And get nowhere. Care service is not a training problem – as is believed by politicians since Ed Balls – it is a system problem. Private Eye reports that Frontline has received £72m for training; what has changed?

Social workers leave because the system gets in the way of their purpose. We need to change the system. Worse, the care we provide is frequently ineffective yet it ticks the boxes of current control systems. It’s the control systems we have to change and we can only do that by redesigning the system.

That’s what happened in Buurtzorg Netherlands and that’s what’s also happened in many UK care services. In both cases it started with leaders change the way they think about the design and management of the system. I describe the differences in how that process occurred for Jos de Blok and UK leaders in the podcast.

But the consequences are the same. There are already many UK care services with results comparable to Buurtzorg. It should be no surprise, because they are systems designed to give each and every care recipient the support that exactly matches their needs.

Matt Hancock says we need care services to work as systems, where needs of care recipients matter more than silos and, he says, this change should not take long. The evidence is already here. It doesn’t take long when leaders understand what is required and, vitally, understand why their current controls are working against the purpose.

It is perhaps counterintuitive to believe that giving people precisely what they need results in lower cost in care services and other systems, greater capacity, and, most importantly, better lives. But the evidence is incontrovertible. We won’t get there with a new structure and years of training in new team roles.

You can have the best of both. As we share the same ambition, we are collaborating with Buurtzorg UK. We will help leaders get through the thinking challenge and Buurtzorg will help people realise the values and practices of outstanding person-centred services.

When leaders get it, change is fast. The podcast describes how they get it.

Sincerely

John

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Radix is the radical centre think tank. We welcome all contributions which promote system change, challenge established notions and re-imagine our societies. The views expressed here are those of the individual contributor and not necessarily shared by Radix.

