When integration authorities were established in 2016, they were charged with responsibly for allocating £8 billion a year towards services from social care for the elderly to mental health support and drug rehabilitation. A more joined-up approach to delivery of these services was supposed to transform the way care is provided.
But just two years later, Members of the Scottish Parliament have raised gravely serious questions about their spending decisions and leadership. The delivery of social care and dental health services has been plagued by problems in recent years: unacceptably long waiting times for care assessments have led to bed blocking; those seeking help with mental health problems may be expected to wait months before seeing a professional.
Never has the need for these services to become more efficient been more apparent. Yet, members of Holyrood’s Health Committee, having examined the work of IAs, suggest the organisations are taking spending decisions without assessing - or even being able to assess - the value of their investment in terms of improving outcomes.
MSPs also noted some IAs were leaving cash allocated for mental health support and tackling drug and alcohol problems unspent. This is a particular scandal. Rarely a week seems to pass without the issue of access to mental health support being raised at Holyrood.
If it is the case that, while members of the public are being forced to wait months for treatment, money meant to improve the process lies untouched, those responsible have serious questions to answer.
The NHS in Scotland is already under intense pressure, with staffing shortages still a significant problem and waiting time targets being missed. An ageing population with increased life expectancy adds to that pressure. If Scotland is to be able to provide the levels of social care needed now and in the future, then it is crucial that IAs work as they were designed to.
Integration authorities - even working well - will not solve the underlying problems in the NHS, which is in dire need of proper reform, but they could make a positive difference. Right now, they seem to be part of the problem rather than the solution.