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1. News & Views
2. Social care research:...
3. Social care research: international cooperation is vital to prepare for
future health shocks

CCBYNC Open access

Opinion Research priorities for future shocks

SOCIAL CARE RESEARCH: INTERNATIONAL COOPERATION IS VITAL TO PREPARE FOR FUTURE
HEALTH SHOCKS

BMJ 2024; 387 doi: https://doi.org/10.1136/bmj.q2145 (Published 07 October 2024)
Cite this as: BMJ 2024;387:q2145

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1. Adelina Comas-Herrera, assistant professorial research fellow

Author affiliations

1. Care Policy and Evaluation Centre, Department of Health Policy, London
School of Economics and Political Science, London, UK

1. A.Comas@lse.ac.uk

Ageing populations, rising costs, and depleted workforces globally mean it’s
time to look beyond national borders to increase the resilience of long term
care, writes Adelina Comas-Herrera?

Providing sustainable, equitable, long term health and social care for people
who need it is a major challenge worldwide because of increasing demand and
costs. Some countries are making more progress than others, however. Learning
from international experiences through comparative research and dialogue among
policy makers could encourage innovative ways to bring much needed reform—and to
increase system resilience to mitigate the impact of the next health system
shock.

A 1999 royal commission on long term care started a public discussion on how to
respond to the UK’s ageing population and increasing need for long term care,1
and these needs will continue to grow.2 The Organisation for Economic
Cooperation and Development warned in 2011: “Facing up to these challenges
requires a comprehensive vision of long-term care. Muddling through is not
enough.”3

But despite these warnings “muddling through” exactly describes social care
policy in the UK to date. Public funding has not kept pace with rising demand,
and fewer than half of older people receive care they need, for example.4 Local
authorities increasingly report concerns about inability to maintain services.5
Workforce gaps remain high, with low pay and poor working conditions inhibiting
retention and recruitment.6 For at least 25 years politicians have avoided the
necessary fundamental reform of social care, perhaps because the scale of
transformation and investment needed have instilled a sense of hopelessness.

FAILING BEFORE COVID-19

Social care in the UK was already failing at the start of the covid-19 pandemic
and struggled to cope. Delayed provision of personal protective equipment and
tests put clients at avoidable high risk of death.7 This poor initial response
has been attributed to lack of preparedness, politicians’ lack of understanding
of the sector, complexity in how the sector is organised, unclear
accountability, poor communication, decades of underinvestment, workforce
shortages, outdated infrastructure, and inadequate data collection and sharing.8

These problems are not unique to the UK. Analyses of how countries globally
coped early in the pandemic have identified common themes for social care: lack
of political priority, fragmentation of responsibilities among departments and
levels of government, failures in coordination of health and social care, weak
regulation, inadequate information systems, underinvestment in community based
care, inadequate buildings, and failure to protect residents’ human rights in
care homes.9 Most long term care systems internationally have workforce
shortages that have worsened since the pandemic, related to low pay and poor
working conditions.10

The numerous structural weaknesses indicate that wholesale reform is needed—to
governance, financing, information systems, and systems to protect human rights.
These weaknesses substantially reduce the ability to respond to growing numbers
of people living longer with conditions that result in a need for care. They
also diminish the resilience of systems to future health shocks, whether from
infections or linked to climate change or political instability.

Encouragingly, many countries have begun to improve their care systems since the
pandemic. The European Union is providing technical support to countries to
improve health and social care systems, backed by €45bn (£37bn; $50bn)
investment for recovery.11 Japan has increased remuneration to long term care
providers,12 and Spain is increasing care in the community and reducing
institutionalisation.13

COUNTRIES LEARNING FROM EACH OTHER

Countries can learn much from each other by sharing how their policy options
play out and build an evidence base on what works in long term care. However,
fragmentation of responsibilities at national level is mirrored at international
level: the World Health Organization, the International Labour Organization, and
the United Nations Department of Economic and Social Affairs are all somewhat
involved, but one international body needs to take a clear lead to advocate for
real change. This may encourage international research donors to invest in long
term care, an area they have not been attracted to historically.

Since Brexit the statistics body Eurostat no longer includes the UK, diminishing
opportunities to benchmark the UK care system. Years of uncertainty about the
UK’s participation in the EU Horizon project has diminished previously strong
participation of UK researchers in European research projects. The primary
social care research funder in England, the National Institute for Health and
Care Research, funds only national projects or those in the global south,
meaning no funding for collaboration with other high income countries in Europe
and Asia, including Japan, the Republic of Korea, and Singapore, that have
instituted polices to respond to policy to increased population ageing, and
culturally similar countries such as Australia, Canada, New Zealand, and the
United States.