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Get email notifications</p></li><li id="field_2_1" class="gfield gfield_contains_required field_sublabel_hidden_label field_description_below hidden_label gfield_visibility_visible" ><label class='gfield_label gfield_label_before_complex' >Name<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_complex ginput_container no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name' id='input_2_1'> <span id='input_2_1_3_container' class='name_first' > <input type='text' name='input_1.3' id='input_2_1_3' value='' aria-label='First name' tabindex='70' aria-required='true' placeholder='First Name*' /> <label for='input_2_1_3' class='hidden_sub_label screen-reader-text'>First</label> </span> <span id='input_2_1_6_container' class='name_last' > <input type='text' name='input_1.6' id='input_2_1_6' value='' aria-label='Last name' tabindex='72' aria-required='true' placeholder='Last Name*' /> <label for='input_2_1_6' class='hidden_sub_label screen-reader-text'>Last</label> </span> </div></li><li id="field_2_2" class="gfield gfield_contains_required field_sublabel_below field_description_below hidden_label gfield_visibility_visible" ><label class='gfield_label' for='input_2_2' >Email<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_email'> <input name='input_2' id='input_2_2' type='email' value='' class='large' tabindex='74' placeholder='Email*' aria-required="true" aria-invalid="false" /> </div></li><li id="field_2_4" class="gfield gf-conf-check gfield_contains_required field_sublabel_below field_description_below hidden_label gfield_visibility_visible" ><label class='gfield_label gfield_label_before_complex' >Confirmation<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_2_4'><li class='gchoice gchoice_2_4_1'> <input class='gfield-choice-input' name='input_4.1' type='checkbox' value='Please keep me updated on new website content and Radix news. (We will process your data in accordance with our <span class="pp"><a href="https://radixuk.org/privacy-policy/">Privacy Policy</a></span>. You may withdraw this consent at any time by &lt;a href=&quot;"mailto:hello@radixuk.org"&quot;&gt;emailing us&lt;/a&gt; or clicking “unsubscribe” at the bottom of our emails).' id='choice_2_4_1' tabindex='75' /> <label for='choice_2_4_1' id='label_2_4_1'>Please keep me updated on new website content and Radix news. (We will process your data in accordance with our <span class="pp"><a href="https://radixuk.org/privacy-policy/">Privacy Policy</a></span>. You may withdraw this consent at any time by <a href="mailto:hello@radixuk.org">emailing us</a> or clicking “unsubscribe” at the bottom of our emails).</label> </li></ul></div></li><li id="field_2_6" class="gfield gform_validation_container field_sublabel_below field_description_below gfield_visibility_visible" ><label class='gfield_label' for='input_2_6' >Phone</label><div class='ginput_container'><input name='input_6' id='input_2_6' type='text' value='' autocomplete='new-password'/></div><div class='gfield_description' id='gfield_description_2_6'>This field is for validation purposes and should be left unchanged.</div></li></ul></div> <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_2' class='gform_button button' value='SUBSCRIBE' tabindex='76' onclick='if(window["gf_submitting_2"]){return false;} if( !jQuery("#gform_2")[0].checkValidity || jQuery("#gform_2")[0].checkValidity()){window["gf_submitting_2"]=true;} ' onkeypress='if( event.keyCode == 13 ){ if(window["gf_submitting_2"]){return false;} if( !jQuery("#gform_2")[0].checkValidity || jQuery("#gform_2")[0].checkValidity()){window["gf_submitting_2"]=true;} jQuery("#gform_2").trigger("submit",[true]); }' /> <input type='hidden' name='gform_ajax' value='form_id=2&amp;title=&amp;description=&amp;tabindex=69' /> <input type='hidden' class='gform_hidden' name='is_submit_2' value='1' /> <input type='hidden' class='gform_hidden' name='gform_submit' value='2' /> <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' /> <input type='hidden' class='gform_hidden' name='state_2' value='WyJbXSIsIjg1ZGYwZWM3YzAyMDRmYTcyZDYxNmIwMWJiNmFhYzVhIl0=' /> <input type='hidden' class='gform_hidden' name='gform_target_page_number_2' id='gform_target_page_number_2' value='0' /> <input type='hidden' class='gform_hidden' name='gform_source_page_number_2' id='gform_source_page_number_2' value='1' /> <input type='hidden' name='gform_field_values' value='' /> </div> </form> </div> <iframe style='display:none;width:0px;height:0px;' src='about:blank' name='gform_ajax_frame_2' id='gform_ajax_frame_2' title='This iframe contains the logic required to handle Ajax powered Gravity Forms.'></iframe> <script type="text/javascript"> gform.initializeOnLoaded( function() {gformInitSpinner( 2, 'https://radixuk.org/wp-content/plugins/gravityforms/images/spinner.svg' );jQuery('#gform_ajax_frame_2').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_2');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_2').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;var mt = parseInt(jQuery('html').css('margin-top'), 10) + parseInt(jQuery('body').css('margin-top'), 10) + 100;if(is_form){jQuery('#gform_wrapper_2').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_2').