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ISBN 0 7559 6020 3 (Web only publication)

A Scottish Executive National Statistics Publication

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1. Introduction

This Statistics Release presents the latest figures for free personal care ( FPC) and free nursing care ( FNC).

Free personal and nursing care was introduced in Scotland on 1 July 2002.

Prior to 1 July 2002, people could be charged for personal care services provided in their own home and many residents in Care Homes had to fully fund their care from their own income and savings.

Since July 2002:

• people aged 65 and over can no longer be charged for personal care services provided in their own home. They can however be charged for domestic services such as help with shopping or housework but any charge would be subject to a financial assessment.
• people aged 65 or over who live in care homes and are assessed as self-funders now receive a weekly payment of £145 towards their personal care, and a further £65 if nursing care is also required. The remainder of the care homes fees - the 'hotel' costs - they still fund themselves. People aged under 65 can also receive £65 towards nursing care.

This release presents information from a variety of sources to give a picture of :

• the number of people benefiting from free personal care and free nursing care in Scotland, and
• the expenditure on this policy.

2. Main points

Care Homes

• The number of self-funders in Care Homes receiving free personal care has increased from 6,900 at July 2002 to nearly 8,900 at September 2005, an increase of 29%. (Annex 1, Table 2)
• The number of self-funders receiving free nursing care has also increased from over 4,600 in July 2002 to over 5,900 in September 2005, an increase of 28%.
• The number of long-stay residents aged 65+ in care homes has fallen slightly since free personal care was introduced. At the same time the number of self-funding residents claiming free personal care has increased. In 2002-03, 23% of long-stay residents were self-funders. This has increased to 27% in 2004-05. (See Annex 1, Tables 1 and 2)

Home Care

• The number of people in receipt of free personal care at home has increased from 24,200 in July 2002 to nearly 40,900 in September 2005. (Annex 2, Table 6)
• These numbers rose sharply in the first year, partly due to underreporting by some local authorities while monitoring systems were put in place. However they have continued to increase, by 8% over the latest year to September 2005.
• The proportion of older home care client requiring personal care services has also increased. In 2002, 45% of clients received personal care services. This has increased each year to reach 68% in 2005. (Annex 2, Tables 5,6)
• Around 150 older people in Scotland use direct payments from local authorities to purchase personal care services.

Expenditure

• Expenditure on free personal care for care home residents was £42 million in 2002-03 (first 9 months) rising to £63 million in 2003-04 and £65 million in 2004-05 (Annex 3, table 10)
• Expenditure on free nursing care for care home residents was £12 million in 2002-03 (9 months) rising to £18 million in 2003-04 and £19 million in 2004-05. (Annex 3, Table 10)
• All of the expenditure on care home residents is new expenditure arising as a result of the free personal care policy.
• Expenditure on free personal care for home care clients was £69 million in 2002-03 (9 months) rising to £116 million in 2003-04 and £136 million in 2004-05. (Annex 3, Table 13)
• Expenditure on home care clients is not all new expenditure attributable to the free personal care policy.

3. People receiving Free Personal Care and Free Nursing Care

3.1 Care Homes

Since 2002, the Scottish Executive has collected information on the number of residents aged 65+ supported by local authorities in care homes. These residents may be mainly funded by their local authority or may be a self-funder receiving £145 or £210 per week towards their care homes fees. All of these residents receive personal care services for free.

Table 1 shows that the average number of long-stay residents aged 65+ in care homes in Scotland reduced slightly over the three years since the introduction of free personal and nursing care. Over this period there have been around 32,000 older people resident in care homes.

In contrast, the number of self-funding residents who receive £145 per week for free personal care has increased by 16.5% from an average of 7,414 in 2002-03 to 8,641 in 2004-05. In 2002-03, 23% of long-stay residents were self-funders. This increased to 25% in 2003-04 and again to 27% in 2004-05.

