A truly integrated care system; a strong emphasis on putting the person at the centre; a focus on ageing in place in the community; creative approaches to staffing; more choice within dementia care – these were just some of the many observations made by participants on this year’s Healthcare Study Tour to the Netherlands.
The study tours are an initiative organised by Jan Weststrate, who runs the National Care Indicator Programme in conjunction with the School of Nursing at Massey University. He felt both New Zealand and the Netherlands had a lot to offer each other.
“The Dutch have a different Healthcare system compared to New Zealand but face the same problems as New Zealand when it comes to how to take care of the growing numbers of elderly,” says Weststrate.
“Because they have a different system they come up with different solutions to the problems that both countries encounter. We wondered if it was interesting for healthcare professionals in New Zealand to hear about these innovations and also see how they work in practice.”
Weststrate and his wife Marian, both trained nurses, came to New Zealand in 2007, from the Netherlands. After a couple of years in New Zealand working mainly with aged care facilities, the couple wondered if there was sufficient appetite for a Healthcare Study Tour to the Netherlands that looked at how the Dutch care for their older people.
In the past Weststrate had organised exchange visits between the Netherlands and the USA for intensive care nurses, which had proven successful. With 200,000 people with Dutch heritage living in New Zealand, many of whom are elderly and require additional care support, he felt sure he could replicate the success of these previous trips.
Six healthcare professionals took part on the first healthcare study tour in June 2016. Their feedback was so encouraging, it prompted Weststrate to organise another tour this year, which according to participants, has been a huge success.
One of these participants was Sandy Blake, Director of Nursing, Patient Safety & Quality for Whanganui District Health Board. She says the trip affirmed the direction they’re taking at the DHB.
“It validates the values-based care that we’re working towards here. It tells me that we’re on the right track and we need to keep going. I’m keen to keep on with the person and family centred care,” she says.
“A strong message I got was that the money follows the person,” says Blake, of the Netherlands’ largely private healthcare system.
“No matter what organisation we went to, that idea of looking after people respectfully, putting the person first, caring for people in that right way is better for all as we get older.”
Blake was impressed with how the Dutch talk about the person, not the disease. For example, they don’t let dementia define a person, she says. The dementia pathway starts at diagnosis and the case manager supports them through that diagnosis in their homes. There are more options to suit the individual needs of the person, including things like farm stays.
Blake felt there was much New Zealand could learn from the way the Dutch integrated their care systems.
“We talk about integrated care but we struggle sometimes to know how that can practically work,” she says.
“I’m looking at my District Nursing team and thinking their workload is getting heavier and heavier but what we don’t do as well as we could do is connect with other providers who provide care to that person or that family, like home care providers.”
In the Netherlands, a big part of a specialist nurse’s job is to build capability in others, says Blake. The Dutch model is to place the patient in the centre, then around them are the informal carers, who are paid. The nurse’s role is to guide and coach those families to be more self-managing.
“Families do complex things. If families can look after someone on a respirator, why can’t they, with the right support, help do more?” queries Blake.
“Our hospitals are all overflowing here and in the Netherlands they’ve got spare beds,” she says incredulously.
This was largely because of an increased emphasis on home care. Blake says it took a “bold move” for the Dutch Government to close 40 per cent of rest home-level beds and reinvest that money so that people can stay in their homes. In the Netherlands, people now only enter care when they’re into the last 18 months to two years of their life.
“The Netherlands have the second highest budget for health after the US. What they’ve been smart about is how they redirect their money to care for the people at home.”
Blake is ready to put into practice some ideas she has gleaned from the study tour.
“The Ministers are talking about the emphasis being on care in the community but we struggle with how to practically do that. My thought is that we might try it with a few of our complex people now and look at how we do it and how much we spend and just understand that if we do it differently we probably can afford it.”
Bupa New Zealand Managing Director Jan Adams also really appreciated the opportunity to visit and learn from a different health system.
“The Dutch model is well funded but their creativity and willingness to do things differently including their approach to dementia care was so valuable.”
Adams notes that the Dutch health system has universal coverage with 100 per cent access to care for the total population of 17 million people. Everyone is obliged to be insured and those who cannot afford to pay are subsidised by the government.
“The problems within the system however are very familiar – a rapidly ageing population growing in numbers every year; a third of the population living with a chronic disease; increasing demands and expectations of the consumers of health and healthcare services; new and expensive treatment options, and reducing productivity within the health system.”
Adams says the visit to De Hogewijk dementia village was of immense value. Residents live in communities of six, they have their meals cooked in their community and are paired with other residents with similar interests. The aim is to invoke memories for the person that are familiar to them. The residents are very active, have a supermarket they can go to and a restaurant and cafe which encourages family and staff interaction.
Their staffing approaches are very different with two carers assigned per house of six, who do all the cooking, cleaning and interaction with the residents.
“It was a great experience and certainly food for thought in terms of creating meaningful and safe environments for the residents, with really good activity programmes.”
The group also explored the Buurtzorg or neighbourhood care model in place across The Netherlands.
Adam says the model has attracted significant worldwide attention because of its focus on autonomous, self-governing nursing teams providing care to the client without additional layers of management or bureaucracy. The approach started in 2007 and now has 950 teams of up to 12 nurses providing care in neighbourhoods of circa 5 to 10,000 residents.
“Staff satisfaction is high and customer satisfaction too, because of the focus on meeting the patients’ needs and developing individual packages of care tailored to their needs,” notes Adams.
The tour also included a small nursing home in The Hague that operates a ‘de Herbergier’ (the innkeeper) model. The home, a converted school on three levels accommodates 16 residents living with dementia who live independently in an apartment with 24-hour on-site oversight from resident managers and a small number of staff. Supported by Dr Frans Hoogeveen, the focus is on improving learning capacity in residents with dementia, giving them new strategies that increase their independence and ownership of their home community.
“The Dutch system was showcased in terms of their homes being a significant part of the local community with schools located in the immediate vicinity,” says Adams.
Weststrate says the Netherlands is constantly innovating and adapting, which warrants future trips.
“The Dutch are well-known for being an extremely innovative country and with one of the most stable economies in the world they are able to finance these projects with the focus to find out what works and what doesn’t work.”
The next Netherlands Healthcare study tour is on the calendar already: 6-10 May 2019.