Fleur Thomese works with the Ben Sajetcentrum (www.bensajetcentrum.nl), an academic study center (“academische werkplaats”) on long term care in Amsterdam.
She is involved in a project in the North of Amsterdam on improving the health care for frail older people. This area of Amsterdam has relatively many residents with lower incomes and poor health. The project aims at decreasing the number of emergency hospital admissions for older people. Emergency hospital admissions in this group often are in large part the outcome of non-medical processes, such as a lack of support and knowledge with the person involved, and insufficiencies in the organization of extramural care. Such admissions are detrimental to the health of older people and they are very costly.
Starting from a large coalition of health and welfare providers, an insurance company and the municipality of Amsterdam, the so-called Krijtmolenalliantie, a process of co-creation has been started to develop better linkages between the hospital (BovenIJ-ziekenhuis) and primary and long-term care. Participation of older people themselves in this process is sought after.
I am presently doing explorative work in this project with an interest in two issues:
(1) More “traditional” methods of participation, such as client councils or formal community participation (inspraak) often do not achieve the participation and influence that is desired by either the organizations or those being represented. This may have to do with low representativity in these formal bodies, and with new kinds over decision making, such as the current co-creation process. What new methods develop that involve target groups in the development of local care and welfare, and what comes out of these? How can efficacy be achieved?
(2) Specific to care and welfare is that the target groups on average may be socially and physically more vulnerable than the average population, and they may be less able to speak up. Yet the interest in hearing directly from them, instead of representatives that may not be that representative, is growing. What methods can be used to give voice to such “vulnerable” populations? Various types of advocacy and co-research are being developed, where the “stronger” members of a group are trained to act as researchers and ambassadors, rather than representatives.
I work together with Ludo Glimmerveen, who is finishing his PhD at ORG, focusing on civil participation in care, and the national Patiëntenfederatie (v/h NPCF). We are preparing a proposal on a larger, comparative project. To make the network complete, this project also features in the care program of the Talma Institute.