Social Care in the Netherlands, Scandinavia and Japan- Sekoia

What could the UK social care sector learn from other countries?

The UK care sector is facing several challenges. One might wonder, isn’t there something that we could learn and perhaps take from other countries? We’ve taken a closer look at social care in the Netherlands, Scandinavia, and Japan. Of course, not everything is similar and transferable to the UK but there are things we can use. And reassurance that it’s not too late to fix social care.


There are loads of aspects to dig into but instead of stringing you along for the conclusion here are the key takeaways.

Key take aways

Reforms can (and probably will) take time but better late than never
Flat hierarchy and inclusive decision making increase staff members' satisfaction
Satisfied staff members are more productive which leads to satisfied service users
Care systems often need to be revised (3-5 years) to make sure it still works
Political willingness is crucial to make significant and country- wide changes

How is the Netherlands’ social care sector?

The land of tulips, windmills and likely the biggest fans of orange in the world. But the Netherlands is also known as one of the pioneers of social care and a frequent destination for inspirational visits abroad. So, let’s take a closer look.

Have you heard about the Buurtzorg model? 

In 2006, a home care manager in a small town was becoming more and more frustrated about the lack of financial support in the care sector. That man was Jos de Blok. It has always been the goal to deliver good quality care and treat the service users with the respect they deserve. But lack of time and resources made that more and more difficult. Something had to be done. Enter the Buurtzorg model.

What started as a local solution soon turned into something more.

What is the Buurtzorg model?

The goal of the model is to deliver care at low costs. While acknowledging people want to have control over their own life as long as possible. Combining these and adding a person-centred focus: the Buurtzorg model was born.

The Dutch word “Buurt” means neighbourhood, “Zorg” means care. The purpose is to provide care as if you were taking care of people in your neighbourhood. The tagline of Buurtzorg is “humanity over bureaucracy.” The feeling of a community.

Nurses build long-lasting relationships with care recipients, and they seek to provide independence and self-care for service users. The carers have a proactive and compassionate approach. All something practically every model of care has in common.

But the significant difference compared to other models is the organisational structure. Using the Buurtzorg model means that the hierarchy system is flat.

Activities that are usually assigned to managers are made by the staff, including duties such as recruiting new members. The team is self-governing. And in charge of their schedules, roles, and assignments. Essentially the team has complete freedom to do what is needed to provide compassionate care to their service users.

The Dutch word “Buurt” means neighbourhood, “zorg” means care. That is what the whole concept is about that the provided care is like taking care of people within your neighbourhood. The tagline of Buurtzorg is “humanity over bureaucracy.”

What is the secret recipe? 

Having a flat hierarchy, inclusive decision-making, and shared responsibility increased staff satisfaction. Which increases productivity and creates happier service users.

Sounds like a fantasy. How does that come about in the real world?

Technology plays a crucial part. The carers use apps for scheduling, documenting, and nursing assessments. This reduces administration costs and the time spent on paperwork. The focus is on care, not admin tasks. Without technological support, the Buurtzorg model could not deliver the care they do now.

The other key element of the concept is that there is a clear division of labour. One care team consists of 12 nurses plus carers. They are responsible for one specific area, or neighbourhood. Handling payslips, IT, and accounting duties fall on a back-office and not the care team.

What are the results of using the model?

Lower overhead costs, lower sickness rate by staff members, increased satisfaction both by staff and service users. That’s the results so far.

According to the founders, they have spent fewer hours on care than other home care organisations which shows higher efficiency and cost savings. Additionally, Buurtzorg’s patients required less care because they regained autonomy quicker and had fewer emergency hospital admissions.

Sounds too good to be true, right? 

Of course, nothing is perfect. The Buurtzorg model has challenges and disadvantages. Some service users find it intrusive to have such close contact with their carer – so it’s important to respect their expectations and preferences.

The lack of hierarchy and changes to the structure might be challenging for some of the countries. Autonomy is not for everyone. There are cultural differences between organisational structures and the styles of leadership.

Also, some countries may have specific healthcare policies that do not allow this type of care approach. For others, the implementation of the model took a long time, even years to fully get introduced.

Key take aways from the Buurtzorg model:

Empowering service users to be as independent as possible
Flat hierarchy and inclusive decision increased employee satisfaction
Satisfied staff members are more productive which makes service users happier, as well
Technology is crucial to enable care

What is going on in Scandinavia?

