5.25 minute read: Mark Raeburn

Social Care reform in the UK can wait no longer. The most vulnerable are in crisis and we need to take note of best practice from around the world, including that which has been observed in China

China’s ageing population threatens to curtail the economic progress it has made in the last forty years. Why? It is facing a unique if not unfamiliar challenge to what is being faced by social care teams across the world. How do we support the elderly members of society in the most cost effective manner possible?

For all of the growth that China has seen, it failed to predict one key challenge. That being rapid ageing, which has been accentuated through the one-child policy. One that has been relaxed in recent years, to now be a two-child policy, but one that has led to a reduction in birth rates. By 2050 China will have the oldest population on the planet.

A very human challenge

The world’s 2nd largest economy has broken the barriers of a centrally planned, closed economy to evolve into the manufacturing and exporting hub of the world. An impressive transformation by any stretch of the imagination but one that has not been without its challenges. One that now points to China getting old before it gets rich.

Often referred to as the ‘world’s factory’, China has moved from the 7th largest economy back in 1980 to the 2nd in 2019. It has grown quicker than any other economy, even to the point of being drawn into a trade war with America. It has weathered all of the storms placed in front of it, walking the human rights tight rope for years. It is a marmite nation but one that you need to admire for its dedication and desire to be the best. The one-child policy arguably playing a large role in emphasising this. Its latest challenge however is a very human one.

Rather than running from this challenge and burying their heads in the sand, they are tackling it head on. Rather than looking at the day-to-day and applying a sticking plaster, they have looked to the long-term, to get ahead of the situation. Rather than throwing in the towel they have seen the bigger picture and followed in the footsteps of Japan and Germany.

We all want to support those in need of care but doing it against finite costs is the real challenge. For all of its wealth, it is still a problem that China needs to tackle and they have seen the benefits that technology can bring to the equation. At both national and provincial level it has embarked on a massive expansion of care provision. This has been designed to keep people in their homes for longer, which they understand is the most cost effective approach to care, one that walks the best line between person-centred care and financial value.

Looking at the long-term problem

The government in China recognised the problem and over the last three to four years has encouraged rapid sector growth within the care sphere. From different prototypes of long-term care insurance to a network of care hubs, China is not waiting around. Whilst the UK debates and delays under the banner of Brexit, the world’s 2nd largest economy is already going through the trial and error stage.

By the time Brexit is conquered and we finally get sight of the Green Paper, many of us reading this will be in need of social care assistance. We will part of the trial and it won’t be until our children are of age that we will have a solution. At the present time you would be hard pressed to argue against someone who made the statement that they would rather retire in China.

We are spending too long dithering over processes, afraid to make any type of commitment, when what should real rule our thinking is one easy to manage principle. Person-centred care and enabling the best life possible for the most vulnerable should be king. There will always be a society in the UK and the way we treat them now says a lot about us as a nation.

“The true measure of any society can be found in how it treats its most vulnerable members.”

We have used this quote from Mahatma Gandhi many times as it is one of our favourites. For us it is the antithesis of the current situation here in the UK. Whilst China is striding forward into the future and caring for those who need assistance, we are recording extra deaths due to delays.

Last month we pointed to the fact that due to continued government austerity more than 120,000 extra deaths have been recorded within care. The deaths according to the British Medical Journal are attributable to the over 60s and care home residents, who have borne the brunt of the cuts. This has been heightened by the Brexit effect, continued debate and stagnation.

Technology is a key component for change

Whilst China is trialling, adapting and embracing, we are still accepting of a social care system that in many areas still utilises paper. This is not a reflection of the thousands of dedicated staff members that go above and beyond, it is a challenge for the system.

Whilst AI is met with equal measures of enthusiasm and trepidation in the UK, in China it is embraced. Coupled with applications such as smart beds that can monitor sleeping patterns, screens that can promote social interactions via Skype and other communications, China is unafraid. Technology-enabled care is seen as complementary to promoting person-centred care and making the best possible use of the care workforce.

Greater expansion of technology helps to prevent accidents before they happen. Use of motion detectors and AI analyse how people walk, and recorded facial analysis help to identify risks of fall or stroke. In China technology has been invested in at the right time and the size of the problem acknowledged. They have placed people first and not shied away from the problem.

Technology such as this seems miles away from that which props up a healthcare system in the UK that has only recently banned fax machines. We are poor relations that are only just waking up to the problem. For too long we have flown on the coat tails of the past but now the future is here. The choices that post Brexit UK make now will affect how the world will see us in years to come.

There is a cost

Nothing in life is free and everyone knows this but as the NHS is paid for and free when needed, there is this underlying perception that social care will also be free. This is not the case and China realises this, trialling different models of long-term care insurance. They are researching now whilst the UK is still debating.

They will have years of data and undoubtedly a properly formulated conclusion and long-term national scheme of savings implemented by the time the UK has delivered the Green Paper. By doing nothing the government is harming the long-term future of the UK. Change is inevitable and we need to be alongside China, shaping the future of care.

Short term political gains are overshadowing decisions that need to be made sooner rather than later, lest the nation will see the emerging generation leave. Air travel and globalisation have created a buyers’ market, one in which the young can seek out the best possible future, they are not stuck here.

We need to be honest about the state of the nation and the problems we are facing. Only by being honest and admitting that social care is failing the most vulnerable can we start on the journey to achieving something akin to what China has created. Social care does cost but by helping people understand why it costs will go a long way to creating public acceptance.

Long term premiums can then be introduced to create universal healthcare rather than a buyers’ market. The current system echoes the class system that is entrenched in society. If you can pay, then in many cases the care you receive in retirement will be greater than that received by someone who cannot afford to pay the fees requested.

The time for debate is over

We need to come together as a nation and hold our hands up for the sins of the past. We need to commit to a better future for all. Brexit needs to be put to rest as quickly as possible in order to heal the divides that have emerged in the nation. Only then can we concentrate on the task of rebuilding the care system to ensure long term stability.

We remain hopeful that Brexit will reach its inevitable climax before the end of the year, bringing with it the Green Paper. We remain hopeful that the race to 2020 will not be cut short and the government under the guises of the long-term NHS plan will invest in the future of care. We remain ever hopeful.