Free personal and nursing care, Scotland, 2017-18

3. Expenditure

This section presents the total expenditure on Free Personal and Nursing Care from 2008-09 to 2017-18, for people in a Care Home or people 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, but 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 1st 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 2017-18 everyone aged 65 and over who has been assessed as requiring personal and / or nursing care services in a Care Home received £171 per week for personal care and £78 per week for nursing care.

The weekly personal and nursing care payments have increased over time. Table 3 shows the value of payments between 2003-04 and 2017-18.

Table 3: Value of weekly payment from 2003-04 to 2017-18

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 to 2017-18	£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, with regards to Care Homes.

Figure 6: Estimated FPNC Expenditure in Care Homes (£ millions), 2008-09 to 2017-18

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

Figure 6 (above) shows that expenditure on Free Personal Care for self-funders in Care Homes stood at £99 million in 2017-18, a slight decrease from the previous year. Expenditure has risen overall from £82 million in 2008-09. Expenditure on Free Nursing Care for self-funders in Care Homes has also risen over this period, from £24 million in 2008-09 to £26 million in 2017-18.

Table 4 (below) shows the total expenditure for FPNC in Care Homes has risen from £106 million in 2008-09 to £126 million in 2017-18. This likely reflects the annual increases in the FPNC payments between 2007-08 and 2015-16. Expenditure on Free Personal and Nursing Care payments to self-funders accounts for around a fifth (20%) of total net expenditure on Care Homes.

Table 4: Expenditure on Care Homes for Older People (aged 65+), (£millions), 2008-09 to 2017-18

Year	Net Expenditure on Care Homes for Older People (£M)	Total expenditure on FPNC in Care Homes (£M)	Expenditure on FPNC as % of Net Expenditure
2008-09	602	106	18%
2009-10	625	108	17%
2010-11	627	108	17%
2011-12	625	111	18%
2012-13	625	119	19%
2013-14	627	123	20%
2014-15	636	126	20%
2015-16	632	126	20%
2016-17	635	126	20%
2017-18	625	126	20%

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. Full figures are available in the accompanying data tables.

3.2 Home Care Expenditure

From 1st 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 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. 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 for Older People (£ millions), 2008-09 to 2017-18

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

Figure 7 (above) shows total expenditure on personal care services at home for Older People increased from £277 million in 2008-09 to £381 million in 2017-18, an increase of 38% over the period. Larger increases in expenditure from 2008-09 onwards have broadly diminished since 2010-11.

Table 5: Expenditure on Home Based Services for Older People (aged 65+), (£millions), 2008-09 to 2017-18

Year	Expenditure on FPC as % of total Net Expenditure
2008-09	73%
2009-10	79%
2010-11	84%
2011-12	87%
2012-13	83%
2013-14	80%
2014-15	81%
2015-16	82%
2016-17	83%
2017-18	84%

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. Full figures are available in the accompanying data tables.

Table 5 shows that expenditure on personal care services accounted for 73% of overall net expenditure on Home Care services in 2008-09. This rose to a peak of 87% by 2011-12 and has then fluctuated reaching 84% in 2017-18.

Figure 8: Personal Care expenditure as a proportion of total net expenditure on Home Care, 2008-09 to 2017-18

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

The increase in spend on Free Personal Care since its introduction may reflect 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 Home Care clients receiving personal care services, with Home Care workers increasingly providing personal care services rather than domestic services.