Free Personal And Nursing Care, Scotland, 2020-21

Background information

Data Sources

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 (FPC) and Free Nursing Care (FNC) payments under the Community Care and Health (Scotland) Act 2002.

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 65s receiving Free Personal Care following the extension of the policy to people of all ages who are eligible. Data relating to the extension of Free Personal and Nursing Care to those aged under 65 is available in a separate report.

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 in the Local government finance statistics page on the Scottish Government website.

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 2020-21 validation process, each Local Authority was sent a spreadsheet summarising their statistics for the latest year. 24 of the 32 Local Authorities provided at least a partial response.

Data on the total net expenditure on Care Homes for older people for 2019-20 is not available, as the relevant line was omitted from the 2019-20 LFR 03 in error.

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. Information is reported for a rolling ten-year period, which in the case of this release is from 2011-12 to 2020-21.

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 activites 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 resident who has been assessted as having assets worth £28,500 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 £28,500 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 £180 in 2020-21.

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, people aged 65 and over can no longer be charged for personal care services provided in their own home.

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 week of the last quarter of the financial year (January, February and March) 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 2021, there were 14,600 long-stay admissions to Care Homes for older people in Scotland (PHS Care Home Census). This represents around 281 long-stay admissions every week.

Care at Home

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. 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 Community Care Quarterly Key Monitoring return has been used for this purpose. As a result, any comparisons with prior years should be treated with caution.

Support Services

From 2012-13 there were changes to the format of the Local Government Finance return (LFR03) that Local Authorities submitted to the Scottish Government. In order to make the figures presented here as comparable as possible with previous years, Net Expenditure on Care Homes and Net Expenditure on Care at Home for 2012-13 to 2017-18 have been adjusted to account for the change in Support Services recording. Figures from 2018-19 onwards have not been adjusted. Further information on these adjustments is available in the Free Personal and Nursing Care 2017-18 publication.

Payments

In 2020-21 everyone aged 65 and over who has been assessed as requiring personal and / or nursing care services in a Care Home received £180 per week for personal care and £81 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 2020-21.

Limitations of the data

Since 2009-10, 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. Where Local Authorities are unable to calculate the specific cost of overheads attributed to the FPNC payments, they can either provide their own estimates, or the Scottish Government can produce an estimate for the latest year.

In 2020-21, 5 Local Authorities provided their own estimates for overheads, and the rest were calculated by applying the rates of previous years (the average across the 5 submitting Local Authorities is approximately 5% of total expenditure on FPNC payments). To take this estimation into account, expenditure figures presented in this report have been rounded to the nearest £ million, and rounded to the nearest £1,000 within the accompanying tables.

Many Local Authorities have seen a rise in personal care at home costs from 2011-12. In addition to increased demand, this is related to:

• 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 living wage 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.

Data Quality

During the Quality Assurance process for this publication, some discrepancies in time series for some local authorities were identified. The relevant Local Authorities were contacted about these. Any discrepancies in data 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. 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.

Estimation of missing figures

Where data was unavailable for Local Authorities, estimates were made by by calculating the total of all areas with a returned figure for the relevant financial years, as well as the percentage change of this total between financial years. This percentage change was then applied to the relevant financial year to estimate the missing figures.

Data presented in this report that are estimated in this way are:

Number of long-stay residents aged 65 and over supported in care homes:

• Orkney Islands 2018-19

Care at Home Clients aged 65 and over:

• Orkney Islands 2018-19
• East Ayrshire 2020-21

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

• Scottish Borders 2018-19, 2019-20, 2020-21
• East Ayrshire 2020-21

Average weekly hours of personal care at home:

• Scottish Borders 2018-19, 2019-20, 2020-21
• East Ayrshire 2020-21
• 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.