What the Chinese can teach us about social care

What a privilege to be invited to join last week’s mission to China about Healthy Ageing. It was organised by Innovate UK and the Knowledge Transfer Network.

In Beijing and Shanghai, we met with Government officials and visited care providers. So what did we find and what did learn? Well, I am blown away by some aspects. Each Chinese province has a different approach to care and it’s a very young market. In China, the tradition had always been of “filial piety” where children look after their parents in old age. As a result of their one child policy there are many families in what they call a 4:2:1 structure: 4 grandparents, 2 parents, 1 child (who has probably moved to a city and can’t look after their relatives themselves). It’s even enshrined in the “Elderly Law” which states that children have responsibility to care for elderly parents and visit them regularly (though that’s not well enforced).

There are 250 million people over the age of 60 in China and the average life expectancy is 82. And they’ve recently started piloting a long term care insurance programme (although as yet it’s not mandatory) which would reimburse care costs up to a set limit. I think that if they can make this work it has the potential to hugely elevate care quality (because all providers have to be validated by government); improve care workforce pay (same problems as UK with low pay and status); workforce skills and retention; and stimulate the sector.

The Shanghai Ministry responsible for care outlined to us a local system of care that has been introduced over the last couple of years, starting from a real and tested sense of what people in different communities and environments (rural and urban) and different stages of ageing prefer; encompassing preventative and mutual support for people to remain in their own living environments through to end stage care. As another delegate observed, in the time it’s taken the UK to write an as-yet unpublished green paper, the Chinese have rolled out a whole system of social care. How I would love to get Matt Hancock and Caroline Dinenage on a plane to Shanghai to find out how to make things happen!

In one community based small care home in Shanghai city there was an Elderly Advice Office, open daily, which signposted local people to services and helped them access aids and mobility devices. Everywhere I visited I saw kind and engaged care. Government funded care homes were rudimentary, often 6 bedded rooms, and rarely single or en suite. That’s apparently commonplace even in private care homes, and culturally the Chinese find this quite acceptable. And yes, there was privately funded care which surprised me. Some other interesting things:

The range of options available to people who could afford to pay
The sheer size of residential care homes: 200 beds wasn’t unusual (inner city/community based ones were smaller, 40/50 beds)
A focus in many places on outdoor space that was actually used and a wonderfully innovative commercial open air market taking place in a care home garden that was well populated with residents (and people from the local community) buying fruit, slippers, washing detergent and even wheeled mobility aids
Residents often opt to move to a care home very early (70+) and can stay 10 or 20 years
Shared rooms aside, a very comfortable feeling of comparability with UK care home environments and practice.
The same workforce issues the UK faces: low pay, low skills, low down the choice of career options

I really hadn’t expected to be so impressed with elderly care in China, and in fact our whole group left feeling that we had as much to learn from the Chinese as we have to offer and I certainly hadn’t anticipated that! So my observations on where we have advanced further:

We’ve got a more highly developed practice model and a more defined sense of personalised care, whereas what I saw was less focused or value based
There’s a real lack of knowledge and skills around dementia, it’s only just beginning to be recognised in Chinese society although making up a significant proportion of the care home population.
The sheer size of the Chinese population – 3.6m 65+ in Shanghai alone – that lends an opportunity for scale in piloting new technologies and innovations, and using data to identify patterns

There was a day where I saw so much technology and had to keep asking why, and what for – as another fellow delegate on the mission remarked, how strange that WCS, an innovator in the sector known for its use of technology was unconvinced by the tech we were seeing. And then, on our last day we visited Cherish-Yearn care community, more like a care village on a massive scale, designed to channel people outdoors to walk and interact, complete with covered walkways and loads of beautiful outdoor space. Their chairman spoke passionately about their overarching focus on happiness and using technology to empower people not define them. And then it came together: you can be driven by the technology and so excited by what it can do and measure that you lose sight of people’s experience. Or you can be focused on people, and use technology to support their wellbeing. Which is what feels right to me.