Firstly, I would like to lay my cards on the table with both a ‘from the heart’ message – the UK has some of the hardest working and most dedicated carers in the world. Are they given the help and support they need? What can the UK take from other countries’ way of doing things so that we can do better? Care on Demand takes a look…

Interestingly, high government spending does not necessarily mean improved social care. The USA and the Netherlands spend the highest proportion of their GDP on health (according to the Commonwealth Fund’s health policy survey of 2013) but were also the two countries that had the most people that could not access health care because of its costs.

Australia – like the UK, our friends on the other side of the world use a means tested system where the government helps those on low incomes. Often people will buy a bond (a type of interest free loan) which can help pay for their care – in 2010 people roughly paid around 25% of the cost of the care themselves. Social care services are mainly paid for by tax revenue and user charges, like in the UK. As in England, people with more money pay for the cost of care themselves up to a limit. What is interesting in Australia, is that the role of non-profit organisations is huge. They are the main providers of residential care – they provide 59% of beds compared to 35% from ‘for-profit’ providers and only 6% by national government.

Japan - A compulsory long-term care insurance (Kaigo Hoken) covers the needs of the population aged 40 and over. Benefits are generous by international standards, designed to cover the costs of care minus up to 10% depending on how much money you have. A third of accommodation costs are covered with the rest and, again, are dependent on how much money you have in the bank. The cash equivalent per person who receives care is much higher than Australia – the figures are in around £2,000 higher. However, people cannot take the benefits as cash. It has to be in the form of care services. This is different to the UK which is continually pushing for a ‘Universal Credit’ cash number. About a half of revenue to pay for this comes from general taxation, one-third from premiums from people aged between 40–64 (at a rate of 1 per cent of income) and the rest from people over 65 paying for a bit themselves. What is worth making note of here is that Japan’s solution is not private health insurance in the form of an insurance company like we know in the UK. Only a tiny proportion of people have access to this. Their type of insurance is a government run mandatory scheme.

USA – as you can imagine, our cousins across the pond do things very differently to the rest of us with a very capitalist theme running through social care. Most Americans enter residential homes as private payers, spending their assets until they qualify for coverage from the Medicaid programme, which is sort of like the UK’s benefit system for low income earners – only not as generous. Although, unlike the UK’s propose ‘dementia tax’ (more info on our blog from last week), Medicaid doesn’t take into account a person’s home, but with the average cost of care being £46,000 it doesn’t take long before people start paying by selling assets (like their home). Medicaid does not cover live in care (a solution Care on Demand is trying to put forward in London). So, the majority of social care in the US is paid for by private individuals. Unfortunately, the more money you have, the more access to care you have. 61% of care homes are ‘for-profit’ and with 2 million residents in care homes across the country, it’s big business. Of course, there have been attempts by the Obama administration to fight a deep routed culture of a ‘not everyone is born equal’ feeling across much of the US. However, despite all the headway that was made between 2009-2017, a certain Donald Trump is doing all he can to reverse this – the repeal of Obamacare being one his top priorities.

So there you have it – no 2 countries have the same way of doing things. But what can the UK learn? Well, firstly, no system is perfect or consistent. We believe that a movement towards a US programme would be a mistake. We understand that the books need to be balanced to some extent as there is no, as Labour has been accused of fabricating, ‘money tree’. Social care should not be a money making scheme. It should be to help people. Of course, incentives are crucial. Take away the incentive to make money and watch the amount of care homes available plummit. According to the BBC, the number of care homes in the UK decreased from 4,697 to 4,633 in 2016. However, interestingly, many blame the inability to recruit carers as the problem. So, is the cap on the amount we have to pay hurting both carers and ourselves? The cost of a care home in the UK is £34,000 per year. Not a nice figure but over £10,000 less than in America. We believe that the Japanese system, as a whole, is the most efficient way of solving this problem. The Kaigo Hoken system covers all people over 40 and is paid for by long term planning. Japan pays less than half the US per GDP on social care, has a longer average life expectancy, has cheaper access to care and the care is of a higher quality. This is because there is a mandatory health insurance scheme. It is time we realised that thinking about care when you need it is too late. We all need to be thinking about it now. Making smaller contributions when you are working and younger to pay for yourself when you are older would ensure the hiring of more carers and opening of new care homes – whether we have a cap on costs or not. As I stated at the start of this week’s blog, the UK has some of the best and hardest working carers in the world, it’s time we gave them a system like Japan’s to help them.