Social care services in Scotland found to be 'unsustainable'

Community health and social care services in Scotland are “unsustainable”, according to a report by the Accounts Commission.

Published today, the report looked at Integration Joint Boards (IJBs) that are responsible for planning and commissioning community-based health and care services in the country.

It found that in the last few years costs have risen due to the cost-of-living crisis and the legacy of the Covid-19 pandemic. Alongside this, the commission expects the need for IJBs to rise in the next few years due to an ageing population.

At present, one in 25 people in Scotland receive social care. Seventy-six per cent of these individuals are aged 65 and over. By 2045 the number of people aged 65 and over is expected to grow by nearly a third. 

Despite these issues, the report found that funding received by IJBs decreased by nine per cent in 2022/23, with the funding gap set to triple in 2023/24.

It went on to say that to continue services, IJBs have dipped into their saving reserves and held off on filling staff vacancies – both strategies the report described as “unsustainable”.

Angela Leitch, Accounts Commission member, said:  “We’re already at the point of increasing levels of unmet need and tightening eligibility to access services. This could be impacting people’s quality of life but data quality is insufficient to fully assess this.

“The pressures facing social care and community healthcare are complex, with health inequalities widening. These issues can’t easily be resolved, and the situation is getting worse.

“IJBs can’t tackle these challenges alone – they need the support of councils, health boards, Scottish Government and other partners to help them make the urgent changes that are needed now. Without this collaborative approach to change, the pressures facing IJBs will get worse.”

The report explained that leaving vacancies open has not been intentional, but rather a result of difficulties with retaining and recruiting a skilled workforce. Nearly half of services reported vacancies, with a quarter of staff leaving jobs within their first three months and a continued turnover in senior leadership. This marks a record high of vacancies in the sector.

It concluded that the pressues on IJBs mean that the current delivery and funding of services is unsustainable and that system change is needed. 

Royal College of Nursing Scotland director Colin Poolman said: “This damming report sets out the challenges facing community health and social care services. Too often the focus is on the crisis in acute hospitals, but hospital overcrowding is a symptom of the lack of investment and prioritisation of community services. The whole system is at breaking point.

​“While the Accounts Commission acknowledges that Scotland’s health and social care partnerships have a committed and driven workforce, the complex governance structures and lack of investment mean staff are operating with their hands tied behind their backs, and patients and communities are suffering as a result.”

In response a Scottish Government spokesperson said: “We have invested a record £19.5bn in health and social care in 2024/25. This includes an allocation of over £2bn for social care and integration to deliver on our commitment to increase spending in this area by 25 per cent – two  years ahead of target.

“Our funding supports the work delivered by Integration Joint Boards, but budgets and overall funding allocations are agreed by local authorities and health boards, not the Scottish Government.

“We understand the recruitment challenges within health and social care and offer funding to advertise vacancies. We remain committed to supporting the delivery of improved, sustainable health and social services across Scotland.”