Denmark, Sweden, Norway, and Finland are countries renowned for their publicly funded care models. They are often referred to as “caring states” so how do they deliver care?

There are slight differences among the countries but the approach is similar. The first difference compared to the UK that you might come across is that the government and the municipalities have a bigger role in the care sector. For-profit private care providers are a rare sight.

Inclusivity and equality are important values that you can see in the Scandinavian culture and care model. No matter who you are, you will get the same care as everyone else. Millionaire and middle-class alike. No exclusion of people, no stigmas.


A nurse is giving orange juice to a resident

Does it work for them? Or is it all talk?

Funding social care in this way is expensive. Decision-making and innovation are also hindered because of governmental/municipal ownership. Bureaucracy makes it difficult to wander “outside the box”.

Overall, the model works for these countries. Much helped by the focus being on quality of care and not turning a profit.

Another common theme for the Scandinavian countries is the digital maturity these societies have. From fully digital payment everywhere to digital COVID passes.

As in the Netherlands, technology plays a crucial role here, as well. Digital care records are a basic requirement for all care services. As is the use of smartphones and tablets at the point of care.

Key take aways from Scandinavia:

Governmental/municipal ownership does not mean bad quality
Inclusivity and equality are key values to delivering good quality of care
Leverage technology to make providing care easier
Focus on care and not on making profit

Let’s travel a bit further away. How are things in Japan?

A country known for its ageing population, Japan is an interesting case. In fact, with more than 28% of its population being over 65 years old, Japan has one of the oldest populations on Earth. And with all signs pointing towards a similar demographic shift coming to the UK, could we learn a thing or two?

A common Japanese stereotype is that many families take care of their older relatives at home. And it’s true to a degree. But what about the people who didn’t have relatives to take care of them? They fell through the cracks and ended up in neglected care homes. Forgotten and hidden away.

A change was needed.

At the beginning of the 1990s, Japan started to consider how to improve the care sector and handle the ageing population. It took a while. The legislation for the new reforms was passed in 1997 and the new system was only implemented in 2000.

The Golden Plan

Japan introduced a plan called “The Golden plan” to revolutionise its care sector. They wanted to focus on home care and on preventive efforts to reduce the number of people in care homes.

Also, a new long-term care insurance system was created to cover expenses from the reform. From age 40, everyone had to have social insurance that contributes to the finances of the care. But, the reform wasn’t solely financed through this insurance but also from taxation and co-payments.

Unlike in the Netherlands, care managers have a key role in care. But, compared to the UK the care managers are still different. Everyone is assessed on a scale of 1-5 based on how independent and healthy the individual is.

If prevention is enough the individual can stay at home and receive preventative care such as improvement of motor functions, oral function, nutrition conditions etc. Everyone is assigned a care manager who handles care plans, finds the right care providers, and coordinates between carers, family members and the individual.

With the Golden Plan and the creation of supportive communities that focus on prevention, Japan managed to change the somewhat negative perception of ageing to a more positive outlook. While reducing the loneliness of older people and maintaining their well-being as long as possible.



Success story? 

Long story short: Japan solved the issues for a while. But it is not clear whether the system can work in the long term without any further changes. As a culture, Japan has always been critical of itself. They review the entire system every 3rd year.

Now it looks like the reform has become a victim of its own success. Enrolment in the scheme has skyrocketed since it was implemented. The number of beds in long-term care facilities is lower than the number of people (and the population is still ageing more and more). Based on the history you could expect that Japan will make some further changes to make and keep the system sustainable.

Creative initiatives 

Japan also implemented some unusual initiatives. These were not part of the official reform but worked to boost the sector. They developed mutual-help networks of local people. A “time-banking system” where volunteers can earn time credits for caring for older people in the community. The credits can then be used to buy similar services for themselves later or for elderly parents too.  

A nursing home “employed” babies as workers. Like the BAFTA-nominated documentary Old People’s Home for 4-Year-Olds. The aim was to cheer up the residents – and it worked. The babies don’t get paid but receive vouchers, coupons, or diapers for their services. Nothing is mandatory of course, the babies, or their parents decide when they come and leave. One of the nurses took her child to work once and that’s where she got the inspiration from. Essentially a system where you pay it forward. And help each other when you can.

Key take aways from Japan:

Reforms can take ages but it's better to make them later than never
It’s important to evaluate your systems regularly
Financing a reform is as important as the reform itself