What can England learn from the long-term care system in Japan?

Nuffield Trust | What can England learn from the long-term care system in Japan? | May 2018

The Nuffield Trust has released a report based on interviews and and observations conducted during a study visit to Japan in October 2017, a literature review  and insights from an earlier visit to Japan all combine to provide a snapshot of what England can learn from the Japanese system.

Image source: nuffieldtrust.org.uk

In Japan, the Long Term Care Insurance (LTCI) system provides universal, comprehensive care to people over the age of 65 and those with a disability aged between 40 and 65.  It is partly funded by a national insurance fund that everyone aged over 40 pay into and partially from general and local taxation.

There are a number of important lessons

  • National criteria for eligibility mean that access to care is the same regardless of where a person lives. Every three years the system is reviewed and reforms made when needed. This flexibility has enabled the Japanese Government to be responsive to public concerns and to address concerns over expenditure.
  • Service users find the Japanese system easy to navigate. This is because a crucial part of the LTCI service includes having a ‘care manager’, responsible for supporting the individual to make a care plan, identifying suitable providers, coordinating between carers, the individual and the family, and overseeing the care plan in the long term. While similar roles exist in some parts of England, provision is patchy and there is no single accepted definition of such a role.
  • At the heart of the Japanese system is a strong commitment to long-term prevention of loneliness and ill health, a stark contrast to England’s short-term approach, driven by budget constraints, which is focused increasingly only on those with highest needs. Services are available both to frail or sick older people and also to healthy ones, with clubs and activities for healthy over-65s promoted as part of the system.

Source: Nuffield Trust

The full report is available from the  Nuffield Trust

Nuffield Trust: the gender pay gap in the NHS

The Nuffield Trust | April 2018  | The gender pay gap in the NHS: the story so far

Businesses with that employ more than 250 employees across Great Britain have  recently reported details of the gender pay gap in their organisation, in line with the requirements of The Equality Act 2010 (Gender Pay Gap Information) regulations. Now John Appleby,  Director of Research and Chief Economist at the Nuffield Trust has written a blog post about the gender pay gap in the NHS.  As it is the largest single employer in Britain – three times the size of the largest private sector employer, Tesco. Most of its organisations (principally trusts) employ over 250 staff.  Appleby questions: what does the data tell us about the gender pay gap in the NHS? (Nuffield Trust)

The full post can be read here 

Public satisfaction with the NHS and social care

Public satisfaction with the NHS and social care in 2017: results and trends from the British Social Attitudes survey | The King’s Fund | Nuffield Trust

Image source: http://www.kingsfund.org.uk

This analysis from the British Social Attitudes survey summarises views on, and feelings towards, the NHS and health care issues. Overall NHS satisfaction levels remain higher than they were in the 1990s and early-to-mid-2000s, however, there has been a statistically significant fall in satisfaction in 2017 which took net satisfaction to its lowest level since 2007.

Key findings:

  • Public satisfaction with the NHS overall was 57% in 2017 – a 6 percentage point drop from the previous year. At the same time, dissatisfaction with the NHS overall increased by 7 percentage points to 29% – its highest level since 2007.
  • Older people were more satisfied than younger people: 64% of those aged 65 and over were satisfied with the NHS in 2017 compared to 55% of those aged 18 to 64. Between 2016 and 2017, satisfaction fell among all age groups.
  • The four main reasons people gave for being satisfied with the NHS overall were: the quality of care, the fact that the NHS is free at the point of use, the attitudes and behaviour of NHS staff, and the range of services and treatments available.
  • The four main reasons that people gave for being dissatisfied with the NHS overall were: staff shortages, long waiting times, lack of funding, and government reforms.

Full report: Public satisfaction with the NHS and social care in 2017: results and trends from the British Social Attitudes survey

Additional links:

What does the Autumn Budget mean for the NHS and social care?

In the budget this week, the Chancellor committed around £2 billion extra for the NHS next year. Nigel Edwards of the Nuffield Trust said this will bring respite for patients and staff, but is only around half of what’s needed.

In a Q&A about the budget, Tom Moberly, The BMJ’s UK editor, met with John Appleby (Nuffield Trust), Anita Charlesworth (Health Foundation) and Siva Anandaciva (King’s Fund) to discuss what it all means for the NHS and social care. You can watch the discussion below:

See also: Autumn Budget 2017: what it means for health and social care | The Kings Fund | Nuffield Trust | The Health Foundation



Understanding the NHS deficit and why it won’t go away

This briefing assesses the financial health of those providers by unpicking the headline figures presented in the official accounts to reveal the true underlying state of the NHS’s finances today, and to outline prospects for the next three to four years | Nuffield Trust

Image source: Nuffield Trust
  • NHS trusts have begun the current financial year, 2017/18, on course for an underlying overspend or deficit of £5.9 billion. To meet their reported deficit target of £500 million, they will need to cut their operating costs by £3.6 billion and receive temporary extra funds of £1.8 billion.
  • This would require trusts to make savings in one year equivalent to 4.3 per cent of their operating costs – far in excess of any level achieved over recent years and likely to be almost impossible to deliver.
  • A more likely scenario is that they will make cost savings similar to the level made last year. That would collectively leave the trusts with an underlying deficit of around £3.5 billion.
  • The headline deficit for 2016/17 (which ended in March 2017) was £791 million. However, that figure was flattered by billions of pounds’ worth of one-off savings, temporary extra funding and accountancy changes that did nothing to improve the underlying state of provider finances. Once they are removed, the underlying deficit for 2016/17 is £3.7 billion.
  • This is compared to an underlying deficit the year before, 2015/16, of £4.3 billion. As trusts also had to soak up additional inflation costs in 2016/17, the reduction in the underlying deficit between 2015/16 and 2016/17 actually represents providers making £2.3 billion in permanent savings.
  • Projections of future years suggest that, even under optimistic assumptions for inflation and continued high levels of savings, NHS providers will continue to run a large collective underlying deficit until at least 2020/21.

Read the full briefing here

What’s behind delayed transfers of care?

Why are we waiting? The causes of DTOCs | By Nigel Edwards for the Nuffield Trust

As the data shows, the NHS had remained responsible for the majority of DTOCs over time, but the proportion for which social care are responsible has grown by 84 per cent since December 2010.

The data also allows us to explore the reasons for delays. The most significant change since November 2010 has been an increase in the number of days delayed due to patients waiting for a care package to be available either at home (172 per cent increase) or in a nursing home (110 per cent).

While the reduced availability of social care is often highlighted as the cause of DTOCs, 57 per cent of the delays occurred because of issues in the NHS.

Image source: Nuffield Trust 

Read the full briefing here

Why extending GP hours won’t solve the A&E crisis

Rosen, R. Nuffield Trust. Published online: 16 January 2017


After a week of grim news about NHS emergency services, weekend newspapers shifted the focus onto primary care, with reports that the Prime Minister had apparently pointed the finger of blame at general practice. The Telegraph reported that she planned to “relieve the pressure on crisis-hit Accident & Emergency units” by demanding “that GP surgeries meet the government’s pledge to open from 8am to 8pm, seven days a week”.

A look at the evidence suggests that increasing seven-day access to GP appointments may reduce the total number of people coming to A&E. However, it is unlikely to affect the rising tide of patients waiting on trolleys in hospital corridors, and there is a risk that it might take GPs away from work that addresses the root causes of these problems.

Read the full blog post here