Extending free personal care to under 65s: feasibility study

Section 5 : Financial Implications

Income from existing service users

A principal concern of the feasibility study was to seek to establish the level of income currently received by Local Authorities from charges for personal care to adults under 65 and which would not be available to support services if personal care was made free for this group. In order to extend Free Personal Care without Local Authorities being required to raise eligibility criteria to manage demand for services this funding would be need to be replaced from other sources.

A survey of Local Authorities and health and social care partnerships was undertaken during July 2017 to collect this and other data. A total of 20 / 29 (69%) LAs who replied to the survey provided quantitative data on income received from charging adults under 65 for personal care. Two (7%) LAs returned no quantitative data as they do not charge adults under 65 for personal care. The remaining 7 (24%) did not submit data for this question.

Some of the data submitted was internally inconsistent and therefore not considered for the analysis. Using the remaining consistent data, the proportion of all community based income from adults aged under 65 that can be attributed to personal care was calculated as shown in the table below.

¹ Includes home care, day care, equipment & adaptations, services to support carers, supported employment, adoption services, fostering/family placement, other

The average proportion calculated above was used to estimate income from charging adults under 65 for personal care for those LAs who did not return data or had inconsistent data. The estimate calculated using this method was compared to actual figures returned by those 10 LAs with consistent data in order to determine the accuracy of the estimates and produce confidence ranges.

Further analysis showed this to be broadly consistent with other Scottish Government data and with analysis undertaken previously by Professor David Bell in 2015.

This shows that in the region of £10m is currently collected by Local Authorities each year towards the cost of personal care services in non-residential settings for adults under 65.

Under 65s in residential care

The Scottish Care Homes Census ^[9] and the Care Homes (Quarterly Monitoring Survey) show that there were around 3,500 people aged under 65 who were long-stay residents in care homes from 2012-13 onwards, and this number has been declining in recent years.

Of those residents, 97% are supported by the Local Authority, suggesting that only 3% (around 120) are self-funders.

Assuming that the number and proportion of self-funders continues to decline in line with the current trend, the estimated cost of extending Free Personal Care to under 65s in care homes is likely to be under £1 million per annum.

Estimated costs of responding to new service users

The experience of providing Free Personal Care to older people was that demand for services increases. Therefore, as well as determining the income expected to be lost to Local Authorities from existing clients who contribute towards the cost of personal care, Scottish Government analysts are undertaking modelling work to seek to estimate the potential impact of extending Free Personal Care on unmet based on various scenarios, building on the experience of what happened when Free Personal Care was introduced to over 65s.