The number of self-funding residents receiving the free nursing care payment (£65) in addition to the free personal care payment (£145) has increased by 20.5% from 4,787 in 2002-03 to 5,763 in 2004-05. Note that all residents aged 65+ who receive the free nursing care payment also receive the free personal care payment. In 2002-03, 65% of self-funders required nursing care as well as personal care and this increased to 67% in 2004-05.

Adults aged under 65 may receive the £65 nursing care payment if they are self-funders in a care home. In 2002-03, an average 45 people aged under 65 received the nursing care payment. This rose to 59 in 2004-05. These numbers are small reflecting the fact that the majority of adults aged under 65 in care homes are funded by the local authority.

Further information on care homes is available from the Scottish Care Homes Census - which can be found at : www.scotland.gov.uk/statistics/commcare/publications

Table 1 : Average number of residents 2002-3 to 2004-05

Source: Monthly and Quarterly monitoring returns

3.2 Home Care

The Scottish Executive publishes home care statistics annually. The latest figures, for 2005, are available from www.scotland.gov.uk/statistics/commcare/publications .

The number of older people receiving home care services reached a low in 2002, at around 53,600 people. Since the introduction of free personal care, it has increased each year to 57,900 in 2005.

The number of home care clients receiving personal care services has increased each year since the introduction of free personal care, from 24,160 clients at 1 July 2002 to 39,100 clients at the end of March 2005. It should be noted that in the early quarters the figures are thought to be an undercount.

Many local authorities could not provide figures straight away as systems were being put in place and early figures were estimated. Between 2003-04 and 2004-05 we have seen an increase from 36,145 clients receiving personal care services at home to 39,105 clients (an increase of 8%).

Over the last 6 years there has been a shift towards more intensive home care provision: the average client hours have increased from 5.6 hours per week to 8.2 hours per week. At the same time there has been an increase in the proportion of clients receiving personal care services. In 2002, when free personal care was introduced, 45% of clients received personal care services. This has steadily increased each year to reach 68% in 2005.

Table 2: Home Care clients 2000-05

Source: H1 home care return, Quarterly monitoring return.
* 2002 figure at 1 July 2002 when free personal care introduced.

3.3 Direct Payments for Free Personal Care

Direct Payments are for self-directed community care whereby eligible people purchase and manage for themselves some or all of the care they have been assessed as needing. They are one way of increasing the flexibility, choice, and control people have over the care they receive, so that they can live more independently in their communities. At June 2005, there were an estimated 150 older people in Scotland using direct payments to purchase the personal care services they needed.

4. Expenditure

Expenditure on free personal and nursing care is illustrated separately for clients in care homes and for those receiving services at home.

4.1 Care Homes

From 1 July 2002, personal and nursing care services became free for people aged 65 and over resident in care homes. In practice this means that everyone aged 65 and over who has been assessed as requiring personal and/or nursing care services receives £145 per week for personal care and £65 per week for nursing care.

Prior to 2002 the majority of people had these services paid for but a significant number of self-funders paid their fees in full. These self-funders now only pay for their accommodation and living costs, sometimes referred to as hotel costs.

The expenditure data on free personal and nursing care relates only to self-funders who previously would have paid for all of their care. The figures therefore allow us to determine the additional cost to Local Authorities in Scotland, following the implementation of this policy, in relation to care homes.

Expenditure on free personal and nursing care

Table 3 shows total expenditure on free personal and nursing care payments for the first three years of the policy. Note that the first year has been factored up to represent a whole year. This allows us to look at trends over the three years.

Table 4 shows the same information with costs for 2002-03 showing only the first 9 months of the policy, from 1 ^st July 2002 to 31 ^st March 2003.

Table 3 : Expenditure on Free Personal and Nursing Care in Care Homes

Source: FPNC expenditure survey, LFR3
*2002-03 expenditure factored up to whole year

Table 4 : Expenditure on Free Personal and Nursing Care in Care Homes

Source: FPNC expenditure survey, LFR3
*2002-03 data relates to first 9 months of policy from 1 July 2002.

