I wouldn’t disagree with that, but I think we need to look elsewhere for some of the solutions. I’m particularly interested in the model that’s been developed in Holland, the Buurtzorg model, because that has both massively increased the approval rate and also the job satisfaction of the nurses. In 2006, four nurses in the small town of Almelo in Holland realised that the relationship with patients had been undermined by the system they were operating under the Government-funded insurance scheme. So, Jos de Blok and three other colleagues set up their own social enterprise called Buurtzorg to look after older people in their own homes, through co-ordinated compassionate care. And, 10 years later, they have more than 9,000 colleagues who have joined them, and they look after more than half of the Dutch people who need care at home. It’s been regularly named the country’s best employer, year on year, and is a role model for the rest of the sector.

Interestingly, it has also cut costs, because nurses manage themselves in 800 different neighbourhood teams. They are engaged more effectively with other local services, voluntary carers and patients themselves, and their self-organised teams are supported not by managers, but by peripatetic coaches and an IT system designed around care-giving and collaboration. The whole national operation is run from a small back office that looks after billing and co-ordinates information and learning across the teams. Forty admin staff for 9,000 people in the field; that is something we should be aspiring to.

So, I think that this is an ongoing debate, but I welcome the fact that there is going to be a seminar on Buurtzorg at the end of March in the Celtic Manor, and I hope that many of our local authorities will be sending delegates to find out how it operates.