A case of English exceptionalism?

In trying to understand why England has struggled to sort out the many problems in social care, it is important to look beyond our borders to see how other countries have fared. What light might this throw on our failures? What lessons can we learn from their experience? How do they pay for and provide care and support to their citizens and how, unlike England, have they managed to introduce major reforms to do this? What lessons can be learned from their road to reform?

England is not exceptional in needing to face these issues. Most advanced countries share some common challenges around the availability, quality and sustainability of care services:

• • A growing and ageing population. In the European Union (EU), the number of people likely to need care is projected to rise from 30.8 million in 2019 to 38 million by 2050. The number of working-age people for every person aged 65 or over will reduce from 3.3 to only 2 during the next 30 years.

• • There are more people with disabilities and long-term health conditions, reflecting better medical care and higher life-expectancy.

• • Changing family and population structures and mobility mean that countries can no longer rely, as they have done in the past, on unpaid, informal, family carers. Many countries are experiencing severe shortages in their care workforce. All face big questions about where the extra care workforce will come from in the future. In the EU area, there are already 6.4 million care jobs, and it is estimated that up to 7 million job openings for health care associate professionals and personal care workers will arise by 2030.

• • The costs of care are rising rapidly everywhere and are rising faster than the public funding available to meet them. Most countries are trying to close the gap by focusing resources on people with the highest needs, by increasing user charges and by seeking greater efficiencies in how services are provided, Across the EU, public expenditure on long-term care is projected to increase from 1.7 per cent of GDP in 2019 to 2.5 per cent of GDP in 2050 on average (European Commission, 2021).