Using the data in table 4 we see that:

• Expenditure on free personal care for self-funders in care homes has risen each year from £42 million in 2002-03 (9 months only) to £63 million in 2003/04 to £65 million in 2004/05.
• Expenditure on free nursing care for self-funders in care homes has also risen each year from £12 million in 2002/03 (9 months only) to £18 million in 2003/04 to £19 million in 2004/05.

Over this same period the number of older people supported by local authorities in Care Homes remained fairly static at just over 30,000. This would suggest that there has been a shift towards more self-funding residents and therefore a reduction in local authority funded residents.

This additional expenditure on free personal and nursing care can be looked at in the wider context of all local authority expenditure on care homes as shown in the table and chart below:

Table 5: Expenditure on care homes - older people: 1999-2005

000s

Source: FPNC expenditure survey, LFR3, GAE

The columns in the chart represent grant aided expenditure ( GAE) provided to local authorities in Scotland by the Scottish Executive. It should be borne in mind that these allocations are not budgets or spending targets and it is up to each council to decide how best to allocate its resources based on local needs and priorities.

The lines on the chart represent gross and net expenditure on care homes for older people and expenditure on free personal and nursing care in care homes for older people.

The chart shows that in 2002/3, expenditure on free personal and nursing care in care homes was the same as the GAE allocation. In later years, expenditure was slightly higher than the GAE allocation. However looking at overall allocation for care homes (older people) shows that overall net expenditure was slightly less than the GAE allocation in 2002/3 and 2003/4 but slightly higher than the overall allocation in 2004/5.

4.2 Home care

From 1 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 means that in practise many people would have 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. Therefore a proportion of these costs are ongoing costs and a proportion are new costs due to the introduction of FPC. Following the introduction of free personal care, it is no longer necessary to carry out a financial assessment for all clients and therefore it has not been possible to estimate precisely what proportion of these costs are new.

The chart below gives a picture of expenditure on home based services for older people. The columns in the chart show the grant-aided expenditure which is given to local authorities to provide home based services. Once again it should be noted that these are not budgets or spending targets and it is up to each council to decide how best to allocate resources based on local needs and priorities.

The lines on the chart represent gross and net expenditure on home care services for older people, and expenditure on personal care services for older people.

Table 6: Expenditure on home based services - older people: 1999-2005

000s

Source: FPNC expenditure survey, LFR3, GAE

Gross expenditure on home care services has increased greatly over the last 6 years, from £132 million in 1999-00 to £365 million in 2004-05, demonstrating the shift in the balance of care from care homes to services provided in peoples own homes. The Home Care Services, Scotland 2005 statistics release shows that over this 6 year period there has been a shift towards more intensive home care provision.

Total expenditure on personal care services at home increased from £69 million in 2002/03 (9 months only) to £116 million in 2003-04 to £136 million in 2004-05.

Expenditure on personal care services accounted for 54% of overall net expenditure on home care services in 2003-4 and 57% in 2004-05.

5. Background information on the collection of the data

These statistics have not been published as National Statistics as some of the data are still under development and there remain quality issues with collecting data on personal care services at home. In particular, weekly hours of personal care at home is highlighted as data under development.

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

Community Care Monthly key monitoring return

Between 2002 and 2005 the Scottish Executive collected monthly information from Local Authorities regarding the number of residents supported in Care Homes. This data is summarised in Annex 1: Table 1.

Community Care Quarterly key monitoring return

Since July 2002, the Scottish Executive 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, prior to free personal care, were self-funders. Anyone who is funded under the National Assistance regulations even if they are topped up to £145 for free personal care are excluded from the figures.

For care at home the figures show all people receiving personal care services at home. A proportion of these would have received their personal care for free prior to the introduction of the Community Care and Health (Scotland) Act 2002. This proportion is not known as this figure was not collected prior to 1 July 2002.

Local Authorities have improved their recording and reporting of this data over time as systems have been set up to monitor and record this information.

Free Personal and nursing care expenditure survey

The Scottish Executive carried out a separate survey asking about expenditure on free personal and nursing care for 2002-03 and 2003-04. From 2004-05 onwards this data is collected through the Local Financial Return (LFR3).

