Irish vs English Care Home Finances: Three Numbers That Differ

Nursing home economics in Ireland and England look superficially similar and behave differently. Three published figures explain most of the divergence, and a fourth comparison that gets made constantly is not a comparison at all.

Staff costs: 59.1% against 55.3%

The BDO survey of private and voluntary nursing homes in Ireland, covering the financial year to 31 December 2023, puts staff costs at 59.1% of turnover. The comparable English figure is 55.3%.

The Irish figure excludes agency. That exclusion is important, because agency is reported separately at €1,543 per occupied bed, up from €1,038 — a rise of roughly 49% on the prior period. Add it back and the gap against England widens rather than narrows.

Nearly four percentage points of turnover is the difference between a thin margin and no margin in a sector whose other large cost lines are largely fixed. We set out how little of a care budget is actually discretionary in how a UK care home budget is built, and the Irish picture is tighter on the same structure.

Occupancy: 92.3% against 88.7%

Here the direction reverses. Irish occupancy at 92.3% is comfortably ahead of England's 88.7%.

This is the finding that surprises people, because it undercuts the intuitive explanation. Irish homes are not under pressure because beds are empty. They are running fuller than their English counterparts and still struggling, which means the problem is on the price and cost side rather than the volume side.

Profitability: a comparison that cannot be made

The Irish survey reports that 51% of homes made no profit. The English benchmark most often quoted alongside it is an EBITDARM margin of 30.1%.

Those two numbers are not comparable, and placing them side by side as though they were is one of the more common errors in cross-border care sector commentary. One is a proportion of operators recording no profit; the other is an earnings margin before interest, tax, depreciation, amortisation, rent and management fees. A home with a healthy EBITDARM margin can make no profit once rent and interest are taken out, which in a leasehold-heavy sector is routine.

The honest statement is narrower: 51% of Irish private and voluntary homes surveyed made no profit, and we do not have a like-for-like English figure to set against it.

The rate picture

On the revenue side, the survey gives an average private weekly rate of €1,285 per bed. The country average Fair Deal rate was €1,207 in November, against an average Fair Deal rate of €1,113 per week during 2023. For context, the public sector cost was €1,846 per resident per week as at May 2024.

Turnover per occupied bed came in at €66,135, with Fair Deal turnover per bed at €58,017. Staff cost per occupied bed ranged from €38,314 to €47,329 depending on home size.

Read as a single model: a home at the country average Fair Deal rate, running at the sector's occupancy, with staff costs at the upper end of that range, has very little between gross income and staff cost to absorb everything else. That is what a 51% no-profit rate looks like from the inside.

The scale gradient is the actionable finding

Staff cost per occupied bed varying by nearly €9,000 according to home size is the most practically useful number in the dataset. It is not a wage difference — pay rates do not vary that much by home size. It is a rostering and supervision ratio difference: smaller homes carry proportionally more fixed senior cover across fewer beds.

That makes it a training and competency question rather than a pay question. Where supervisory cover cannot be spread across more beds, the alternative is raising the competence level of the staff already on shift so that less senior cover is required per occupied bed. The cost of failing to do that shows up as turnover, and the replacement cost of Irish care staff is higher than most operators model, as we set out in the true cost of care staff turnover in Ireland.

Agency is the fastest-moving line

A 49% increase in agency cost per occupied bed in a single reporting period is faster than any other line in the survey. Ireland has no direct equivalent of the English agency price cap regime, so there is no ceiling doing the work that caps do in the NHS — a mechanism we describe in the NHS agency price caps. The discipline has to come from the operator's own recruitment and retention position instead.

Two caveats worth stating plainly

First, the survey's own caveat: the figures were not audited or verified by BDO. They are returns from participating homes. Treat them as the best available sector picture rather than as audited accounts.

Second, the reporting periods differ. The Irish staff cost and occupancy figures are for the year to 31 December 2023; the public sector cost is as at May 2024; the Fair Deal country average is a November figure. Anyone building a model from these numbers should carry the dates with them, because wage settlements and Fair Deal rates have both moved since.

What the three numbers add up to

Irish nursing homes run fuller than English ones, spend a higher share of turnover on staff before agency is counted, and half of them report no profit. The pressure is not demand. It is the distance between a fee rate set largely by a public scheme and a cost base dominated by labour, with agency the one line growing fast enough to close that distance on its own.

This article summarises published sector survey data and is not financial advice.