Social care: what can we learn from other countries?

by Natasha Curry

19 July 2019


Social care is frequently in the headlines. The system is widely regarded as unfair, complex, confusing and failing to meet needs.

A combination of a rapidly ageing population with growing needs alongside real terms cuts to local authority budgets over the last decade has led to a sense of crisis in the system.

Yet, despite a series of reviews, inquiries and commissions with increasingly urgent calls for change, reform has been elusive. But, that doesn’t mean that reform is impossible. England is not alone in the challenges that we face. In the run up to the long-promised green paper on social care, the Nuffield Trust has been looking to Japan and Germany to see what we can learn from the reforms to their care systems.

Principles to learn from

Like many developed nations, Germany and Japan responded to the challenges of ageing and growing need by reforming their care systems. Both countries were in similar situations to England now, with a shortage of provision that came at a high cost to those who needed care. But, unlike England which has chosen to pursue a series of piecemeal and one-off policy ‘fixes’ in the form of the Better Care Fund, the social care precept and occasional extra non-recurrent funding, both countries set about a fundamental reform of how care was both funded and delivered. There is much to learn from both countries but perhaps three features of the design of their systems stand out:

1. National collective funding - In England, if you have assets/income/savings in excess of £24,250, the costs of care fall entirely on you as an individual. There is no way to predict who will face high costs nor is there any way to insure against the risk. Germany and Japan have chosen to protect people from catastrophic costs by pooling risk across society through a national funding system (much like we do for all other public services). Seen as the fairest way to fund a care system, everyone pays in from incomes and continues to pay in beyond retirement.

2. Consistency of eligibility - Eligibility assessment in England is very much up to the discretion of local authorities which means that access to publicly-funded care in England largely depends on your postcode. A central national eligibility assessment was adopted by both Japan and Germany which is based solely on need. It is blind to means, diagnosis, postcode and living circumstances. This consistency has helped to create a sense of fairness and has resulted in high levels of public trust and support for the system.

3. Clarity of benefits - It is estimated that around one in ten of us will face care costs in excess of £100,000 across our lifetimes but it is difficult to predict who will face such high costs. To provide greater certainty, Germany and Japan have created a clear schedule of benefits which are directly linked to needs and defined on a monthly basis. If you have care needs, there is clarity about how much contribution towards your care you can expect from the state. That clarity and consistency means that public support for contributions is high.

Whats next for England?

The problems with England’s care system are well-known and understood. Proposals for potential funding options are plentiful and extensively explored. No system is perfect and Japan and Germany’s care systems are no exception. But they do provide rich learning for England as we look to reform our own creaking care system. What is needed now is strong political leadership in order to drive cross-party cooperation on this crucial issue.  The consequences of not addressing the crisis in care are far-reaching both for individuals and for other public services.

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