All bodies involved in the integration of health and social care services need to work together better if it is to make a “meaningful difference” to people in Scotland, according to a report.
A new publication from public spending watchdog Audit Scotland found there is still a long way to go to achieve the potential for a “profound” shift in the way those services are delivered.
It has outlined a series of recommendations, across six areas, for the Scottish Government, councils, NHS boards and Integration Authorities.
Integration Authorities (IAs), established following a 2014 Act, are responsible for joining up services provided by the NHS, councils and others to shift care from hospitals into the community.
The integration of health and social care services is a major programme of reform, affecting nearly £9 billion of public money.
The latest report from the Auditor General and the Accounts Commission is the second of three progress updates since the Act was introduced.
It found that IAs have started to introduce more collaborative ways of delivering services, with improvements including reducing unplanned hospital activity and delays in discharging people from hospital.
People at the end of their lives are also spending more time at home or in a homely setting, rather than in hospital, the report noted.
However, it added that IAs are operating in an “extremely challenging environment” and “there is much more to be done”.
It found that “financial planning is not integrated, long term or focused on providing the best outcomes for people who need support”.
It continued: “This is a fundamental issue which will limit the ability of IAs to improve the health and social care system.”
Auditors also called for improvements in strategic planning and said “several significant barriers must be overcome to speed up change”.
The report said: “These include a lack of collaborative leadership and strategic capacity; a high turnover in IA leadership teams; disagreement over governance arrangements; and an inability or unwillingness to safely share data with staff and the public.
“Significant changes are required in the way that health and care services are delivered.
“Appropriate leadership capacity must be in place and all partners need to be signed up to, and engaged with, the reforms…
“Change cannot happen without meaningful engagement with staff, communities and politicians. At both a national and local level, all partners need to work together to be more honest and open about the changes that are needed to sustain health and care services in Scotland.”
Commenting on the report, Auditor General Caroline Gardner said: “All partners, at a national and local level, need to work together to ensure the successful delivery of integrated health and social care services in Scotland.
“This will allow people to receive the care they need at the right time and in the right setting, with a focus on community-based, preventative care.”
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.”
Responding to the report, 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. We are committed to working together to deliver integration successfully because we believe it is the right way to deliver better services for the people of Scotland.
“Integration is the most significant reform to health and social care services since the creation of the health service in 1948. It brings together almost £9 billion which was previously managed separately in health boards and councils, and this year includes more than £550 million of NHS frontline investment to support integration and social care.
“Changes this ambitious take time.”