International collaboration in long term care continues regardless. For example,
I am director of the Global Observatory of Long-Term Care (https://goltc.org),
which connects international research and policy communities established during
the covid-19 pandemic to strengthen long term care systems. The observatory now
includes 360 members from 46 countries, who share knowledge, including on data
science in long term care research, care workers and migration, pain management
in care homes, and climate change and long term care. This collaboration is
mostly powered by willingness to collaborate and share, but to sustain such
infrastructure will also require adequate funding. Without that, it will be
harder for the UK to stay involved in international knowledge sharing to help
respond to future health shocks affecting older and frail people.

FOOTNOTES

* Competing interests: I have read and understood BMJ policy on declaration of
interests and declare that I am director of the Global Observatory of
Long-Term Care, I have been a consultant for the World Health Organisation
and an adviser to the Spanish National De-institutionalisation strategy and
my research is funded by the National Institute of Health and Care and the
Alzheimer’s Society.

* Provenance and peer review: Commissioned; not externally peer reviewed.

* This article is part of a collection proposed by the Health Foundation. The
Health Foundation provided funding for the collection, including open access
fees. The BMJ commissioned, peer reviewed, edited, and made the decision to
publish this article. Richard Hurley was the lead editor for The BMJ.

http://creativecommons.org/licenses/by-nc/4.0/

This is an Open Access article distributed in accordance with the Creative
Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others
to distribute, remix, adapt, build upon this work non-commercially, and license
their derivative works on different terms, provided the original work is
properly cited and the use is non-commercial. See:
http://creativecommons.org/licenses/by-nc/4.0/.

REFERENCES

1. ↵
1. Royal Commission on Long Term Care

. With respect to old age: long term care - rights and
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4. MODEM project

. Forecasting the care needs of the older population in England over the
next 20 years: estimates from the Population Ageing and Care Simulation
(PACSim) modelling study. Lancet Public Health2018;3:e447-55.
doi:10.1016/S2468-2667(18)30118-X pmid:30174210
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. Help wanted? Providing and paying for long-term care.OECD Publishing,
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. The decline of publicly funded social care for older adults. QualityWatch
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House of Commons Levelling Up, Housing and Communities Committee. Financial
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6. ↵
Skills for Care. The state of the adult social care sector and workforce in
England, 2023. www.skillsforcare.org.uk/stateof.

7. ↵
1. Rajan S,
2. Comas-Herrera A,
3. Mckee M

. Did the UK government really throw a protective ring around care homes in
the covid-19 pandemic?J Long Term Care2020:185-95. doi:10.31389/jltc.53.
OpenUrlCrossRefGoogle Scholar
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Curry N, Oung C, Hemmings N, Comas-Herrera A, Byrd W. Building a resilient
social care system in England. What can be learnt from the first wave of
Covid-19? 2023.
https://www.nuffieldtrust.org.uk/research/building-a-resilient-social-care-system-in-england-what-lessons-can-be-learnt-from-covid-19

9. ↵
World Health Organization. Preventing and managing COVID-19 across
long-term care services: policy brief. 2020.
https://www.who.int/publications/i/item/WHO-2019-nCoV-Policy_Brief-Long-term_Care-2020.1

10. ↵
1. OECD

. Beyond applause? improving working conditions in long-term care.OECD,
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Ping R, Oshio T. Long-term care system profile: Japan. 2023.
https://goltc.org/system-profile/japan/

13. ↵
Ministerio de Derechos Sociales. Consumo y Agenda 2030.
https://estrategiadesinstitucionalizacion.gob.es

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Adelina Comas-Herrera assistant professorial research fellow
Comas-Herrera A. Social care research: international cooperation is vital to
prepare for future health shocks BMJ 2024; 387 :q2145 doi:10.1136/bmj.q2145

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JI Haining, Experiment Science and Technology-1, 2022
* Research on the Joint Training Mode of International Cooperation for
Postgraduates Based on Scientific Research Group
JI Haining, Experiment Science and Technology, 2022
* Experimental Overview of Recent Research Highlights on International
Cooperation in High-energy Nuclear Physics
Nuclear Physics Review, 2020

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