How much social care does each country fund?

This explainer covers Nuffield Trust analysis of public expenditure per capita for each country, and discusses estimations of self-funders in relation to their publicly funded counterparts.

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Published: 18/03/2020

Key points

  • There is wide variation in public expenditure per capita. England is by far the least generous, spending on average £303 per head, compared to £428 in Scotland, £396 in Wales and £461 in Northern Ireland.
  • Estimates of self-funders also vary considerably by country – with England having the highest proportion.

Total public expenditure on social care 2017/18, per head 18/03/2020

Chart

Source:  

Nuffield Trust analysis of HM Treasury Public Expenditure Statistical Analyses 2019. Adult social care expenditure is defined as personal social services spending on sickness and disability and personal social services spending on old age.

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Across the board, England’s public expenditure per capita is considerably lower than in the other countries.

The above graph represents the total identifiable expenditure on social care as collected by HM Treasury in the Public expenditure statistical analyses  publication for each of the four countries. Although these figures are derived from the same HM Treasury source, it is worth noting they may not be directly comparable due to the integrated nature of the system in Northern Ireland, and should be used for indicative purposes only.  

A large amount of social care services are funded privately by individuals who are not eligible for state support (see ‘Offer and eligibility’). The proportion of state-funded to self-funded individuals varies substantially across the four countries. England in particular has a high proportion of self-funders, whereas Northern Ireland has the lowest (this is particularly the case in the domiciliary care sector, in which services are provided free in Northern Ireland). 

Self-funders versus local authority/HSCT funded in residential and nursing care 18/03/2020

Chart

Source:  

Skills for Care and Development reporting of Laing Buisson, 2018

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Local authority/HSCT versus self-funders in domiciliary care 18/03/2020

Chart

Source:  

Skills for Care and Development reporting of Laing Buisson, 2018

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There is no source that can estimate with certainty the number of individuals who self-fund across the UK, and their experiences with social care services are not reported in a similar way to publicly funded individuals.[1] This is due to a variety of reasons, including the different ways self-funders access and use care, as well as the complexity of defining self-funding across the varying social care settings. The proportions reported above are thought to be approximately representative of distribution within the sector and the differences between the UK countries.

While local authority (or HSCT) funded clients make up the higher proportions of social care users in all UK countries, England has the highest proportion of self-funders, especially in residential and nursing care. Estimates from various sources suggest self-funders represent approximately 46% of all residential and nursing care users, and in the domiciliary care sector they represent around 30%.[2]

In contrast, estimates of self-funders in Wales, Scotland and Northern Ireland are considerably lower. Around 32% of people receiving residential or nursing care in Wales self-fund, while in domiciliary care this proportion is around 21%.[3] In Scotland, approximately 36% of individuals in a residential or nursing home self-fund, while around 25% of care users pay for their domiciliary, day or other care themselves.[4] Northern Ireland has the lowest proportions of self-funders, with only 11% of service users in a residential or nursing care setting paying for their care themselves, while it is estimated that only 7% of domiciliary care users are self-funders.[5]

Suggested citation

Oung C, Curry N and Schlepper L (2020) 'How much social care does each country fund?, in Adult social care in the four countries of the UK. Explainer series, Nuffield Trust.

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