Community Care in the UK and Some Possible Lessons for Shanghai By Tony 21/February/2013

 Overview  The aged population situation in Shanghai;  The history of community care in the UK;  Some case studies of community care ;  The advantages and disadvantages of community care in the UK;  Some possible lessons for Shanghai.

 The Aged Population Situation in Shanghai  The average life expectancy is getting longer and longer;  The percentage of elderly in the population is getting higher and higher;  The speed of demographic aging is getting faster and faster;  The average number of persons per household is getting smaller and smaller.

 The average life expectancy is getting longer and longer  Significant improvements in living standards, including improved nutrition, access to education and medical care. OverallMaleFemale Shanghai UK

 The percentage of elderly in the population is getting higher and higher  In 2010 those aged 60 or over accounted for 3.3million, or 23.4%;  In 2005 those aged 60 or over accounted for 2.7million,or just 19.9%

 The speed of demographic aging is getting faster and faster  It took 21 years in Shanghai for the percentage of the elderly to increase from 7 percent to 14 percent of the population.

 The average number of persons per household is getting smaller and smaller  In 2010 one-child families accounted for 37% of all families.

 The history of community care in the UK

 It resulted in the quantities of hospital beds and nursing beds increased quickly from 1948 to The institutional care In 1601 home remedy Most died still working before 40yrs In 1723, the poorhouses In 1834 Workhouse (See Dickens) In 1946 Free NHS service In 1948 Residential care  Before 1960

 From 1960 to 1970  In 1957 the anti- institutionalization movement arose, and the point is that the older people with good health should stay in the community with home help service.  In 1962 the Ministry of Health issued the Hospital Plan to close some hospitals and reduce the care expenditure;  In 1963 the Health and Welfare ： the Development of Community Care; Community care The health services Ministry of health The social services Local authority

Community care Local authority familyfriendsneighbour Private sector Charity organization community Religious institution From 1970 to 1985  In 1970 the local authority social service act was issued;  The social service departments were set up by the local authorities;  The family, friends, neighbors and the community, etc, should be involved in the community care as well;  A community care pattern with blood and geographic ties came into being.

 After 1985  Marketization & privatisation of public service;  In 1986 the Social Security Act ;  In 1990 the National Health Services and Community Care Act;  The local authority not only supported the caregivers, but also supported all of organizations which supplied the services to keep the elderly with independence and dignity. Wherever possible at home.

 The case studies of community care

 St Catherine ’ s Lodge  It is sheltered housing with 3 part-time staff and run by the Orbit Housing Association.  New residents who can live on their own are accepted from 55 years of age ;  The residents rent or buy the properties to live there and have to pay £90+ each month for the services provided by Orbit. They pay their own electricity and water bills.  More care can be purchased by the residents as required..

 Lammas House care home  It is a residential care centre and run by the Sanctuary Care. A private company with charitable status.  The services there may be charged, depending on the residents ’ income and savings.  I t does not cater for residents needing long term nursing care.  It is regulated by the CQC and all of the services must meet the National Standards of care home.

 Castel Froma Specialist Care Centre  It is a CF, founded in 1884, which has 67 permanent beds and 14 respite beds.  Its main object is to deliver care to people with a neurological disability, so the residents there are eligible for NHS continuing healthcare. If it is long term health care the fees are paid by the NHS after complex assessment.  It does not have a contract with a local authority, however, it has lots of mini contracts with each person who stays with them.

 Zhaoxiang Town care home  It is run by the local authority;  There are 90 beds in the care home.  The elderly without children can be free to enter the care home; but the others need to pay ¥800 per month for the services.  The services, including the accommodation, diet,cleaning, health, bathing, and even the funerals, etc.

 Zhao Xiang town care home  It is equipped with alarm systems, TV, water heater, fitness equipment and health facilities, etc.  It supplies regular social activities, including playing chess, watching TV, Library, playing cards, Knitting class and regular tours;  There are 18 full-time staff who serve 54 aged people.

 The advantages of community care  Deinstitutionalization  Minimize the supply of the institutional care;  Low cost  The long-term institutional cares were more expensive and the older people can maintain their independence with special support services;  More Support by the informal care  a supplement of formal care, for example the relatives, friends, neighbors, community, etc;  Demand – targeted  the service users and the caregivers must be involved in the need survey and care design.

 The disadvantages of community care in the UK  The support from family members is less;  The traditional culture in the UK advocates the independence and freedom which cause the elderly to live separately from their adult children;  The family care is not a statutory obligation.it is a loose support but not a necessarity.  The high living cost and working pressure;  The services supported by the charity organizations are not stable.

 Some possible lessons for Shanghai

Transforming the functions of the government and strengthening the government regulation  It is proved that the local authority supplies the services directly without competition is inefficient and with high cost;  The role of government should be transformed from the service supplier to the service buyer;  In order to strengthen the regulation of the care industry and the quality of services, the government should set up the independent regulatory agency just like CQC in the UK.

 Encouraging the social organizations to participate in the care industry  It was a good experience in the UK to attract more nongovernmental organizations such as charities, religious organizations and private companies to participate in the care industry.  The central government of China should open the care market to all kinds of social organizations and take measures to attract more funds to invest in the care industry.

 Increase in the supply of the retirement properties  Retirement properties are popular and a useful way to help meet the problem of the residential care, but in China it is rare, though the real estate is developed everywhere.  The government should take measures to encourage the development of the retirement real estate, for example supplying the regular services, fund supports and tax relief, etc.

 Improving the ability to family care  According to the national government ’ s current policy, 90 percent support for older people in the family, 7 percent in the community and 3 percent in residential facilities;  It is vital for the government to support the family care which is the core of the whole care system.  Supporting the parents is legal matter in China.  Supplying the support to the family carers. For example the carer ’ s allowance, tax relief, National Insurance credits and the regular and free training, etc.  Others.

 Thank you