Free Personal and Nursing Care, Scotland, 2021-22

Background information

Data Sources

Scottish Government Quarterly Monitoring Return (Community Care Quarterly Key Monitoring Return)

Since July 2002, the Scottish Executive - followed by the Scottish Government - has collected quarterly information on the number of people receiving free personal care services at home and the number of self-funding care home residents  receiving Free Personal Care (FPC) and Free Nursing Care (FNC) payments under the Community Care and Health (Scotland) Act 2002.

From 2012-13 to 2020‑21 this survey has been conducted during the final quarter of the year only. This means that from 2012-13, the figures show a snapshot of the year at the end of Quarter 4 rather than the average across the year. Annual figures for the number of clients, and the number of hours of care represent a snapshot at the end of Quarter 4. For 2021-22, data is published for all four quarters within the accompanying tables. This has always been the case for figures for those aged 65 and over, and figures for those aged 18-64 have also been presented in this way within this publication.

Prior to 2018-19, numbers of self-funding residents aged 18 to 64 receiving FNC payments were combined with the total number of residents aged 65 and over receiving FNC, and published as a single total. As the number of residents aged 18 to 64 receiving FNC are very small, figures for those aged 65 and over are broadly comparable before and after 2018-19. Due to small numbers, some figures for residents aged 18 to 64 are reported at Scotland-level only for disclosure control purposes. 

Annual expenditure figures are the sum of figures for all four quarters.

In 2019, this survey was updated to collect information on under 65s receiving FPC following the extension of the policy to people of all ages who are eligible. This data was first published in a separate report.

Social Care Survey

Prior to 2017/18, data on Care at Home was collected and published by the Scottish Government via the Social Care Survey. Further information is available on the Social Care Survey publication, published on the Scottish Government website.

Understanding the Statistics in this Report

All information in this Statistics Release is presented for financial years - from 1 April to 31 March. Where possible, information is reported for a rolling ten-year period, which in the case of this release is from 2012-13 to 2021-22.

Before the introduction of FPNC in 2002, Local Authorities had discretion to charge for these services and a variety of charging policies operated across the country. Any charges were subject to a financial assessment which meant that in practice many people received these services for free prior to the introduction of Free Personal Care. With the introduction of Free Personal Care, these services became free for all clients aged 65 and over, and for all clients aged 18 and over in 2019 with the introduction of the extension of Free Personal Care. Local Authorities can still charge for domestic services such as help with shopping or housework.

Since 2002, information has been collected on the cost of providing personal care services at home. It should be noted that these costs do not tell us the additional cost of this policy as many people would have received these services for free prior to 2002.

Definitions and Eligibility

Personal care: this involves care of a personal nature. It can include activities such as help with eating, bathing and toileting. It can also include tasks such as assistance with reminders and managing behaviour. A fuller list of the types of care counted as personal care can be found on the Care Information Scotland website.

Financial quarter: a three month period of the financial year. Quarter 1 (Q1) lasts from April to June, Q2 from July to September, Q3 from October to December and Q4 from January to March.

Long stay care home resident: as defined in the Quarterly Monitoring Return, this includes all residents that Local Authorities are paying a contribution for on the last day of the financial quarter.

Local Authority funded resident: a care home resident who has been assessed as having assets worth £28,750 (for 2021-22) or less whose care is publicly funded. These residents may still contribute to their care home fees from their pensions, capital and any other income.

Self-funding resident or self-funder: a resident with assets, including property, that have been assessed as being worth more than £28,750 (for 2021-22) who pay the total of their care home fees. These residents may be eligible for Free Personal Care and Free Nursing Care payments.

Free personal care payment: a set, weekly payment available to self-funding care home residents towards their personal care needs. The value of the payment has increased over time (as shown in Table 1) and was £193.50 in 2021-22.

Free nursing care payment: a set, weekly payment available to self-funding care home residents towards their nursing care needs. The value of the payment has increased over time (as shown in Table 1) and was £87.10 in 2021-22.

