Other types of support: how do the countries compare?

This explainer looks at what other types of support – such as welfare benefits and access to continuing health care – people with care needs might be eligible for.

Blog post

Published: 09/03/2023

Key points

  • The proportion of individuals with a disability in 2020/21 was similar for Scotland, England and Northern Ireland, but higher in Wales at 33%. However, the proportion of the population receiving disability living allowance, personal independence payments and attendance allowance is variable.
  • Across all types of benefit, the proportion of recipients is consistently lower in England than in the three other UK countries. This could be explained by the other countries’ relative higher rates of poverty, and/or individuals in those countries having comparatively more severe or complex disabilities.
  • In all countries, there is a lack of clarity around which people with social care needs are eligible for funded health services. In England, Wales and Northern Ireland, the issues surrounding Continuing Health Care (or its equivalent) are well rehearsed, particularly in relation to those with dementia who typically do not qualify for funding for care. Scotland is the only country to have reformed the system to offer more certainty about the delineation between the two services, although what impact this has had on access is unclear.

Welfare benefits


The proportion of individuals with a disability is broadly similar in England, Scotland, and Northern Ireland; Wales has a greater proportion of individuals with a disability. However, spending on welfare benefits differs significantly. England falls behind the other countries in providing additional financial support, while Northern Ireland is the most generous.

These differences in spending could be due to several reasons. A higher number of applicants in the other countries could reflect different expectations of the state, a higher proportion of individuals with a (more complex) disability in the other countries, and/or a greater proportion for whom the payout is of greater financial significance.

The extent to which benefits are devolved is limited. The Department for Work and Pensions manages benefits, set at the same level, for England and Wales. For Scotland, both the Department for Work and Pensions and a new agency, Social Security Scotland, are responsible for health and disability benefits. Social Security Scotland is progressively taking ownership of the delivery of a greater number of benefits.1 In Northern Ireland, benefits are administratively devolved to the Department for Communities, but the type and value are identical to benefits in the other countries under current arrangements.




Benefits are centrally organised and administered by the Department for Work and Pensions. For most adults, the disability living allowance (DLA) is progressively being replaced by the personal independence payment (PIP) for people who have both a long-term physical or mental health condition or disability, and difficulty with tasks as a result of these conditions.2

The personal independence payment is made up of two parts: the daily living part (lower weekly rate £68.10 / upper weekly rate £101.75, 2023/24 rates) and the mobility part (lower weekly rate £26.90 / higher weekly rate £71.00, 2023/24 rates).3 Individuals can qualify for one or both parts.4

Attendance allowance is another benefit available to those over the age of 65 who are severely disabled physically or mentally and require personal care.5 The 2023/24 weekly rates are £68.10 as the lower rate, and £101.75 as the higher rate. The rate you receive is dependent on the level of help you need, not on your means.6




As in England, benefits are centrally organised and administered by the Department for Work and Pensions. Spending on benefits in Wales is comparatively higher than in England.7 Literature suggests there is a greater need in Wales for the state to provide support – the Wales Fiscal analysis reports the number of over 65s claiming disability living allowance and personal independence payments is almost twice as high as in England. This could potentially be explained by a comparatively higher level of disability due to higher incidence of chronic disease and greater health inequalities. Furthermore, the higher spending on benefits could be explained by a proportionally greater number of individuals for whom receiving a benefit payment is financially significant.

There has been some appetite in Wales to follow Scotland in the devolution of benefits.8 The Welsh Affairs Committee published its Fourth Report of Session, 2021/22: The benefits system in Wales in March 2022, which outlined potential options for improved better delivery of benefits including devolution.9 This follows the signing of the Cooperation Agreement in November 2021 by the Welsh government and Plaid Cymru stating their support for devolution of the “administration of welfare”.10 Note, this does not mean a comprehensive devolution of welfare, and at present no benefits have been devolved in Wales. Regardless of whether benefits are devolved or not, it is acknowledged by both the Welsh and UK governments that there needs to be greater awareness of benefit entitlements and support for people making claims.11

As in England, the DLA is being progressively replaced by the personal independence payment. Attendance allowance is also available for Welsh residents at the same rates as in England. Recipients of all three types of benefits are also eligible for an additional one-off £200 cash payment to provide support towards paying fuel bills, in light of the cost-of-living crisis.12




Benefits in Scotland are partly devolved and operate under a new social security agency called Social Security Scotland – formed in 2018 and operational from 2021. However, the DWP still manages some benefits.

Those with a disability or long-term health condition may be eligible for an adult disability payment. This scheme was initially introduced as a pilot to replace the personal independence payment across certain regions in Scotland but was rolled out nationally in August 2022. The amount an individual receives is dependent on their care needs rather than means, and currently is identical to the personal independence payment in England and Wales.13 This benefit is now being delivered by Social Security Scotland.14

For carers, Social Security Scotland currently administers an additional benefit, titled the carer’s allowance supplement. This is an extra payment of £245.70 (2022) twice a year for recipients of the carer’s allowance.15 While DWP administers the carer’s allowance, Social Security Scotland pays the carer’s allowance supplement.

In October 2019, Scotland introduced a new benefit to support young carers aged between 16 and 18, called the Young Carers Grant. This is an annual payment of £326.65 (2022) to young people to spend how they choose (reporting is not required).16


Northern Ireland 


In Northern Ireland, benefits are organised and administered by the Department for Communities, although in practice the rates of pay are the same as in England and Wales. 