For Care Homes, the numbers represent spend on those people receiving FPC and FNC under the Community Care and Health (Scotland) Act 2002. i.e. those prior to free personal care who were self-funders. Expenditure figures also include the amount spent on anyone who was topped up to the £145/£210 per week.

For care at home, the numbers represent all spend on personal care services provided to people in their own homes.

Local Financial Return (LFR3)

The Local Financial Return collects expenditure statistics for each local authority in Scotland. The LFR3 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 LFR3 return. Further information available from http://www.scotland.gov.uk/Topics/Statistics/16945/6901

Grant aided expenditure ( GAE)

Grant aided expenditure allocations are presented in Annex 4: tables 14-16. These allocations are not budgets or spending targets and it is up to each council to decide how best to allocate resources based on local needs and priorities. Please note that the 2005/06 GAEs are notional only. Further information available from www.scotland.gov.uk/Topics/Statistics/18209/12073

Points to note

The quality of the data has improved since the last publication both in terms of coverage and quality. However there remain issues with this data which still preclude it from being labelled as a National Statistics publication.

In general, the data on 'numbers' of people receiving free personal care and 'expenditure' on free personal care are collected from different sources and care should be taken when making comparisons between these figures.

The hourly data on free personal care at home (table 7) should be regarded as data under development and caution should be taken in making any comparisons with expenditure data or other data sources, particularly at local authority level.

Copies of all Community Care Surveys are available from the website at: www.scotland.gov.uk/statistics/commcare/forms

All figures published on Free Personal and nursing care are provisional and subject to possible change in future publications. Some particular issues that we are aware of:

Many local authorities could not provide accurate data for some time after July 2002 as they were getting monitoring systems set up and put in place. The accuracy of the quarterly monitoring returns has improved over time and care should be taken in drawing any conclusions from the very early data as some estimation was involved in producing these figures,

City of Edinburgh have been unable to count self-funders in LA care homes in both their quarterly monitoring return and expenditure returns. They are currently looking into this and figures may subsequently change in future publications. The Scottish Care Homes Census indicates that there were 95 such self-funders at September 2005.

Further information

Further details and analysis of the data presented in this Statistics Release are available on request from the address given below. The Statistics Release is available on the Internet by accessing the Scottish Executive web site - www.scotland.gov.uk/statistics/commcare/publications

Information at local authority level is shown in the annex to this Statistics Release.

Contact: Steven Gillespie
Tel: 0131 244 3777
E-mail: SWStat@scotland.gsi.gov.uk

This statistics release was published on 29th March 2006.

7. Annexes

The Annexes provide detailed information for each Local authority area in Scotland:

Annex 1 : Care Homes for Older People
Table 1: Residents aged 65+ supported by local authorities in Scotland, 2002-05
Table 2: Self-funders aged 65+ receiving FPC payment, 2002-05
Table 3: Self-funders aged 65+ receiving FNC payment, 2002-05
Table 4: Adults aged under 65 receiving FNC payment, 2002-05

Annex 2 : Home Care Services for Older People
Table 5: Older people (aged 65+) receiving home care services, 2000-05
Table 6: Older people (aged 65+) receiving personal care services at home, 2002-05
Table 7: Hours of personal care received by older people at home, 2002-05

Annex 3 : Expenditure
Table 8: Gross expenditure on care homes, 2000-05
Table 9: Net expenditure on care homes, 2000-05
Table 10: Expenditure on FPNC in care homes, 2002-05
Table 11: Gross expenditure on home care services, 2000-05
Table 12: Net expenditure on home care services, 2000-05
Table 13: Expenditure on FPC at home, 2002-05

Annex 4 : Grant-aided expenditure
Table 14: GAE: Services for home based elderly, 2001-05
Table 15: GAE: Residential accommodation elderly, 2001-05
Table 16: GAE: Personal and Nursing care for older people in care homes, 2002-05

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