The truth is that no one wants to foot the bill for long-term care in an ageing society.
A mere handful of nations have grasped the nettle and set about comprehensively redesigning the way they deliver and pay for care. Germany and Japan are two countries that have implemented social insurance schemes. Both can teach the UK lessons. But if we are looking for a country that has recognised the scale of the challenge of an ageing society, it is China.
I have just returned from a week-long visit to China with Innovate UK, to learn how the country is tackling this challenge.
China is experiencing rapid ageing as life expectancy rises and, due to the one-child policy, birth rates have fallen. As a result there are more people over the age of 60 than under 15. Within the next three decades, China will have the oldest population on the planet: by 2050, 39% of Chinese people will be over 65.
China is getting old before it gets rich. At both national and provincial level, the government has embarked on a massive expansion of care provision to support family care and help people remain in their own homes.
The policy is to grow the homecare and community care market. In 15 cities, different models of long-term care insurance are being prototyped and the results will feed into a final scheme. Just one of these pilots, in Shanghai, covers a population about a third the size of the whole UK.
In the past three or four years the Chinese care sector has seen explosive growth in services from homecare to retirement communities. One example is a network of more than 200 care hubs that has been established across Shanghai.
The hubs provide social activities and connections, rehabilitation, information and advice as well as respite and early stage dementia care. Publicly funded and owned but privately operated, they are playing a key role in supporting older people in their own homes.
Technology is also an important part of China’s plans. That might include things like smart beds that can monitor sleeping patterns, and enable social connections via a screen that can be used for Skype and other communications; screening and rehabilitation equipment; and greater use of motion detectors and AI, to analyse how people walk, or facial analysis, to identify potential risks of falls or stroke.
Technology-enabled care is seen as complementary to expanding and making the best possible use of the care workforce. Here too there are lessons when it comes to growing and retaining a quality workforce. In the time it has taken Shanghai to roll out its network of care hubs, the UK has been left waiting for the government to publish its green paper. Where the UK dithers, China is decisive.
Here in the UK, most people think social care is like the NHS and will be free when they need it. Social care includes all forms of personal care and other practical assistance for adults who need extra support. It comes as a shock when people find out that care is means-tested and not free at the point of need.
Before any reforms can be sold to the public, it is necessary to tell the truth about the rotten system we have today, which is complex, dysfunctional and underfunded.
Our system is too complicated when it comes to working out who gets help and who pays for it. And it is dysfunctional because chronic underfunding inhibits investment in prevention that could improve people’s quality of life and help manage the increasing demand that puts such pressure on our health and care system.
I remain hopeful that the government will be bold and use its green paper to make the case for change. It could do worse than look at China’s long-term care insurance, which echoes the solution proposed for the UK by members of two cross-party parliamentary committees. Having taken evidence from experts and commissioned a citizens’ assembly, the MPs said extra funding was needed and should be raised by a social care premium, either as an additional element of National Insurance or as a premium paid into a dedicated not-for-profit social insurance fund.
But it is hard to tell people they must pay for something they know little about and think is free. No single approach will be universally popular or seen as fair to all. If there were such a solution, the problem would have been fixed long ago.
My visit to China left me in no doubt that there are opportunities for collaboration for mutual benefit between the UK and China. There is much we can learn from China that would transform our care sector.
But first as a country we have to accept there is a bill to be paid.
• Paul Burstow was minister of state for care and support (2010-12) and now chairs the Social Care Institute for Excellence