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.
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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.

84
84
82
81.28
82.13
80
82
80
78
78
77
76
76
74.63
74
74
73.35
72
72
70
70
68
68
1978
1988
1998
Overall
系列2
系列1
2008
Male
2010
Female
Shanghai
82.13
79.82
84.44
UK
79.58
77.38
81.68
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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 population structure of Shanghai In 2010
,over 80
,65-80
4.6%
11.4%
,60-65
7.4%
,below 60
76.6%
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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 international comparision of the speed of aging population
140
120
Year
100
80
60
40
20
0
系列2
Shanghai
Japan
UK
USA
France
21
24
45
65
115
Area

In 2010 one-child families accounted for 37% of
all families.
Average Number of Persons per Household
4
Number

The average number of persons per
household is getting smaller and
smaller
2
0
Average Number of
Persons per
Household
1980
1990
2000
2010
3.8
3.1
2.8
2.5
Year

The history of community care
in the UK
Before
1960
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
It resulted in the quantities of hospital beds and
nursing beds increased quickly from 1948 to 1962.

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
The social services
Ministry of health
Local authority
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.
Local authority
family
Religious institution
community
Community care
Charity organization
friends
neighbour
Private sector
 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
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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
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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
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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
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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.
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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.
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The advantages of community care

Deinstitutionalization

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Low cost

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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

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Minimize the supply of the institutional 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.

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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.

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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
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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
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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
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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
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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.

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Others.
Thank
you