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_2').removeClass('gform_validation_error');}setTimeout( function() { /* delay the scroll by 50 milliseconds to fix a bug in chrome */ jQuery(document).scrollTop(jQuery('#gform_wrapper_2').offset().top - mt); }, 50 );if(window['gformInitDatepicker']) {gformInitDatepicker();}if(window['gformInitPriceFields']) {gformInitPriceFields();}var current_page = jQuery('#gform_source_page_number_2').val();gformInitSpinner( 2, 'https://radixuk.org/wp-content/plugins/gravityforms/images/spinner.svg' );jQuery(document).trigger('gform_page_loaded', [2, current_page]);window['gf_submitting_2'] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find('.GF_AJAX_POSTBACK').html();if(!confirmation_content){confirmation_content = contents;}setTimeout(function(){jQuery('#gform_wrapper_2').replaceWith(confirmation_content);jQuery(document).scrollTop(jQuery('#gf_2').offset().top - mt);jQuery(document).trigger('gform_confirmation_loaded', [2]);window['gf_submitting_2'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_2').text());}, 50);}else{jQuery('#gform_2').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger('gform_post_render', [2, current_page]);} );} ); </script>
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[gravityform id=5 title=false description=false ajax=true tabindex=64]
<div class='gf_browser_unknown gform_wrapper gform_legacy_markup_wrapper' id='gform_wrapper_5' ><div id='gf_5' class='gform_anchor' tabindex='-1'></div><form method='post' enctype='multipart/form-data' target='gform_ajax_frame_5' id='gform_5' action='/opinion/why-buurtzorg-social-care-doesnt-work-in-the-uk/#gf_5' novalidate> <div class='gform_body gform-body'><ul id='gform_fields_5' class='gform_fields top_label form_sublabel_below description_below'><li id="field_5_5" class="gfield gravity_head gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible" ><h3>Get emails</h3></li><li id="field_5_1" class="gfield gfield_contains_required field_sublabel_hidden_label field_description_below hidden_label gfield_visibility_visible" ><label class='gfield_label gfield_label_before_complex' >Name<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_complex ginput_container no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name' id='input_5_1'> <span id='input_5_1_3_container' class='name_first' > <input type='text' name='input_1.3' id='input_5_1_3' value='' aria-label='First name' tabindex='65' aria-required='true' placeholder='First Name*' /> <label for='input_5_1_3' class='hidden_sub_label screen-reader-text'>First</label> </span> <span id='input_5_1_6_container' class='name_last' > <input type='text' name='input_1.6' id='input_5_1_6' value='' aria-label='Last name' tabindex='67' aria-required='true' placeholder='Last Name*' /> <label for='input_5_1_6' class='hidden_sub_label screen-reader-text'>Last</label> </span> </div></li><li id="field_5_2" class="gfield gfield_contains_required field_sublabel_below field_description_below hidden_label gfield_visibility_visible" ><label class='gfield_label' for='input_5_2' >Email<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_email'> <input name='input_2' id='input_5_2' type='email' value='' class='large' tabindex='69' placeholder='Email*' aria-required="true" aria-invalid="false" /> </div></li><li id="field_5_4" class="gfield gf-conf-check gfield_contains_required field_sublabel_below field_description_below hidden_label gfield_visibility_visible" ><label class='gfield_label gfield_label_before_complex' >Confirmation<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_5_4'><li class='gchoice gchoice_5_4_1'> <input class='gfield-choice-input' name='input_4.1' type='checkbox' value='Consent' id='choice_5_4_1' tabindex='70' /> <label for='choice_5_4_1' id='label_5_4_1'>Please keep me updated on new website content and Radix news. (We will process your data in accordance with our <span class="pp"><a href="https://radixuk.org/privacy-policy/">Privacy Policy</a></span>. You may withdraw this consent at any time by <a href="mailto:hello@radixuk.org">emailing us</a> or clicking “unsubscribe” at the bottom of our emails).</label> </li></ul></div></li><li id="field_5_6" class="gfield gform_validation_container field_sublabel_below field_description_below gfield_visibility_visible" ><label class='gfield_label' for='input_5_6' >Phone</label><div class='ginput_container'><input name='input_6' id='input_5_6' type='text' value='' autocomplete='new-password'/></div><div class='gfield_description' id='gfield_description_5_6'>This field is for validation purposes and should be left unchanged.</div></li></ul></div> <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_5' class='gform_button button' value='SUBSCRIBE' tabindex='71' onclick='if(window["gf_submitting_5"]){return false;} if( !jQuery("#gform_5")[0].checkValidity || jQuery("#gform_5")[0].checkValidity()){window["gf_submitting_5"]=true;} ' onkeypress='if( event.keyCode == 13 ){ if(window["gf_submitting_5"]){return false;} if( !jQuery("#gform_5")[0].checkValidity || jQuery("#gform_5")[0].checkValidity()){window["gf_submitting_5"]=true;} jQuery("#gform_5").trigger("submit",[true]); }' /> <input type='hidden' name='gform_ajax' value='form_id=5&amp;title=&amp;description=&amp;tabindex=64' /> <input type='hidden' class='gform_hidden' name='is_submit_5' value='1' /> <input type='hidden' class='gform_hidden' name='gform_submit' value='5' /> <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' /> <input type='hidden' class='gform_hidden' name='state_5' value='WyJbXSIsIjg1ZGYwZWM3YzAyMDRmYTcyZDYxNmIwMWJiNmFhYzVhIl0=' /> <input type='hidden' class='gform_hidden' name='gform_target_page_number_5' id='gform_target_page_number_5' value='0' /> <input type='hidden' class='gform_hidden' name='gform_source_page_number_5' id='gform_source_page_number_5' value='1' /> <input type='hidden' name='gform_field_values' value='' /> </div> </form> </div> <iframe style='display:none;width:0px;height:0px;' src='about:blank' name='gform_ajax_frame_5' id='gform_ajax_frame_5' title='This iframe contains the logic required to handle Ajax powered Gravity Forms.'