Free Personal And Nursing Care, Scotland, 2013-14

4. Expenditure

This section presents the total expenditure on free personal and nursing care over the last ten years, from 2004-05 to 2013-14, for clients in a Care Home or receiving a Home Care service. Note that, as explained in section 2, the expenditure figures presented have been adjusted to account for overheads and differences in recording practice between Local Authorities, and so the figures presented contain some degree of estimation. However the 2013-14 figures are broadly comparable to 2012-13. Further information is available in sections 5.3 / 5.4 / 5.5 of this report.

4.1 Care Homes Expenditure

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 in 2013-14 everyone aged 65 and over who has been assessed as requiring personal and/or nursing care services in a care home received £166 per week for personal care and £75 per week for nursing care.

The weekly payments for personal care and nursing care have been increased in recent years. The following table shows the different value in payments between 2003-04 and 2013-14.

Value of weekly payment from 2003-04 to 2013-14

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

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 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 from 2004-05 to 2013-14 (£ millions)

Source: LFR03 return / Scottish Government FPNC validation return. Please note that figures presented contain estimates for overheads.

Table 3 shows that expenditure on free personal care for self-funders in care homes has increased each year from £72 million in 2004-05 to £102 million in 2013-14.

Expenditure on free nursing care for self-funders in care homes rose each year from £21 million in 2004-05 to £24 million in 2008-09. This has remained around £23 million until 2011-12, followed by a rise in each of the last two years (£28 million in 2013-14).

The total expenditure for FPNC in care homes has risen from £93 million in 2004-05 to £130 million in 2013-14. This increase reflects the increasing number of self-funders up until 2008-09 and the annual increases in the FPNC payments from April 2008. Expenditure on Free Personal and Nursing Care payments to self-funders accounts for around a fifth of total net expenditure on Care Homes.

Table 3: Expenditure on Care Homes for Older People (aged 65+), 2003-04 to 2012-13

£ Millions

	2004-05	2005-06	2006-07	2007-08	2008-09	2009-10	2010-11	2011-12	2012-13*	2013-14*
Net Expenditure on Care Homes for Older People (£M)	466	480	529	556	602	625	627	625	625	633
Expenditure on FPC Payments (£M)	72	76	77	81	82	84	85	88	93	102
Expenditure on FNC Payments (£M)	21	22	22	23	24	23	23	23	26	28
Total expenditure on FPNC in Care Homes (£M)	93	97	99	104	106	108	108	111	118	130
Expenditure on FPNC as % of Net Expenditure	20%	20%	19%	19%	18%	17%	17%	18%	19%	21%

Source: LFR03 return / Scottish Government FPNC validation return. Please note that figures presented contain estimates for overheads.

*Due to a change in format of the Local Government Finance return, the 2012-13 and 2013-14 net expenditure figures include an estimate of "Support Services" expenditure, in order to make the figure comparable to previous years. See 5.4 of this report for more information on support services.

4.2 Home Care Expenditure

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 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), 2004-05 to 2013-14

Source: LFR03 return / Scottish Government FPNC validation return. Please note that figures presented contain estimates for overheads.

Table 4 and Figure 7 (above) show total expenditure on personal care services at home has increased each year from £158 million in 2004-05 to £364 million in 2013-14, an increase of 131%. This increase has been levelling off since 2010-11.

Table 4: Expenditure on Home Based Services for Older People (aged 65+) 2003-04 to 2012-13

£ Millions

	2004-05	2005-06	2006-07	2007-08	2008-09	2009-10	2010-11	2011-12	2012-13*	2013-14*
Net Expenditure on Home Care Services	248	287	305	335	378	399	407	398	423	468
Expenditure on Personal Care at Home	158	189	228	267	277	316	342	347	351	364
Expenditure on FPC as % of total Net Expenditure	64%	66%	75%	80%	73%	79%	84%	87%	83%	78%

Source: LFR03 return / Scottish Government FPNC validation return. Please note that figures presented contain estimates for overheads.

*Due to a change in format of the Local Government Finance return, the 2012-13 and 2013-14 net expenditure figures include an estimate of "Support Services" expenditure, in order to make the figure comparable to previous years. See 5.4 of this report for more information on support services.

Figure 8: Personal Care expenditure as a proportion of total net expenditure on Home Care from 2004-05 to 2013-14

Source: LFR03 return / Scottish Government FPNC validation return. Please note that figures presented contain estimates for overheads.

Table 4 / Figure 8 shows that expenditure on personal care services accounted for 64% of overall net expenditure on Home Care services in 2004-05, increasing to around 80% in 2007-08. This proportion has fluctuated since 2007-08, with 78% of Home Care expenditure spent on Personal Care in 2013-14.

The more than doubling of spend on free personal care since its introduction is reflected in the shift away from care being provided in either care homes or hospital towards more care being provided in peoples 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.