Grasping the nettle: lessons for the social care green paper


Blog written by Mike Birtwistle, Founding Partner, Incisive Health

By 2068 there will be an extra 8.6 million people aged 65 or over living in the UK, with over-65s making up 26% of the population. With more of us living longer and many people having one or more long-term conditions, more people will need access to long-term care. How will a social care system that is in crisis, respond?

These are questions that are being asked by many healthcare economies across the world. And some have grasped the nettle, changing the way they fund and organise long-term care. Germany began to modify its system in 1995 and Japan did so in 2000. Over the same period, despite two Government consultations, two official Commissions, five Green or White Papers and one Act of Parliament, England’s system for means tested care funding is broadly unchanged.

With yet another Green Paper (over)due in Autumn, Incisive Health partnered with Age UK to examine what five other countries have done to respond to the question of how long-term care should be funded and delivered. We analysed funding models and systems in France, Germany, Spain, Italy and Japan. Our findings are set out in a new report, An international comparison of long-term care funding and outcomes: insights for the social care green paper.

In every country we examined, increasing numbers of people need long-term care which is expensive, labour intensive and resistant to productivity improvements. Each country has taken a very different approach. None have been wholly successful. Finding the perfect balance for a system that is financially fair to both recipients and the taxpayer, whilst providing equitable access to high quality care, remains one of the most pressing challenges of our times.

Jeremy Hunt, former Health and Social Care Secretary as part of the process of developing the Green Paper, outlined seven principles that will “guide the Government’s thinking”[1]:

  • Quality and safety embedded in service provision
  • Whole-person, integrated care with the NHS and social care systems operating as one
  • The highest possible control given to those receiving support
  • A valued workforce
  • Better practical support for families and carers
  • A sustainable funding model for social care supported by a diverse, vibrant and stable market
  • Greater security for all – for those born or developing a care need early in life and for those entering older age who do not know what their future care needs may be

From our analysis, we think there are also three fundamental questions which the Green Paper will need to address:

  • Should a system provide at least basic universal care, free at the point of use?
  • Should the financial cost of that care be borne by the state or by recipients?
  • To what extent should progressive means be used to finance that care?

These are questions which would lead to challenging but productive conversations for the future of long-term care policy in England. We hope the international examples and analysis in this report helps inform the discussions around the Green Paper. A sustainable, high quality and fair long-term care system is urgently needed in England. We can’t afford to wait until 2068 to act.

[1] The Rt Hon Jeremy Hunt MP and the Department of Health and Social Care, We need to do better on social care, 2018

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