></iframe> <script type="text/javascript"> gform.initializeOnLoaded( function() {gformInitSpinner( 5, 'https://radixuk.org/wp-content/plugins/gravityforms/images/spinner.svg' );jQuery('#gform_ajax_frame_5').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_5');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_5').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;var mt = parseInt(jQuery('html').css('margin-top'), 10) + parseInt(jQuery('body').css('margin-top'), 10) + 100;if(is_form){jQuery('#gform_wrapper_5').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_5').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_5').removeClass('gform_validation_error');}setTimeout( function() { /* delay the scroll by 50 milliseconds to fix a bug in chrome */ jQuery(document).scrollTop(jQuery('#gform_wrapper_5').offset().top - mt); }, 50 );if(window['gformInitDatepicker']) {gformInitDatepicker();}if(window['gformInitPriceFields']) {gformInitPriceFields();}var current_page = jQuery('#gform_source_page_number_5').val();gformInitSpinner( 5, 'https://radixuk.org/wp-content/plugins/gravityforms/images/spinner.svg' );jQuery(document).trigger('gform_page_loaded', [5, current_page]);window['gf_submitting_5'] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find('.GF_AJAX_POSTBACK').html();if(!confirmation_content){confirmation_content = contents;}setTimeout(function(){jQuery('#gform_wrapper_5').replaceWith(confirmation_content);jQuery(document).scrollTop(jQuery('#gf_5').offset().top - mt);jQuery(document).trigger('gform_confirmation_loaded', [5]);window['gf_submitting_5'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_5').text());}, 50);}else{jQuery('#gform_5').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger('gform_post_render', [5, current_page]);} );} ); </script>
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[gravityform id=6 title=false description=false ajax=true tabindex=999]
<div class='gf_browser_unknown gform_wrapper gform_legacy_markup_wrapper' id='gform_wrapper_6' ><div id='gf_6' class='gform_anchor' tabindex='-1'></div><form method='post' enctype='multipart/form-data' target='gform_ajax_frame_6' id='gform_6' action='/opinion/why-buurtzorg-social-care-doesnt-work-in-the-uk/#gf_6' novalidate> <div class='gform_body gform-body'><ul id='gform_fields_6' class='gform_fields top_label form_sublabel_below description_below'><li id="field_6_5" class="gfield gravity_head gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible" ><h3>Before you go!</h3> <p>Stay up to date with what's happening at Radix. Get email notifications</p></li><li id="field_6_1" class="gfield gfield_contains_required field_sublabel_hidden_label field_description_below hidden_label gfield_visibility_visible" ><label class='gfield_label gfield_label_before_complex' >Name<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_complex ginput_container no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name' id='input_6_1'> <span id='input_6_1_3_container' class='name_first' > <input type='text' name='input_1.3' id='input_6_1_3' value='' aria-label='First name' tabindex='1000' aria-required='true' placeholder='First Name*' /> <label for='input_6_1_3' class='hidden_sub_label screen-reader-text'>First</label> </span> <span id='input_6_1_6_container' class='name_last' > <input type='text' name='input_1.6' id='input_6_1_6' value='' aria-label='Last name' tabindex='1002' aria-required='true' placeholder='Last Name*' /> <label for='input_6_1_6' class='hidden_sub_label screen-reader-text'>Last</label> </span> </div></li><li id="field_6_2" class="gfield gfield_contains_required field_sublabel_below field_description_below hidden_label gfield_visibility_visible" ><label class='gfield_label' for='input_6_2' >Email<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_email'> <input name='input_2' id='input_6_2' type='email' value='' class='large' tabindex='1004' placeholder='Email*' aria-required="true" aria-invalid="false" /> </div></li><li id="field_6_4" class="gfield gf-conf-check gfield_contains_required field_sublabel_below field_description_below hidden_label gfield_visibility_visible" ><label class='gfield_label gfield_label_before_complex' >Confirmation<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_6_4'><li class='gchoice gchoice_6_4_1'> <input class='gfield-choice-input' name='input_4.1' type='checkbox' value='Please keep me updated on new website content and Radix news. (We will process your data in accordance with our <span class="pp"><a href="https://radixuk.org/privacy-policy/">Privacy Policy</a></span>. You may withdraw this consent at any time by &lt;a href=&quot;"mailto:hello@radixuk.org"&quot;&gt;emailing us&lt;/a&gt; or clicking “unsubscribe” at the bottom of our emails).' id='choice_6_4_1' tabindex='1005' /> <label for='choice_6_4_1' id='label_6_4_1'>Please keep me updated on new website content and Radix news. (We will process your data in accordance with our <span class="pp"><a href="https://radixuk.org/privacy-policy/">Privacy Policy</a></span>. 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