Free personal and nursing care, Scotland, 2017-18

4. Background information

4.1 Data Sources

A variety of different data sources were used to compile this Statistics Release, as detailed below:

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 personal care services at home and the number of self-funders receiving Free Personal Care and Free Nursing Care payments. The numbers represent only those people receiving FPC and FNC under the Community Care and Health (Scotland) Act 2002.

For Care Homes, this provides a count of those people who are self-funders and are assessed as requiring Free Personal Care and / or Free Nursing Care.

For Home Care, the figures show people receiving personal care services at home for the current financial year. Many of these people would have received their personal care for free prior to the introduction of the Community Care and Health (Scotland) Act 2002, but prior to July 2002 this was dependent on local policy and the client's financial status. It is estimated that Local Authorities spent at least £64.5 million in 2001-02 on providing personal care services. Full details are available from: http://www.gov.scot/Topics/Statistics/Browse/Health/Data/FPNC

The results of the quarterly survey are available at: http://www.gov.scot/Topics/Statistics/Browse/Health/Data/QuarterlySurvey

A copy of the survey form and notes for guidance is available at: http://www.gov.scot/Topics/Statistics/Browse/Health/DataSupplier

Up until 2011-12, this survey was conducted on a quarterly basis and the average of the four quarters was taken to produce an annual figure. However, since 2012-13 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 rather than the average across the year.

In 2019, this survey was updated to collect information on under 65's receiving Free Personal Care following the extension of the policy to people of all ages who are eligible.

Home Care Census / Social Care Survey

Information on Home Care services has been collected since the 1980s by means of an annual census. The census covers all Home Care services provided or purchased by Scottish Local Authorities.

An aggregated table return for the Home Care statistical collection, called the H1, was introduced in 1998. Local Authorities were asked to provide details of all Home Care services provided by their own staff as well as services bought in from other Local Authorities and from private / voluntary organisations. Information on client age, for level and type of service, was introduced to the collection in 2005.

The information collected in the Home Care census was reviewed by the Home Care review group and a revised Home Care statistical collection was introduced in March 2010. This collected information on an individual basis for each Home Care client receiving home help services, meals services and community alarm / telecare services. From March 2013, this was merged with the Self-Directed Support / Direct Payments publication into the Social Care Survey. The final edition of the Social Care Survey was published in 2016-17 and at this point NHSScotland Information Services Division began gathering Home Care data. This change necessitated Home Care data being requested as part of the Community Care Quarterly key monitoring return for the requirements of this release. Further information is available from: http://www.gov.scot/Topics/Statistics/Browse/Health/Data/HomeCare

Local Financial Return (LFR03)

The Local Financial Return collects expenditure statistics for each Local Authority in Scotland. The LFR03 collects all expenditure and income relating to social work services. From 2004-05, questions relating to expenditure on Free Personal Care were added to the LFR03 return. Further information is available from: http://www.gov.scot/Topics/Statistics/Browse/Local-Government-Finance

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 2017-18 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. http://www.gov.scot/Topics/Statistics/Browse/Health/FPNC

4.2 Understanding the Statistics in this Report

All information in this Statistics Release is presented for financial years - from 1st April to 31st March. Information is reported for a rolling ten-year period, which in the case of this release is from 2008-09 to 2017-18.

Care Homes

In general, care should be taken when comparing the data on 'numbers' of people receiving Free Personal Care and 'expenditure' on Free Personal Care. The number of people receiving FPC and FNC payments is collected for the last 3 months of the financial year and so represents the number of people receiving payments at the end of March, rather than for the whole financial year.

Due to the large number of admissions and discharges throughout the year, this does not necessarily represent the number of people receiving FPNC for the full 52 weeks of the year. In the year to March 2017, there were 13,700 long-stay admissions to Care Homes for older people in Scotland (ISD Care Home Census). This represents over 263 long-stay admissions every week.

Home Care

As with the Care Homes data, the data for clients receiving personal care services at home provides a snapshot at the end of the financial year. This will not compare directly with the expenditure data which takes into account variations across the whole financial year. For the 2017-18 report in the absence of the Social Care Survey the Home Care data was requested as part of the Community Care Quarterly key monitoring return. As a result any comparisons with prior years should be treated with caution. Prior to this publication from 2009-10 onwards the Home Care Census (and from 2012-13 the Social Care Survey) had been used to provide the number of Home Care clients at the end of March each year.

