The changing cost of care in Scotland: A post-Storm assessment

Over a year on from our market report focusing on the cost of care, we revisit the evolving care landscape in Scotland to assess what’s changed – and what challenges remain.

Drawing on insights from experienced care expert Allison Dunning RGN, this update explores stabilising costs, regional disparities, and practical strategies for insurers facing the complex realities of catastrophic injury claims north of the border.

It’s been a little over a year since Clyde & Co published our exclusive market insight report ‘The Cost of Care – Navigating the Storm’ which pulled together data from our survey and from in-depth interviews with care experts from across the UK, including Scotland, to assess the current state of the market. The cost of care is often by far the biggest head of loss in catastrophic injury claims, so we know it’s vital for insurers to stay on top of developments.

Our report highlighted the ever-growing costs associated with care, which impact claims across all three UK jurisdictions. We thought the timing was good to catch up with Scottish care expert Allison Dunning RGN of Tessa Gough Associates, an accomplished Court expert and case manager, to see how things are developing in Scotland.

Up until at least 2023, the perfect storm of Covid, Brexit and the war in Ukraine was causing unsustainable levels of inflation across all parts of the economy – with the impact on the cost of care for catastrophically injured claimants particularly acute. Thankfully for insurers, Allison reported seeing a trend of stabilisation over the last 12 to 18 months. While we’re unlikely to see rates falling, new companies entering the market means that the inflationary bubble has burst to some extent, but it remains to be seen what impact April 2025’s increases in national minimum wage and employers’ national insurance contributions will make going forward.

For now, even in the more rural areas of Scotland, things have eased, with improved access to services. Allison highlighted, however, that while the supply is available to those areas, increasingly we are seeing travel costs added on top, rather than included in flat rates. That means that travel costs can quickly outweigh the actual care costs for claimants in remote areas which is a particular problem here in Scotland when a claimant lives outside the central belt. This is not uncommon given that a disproportionately high number of our most serious road accidents happen in those areas, despite the smaller population.

Allison emphasised that the best means of tackling those travel costs is through detailed research, to produce an individual, bespoke care plan for every claimant, rather than a one-size-fits-all solution. While some care experts will only look at so-called ‘complex care agencies’ which offer full Scotland or UK-wide coverage, this doesn’t necessarily result in better or more appropriate provision, and it’s often at an unnecessarily high cost. Scotland’s geographical challenges will mean that the usual agencies and rates are not necessarily the most effective.

Instead, Allison noted the importance of looking at the specific geographical location and the specific needs of the claimant. Often there may be smaller agencies operating on the ground locally, even in areas which have typically been challenging to source. It’s also important to keep in mind what kind of service is actually required; some larger agencies will charge rates that are higher than those for a newly qualified nurse for all care, when nursing care simply isn’t required. When it is, the carers provided by these agencies don’t necessarily have experience of complex care, which can leave family members needing to step in.

With even basic agency care rates now as high as £30 per hour, some care experts suggest this is now simply non-negotiable and it would be impossible to recruit below that. However, Allison noted that in fact, an old-fashioned advert in the local newspaper will often attract many applicants at advertised rates below that, dispelling that myth. The market in Scotland is inevitably less extensive and less sophisticated than south of the border, where increases have been heavily driven by the higher volume of litigation and case management.

Of course, direct employment of carers isn’t necessarily a cure-all. Understandably in a cost-of-living crisis, carers want more money in their pockets, and direct employment often doesn’t offer them guaranteed hours. The co-ordination of a directly employed care team can also be complex, requiring hours of case management time and effort, as well as being stressful for the individual claimant.

New online care platforms have grown massively in popularity as a result. These platforms can match those requiring care with self-employed carers online, often even at short notice and with very specific care requirements. Case managers report this model involves less responsibility than direct employment, but is more attractive to carers and offers better pay. As such, there’s usually good availability, and it’s often less intrusive for claimants too, who can match and discuss with potential carers online in advance rather than in their home.

The highly critical King’s Bench decision in Muyepa v Ministry of Defence from 2022 should also be a cautionary tale to any care expert, and a salutary reminder to solicitors or insurers of the risk of instructing experts who prepare reports exclusively for either claimants or defendants. The courts made clear they are unimpressed by experts who recommend lengthy generic ‘wish lists’, often including a range of ordinary household items or equipment that offers little benefit to the claimant at high cost, without any impact on the level of care recommended. Instead, experts must apply their mind to what equipment would support and empower the individual to meet their specific needs, promoting independence where possible – and then consider what level of care is required in light of that, and how those care arrangements would work in practice. The Scottish courts are very likely to take the same approach, and this decision can be cited to claimants’ solicitors in Scottish cases as an indication of what may well happen in a Scottish court if their expert took a similar approach.

Finally, it’s also vital that experts remain abreast of developments in statutory services. Allison commented that across Scotland, the provision is hugely variable across different geographical areas, despite local authorities’ claims to operate on the same criteria, and it can be difficult to get accurate information from local authorities on what is available. On the whole, however, it’s worth noting that the picture remains generally more positive north than south of the border in terms of statutory funding. Any report, particularly in Scotland, must take careful consideration of what is available to the claimant and explain why that option is not being utilised if that is not the recommendation.

Clyde & Co are specialists in dealing with serious injury claims and thier follow-on care costs, and we closely monitor developments around this topic. For more on this subject, you can read all of our previous articles here, and if you have any questions about this topic you can contact Sarah Donaldson or any of our Scottish catastrophic injury team.