A clear plan for social care?

With our new report on the long-term care system in Germany following our review last year of how things are done in Japan, author Natasha Curry looks at the factors that prompted change in those countries. Will the social care system in England be able to follow suit?

Blog post

Published: 12/09/2019

Last week’s Spending Round produced some new money for social care. There’s no doubt it will be welcomed in social care departments up and down the country where difficult decisions are being made every day, but the consensus among social care commentators and those in the system is that it’s simply not enough.

It doesn’t even restore us to the levels of spending in 2010/11, when Andrew Dilnot’s report urged change because “the current social care system is inadequately funded [and] people are not receiving the care and support that they need”. And it certainly will not be enough to meet the growing needs in our society – among both older people and working-age adults, not to mention children.

On winning the Conservative leadership race, the new Prime Minister Boris Johnson pledged to fix the social care crisis “once and for all”. Yet instead of the comprehensive and fundamental reform to the system that is needed, what we have once again is a sticking plaster that might, if we’re lucky, keep the broken system limping along for one more year.

Last year, we published a report on the Japanese long-term care system, and this week we published our analysis of the German long-term care system. Although not without its challenges, it’s a system that seeks to spread financial risk across society, to protect individuals from catastrophic costs and to ensure that everyone of all ages and means can access a minimum level of care.

I wrote a few months ago about what I think we can learn from the design of Germany’s and Japan’s systems. But what enabled them to effect change where England has repeatedly failed?

Public pressure for change

While it does feel there is growing public discontent with the existing social care system in this country, it’s not clear we have reached the groundswell of public discontent that was witnessed in Germany and Japan. Those levels of public pressure were instrumental in pushing politicians to enact change.

Perhaps as a result of more people butting up against its labyrinthine complexities or as a result of recent high-profile media campaigns (such as on the BBC’s Panorama), we might start to see a shift in public understanding of our social care system. That shift is urgently needed, as a survey in 2018 found that 44% still believed their care will be funded by the NHS.

Cross-party cooperation

Perhaps because of that lack of widespread public awareness, social care in England remains a hugely politicised area of public policy. Both Labour and the Conservatives have been burnt badly by the issue in recent elections, so perhaps it’s no wonder it’s regarded as politically toxic. With proposals for reform too often put forward at election time, when there is little incentive for politicians to cooperate, the much-needed cross-party cooperation on the issue remains elusive.

In Germany, a much-respected politician and long-standing voice on care, Norbert Blüm, provided consistent leadership and was able to draw support for a solution across party divides. Because reforming the care system was seen to be a vote winner, there was a strong incentive for parties to cooperate.

Designing a system that addresses problems

Germany and Japan sought to build public trust and support for contributions by carefully designing a system that went with the grain of social trends and directly addressed deficiencies in the existing systems. In doing so they sought to create a vision for what the service should look like, which offered clarity on what people could expect to get in return for their contributions.

Alongside reform of the funding mechanism, both countries sought to reform how care was delivered, establishing processes to ensure a stable provider market. Both countries were successful in putting in place the building blocks of a system that not just suited their particular challenges and contexts, but that they have been able to adapt and adjust according to changing needs and demographics.

The debate in England too often focuses on the funding element and doesn’t seek to answer fundamental questions about how extra money should be spent.

Yet it took a long time there too

England has witnessed 20 years of unsuccessful attempts at social care reform, but perhaps we should take heart from the fact that bringing about large-scale system change was a slow process in Germany and Japan too.

Germany saw the publication of a series of reports and reviews between 1975 and the early 1990s, before reform was implemented in 1995. Similarly, Japan’s attempts at reform began in the late 1980s, but it wasn’t until 2000 that its new system was implemented.

What feels different in England is that we don’t have the essential ingredients that both those countries seemed to have at the point real reform was on the table. And while the significant political and economic turmoil experienced by both countries in the years preceding reform (reunification in Germany and the stock market crash in Japan) appeared to usher in a window of opportunity for a new form of debate, our own particular brand of political turmoil appears to be more of a distraction from the domestic agenda.  

A clear plan?

I was heartened to hear the Chancellor in his Spending Round speech refer to the government’s commitment to a “clear plan to fix social care”. I think that a clear plan is exactly what is needed as a first step in establishing a fair, stable and sustainable social care system.

Reform of our social care system cannot be put off any longer. We urge policy-makers to start a positive dialogue about social care and we urge politicians to cross political divides to find a workable long-term solution.

Suggested citation

Curry N (2019) “A clear plan for social care?”, Nuffield Trust comment.

Comments