The Nuffield Trust this month released a widely reported report into Japan’s social care system which may help England ensure the current policy debate and the upcoming green paper as turning point for social care.
The Nuffield Trust is an independent health think tank which aims to improve the quality of health care in the UK by providing evidence-based research and policy analysis and informing and generating debate.
The Trust looked at the Japanese long-term care system to find out how Japan managed to go from a state of highly variable and largely unaffordable care provision in the 1990s to a universal care system servicing the needs of nearly 6 million people. Although contextually different, there are some valuable lessons that Japan can teach social care professionals in England about how Japan managed to implement change with widespread public support.
Natasha Curry, Senior Fellow in Health Policy at Nuffield Trust wrote in the Guardian Social Care Network blog upon the release of the report that in Japan, the need for long-term care became a priority in the 1990s. A confluence of economic difficulties and social change – with increasing numbers of older people living alone – created pressures that affected a large proportion of the population. The lack of affordable care led to people sending their elderly parents to hospitals – with little medical justification – because they provided relatively low-cost care and accommodation. As a result, the average hospital stay reached more than 50 days and costs soared. There was collective recognition that something had to change.
The Telegraph, picking up on the publication of the report noted that the think tank said Japan had struggled with the same problems facing the UK, with hospitals becoming “de facto nursing homes” with long stays in hospital for want of state-funded social care.
In 2000 it introduced long-term care insurance, with compulsory payments from the age of 40 used to provide care for those over the age of 65. In addition, those who take up care are expected to pay 10 to 30 percent of the costs of their care.
The system has national standards of eligibility, avoiding the postcode lottery in England, where the level of care received depends on what is funded locally.
The Times, focusing on the current debate in the UK over intergenerational fairness picked up on a separate point, stating people over 40 should pay a tax of hundreds of pounds a year because this helped Japan to solve an elderly care crisis, experts have said. This was after a commission on intergenerational fairness set up by the Resolution Foundation think tank proposed that the “citizen’s inheritance” could be used to help those aged 25 to buy a home or pay for education
Natasha Curry’s final comment was that Japan’s system may not be perfect and its experience has certainly not been without its challenges. But as with other countries that have made this journey, it should give hope that radical change is possible, even when the issues are so complex. Ensuring public understanding and support for change, coupled with the careful design of a system underpinned by the principles of transparency and fairness, appear to be the necessary ingredients for effective change.
A full summary of the report can be read HERE.
References:
https://www.theguardian.com/social-care-network/2018/may/09/england-japan-social-care-reform
https://www.telegraph.co.uk/news/2018/05/08/britain-should-learn-japan-comes-care-elderly/
https://www.thetimes.co.uk/edition/news/tax-on-over-40s-could-end-elderly-care-crisis-rrx5zpgnd
