Health and social care integration still held back by ‘lack of leadership’ warns Audit Scotland

A lack of national leadership and clear planning is preventing the change needed if Scotland’s health and social care services are to adapt to increasing pressures, according to the country’s spending watchdog.

The report by the Accounts commission and Audit Scotland follows a similar warning in December, and comes less than a month before the April 1 deadline for councils and health boards to have integrated services in place.

Although the report highlights some isolated examples of good work happening across Scotland, it warns the shift to new models of care is not happening fast enough to meet growing needs of an ageing population.

The Scottish Government, it advises, needs to be clearer with health boards and councils about what it expects them to do to meet its 2020 vision for health and care services.

It has also failed to shift spending from hospitals into community settings.

Caroline Gardner, Auditor General, said: "An ambitious vision can be a catalyst for change but, without a clear and detailed plan of action, there's a risk that ambition is overtaken by circumstances.”

The integrated joint boards, which are to be operation by April 1, continue to focus on structures and governance and must shift to what needs to be done on the ground to make the necessary changes to services, according to the report.

The report also advised an increased focus by Government on recruiting and retaining GPs, something doctors’ organisations the BMA and RCGP welcomed.

Chair of BMA Scotland’s GP Committee Dr Alan McDevitt said: “These huge challenges that the health service is facing means that changes are needed, but those changes must be resourced adequately if they are to succeed.

“That is particularly true in general practice where we are working to negotiate a new contract that will allow GPs to be GPs, so that they can better look after the needs of their patients. There is no way round the fact that investment will be required to successfully deliver the kind of transformative change that is needed in primary care and general practice.”

Royal College of Nursing Scotland director Theresa Fyffe said it was clear change was not happening quickly enough.

“While the report highlights pockets of excellence, where new models of care are being introduced, these are generally locally driven and lessons are not being learnt or implemented across the country,” she said.

According to the Accounts Commission, between 2011 and 2015, the health budget decreased by 0.6 per cent in real terms to £11.85bn, while overall funding for councils decreased by 5.9 per cent in real terms to £10.8bn.

Council umbrella body COSLA said the report didn’t add anything new, labelling it “little more than an incomplete list of activity”.

Health and social work spokesperson Councillor Peter Johnston said: “What IJBs are being asked to do is incredibly difficult and we hope transformative however we, and Audit Scotland, need to let them get on with it now.”

The number of people aged 85 and over in Scotland is expected to rise by two-thirds from 114,375 in 2014 to 187,219 in 2030, and double by 2034.