Who organises and funds social care?

This explainer covers how adult social care is funded, assessed and organised in each UK country.

Blog post

Published: 18/03/2020

Key points

  • In England, Wales and Scotland, local authorities are responsible for adult social care and this duty is set in law. Funding comes from central grants, which can be subject to squeezes from central government, and from council tax on properties.
  • In Northern Ireland, health and social care trusts have this responsibility due to the integrated nature of their health and social care system.

England

152 local authorities[1] organise and support care for those unable to fund it themselves. They are also able to organise care services for self-funding individuals who may require assistance to do so.

Local authorities fund social care through a combination of a grant from central government via the Ministry of Housing, Communities and Local Government, and local revenue-raising mechanisms, such as council tax and the specific social care precept. The local clinical commissioning group is mandated by the NHS to transfer a set amount to a local authority via the Better Care Fund.[2] Social care funding is not ring-fenced, which means that local authorities can decide how much of their budget they allocate to care. In addition, where an individual is assessed as eligible for NHS funding[3] under the continuing health care scheme, this funding will also cover their associated social care needs (see ‘Support for health needs’). 

There are proposals to reduce the central government grant and to require local authorities to raise a greater proportion of their revenue themselves[4] – these continue to be discussed under the new government.[5]

Local authorities are responsible for the organisation of care and support plans and personal budgets (see ‘Offer and eligibility’). The Care Act 2014 set out a national minimum threshold for eligibility to which all local authorities must comply. However, local authorities have discretion to provide services to individuals outside of the eligibility threshold.[6]

Wales

22 single-tier local authorities organise and support care for those unable to fund it themselves. As in England, local authorities are able to organise care for individuals who self-fund if they choose to do so. In time, this will move to delivery through seven statutory regional partnership boards to encourage closer integration with the health care sector.[7]

Local authorities receive grants from the Welsh Assembly via the revenue support grant. Local taxes are devolved to the Assembly[8], which means that the local revenue-raising powers in Wales are subject to different legislation than in England, such as over business rates.[9],[10] In Wales, the social care precept does not apply. Local authority revenue is also supplemented by NHS Wales funding through local health boards under the NHS continuing health care scheme (see ‘Support for health needs’).[11]

Local authorities are responsible for the format of care and support plans (see ‘Offer and eligibility’), and are required to be consistent across the country with the use of the national eligibility criteria.[12]

Scotland

32 local authorities organise and support care for those unable to fund it themselves. They are also able to organise care services for self-funders who may require assistance to do so. In time, this will move to delivery through 30 integration joint boards[13] and one lead agency[14] (NHS Highland assumes responsibility for both health and social care), under the Public Bodies (Joint Working) (Scotland) Act 2014.

Scottish local authorities fund social care through a combination of a grant from the Scottish government (General Revenue Funding of Local Authorities) and local taxes.[15] In Scotland, local taxes are devolved which means that the local revenue-raising powers are subject to different legislation from England.[16]. There are different council tax rates[17] and the social care precept does not apply as it does in England. Local authority revenue is also supplemented by NHS Scotland funding through NHS health boards[18], under the Hospital Based Complex Clinical Care scheme (see ‘Support for health needs’).[19]

Local authorities are responsible for the format of self-directed support plans (see ‘Offer and eligibility’). Each local authority has their own eligibility criteria to determine whether an individual will be able to access social care, which must be compatible with the National Eligibility Framework.[20] National eligibility applies for service users with a need for personal care, under which those with a critical or substantial risk must receive services within six weeks of assessment.

Northern Ireland

In Northern Ireland, social care is integrated with health care under five health and social care trusts. These manage their own budget allocated by the Northern Ireland Executive through the Department of Health (NI). As health and social care services in Northern Ireland are integrated, provision of continuing health care is organised directly by the health and social care trust and thus does not represent an additional source of revenue (see ‘Support for health needs’).

Trusts are responsible for the format of self-directed support plans (see ‘Offer and eligibility’). The Northern Ireland single assessment tool is designed to ensure a consistency of assessment across different trusts and different professionals, whether undertaken by a nurse or a social worker. However, trusts have discretion to determine at what level of need an individual is entitled to social care support.

Suggested citation

Oung C, Curry N and Schlepper L (2020) 'Who organises and funds social care?', in Adult social care in the four countries of the UK. Explainer series, Nuffield Trust.

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