Integration of health and social care ‘has not led to joined up financial planning’, warns auditor

Flagship reforms to integrate health and social care services have not brought together council and health board budgets for the benefit of patients in the community, Scotland’s public spending watchdog has reported.

Audit Scotland and the Accounts Commission have recommended local authorities and health boards need to work closer together to achieve the “meaningful difference” intended by the policy.

Integration boards were established by 2014 legislation to join up social care services to hospital with the intention of improving experiences for patients and having more care delivered closer to home or in a homely setting.

Nearly £9bn of public money has backed the reform, but its early years were characterised by disputes over cash at the top level.

While some collaborative working has been introduced, including the reduction of unplanned hospital activity and delayed discharge, particularly towards the end of life, auditors found “financial planning is not integrated, long term or focused on providing the best outcomes for people who need support”.

The report continued: “This is a fundamental issue which will limit the ability of IAs to improve the health and social care system.”

It highlighted “a lack of collaborative leadership and strategic capacity” amid governance disputes within the authorities.

“Significant changes are required in the way that health and care services are delivered,” it concludes.

“Appropriate leadership capacity must be in place and all partners need to be signed up to, and engaged with, the reforms.”

Graham Sharp, chair of the Accounts Commission, said: “The potential for a profound and long-term shift in the way health and social care services are delivered is clear, but there is still a long way to go.

“A collective effort from the Scottish Government, COSLA, NHS boards, councils and the Integration Authorities is needed for health and social integration to make a more meaningful difference to the people of Scotland.”

Health Secretary Jeane Freeman said: “We recognise the report’s conclusions that while we are already seeing improvements in terms of the balance of care in communities and hospitals, we have more to do with our partners in local government, the NHS and Integration Authorities.

“We want to step up the pace and agree that further progress requires our strong, shared leadership.”

Third sector body the Health and Social Care ALLIANCE said the report showed that authorities needed to include the voices of charities and volunteer groups, who often act as partners in delivery.

ALLIANCE chief executive Professor Ian Welsh, who also sits on the East Ayrshire Health and Social Care Partnership, said: “This report is a welcome reminder that the purpose of integrating health and social care is to improve the outcomes of people who use support and services.

“Clearly, we welcome reductions in unplanned hospital activity and delayed discharges which have occurred as a direct result of integration, but it is concerning to note the auditors view that planning is not geared towards improving outcomes.”