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We go into this major period of public sector reform knowing that prevention matters and talking about it often. Yet when reform becomes practical, the debate still tends to return to structures, governance and reorganisation.For reform to be sustainable, prevention must move from aspiration to organising principle: help people stay independent, strengthen communities and reduce demand before crisis occurs.Japan offers an instructive comparison because it has been confronting many of the same pressures now facing the UK: an ageing population, rising care demand, workforce shortages and constrained public finances. Those pressures have pushed Japanese policy-makers to rethink not only how services are delivered, but also the relationship between citizens, communities and the state.The lesson for the UK is clear: too much public spending still manages failure rather than preventing it. In health inequalities, family support and social care, we often intervene only when problems have become acute and expensive. Prevention is discussed often but feels rarely prioritised when resources are allocated.While Japan has pursued institutional reform, its most relevant lesson for the UK is its sustained focus on prevention, independence and community resilience.Japan's Long-Term Care Insurance system, introduced in 2000, shows this shift in practice. Beyond funding reform, it encouraged local authorities to support people before intensive care became necessary, through exercise programmes, social participation and community-based support.Its community-based Integrated Care System builds on the same philosophy by bringing healthcare, social care, housing, voluntary organisations and community networks together around the individual. Japan has also treated social isolation as a public service issue, investing in neighbourhood networks, community hubs and intergenerational programmes before loneliness contributes to poorer health and higher demand.Japan's experience is not perfect. Municipalities still face financial pressure, workforce shortages and growing demand. But an emphasis on early intervention and community resilience has given it a stronger platform for managing those pressures.The lesson for the UK is clear: too much public spending still manages failure rather than preventing it. In health inequalities, family support and social care, we often intervene only when problems have become acute and expensive. Prevention is discussed often but feels rarely prioritised when resources are allocated.The UK now faces the same underlying pressures. Reactive models are becoming progressively less sustainable and we cannot simply continue to reorganise our way out of them.Structural reform still matters; devolution, local government reorganisation and service integration can improve outcomes. But they should be enablers, not ends in themselves. The real test is whether reform helps people live healthier, more independent and more fulfilling lives.Japan's experience suggests that resilience is built before crisis occurs: through early intervention, strong communities, integrated services and a willingness to invest in prevention even when immediate financial returns are not obvious.As England reshapes its public institutions, that may be the most important lesson. The question is not can we afford prevention. It is whether we can afford to keep paying the price of neglecting it.Keith Kelly is head of public affairs and communications at the Japan Local Government Centre CLAIR (Council of Local Authorities for International Relations) and Simon Fletcher is chief executive of Lichfield DC

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PUBLIC SERVICE REFORM

Lessons in demand from Japan

By Keith Kelly, Simon Fletcher | 29 July 2026

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