How the UK’s four social care systems measure up against each other

By Grant Dalton, Institute for Government 

The social care systems of England, Scotland, Wales, and Northern Ireland provide different levels of care. The proportion of older people who receive care at home or in a care home in Northern Ireland is nearly double the proportion in England, and all three devolved governments spend more per head on care than in England.

This divergence is likely to continue. The SNP government is planning to create a more centralised National Care Service and abolish charges for community care in Scotland, and the UK government has promised to reform social care funding in England so that “nobody has to sell their home to pay for care”.

The divergent paths taken since devolution should provide an opportunity for governments to learn from each other’s experiences about what policies work best; but a paucity of comparable data on social care makes this harder that it needs to be.

Our new report aims to fill that gap. Building on previous work from Skills for Care and the Nuffield Trust, we analysed statistics on social care spending, users and services for the first comprehensive comparison of the four nations’ social care systems since devolution.

Decade of declining support

The results were striking. Despite big variations in the generosity of the four state-funded care systems, the number of people receiving state-funded social care in Wales, England and Scotland has consistently declined over the past decade – because budgets have been static or decreasing.

In England, where cuts were deepest, the proportion of the population receiving state-funded social care fell by over a third between 2006-07 and 2013-14. Only in Northern Ireland, where real-terms social care spending has increased by nearly 20% since 2011-12, has the proportion of people receiving care remained the same.

Owing to squeezed budgets over the last decade, local authorities in England, Wales and Scotland have been limiting access to care through tighter eligibility requirements, reducing the care hours they provide or delaying care assessments.

Tight funding has limited the impact of free personal care in Scotland. Personal care, which includes most aspects of care at home, has been free for people aged 65 and older in Scotland since 2002, but the proportion of people receiving state-funded home care in Scotland is now lower than in 2002, when it was first rolled out.

Trend away from care homes

Our research also found a consistent trend away from councils providing care in care homes. In Scotland and Northern Ireland, this has been accompanied by a growing supply of care at home, although often to fewer, more care-intensive patients – suggesting there may be some displacement of care from residential to community settings.

We also found that the proportion of people receiving direct payments from the government to pay for care has increased in all four nations of the UK. It is highest in England, where nearly one pound in every ten spent is given to care recipients or their carers directly.

The differences between the four systems are complicated – but one simple way to assess their performance is to compare volumes of self-funded care, unpaid care, and unmet need. Where the state doesn’t provide care, those in need must pay for their own care, use unpaid care from friends and family, or learn to live without the care they need.

Divergences in self-funding and carer rates

The proportion of people who fund their own care varies hugely. Skills for Care estimates that 46% of those receiving residential or nursing care in England are self-funded, but just this falls to just 11% in Northern Ireland. The number of unpaid carers likewise varies across the UK. According to the 2011 census – the last comparable data for all four nations – 9% of the population in Scotland provide unpaid care, versus 12% in Wales and Northern Ireland.

Assessing the extent of unmet need is much harder due to a lack of data, a repeated finding of our research. The four nations rarely release data in the same way as each other, and often do not agree on how comparable the data they do publish is.

This is a missed opportunity. Better data, published in a consistent way between the nations, would allow researchers to evaluate the impact of the policies pursued by different governments more thoroughly. This would provide policymakers with better evidence on the effects of policies – and ultimately, improve services for citizens.

More data on delayed discharges in Northern Ireland, for instance, would allow researcher to analyse the effects of health and social care integration on the relationship between hospitals and the care sector. Comparable data on waiting times for care assessments might tell us how councils have managed squeezed budgets in England, Wales, and Scotland.

This report should be a wake-up call to governments in all four nations for better, comparable, data. The current UK government has promised to improve data in the most recent health and social care white paper, but there is still a way to go. All four governments must prioritise better data as a vital tool for understanding and improving the performance of services.

Grant Dalton is a researcher at the Institute for Government