Free personal and nursing care, Scotland, 2014-15

3. Expenditure

This section presents the total expenditure on Free Personal and Nursing Care from 2005-06 to 2014-15, for clients in a Care Home or receiving a Home Care service. The expenditure figures have been adjusted to account for overheads and differences in recording practice between local authorities. Consequently, the figures presented contain some degree of estimation, though are broadly comparable year-on-year at Scotland-level. Further information is available in Sections 4.3 - 4.5 of this report.

3.1 Care Homes Expenditure

From 1^st July 2002, personal and nursing care services became free for people aged 65 and over who are resident in Care Homes. In practice, this means that in 2014-15 everyone aged 65 and over who has been assessed as requiring personal and / or nursing care services in a Care Home received £169 per week for personal care and £77 per week for nursing care.

The weekly personal and nursing care payments have increased in recent years. Table 3 shows the value of payments between 2003-04 and 2014-15.

Table 3: Value of weekly payment from 2003-04 to 2014-15

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

The expenditure data on Free Personal and Nursing Care relates to self-funders in Care Homes only, who previously would have paid for all of their care. The figures allow us to determine the additional cost to local authorities following the implementation of this policy, in relation to Care Homes.

Figure 6: Estimated FPNC Expenditure in Care Homes (£ millions), 2005-06 to 2014-15

Source: LFR03 return / Scottish Government FPNC validation return.
Figures contain estimates for overheads.

Figure 6 (above) and Table 4 show that expenditure on Free Personal Care for self-funders in Care Homes stood at £114 million in 2014-15, an increase of 6% on the previous year. Expenditure has risen each year from £76 million in 2005-06.

Expenditure on Free Nursing Care for self-funders in Care Homes rose from £22 million in 2005-06 to £29 million in 2014-15. Within this period, expenditure was broadly flat until 2011-12, from which point larger increases occurred.

The total expenditure for FPNC in Care Homes has risen from £97 million in 2005-06 to £144 million in 2014-15. This overall increase reflects the increasing number of self-funders across the period and the annual increases in the FPNC payments from April 2008. Expenditure on Free Personal and Nursing Care payments to self-funders accounts for over a fifth (23%) of total net expenditure on Care Homes.

Table 4: Expenditure on Care Homes for Older People (aged 65+), (£ millions), 2005-06 to 2014-15

	2005-06	2006-07	2007-08	2008-09	2009-10	2010-11	2011-12	2012-13*	2013-14*	2014-15*
Net Expenditure on Care Homes for Older People (£M)	480	529	556	602	625	627	625	625	627	636
Expenditure on FPC Payments (£M)	76	77	81	82	84	85	88	93	108	114
Expenditure on FNC Payments (£M)	22	22	23	24	23	23	23	26	28	29
Total expenditure on FPNC in Care Homes (£M)	97	99	104	106	108	108	111	118	137	144
Expenditure on FPNC as % of Net Expenditure	20%	19%	19%	18%	17%	17%	18%	19%	22%	23%

Source: LFR03 return / Scottish Government FPNC validation return.
Figures contain estimates for overheads.
*Due to a change in format of the Local Government Finance return, net expenditure figures from 2012-13 onwards include an estimate of 'Support Services' expenditure, in order to make the figure comparable to previous years. See Section 4.4 of this report for more information on support services.

3.2 Home Care Expenditure

From 1^st July 2002, all personal care services provided to people in their own homes became free of charge. Prior to this date, 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 practise 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. 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 as noted above. It is estimated that at least £64.5 million was spent by local authorities on providing personal care services in 2001-02, the year before the policy was introduced. Details of how this was estimated are available from: http://www.gov.scot/Topics/Statistics/Browse/Health/Data/FPNC

Figure 7: Expenditure on Personal Care at home (£ millions), 2005-06 to 2014-15

Source: LFR03 return / Scottish Government FPNC validation return.
Figures contain estimates for overheads.

Figure 7 (above) and Table 5 show total expenditure on personal care services at home increased from £189 million in 2005-06 to £368 million in 2014-15, an increase of 95% over the period. Larger increases in expenditure from 2005-06 onwards have broadly diminished since 2010-11.

Table 5: Expenditure on Home Based Services for Older People (aged 65+), (£ millions), 2005-06 to 2014-15

	05-06	06-07	07-08	08-09	09-10	10-11	11-12	12-13*	13-14*	14-15*
Net Expenditure on Home Care Services	287	305	335	378	399	407	398	423	445	451
Expenditure on Personal Care at Home	189	228	267	277	316	342	347	351	364	368
Expenditure on FPC as % of total Net Expenditure	66%	75%	80%	73%	79%	84%	87%	83%	82%	82%

Source: LFR03 return / Scottish Government FPNC validation return.
Figures contain estimates for overheads.
*Due to a change in format of the Local Government Finance return, net expenditure figures from 2012-13 onwards include an estimate of 'Support Services' expenditure, in order to make the figure comparable to previous years. See Section 4.4 of this report for more information on support services.

Table 5 (above) shows that expenditure on personal care services accounted for 66% of overall net expenditure on Home Care services in 2005-06, increasing to around 80% in 2007-08. This proportion has subsequently fluctuated, though a similar 82% of Home Care expenditure was spent on Personal Care in 2014-15.

Figure 8: Personal Care expenditure as a proportion of total net expenditure on Home Care, 2005-06 to 2014-15

Source: LFR03 return / Scottish Government FPNC validation return.
Figures contain estimates for overheads.

The large increase of spend on Free Personal Care since its introduction is reflected in the shift away from care being provided in either Care Homes or hospitals towards more care being provided in people's own homes. At the same time there has been an increase in the proportion of clients receiving personal care services as Home Care workers are increasingly providing personal care services rather than domestic services. This increase is linked to the following National indicators:

• Improve support for people with care needs
• Increase the percentage of people aged 65 and over with high levels of care needs who are cared for at home.