Shortages of mental health expertise, bed-blocking and financially unstable GP practices are among the obstacles outlined in the report compiled for the Edinburgh Integration Joint Board, one of 31 bodies established to oversee the transformation.
The policy to bring together certain services that were once the preserve of councils and health boards has been introduced in an attempt to move people from hospitals into the community.
Although the report, obtained by Scotland on Sunday, deals specifically with Edinburgh, other Integration Joint Boards (IJB) across the country are experiencing similar pressures.
The new boards are also having to make dramatic cash savings amid concerns over how elderly and vulnerable people are to be cared for under the new system.
The Edinburgh IJB is facing a funding shortfall of £12.4 million in 2018/19, assuming savings of £11.1m are made.
The 100-page document was recently presented to the Edinburgh IJB to seek a way to make the key policy introduced by the previous SNP administration work properly.
The report found a “suboptimal” performance when it came to dealing with elderly people and warned that over the next two decades the number of dementia patients would increase by 65 per cent to 12,944 people in the city.
There were 1,000 people waiting for care assessments and a further 1,000 who had been assessed but were waiting for services.
In addition there were around 175 people in blocked beds with 64 needing to be moved to care homes and 88 in need of care packages.
The document warned that it would cost another £50m over the next decade if things stay as they are when it comes to looking after the elderly.
It identified challenges when it came to caring for people with mental health problems, which included “scarce” capacity and expertise.
There was “variability” in service provision and “an under-representation of social care and housing” as well as a lack of mental health expertise in GP surgeries and in accident and emergency departments.
It added that there were “disconnects in out of hours services and inconsistent and misaligned services for youngsters”.
The report said pressure was created by an increasing demand created by people with learning disabilities. There had been an increase in people with “extreme, challenging behaviour and complex needs”.
People with learning disabilities were living longer creating pressure on services to provide more care for an elderly population with elderly carers.
Services were “regularly at capacity” while getting people into their own homes was expensive. It said there were 76 people in Edinburgh who were known to want to move into their own accommodation. The cost of providing them with a home plus support would amount to £10.8m over four years.
The document also flagged up pressures on primary care and GPs, noting that many practices have become “clinically/financially unstable”.
This was combined with extra demands put on doctors by ever-expanding patient lists. Ten years ago 500,000 patients were registered with GPs in Edinburgh and by 2017 this had increased to 550,000. By 2026 this is expected to rise to 600,000.
Other areas of the country are facing similar pressures. The precarious financial position of NHS Tayside is likely to have an impact on the IJBs in its area. The health board has received Scottish Government loans totalling almost £40m to plug its funding gap.
A paper produced by the Dundee IJB says that NHS Tayside “continues to be faced with unprecedented financial challenges” adding the board needed to identify substantial savings. IJBs in the area have been asked to bring their budgets into balance to minimise risk and Dundee IJB has committed to reducing prescribing expenditure.
Jim McFarlane, of the Dundee IJB, said: “We have concerns on how that will impact on services and jobs. There is already a feeling that there is a shortage of staff, who provide services to older people and other adults in the community.”
Leader of the Tory group in North Lanarkshire council Meghan Gallacher said around £4.5m in efficiency savings had to be found in her area’s IJB.
“It is really quite a horrible experience to go through looking at the different efficiency savings,” she said, adding that items such as mental health and addiction services were under consideration.
Last night, Conservative Shadow Health Secretary Miles Briggs said: “It is widely agreed that integration of health and social care is the right direction of travel.
“Two years after their establishment across Scotland the 31 integrated joint boards members are increasingly expressing concern at the ability to deliver the integration of health and social services and the impact this is having on both financial targets and the integration agenda. But this is not just about numbers on a spreadsheet – it is people’s lives; it is our fellow Scots and loved ones’ lives – and it is becoming increasingly concerning that the SNP government’s flagship reform of health and social care is not delivering – a situation which cannot continue to go unaddressed.”
Cllr Ricky Henderson, chair of the Edinburgh IJB, said the document outlined some “very real and significant challenges”, but also described solutions.
He said the EIJB had invested £4.5m in improving assessment and access to care homes which had seen a reduction in those waiting. Around £2m had been invested in GP services annually. He added: “While there is no disguising the size of the challenge ahead of us, we do believe we have begun to make real improvements.”
A Scottish Government spokesman said: “The integration of health and social care services is one of the most significant changes to these services since the creation of the NHS, which brings together £8.5 billion previously managed separately by health boards and local authorities. This approach enables local health and social care partnerships to make best use of their total resources and to ensure people have access to the right care in the right place at the right time, and are supported to stay at home and in their own communities for as long as possible.”