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Same challenges, different solutions

PSSRU-led international network helps countries learn from each other's approaches to long-term care

Across the developed world, different countries face essentially the same challenges as their ageing populations push up demand for formal and informal support: how to fund long-term care, ensure high quality services, commission and regulate services efficiently. However, while the problems are similar, the chosen solutions often differ so there is a wealth of experience of different policies for addressing the same problems. Yet, despite sharing common goals, social care researchers and policymakers in one country can often be unaware of social care reforms underway elsewhere, how well they are working, and their potential relevance for other countries.   


In 2010, it was the evident appetite among international colleagues for a better understanding of long-term care developments in other countries that led me to co-found the International Long-term care Policy Network (ILPN), alongside Dr Cristiano Gori, a Visiting Fellow from Italy. At PSSRU there was already a tradition of work comparing different countries’ social care systems but interest had heightened in developing this further. The idea was to create an international network that would bring together key researchers and policymakers to learn from other countries’ experiences and to promote more comparative research in the field of long-term care.


The ILPN’s biennial conference has now established itself as a forum for leading international long-term care professionals, academics and policy makers to share information and views on recent research and reforms globally. In 2012, nearly 300 people attended the conference, two-thirds from outside the UK, with delegates from North America, mainland Europe, east Asia and Australasia. Members of the Department of Health social care team were among those attending and contributing to the conferences. The most recent biennial conference in September 2014 attracted a similar number of participants. ILPN also hosts smaller focussed seminars and workshops; among the topics covered recently are the role of private long-term care insurance and evidence-based policy in long-term care.


The network has brought home to me how the pace of reform and constant changes in different countries’ long-term care systems makes it crucial to update one’s knowledge regularly. Talking to people with first hand knowledge about their own systems tends to reveal how easy it is to misinterpret what happens in other countries and the importance of understanding the detail of the way a system works, the politics behind the scenes and the cultural context.  


Japan is one country that has impressed me. It has made the social care system a true social priority; even though it faces some of the most acute ageing challenges, it still decided to press ahead with a universal and relatively generous long-term care system. That was quite a courageous thing to do when the obvious financial response would have been to retrench. There are still some issues, of course, such as quality but the reformed system provides a reasonable level of coverage to the whole population. In comparison, in some other countries - even some with universal systems - the level of coverage can be quite limited and puts a lot of responsibility on individuals and their families to look after themselves.


As a result of ILPN strengthening the links within the long-term care research community, research collaborations are helping to develop new evidence in areas where knowledge gaps exist in long-term care. A number of research proposals have been developed between colleagues who have attended ILPN’s conferences and a group of delegates to the 2012 conference are involved in a special issue of one academic journal on the economics of long-term care.


England, like all countries, can benefit greatly by looking at what is happening in other countries and the reforms under way elsewhere. Here, for instance, social care is in the process of defining new processes for determining eligibility to services and appropriate assessment frameworks – an area where there is a wealth of evidence in other countries. Equally there is a lot of interest abroad in what is happening in England – our model is perceived as more individualistic and focussed on efficiency than many other countries’ but there is a lot of respect for the evaluation culture here.

Looking ahead, over the next five years I would like the network to obtain ongoing secure funding, something it currently lacks. Rather than just acting as a network, it could then also fulfill the role of an international long-term care observatory, establishing and maintaining a repository of knowledge about models of long-term care in different countries and providing a hub for the dissemination and presentation of such information. That would be very worthwhile.  


Interviewed by Teresa Poole

Dr José-Luis Fernández is Deputy Director and Principal Research Fellow at PSSRU, London School of Economics and Political Science. Here he talks about the International Long-term care Policy Network (ILPN), which he co-founded in 2010.

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