Japan has been operating in a challenging economic context since the early 1990s. Despite this, the country has succeeded in increasing investment in health and social care, resulting in major changes to the delivery of care for older people. This project explores how the Japanese Government has achieved such change and examines the interesting points of consideration for reform in England.

In this video interview, Rt Hon Paul Burstow MP describes the need for social care reform in England.

The economic and demographic situation in Japan might seem at first glance to represent an impossible challenge. By 2050, over 35 per cent of the Japanese population are projected to be over 65 years old but the country’s health care expenditure was 8.5 percent in 2011 – compared to the UK’s 9.8 per cent.

With the proportion of older inhabitants projected to become one of the largest in the world, how will Japan maintain its current levels of service delivery?

The introduction of long-term care insurance in 2000 makes Japan a particularly interesting case study of health and social care reform for England as it grapples with the issue of social care funding.

Whilst facing similar challenges to the English NHS, Japan has increased investment in health and social care, changed patterns of care and altered attitudes towards services

The Japanese Government has been successful in changing deeply-ingrained attitudes towards services, putting in place a new system of long-term care designed to offer comprehensive care to older people whilst taking pressure off overloaded health services.

In introducing a long-term care insurance system, the Government has tried to tackle historically high rates of hospital utilisation, which have been fuelled partly by stigma associated with care homes.

Japan’s attempts to bring about large-scale system reform offers interesting learning for us not least because the country shares many of the same challenges that England now faces.

It shares a challenging financial future and concerns about sustainability of health and long-term care services are pressing. Against this backdrop, it is observing an increase in the prevalence of long-term conditions such as dementia.

The development of more preventative care and proactive management of risk is a priority in both countries in our efforts to tackle the over reliance on inpatient and residential care.

Japan is also particularly interesting because it has separate funding streams for health and social care and therefore faces challenges in integrating and coordinating care for complex older people.

This project has been established in order to exchange ideas and best practice with Japanese practitioners, policy-makers, academics and researchers.

Points to consider from reform in Japan

There is almost universal agreement that the social care system in England needs urgent and fundamental reform, but despite this consensus various attempts at reform over the last 20 years have all stalled.

Finding a sustainable and fair model of funding for social care for our growing older population is a matter of significant political and policy attention in England.

In our report: Caring for an ageing population: points to consider from reform in Japan, we identify key issues related to reform in Japan and discuss how these link to the English context. Particular points of interest include financing and coverage, equity, diversity of providers, quality, choice and competition, volunteering and care co-ordination.

Our key collaborator, Professor Naoki Ikegami of the Keio University School of Medicine, visited the UK in May 2011 and a return study visit to Tokyo was organised in May 2012.

Joining Nuffield Trust’s Senior Fellow Natasha Curry and Fellow Holly Holder on their trip to Tokyo were Gill Ayling, Deputy Director of the Social Care, Local Government and Care Partnerships Directorate at the Department of Health and Dr Linda Patterson, Clinical Vice President of the Royal College of Physicians and Senior Geriatrician.

Also participating in a parallel and separately-funded visit were Andrew Chidgey from the Alzheimer’s Society and Beverley Bryant from Capita Health.

The project is jointly funded by the Nuffield Trust and the Great Britain Sasakawa Foundation.

We also held a joint event with the Daiwa Anglo-Japanese Foundation to discuss our key findings. Speaking at the event were Rt Hon Paul Burstow MP, Minister of State for Care Services (2010-2012); Masahiko Hayashi, Deputy Assistant to the Minister for International Affairs, Ministry of Health, Labour and Welfare, in Japan; and Dr Mayumi Hayashi, Leverhulme Early Career Fellow, Institute of Gerontology, King’s College London.

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