What Britain can learn from Japan and Germany’s social care systems

The government has been accused of kicking the issue of adult social care into the long grass this week as it failed to set out concrete plans to address the sector’s funding crisis in the Queen’s Speech.

Although Boris Johnson promised to “fix” social care when he became prime minister nearly two years ago, there was just one line in Tuesday’s speech announcing his legislative plans: “Proposals on reforms to social care will be brought forward.”

He faced criticism from both sides of the Commons, with Labour leader Keir Starmer calling the lack of strategy “nothing short of an insult to the whole nation”.

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Tory MP Damian Green, who commissioned a government green paper on social care in 2017, said: “I am absolutely insistent that this needs to be the year for action and decision rather than kicking the can down the road any further.”

Politico notes that Germany and Japan have been lauded by reformers as countries using models that the UK could replicate.

In a letter to The Times last month, former health secretary Jeremy Hunt said: “Countries such as Germany and Japan foresaw the demographic timebomb facing societies everywhere and grasped the nettle decades ago.”

They now boast “equitable and well- funded care systems that guarantee the elderly dignity and security in old age”, wrote the South West Surrey MP. “In comparison, we have failed that challenge.”

What’s wrong with the UK system?

“The current system is widely regarded as unfair, complex, confusing and failing to meet growing care needs in the population,” says the Nuffield Trust.

It varies widely not only between England, Scotland, Wales and Northern Ireland, but also between different local authorities within each part of the UK.

While some people’s care is paid for by the state, others have to use up most of their savings before they can receive government support.

How does social care work in Japan?

Japan has “one of the most comprehensive social care systems for the elderly in the world”, says The Conversation. It was introduced in 2000 after a long debate about how to care for the world’s oldest population.

“The system is partly funded by a national insurance fund that all over 40s pay into and partly out of general and local taxation,” says the Nuffield Trust. Individuals pay 10% of the costs out of their own pockets.

“Japan has traditionally relied on hospitals to provide care for the long-term sick,although use of residential care is increasing,” says the King’s Fund. “Residential care institutions are not allowed to be profit-making,” but in-home care is provided mostly by private companies.

Eligibility for services is determined by a medical assessment carried out by a care manager, who is then responsible for arranging the necessary support.

“At the heart of the Japanese system is a strong commitment to long-term prevention of loneliness and ill health,” says the Nuffield Trust.

This represents “a stark contrast to England’s short-term approach, driven by budget constraints, which is focused increasingly only on those with highest needs”, it adds.

How does social care work in Germany?

In 1994, Germany launched a “universal and equitable funding model, supported by both main political parties”, says the London School of Economics.

Less generous than the Japanese system, it is intended only “to cover basic needs”, says the King’s Fund. But the care provided is identical throughout the country and is determined by an individual’s need rather than his or her ability to pay.

Although wealthier individuals are expected to top up government contributions with their own money, they’re not expected to pay the whole cost of their care - as they are in England. Poorer Germans can apply for means-tested benefits to cover the funding gap.

To fund the system “everyone starts paying into a fund from the time they start working”, says City A.M.. “Currently 1.5% of every person’s salary, and an identical sum from employers, is safeguarded to pay for care in later life.”

The contributions are “administered by health insurers”, says the King’s Fund, and used to pay for a wide variety of support. “Nearly all social care, including institutional and home care, is delivered by private providers,” it adds.