The Government can learn important lessons from
the Japanese social care system in achieving public buy-in, an
easy to navigate system and a strong focus on prevention of
loneliness and ill health, experts suggest today.
These are the key findings from the Nuffield
Trust report, What can England learn from the long-term care
system in Japan?, published as the Government in Westminster
grapples with the future of social care ahead of this summer’s
planned Green Paper. The report draws on interviews and
observations carried out during a study visit to Japan in October
2017, as well as a literature review and the insights from a
previous study visit, to identify what England can learn from the
Japanese system.
With over 65s set to account for a third of the
Japanese population by 2040, the Long Term Care Insurance (LTCI)
system provides universal, comprehensive care to people over the
age of 65 and those with a disability aged between 40 and 65. The
system is partly funded by a national insurance fund that all
over 40s pay into and partly out of general and local taxation.
Emerging out of a national debate about how to support a growing
older population, the system helped many who were not getting the
care they needed.
Despite LTCI being a system unique to Japan,
focussed specifically on the needs and demographics of their
population, the report authors argue that some features of this
system offer important lessons for England:
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Its key success, where England has repeatedly
failed, has been to garner public support through a commitment
to transparency, fairness and consistency. National criteria
for eligibility mean that access to care is the same regardless
of where a person lives. Every three years the system is
reviewed and reforms made when needed. This flexibility has
enabled the Japanese Government to be responsive to public
concerns and to address concerns over expenditure.
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Service users find the Japanese system easy to
navigate. This is because a crucial part of the LTCI service
includes having a ‘care manager’, responsible for supporting
the individual to make a care plan, identifying suitable
providers, coordinating between carers, the individual and the
family, and overseeing the care plan in the long term. While
similar roles exist in some parts of England, provision is
patchy and there is no single accepted definition of such a
role.
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At the heart of the Japanese system is a
strong commitment to long-term prevention of loneliness and ill
health, a stark contrast to England’s short-term approach,
driven by budget constraints, which is focused increasingly
only on those with highest needs. Services are available both
to frail or sick older people and also to healthy ones, with
clubs and activities for healthy over-65s promoted as part of
the system.
The report warns that the Japanese system is not
without its own problems and these too can offer lessons for
England. When the scheme was set up, the Japanese Government
underestimated demand for long-term care at the outset and has
had to adjust the system to reduce eligibility, increase
co-payments and change insurance premiums as a result. The
authors highlight similar risks in England from not fully
recognising the extent of informal and unpaid care currently
supporting the provision of social care. A further problem in
Japan is the threat posed by a growing shortfall in care workers
over the next 10 years, something that is also present in England
and could be exacerbated by Brexit.
Commenting on the findings, lead author
Natasha Curry Senior Fellow in Health Policy
said:
“The cultural differences between the two
countries, the very different funding systems for healthcare in
both, and differences in the political setup mean that the
Japanese system is not a ‘silver bullet’ to solving the crisis in
social care in England.
“But as the Government begins to ask difficult
questions about the future of social care, the Japanese
experience in reforming long-term care for the elderly offers
some important lessons for policymakers as they seek to bring
about much-needed reform in England. In particular, the Japanese
experience suggests there is real value in embedding transparency
and flexibility in the system, helping people navigate their way
around it, and promoting healthy living”.