Care at home: care provided by a professional social care worker in a person’s own home. This can include personal care and other tasks such as help with shopping and cleaning. Since July 2002 for people aged 65 and over, and 2018 for people aged 18 to 64, individuals can no longer be charged for personal care services provided in their own home – personal care at home is provided for free.

Care Homes

Numbers of individuals in care homes quoted in this publication represent snapshots at the end of each financial year. Likewise, quarterly figures, available in the accompanying tables, represent snapshots of the final week of each financial quarter. As numbers of residents aged 18-64 receiving FNC have historically been very low, comparable information from the Quarterly Return has not been published for years prior to 2021-22.

Due to the large number of admissions and residents leaving the care home population throughout the year, this does not necessarily represent the number of people receiving FPNC for the full year. In the year to 31 March 2022, there were 15,090 long-stay admissions to care homes for all ages, and 14,660 long-stay admissions to Care Homes for older people in Scotland (PHS Care Home Census). This represents around 281 and long-stay admissions every week respectively.

Expenditure on FPC and FNC payments to care home residents is estimated based on these snapshots of the number of recipients at the end of each quarter. As this method assumes that numbers of individuals receiving payments for all weeks within the quarter are the same as those provided for the final week, estimates for expenditure may not reflect any variation within each quarter. Annual figures for expenditure are the sum of all four quarterly figures.

Care at Home

As with data for care home residents, numbers of clients receiving personal care services at home quoted in this publication provide a snapshot at the end of each financial year. Quarterly figures available in the accompanying tables again represent snapshots of the final week of each quarter.

From 2009-10 to 2016-17, the Home Care Census (and from 2012-13 the Social Care Survey) had been used to provide the number of Care at Home clients at the end of March each year. Since 2017-18, the Scottish Government Quarterly Monitoring return has been used for this purpose. As a result, any comparisons with prior years should be treated with caution.

Similar to data for care home expenditure, data for quarterly expenditure for those receiving care at home represents a snapshot of the final week of each quarter. Annual figures for expenditure as quoted in the publication again represent the sum of all four quarterly figures.

Payments

All self-funding care home residents, who pay for their own care, who have been assessed as requiring personal and / or nursing care services are entitled to payments to cover the costs of providing these services. The rates of payment are set nationally and Local Authorities make these payments directly to the care provider on behlaf of the individual. In 2021-22 these rates were ser at £193.50 per week for personal care and £87.10 per week for nursing care.

The weekly personal and nursing care payments have increased over time. Table 1 shows the value of payments between 2003-04 and 2021-22.

Table 1: Weekly FPC and FNC payments, from 2003-04 to 2021-22

Year	Free Personal Care	Free Nursing Care
2003-04 to 2007-08	£145	£65
2008-09	£149	£67
2009-10	£153	£69
2010-11	£156	£71
2011-12	£159	£72
2012-13	£163	£74
2013-14	£166	£75
2014-15	£169	£77
2015-16	£171	£78
2016-17	£171	£78
2017-18	£171	£78
2018-19	£174	£79
2019-20	£177	£80
2020-21	£180	£81
2021-22	£193.50	£87.10

 

Limitations of the data

Many Local Authorities have seen a rise in personal care at home costs from 2012-13. In addition to increased demand, this is likely related to reasons including:

• a shift in the balance of care, away from Care Homes towards more care at home
• the introduction of equal pay provision resulting in higher wage costs
• the provision of refunds to clients for meal preparation where this was previously charged for
• introduction of real living wage and other wage inflation which has led to increased cost of services

Please note that numbers of people within this report and in the accompanying tables have been rounded to the nearest 10 for disclosure control purposes. Numbers of hours of care provided have been rounded to the nearest 100, and expenditure figures have been rounded to the nearest £1,000.

Due to the changes in methodology, as detailed in the Expenditure on Free Personal and Nursing Care section, expenditure data for those aged 65 and over is not comparable to expenditure data from previous publications. Previous data was from LFR03 returns, whereas expenditure data within this publication is either estimated using information submitted to us by Local Authorities (expenditure on FPNC in care homes), or directly submitted by Local Authorities (expenditure on personal care at home).

