In July last year UK Ministers discussed the possibility of a new tax scheme to resolve the UK’s social care crisis. Under the plan, people over 40 would have to pay more in tax or national insurance to cover the cost of care in later life. This would be based on the widely admired Japanese system for covering senior care costs. In 2019 I travelled to Japan to explore their approach to providing care and support to people in later life. Here are my top tips for implementing a similar system in the UK.
“The demand for social care is growing, and it is important to make sure that we invest in preventative services and healthy communities.” – Rebecca Jarvis, The Winston Churchill Memorial Trust Fellow
Introduced in 2000, Japan’s Long Term Care Insurance system has been instrumental in the development of a range of innovative housing and care models, which support people in community settings rather than in care homes, which was the focus of my research. This is a compulsory initiative for adults aged over 40, who pay insurance contributions that fund their long-term care in older age. Setting out a clear national policy for funding long-term care for older people is one of the main recommendations in my Fellowship Report. I was delighted to learn this year that the UK Government’s new health and social care taskforce, and the Department of Health and Social Care, are considering introducing a similar approach here.
I have been reflecting on what I learnt in Japan. Here are some of my top tips on what we should consider in order to adopt a similar system.
Insurance information from Mito City, Ibaraki Prefecture; local government in Japan has a strong role in the ‘kaigo hoken’ system
The most important thing is to get the public on-side. Japan’s Long Term Care Insurance Act was introduced in 2000 after a decade of consultation and planning, and we should not underestimate the level of debate that needs to happen here. Our current social care system is very complicated and the funding implications are not understood by people until they need it. The fact that many people have to pay for social care themselves, often the most expensive thing they will buy after property, can come as a shock. We need to have a frank discussion with the public about what kind of things they may need to pay for in later life – and what that could cost them.
Don’t underestimate the role of the social worker or care manager. I heard in Japan that the success of their system is still very much dependent on the care manager, who is responsible for creating support plans for individuals within their funding allocation. The system works very well for people when the care manager is skilled at their role and can think creatively and flexibly about how the individual’s needs can be met.
Consider the social care workforce more generally. Vacancies and staff turnover are high in the social care sector, and a quarter of social care staff are on zero-hour contracts. We must do more to make this an attractive career option for people, with pay that reflects the skilled and demanding work they do and opportunities for career progression. Otherwise, people in need of social care may well end up having the money they need to purchase support but lacking the workforce to provide it.
Finally, let’s be careful of believing that this alone will ‘fix the crisis in social care once and for all,’ as Boris Johnson promised in his first speech as Prime Minister. Introducing a funding system like Japan’s would be a positive step in making the funding of social care fairer and more sustainable, and that is to be welcomed. But the demand for social care is growing, and it is important to make sure that we invest in preventative services and healthy communities. The Japanese government is committed to creating a positive image of ageing and building communities that support people to age well. This helps to reduce the demand for long-term social care, which is hugely important too.
Rebecca Jarvis is Director of Operations at Health Innovation Network, and took part in the JET Programme in Nagasaki in 1999-2001. Rebecca was awarded The Winston Churchill Memorial Trust scholarship to research social care overseas and partly in Japan. JLGC supported Rebecca with some of the research trip facilities visits. Rebecca kindly gave permission for this text from The Winston Churchill Memorial Trust to be reproduced on the JLGC website. Rebecca’s full report for the trust can be read here.