Although the country is also transitioning from the disability living allowance to personal independence payments, the devolved department has put in place additional support for those affected by the transition.17 Individuals suffering from injuries relating to the Northern Ireland Conflict are also entitled to a supplementary payment from the Department for Communities.18

Spending on benefits is comparatively high against the other countries of the UK. Conversations with stakeholders reflected that this is partly due to an increased expectation of the state to support individuals in the aftermath of the Conflict.


Support for health needs




Under the NHS Continuing Health Care (CHC) scheme, individuals whose social care need is, according to an assessment process, deemed to be the consequence of a primary health need do not pay for their social care.19 They are instead fully funded by the NHS, regardless of the setting in which they receive their care or the type of package they need (this includes accommodation costs for residential and nursing care).20 The assessment uses the national assessment tool and is undertaken by the local clinical commissioning group.21 Individuals with a social care need who are deemed responsible for paying for their own care, and who require the medical support provided by a nurse in a registered care or nursing home, are entitled to a funded nursing care payment of £209.19 (2022/23) per week from the NHS, directly to the nursing home. 22

There have been major concerns around CHC delivery in England, in particular around the low number of people deemed eligible after assessment, waiting times and where the responsibility lies between the health and social care systems.23 It is furthermore felt to be a source of inequality particularly for dementia sufferers, whose needs are often perceived to fall under social rather than health care.24 These were recognised by the government in 201825, but it is clear those problems continue to persist and have been under increasing public and media attention.26

NHS Digital collects data from clinical commissioning groups, and on average there were 54,000 service users eligible for CHC at any one point in 2021/22.27 This figure has fallen from 56,000 in 2018/19.




As in England, the Welsh NHS covers the full social care costs of individuals who require social care arising from a health need after an assessment, regardless of the setting in which they receive their care or the type of package they need (this includes accommodation costs for residential and nursing care). Care is then organised through local health boards.28 Most recent reports from the Welsh government indicate that, on average, approximately 5,000 Welsh people receive NHS-funded Continuing Health Care at any one point.29 30

Individuals with a social care need who are deemed responsible for paying for their own care, and who require the medical support provided by a nurse in a registered care or nursing home, are entitled to a funded nursing care payment of £193.88 per week (2022/23; with a local authority component of £7.86 totalling £201.74) from the Welsh NHS directly to the nursing home.31

As in England, there have been similar concerns raised in Wales about the consistency and fairness of the CHC assessment process.32 Dementia sufferers are also deemed to be treated unfairly.33 The CHC process in Wales was recently under consultation and a revised framework is expected shortly.34



After an independent review of NHS Continuing Health Care in 2014, the scheme was replaced by Hospital Based Complex Clinical Care in 201535 – under which the NHS would fully meet the costs of care for service users with a health need if they needed to be delivered within a hospital setting.36 Individuals whose care needs can be “properly met” in a setting other than a hospital must meet their own accommodation and board costs.

Their other social care needs are met in the same way as other service users who are not deemed to have a primary health need (see ‘Offer and eligibilty’), including the delivery of free personal care if the individual has an eligible need.

In addition, all service users requiring nursing care within a care home setting receive this for ‘free’, delivered by the local GP.37 This takes the form of a funded nursing care weekly payment from the local authority directly to the care home. The rates as of April 2022 were £95.80 for nursing care and £212.85 for personal care.38

According to the government inpatient status in 2022, around 575 individuals were receiving Hospital Based Complex Clinical Care (HBCCC).39 There has been a fall in the number of individuals receiving HBCCC, as in 2019 there were 889 individuals receiving HBCCC.40 These numbers are not directly comparable to those in England, as they represent only those individuals whose care costs were fully met by the NHS in a hospital setting.

Northern Ireland


Continuing Health Care in Northern Ireland is offered to individuals for whom the outcome of an assessment is a primary health need (as opposed to a primary social care need – for more details see ‘Offer and eligibility’). In such cases, the health and social care trust must meet the full costs of the individual’s care package, regardless of the setting (this includes accommodation costs).41

Individuals with a primary social care need who are deemed responsible for paying for their own care, and who require the medical support provided by a nursing home, are entitled to a funded nursing care payment of £100 per week from the health and social care trust directly to the nursing home.42  It is not clear whether Northern Ireland intends to increase this amount. As for all service users, individuals whose needs can be met in a domiciliary setting can do so for free.

In response to a 2014 report from Age UK outlining the extent of access to Continuing Health Care in Northern Ireland, along with other queries on eligibility from individuals and their families, a consultation led by the Department of Health was carried out in 2021 with the intention of creating a fairer and more transparent system.43 As a result, reforming the assessment criteria to a single eligibility criteria question: ‘can your care needs be properly met in any other setting other than a hospital?’ has been proposed.44 It is argued that this will be more straightforward and allow for greater consistency in access across regions.45 Next steps will involve the Department of Health working with key stakeholders to further develop and implement the proposed reform.




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Inpatient census 2022: hospital based complex clinical care and long stay - gov.scot (www.gov.scot)


Inpatient census 2022: hospital based complex clinical care and long stay - gov.scot (www.gov.scot)/