Social care systems in other nations

August 29, 2018

A new report commissioned by Age UK highlights the different social care systems in other nations in the developed world, their approaches to long-term care, and how they compare to the system in England.

The Incisive Health report, An international comparison of long-term care funding and outcomes: insights for the social care green paper explores key characteristics and outcomes of social care systems operating in other advanced nations, with a view to seeing what lessons could be learned and applied in England. The other countries were Italy, Spain, France, Germany and Japan.

The findings suggest that creating a sustainable social care system fit for a rapidly ageing population is a challenge in every one of these countries, which none has completely overcome. However, most of the social care systems in other nations have undergone significant reforms during the last 25 years. For example, Germany began to modify its system in 1995 and Japan in 2000. According to the report, over the same period, despite two Government consultations, two official Commissions, five Green or White Papers and one Act of Parliament, England's system is broadly unchanged.

The report notes that England has a stricter means test than the other countries examined. It found that other countries have more progressive systems, either providing a non-means-tested basic level of support (Germany), capping the level of co-payment for all (at 10% in Japan), or using a more generous and gradual means test (France).

Furthermore, in recent years, England’s means test has become increasingly less generous, says the report, explaining that:

  • The capital thresholds (£14,250 to £23,250) have not changed in nearly a decade: if the value had risen in line with inflation, the upper level would be £25,559 today. This is effectively a 9% cut over the last ten years.
  • Charges for care have increased as local authorities have come under growing financial pressure. In 2010/11 the average charge was £2016.49 a year. By 2013/14 (the last comparable year) this had risen by over £500 to £2563.90 (2015/16 prices).
  • Since 2010, Personal Expense Allowance in a care home has risen by only £2.60, to £24.30 a week.

England and Germany both rely on citizens making high payments to fund their own care. In the UK, this amounts to 33% of the overall spend on long-term care. In Germany, mandatory social care insurance covers the costs of basic care with out-of-pocket expenditure only expected to pay for anything additional.

England also has a system with noticeably less risk pooling for the non-health aspects of care than social care systems in other nations. In addition, in England long-term care needs which are paid for by the NHS are covered totally, with risk completely pooled through the Continuing Healthcare scheme, whereas needs that fall under the social care system have very limited coverage. This contrasts to the other countries included in the report where health and long-term care systems are more similar to each other, meaning that people with dementia, for example, get a much better deal than they do here.

The report also finds that:

  • Roughly similar levels of family caring exist here as in other European countries.
  • Italy’s system is notable for being highly localised. The authors conclude, drawing especially on experience there, that the greater the degree of devolution in terms of social care, the greater the potential for variance in quality and funding of services. Reliance on local fund-raising in combination with local discretion over access criteria, as in Italy, in particular risks major variations in quality.
  • No country included in the study has succeeded in fully integrating health and care, with differing financial models often proving an insurmountable challenge.
  • In financially distressed social care markets, quality is better ensured by a system based solely on service standards, rather than price competition. In Japan, the price of services is set nationally with recipients able to choose provider, keeping quality high, with providers unable to undercut each other.

Caroline Abrahams, Charity Director at Age UK said, 'Sadly, this new report shows that England has been left behind in the race to update the funding of care for older people...It is crucial that the forthcoming Social Care Green Paper isn’t yet another failed exercise. The evidence from other countries is that a package of measures that significantly improve the care offer to older people attracts a lot more public support than something more timid – the public isn’t stupid and will demand good value in return for paying more. Our Government needs to take note and develop some exciting proposals that will really make a difference. Bringing our care system up to a decent standard and making it sustainable won’t happen overnight and as citizens we will all need to contribute to the cost in different ways, but if they can do it in these other countries surely we can here too. And the sooner we start, the better.'

Mike Birtwistle, Founding Partner at Incisive Health said, 'The social care system in the UK is in crisis. Recent budget cuts have combined with decades of political inaction to a leave an outdated system struggling – and in some cases failing – to deliver care to the standard we all expect.

'The ripples of this crisis spread throughout the public sector, with local council budgets increasingly pushed to breaking point and the NHS left with large numbers of ‘delayed transfers of care’ – with older people trapped in hospital because no social care service is able to care for them in the community.

'The Green Paper must grasp the nettle of this challenge and propose a realistic and funded plan to address the immediate crisis, as well as delivering longer term reforms to ensure the fairness and sustainability of England’s social care system. Ducking the issue cannot be an option.'

Responding to the report, Glen Garrod, President of the Association of Directors of Adult Social Services (ADASS), said, 'This report rightly asks searching questions about both the level of future funding and how that funding is to be found, and how England’s provision of that care compares to other nations. The obvious question that arises is how ambitious do we want to be – do we want a social care service in England that is high quality for everyone or just those lucky enough to afford it.

'With an ageing population and a significant funding gap facing adult social care that the sector has long warned of, it’s crucial that the Government seize the opportunity of the upcoming green paper to explain how it will put social care on a sustainable, long-term footing.

'We know that ensuring older people or people with disabilities can live as independently as possible is essential to making sure that we not only reduce pressures on both adult social care and the NHS, but also to ensure people can have fulfilling lives. That’s why it’s essential the government supply urgent interim funding whilst we wait for a long-term funding settlement in the upcoming green paper.'


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