4.3 Limitations of the data

The CIPFA Best Value Accounting Code of Practice (BVACOP), requires the inclusion of overheads within expenditure. Since 2006-07 the LFR03 has required Local Authorities to include overheads in line with the BVACOP. It has been identified, however, that overheads were not being included consistently within expenditure figures by local authorities. In 2011, a revised time series for expenditure on FPNC payments from 2003-04 to 2008-09 was published, after extensive work to ensure that all figures included overheads.

Since the 2009-10 validation exercise, Local Authorities have been asked to confirm if their expenditure figures firstly contained overhead figures and then to either detail the amount included or to provide an estimate of that amount. Several Local Authorities are unable to calculate the specific cost of overheads attributed to the FPNC payments. Consequently, they are given the option of either providing their own estimates or having the Scottish Government provide an estimate for the latest year. In 2017-18, 15 Local Authorities provided their own estimates for overheads, and the rest were calculated by applying the rates of previous years (the average across Local Authorities is approximately 8% of total expenditure on FPNC payments). To take this into account, the expenditure figures presented in this report have been rounded to the nearest £10,000.

For some Local Authorities it appears that net expenditure on personal care services at home is higher than overall gross expenditure on Home Care services for certain years. This can happen for a number of reasons: a) where resource transfer from Health Boards has been included as income against Home Care services for older people; b) where supporting people grant has been included as income against Home Care services for older people; and c) where the personal care expenditure includes overheads but the Home Care expenditure returned in the LFR03 did not include an allocation of overheads.

Many Local Authorities have seen a rise in personal care at home costs from 2008-09. In addition to increased demand this is related to: a) a shift in the balance of care, away from Care Homes towards more care at home; b) the introduction of equal pay provision resulting in higher wage costs; and c) the provision of refunds to clients for meal preparation where this was previously charged for.

4.4 Support Services

From 2012-13 there were several changes to the format of the Local Government Finance return (LFR03) that Local Authorities submitted to the Scottish Government. Most notable was the introduction of a separate 'Support Services' row, which includes expenditure on Finance, Legal, Human Resources, IT, Internal Audit, Procurement and Asset Management. This figure would previously have been spread across other rows representing specific service types.

In order to make the figures presented here as comparable as possible with previous years, Net Expenditure on Care Homes and Net Expenditure on Home Care have been adjusted to account for the change in Support Services recording. This involves apportioning a fraction of the total Net Support Services expenditure for Older People to the Net Care Home / Home Care expenditure. The fraction to be applied is calculated using Gross Expenditure, in order to avoid negative values. The expenditure figures for Free Personal and / or Nursing Care have been validated by each Local Authority to include overheads in line with previous years, therefore these figures have not been adjusted to include Support Services.

4.5 Changes in Local Authorities

Renfrewshire

From 2013-14, the figure for Net expenditure on Care Home Services for older people includes cleaning cost allocation from other council services that was not included in previous years, which has resulted in a slight increase.

Dumfries and Galloway

The system used to report the number of clients in care homes has been updated to properly reflect the number of self-funders in receipt of free personal and nursing care. This means that the number of clients in care homes from years prior to 2016/17 cannot strictly be compared with following years.

Fife

Changes in reporting practices have resulted in larger than expected growth in the measures Number of long-stay residents aged 65+ supported in Care Homes and Number of people aged 65+ receiving FPC at home in Fife.

4.6 Changes to the data

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. This also means that figures will differ slightly from those within source publications. It should be noted that the revisions made at Local Authority level generally have a comparatively small effect on the Scotland figures.

4.7 Data estimation

In 2017-18, expenditure on Free Personal and Nursing Care in Care Homes was estimated for Scottish Borders. This was due to an observed discrepancy between expenditure and the number of clients receiving Free Personal and Nursing Care in Care Homes. To estimate the expenditure, the standard weekly payments were first multiplied by the number of clients receiving payments in Care Homes and then, an estimate of the overheads was added to obtain the final figures where appropriate.

Home Care expenditure was also estimated for Scottish Borders in 2017-18. This was due to all expenditure on Home Care being recorded in the 'Other' category in the LFR03 return. To estimate expenditure, the hourly rate (£17.61) for Free Personal Care provided at home across Scotland in 2016-17 was estimated and multiplied by the total number of Free Personal Care at home hours in each Local Authority in 2017-18.

4.8 Cost of respondent burden

Based on information provided by Local Authorities in recent years, such as the time taken in hours to extract the requested information and complete the survey form, the estimated cost of responding to this survey has been estimated at £400.

4.9 Further information

This statistics release was published on 6th August 2019. Further details and analysis are available on request from the following address:

Tel: 0131 244 3777
E-mail: SWStat@gov.scot

This Statistics Release is also available via the Scottish Government website: http://www.gov.scot/Topics/Statistics/Browse/Health/Publications