Reform of Social Care in England is Possible – Three Countries Show How

As England’s social care funding crisis deepens, a new report from the International Longevity Centre UK (ILC) suggests the answers may lie overseas — pointing to reforms already delivering results in Australia, Japan and Germany.

With social care at the centre of the government’s agenda and the Independent Commission on Adult Social Care, chaired by Baroness Louise Casey, due to report in 2027, there is a chance to fix a broken system that can force people to spend all their savings and sell their assets to pay for care, – and where unmet need continues to grow.

Home truths – what Australia, Japan and Germany can teach us about social care reform draws on roundtables held in Summer 2026 with practitioners, policymakers, academics and other experts in all three countries.

Key things to consider when designing reform options in England include:

• Anticipate and plan for greater social care demand. Germany’s 2017 eligibility reform brought over 2.3 million more people into support within three years – a sign that current data can understate unmet need
• Set co-payment charges in line with the cost of living. In Australia and Japan, high co-payments led some people to step back from formal care, so any charging system should be tested against the point at which people withdraw
• Cash benefits can be a step forward but be clear-eyed about consequences. They increase choice and can compensate family carers, but Germany’s experience shows the need to guard against unregulated care and added pressure on families
• Design reform with the workforce in mind. All three countries face a shortfall of care workers, so realistic pay and employment assumptions are important to incorporate in planning and design
• Bring accommodation costs into view. Germany’s 2022 supplement covers care costs but excludes hotel, food and accommodation charges, which has, in part, eroded the protection it was designed to give
• Design for legibility as well as affordability. Complexity and long waiting lists can become covert rationing; published waiting times would help people know what they are entitled to and when it will arrive
• Build on what people already recognise. Germany’s social insurance was accepted partly because it was familiar, and Japan’s earmarked premium succeeded where a consumer tax had failed because it was visibly tied to a future entitlement

Molly Townsend, ILC’s Research and Policy Officer and report author, said:

“Australia, Japan and Germany have done what England has debated for decades. None of their systems is perfect, but all three show that fundamental reform is achievable to reduce catastrophic costs and improve fairness without bringing the public finances to its knees.”

“What these countries have in common is that reform answered something people already cared about – the pressure on family carers in Japan, a social insurance system Germans already understood, dignity for people in care in Australia. That is the feasibility test for England: a settlement has to speak to a substantive concern the public recognises, not just work as a funding formula.”

The report was produced as part of ILC’s work with the Joseph Rowntree Foundation and the Nuffield Trust examining how the cost of care could be shared more fairly between individuals and the state.

A PDF of Home truths: what Australia, Japan and Germany can teach us about social care reform is available here: https://ilcuk.org.uk/home-truths-what-australia-japan-and-germany-can-teach-us-about-social-care-reform/