In previous iterations of this publication, which are available on the Scottish Government website, estimates of overhead costs for FPNC expenditure for those aged 65 and over were made. Due to the new methodology, estimates of overhead costs are no longer included in expenditure figures. For each of the latest three years where overhead costs were estimated (2018-19 to 2020-21), estimated overhead costs represented on average 6% of the total expenditure of each Local Authority on FPNC. 

Data Quality

Each year, data validation work is conducted on each of these sources before the official publication of the Free Personal and Nursing Care statistics. As part of the 2021-22 validation process, each Local Authority was sent a spreadsheet summarising their statistics for the latest year. 25 of the 32 Local Authorities provided at least a partial response for 2021-22. 

In some instances within the tables, the Scotland-level total figure may not be exactly equal to the sum of figures for each Local Authority. This is due to rounding procedures. All figures, including totals and year-on-year percentage changes between totals, are calculated using the un-rounded data. Rounding is the final step applied.

Estimated figures have been estimated using the quarter-on-quarter percentage change in the sum of the figures for all Local Authorities who submitted data for the whole period of estimation. This percentage change is then applied to the latest available figure for the Local Authority being estimated for. In previous years, the year-on-year percentage change (considering Q4 only) has been used.

Any large year-on-year or quarter-on-quarter increases or decreases in data for a single Local Authority may be due to reasons such as:

• Changes in recording methodology
• Changes to the allocation of services and funding, particularly in light of the COVID-19 pandemic for financial year 2020-21

During the data validation process, some Local Authorities identified errors within data returns that has resulted in previously published figures being revised for some tables. It should be noted that the revisions made at Local Authority level generally have a comparatively small effect on the Scotland figures.

Estimation of missing figures

Where data was unavailable for Local Authorities, missing figures were estimated by calculating the total of all areas with a returned figure for the relevant quarters, as well as the percentage change between quarters. This percentage change was then applied to the relevant quarter to estimate the missing figures.

Data presented in this report for 2021-22 that are estimated in this way are:

Number of long-stay residents aged 65 and over receiving any FPNC payments, both FPC and FNC, and FPC only in care homes:

• Eilean Siar: Quarters 1, 2 and 3
• South Ayrshire: Quarter 3

Care at Home Clients aged 65 and over:

• South Ayrshire: All quarters

Clients aged 65 and over receiving free personal care services at home:

• Scottish Borders: All quarters
• South Ayrshire All quarters

Average weekly hours of personal care at home for clients aged 65 and over:

• Scottish Borders: All quarters
• South Ayrshire All quarters

Expenditure on FPNC payments to long-stay residents aged 65 in care homes:

• Eilean Siar: Quarters 1, 2 and 3
• South Ayrshire: Quarter 3

Number of long-stay residents aged 18 to 64 receiving any FPNC payments, both FPC and FNC, and FPC only in care homes:

• South Ayrshire: Quarter 3

Care at Home Clients aged 18 to 64:

• South Ayrshire: All quarters

Clients aged 18 to 64 receiving free personal care services at home:

• South Ayrshire All quarters

Average weekly hours of personal care at home for clients aged 18 to 64:

• South Ayrshire: All quarters

Expenditure on FPNC payments to long-stay residents aged 18 to 64 in care homes:

• South Ayrshire: Quarter 3

No data on the average weekly hours of personal care at home from 2011-12 to 2020-21 is available for Glasgow City, due to the historic omission of hours for self-directed support clients from the data. Where calculations have been made to find the average number of hours of care per client in Scotland, the total number of clients from Glasgow City has been subtracted from the total number of clients in Scotland. To give a sense of the impact of this, NRS mid-2021 population estimates show that Glasgow City accounts for 12% of the population of Scotland. 

All estimated figures, including those for previous years, are denoted with [e] within the relevant cells, within the accompanying tables.