Hospital bed-blocking, mental health support and drug and alcohol services are among the areas of concern raised in a study into shortcomings in the integration of health and care services.
The overhaul is at the heart of the Scottish Government’s blueprint of the future of the NHS to deal with an ageing population and provide more care at home. But Holyrood’s health committee warns today that three years into the creation of Integration Authorities (IAs) which had the task of delivering the change, the bodies are not working.
It comes after a Scotland public spending watchdog issued a stark warning last week that progress towards the essential transformation of health services was too slow and that the NHS in its current form is “unsustainable”.
Today’s report warns that many IAs – which spend £8 billion of public cash – are not challenging the status quo and much of their budget decisions are dictated by “individual” partners, which are likely to be the NHS or councils.
“This situation cannot be allowed to persist,” the report warns. “We do not believe at this stage we are seeing evidence that IA leadership across all 31 IAs is equipped to deliver this change in relationships and ultimately deliver the transformational change in health and social care that is required.”
A key role of the IAs was to drive down hospital bed-blocking, which usually happens when a patient’s stay is hospital is prolonged because an appropriate care package is not in place allowing them to return home.
Bed-blocking has been on the rise again in recent months, prompting criticism of the effectiveness of integration. The situation is particularly acute in Edinburgh, where many vulnerable people are denied home care packages because of a lack of resources.
Meanwhile, some IAs are even leaving cash allocated for tackling mental health and dealing with drug and alcohol problems unspent.
Committee convener Lewis Macdonald said: “The successful integration of health and social care is one of the biggest challenges facing us. It is clear that transformational change is required in the sector in order for us to meet long-term challenges such as our aging population. This requires those in charge to use the powers Parliament has given them and drive change.
“It is vital that the significant budget for health and social care is spent efficiently and effectively. It is unacceptable that this is not happening.”
With the Scottish Government working towards providing more care in the community away from hospitals, the report found there had been a “modest shift” in how budgets are spent in the three years IAs have been in operation.
But it said while there had been “progress in shifting the budgets towards community healthcare, this appears to be at the expense of family health services/prescribing and social care, rather than resulting from a reduction in hospital expenditure, which is showing an increased proportion of spend”.
The report also noted: “Some IAs have spent less than the budget that has been allocated to these services. Given concerns raised regarding mental health service provision we find it difficult to understand why this is the case.”
Conservative public health spokeswoman Annie Wells said the report raised “difficult questions” for the SNP government. She said: “There are clear concerns about the work of integration authorities and worrying issues around the use of public money.
“It is up to SNP ministers to make the changes required.”
Liberal Democrat health spokesman Alex Cole-Hamilton said: “With pressures on budgets everywhere it’s important that we are getting the most from every penny.”
In a statement, a Scottish Government spokesperson said: “Integration is the most significant change to health and social care services in Scotland since the NHS was established, and ensuring its success is a priority for the Scottish Government.
“The financial framework we published this month is clear about the twin approach of investment and reform that will be required to ensure health care services are fit for purpose in the future.”