Learn News Opinion

Overhauling social care: Does Japan have the answer?

Natasha Curry, Deputy Director of Policy, Nuffield Trust

Social care in England is in a state of crisis. Cuts to local authority budgets over the last 8 years have resulted in 26 per cent fewer people accessing care. Only those with the highest needs and the lowest assets are able to access state-funded care. Others must rely on family and friends for support or simply go without.

The social care system is hugely complex leaving people struggling to navigate it when they are at their most vulnerable. Unlike the NHS, social care is means-tested which means that, before you can access care, your wealth is assessed. It is also widely felt to be unfair, with access to care largely depending on where you live and what happens to be available in your local area. Costs are potentially unlimited with an estimated one in ten of us facing care costs in excess of £100,000.

This summer, the government is due to bring out a consultation paper on the future of social care for older people. It presents an important opportunity to bring about positive change and colleagues and I have been looking to Japan to see what lessons we might be able to learn.

What can we learn from Japan?

Japan has the longest life expectancy in the world. One quarter of its population is already over 65 and almost one in ten are over 80 – a situation we won’t be facing until 2040. In 2000, Japan introduced a new long-term care system to ensure that older people have access to the care and support they need.

From the age of 40, everyone in Japan starts to pay into a social insurance fund. Payments are linked to income so the more you earn, the more you pay. Care is available to people who are over 65.  To access care, people undergo a needs assessment which is the same wherever they live. Income and assets are not taken into account – it is purely based on need. Those found to need care are assigned a care level which determines a monthly budget to spend on care services and approved providers. A care manager play a really important role, supporting the individual to choose services that meet their needs and guiding them through the system. Services range from home help with things like washing and dressing right through to nursing homes. Individuals have to contribute around 10% of the cost of their care up to a monthly limit – beyond that, their care is free.

One of the most interesting things about the Japanese system is that, as well as formal care services, they also invest heavily in services that are designed to keep people independent and well. It is hoped that, by keeping people healthy for longer, they will need fewer formal care services for less time. Volunteer-led initiatives, such as exercise classes or lunch clubs, are intended to encourage the more active members of the older community to help support their frailer neighbours while reducing the risk of isolation and deterioration.

Is a Japanese-style system the answer?

Japan is an example of one model that England could adopt but it’s not the only one. There are other options that may be more appropriate for England. Japan has faced, and still faces, challenges in managing its system and keeping it affordable. While there may be no perfect system, it is clear that a radical overhaul of our own system is long overdue. The green paper needs to be a significant step on the journey towards a system that is clear, sustainable and fair.


Edel Harris





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