The sheer scale of the job of adapting Scotland’s health and care systems to meet the challenges of an aging population is set out today in a report by the Auditor General for Scotland.[i]

Caroline Gardner says it’s time for national leadership to deliver transformational change in health and social care, to turn the ambition of integrated delivery close to home into reality, and to scale up good local initiatives so all Scots can benefit.

"An ambitious vision can be a catalyst for change,” she says, “but, without a clear and detailed plan of action, there's a risk that ambition is overtaken by circumstances.”

In her news release to accompany the publication of her report Changing models of health and social care, Ms Gardner says:

"Current health and social care models are unsustainable but with the right services in place, many people could avoid unnecessary admissions to hospital, or be discharged more quickly. This will have benefits for service users, and for the staff who work extremely hard in challenging circumstances to deliver health and social care.”

The current pressures on the NHS and care services are already considerable. And, with the number of people aged 85 and over in Scotland expected to rise by two-thirds from 114,375 in 2014 to 187,219 in 2030 (and to double by 2034), the language of a demographic time bomb, while not used by Audit Scotland, does not seem to be over-dramatic.

The report’s supplements cite a series of new models of good practice that can deliver the Scottish Government’s 2020 vision of people in Scotland being supported to live longer, healthier lives, with their healthcare delivered at home or in a homely setting.

However, the Auditor General says change is simply not happening fast enough and the new models of care that are being seen in Scotland are small-scale and local.

In a series of recommendations, the report calls on the Scottish Government to provide leadership by setting up a clear framework that tells Scotland’s 14 NHS boards, 32 local councils and 31 integration authorities how ministers want the vision turned into reality. The Auditor General also wants to see the Government assess and address the cost of resourcing the transformation of care that it has been committed to since publishing the 2020 vision in 2011.

Ms Gardner pointed out on the BBC’s Good Morning Scotland programme this morning that since 2011 the proportion of money spent on adult care in acute hospitals has remained unchanged. She also said that some £300 million of so-called change funds spent over four years had delivered small scale projects not transformational change.

In short, the Auditor General has signalled that the time has come to move from focusing on strategies, structures and governance to making Scotland-wide changes on the ground.

Today’s report echoes another from the same source published at the beginning of December[ii] where the Accounts Commission and Auditor General expressed concern that the new integration authorities had been spending too much time setting themselves up and too little time setting targets and timescales for the delivery of the £8 billion of integrated health and social care services they will be responsible for in Scotland.

The Scottish Government says it recognises the new demands and is taking steps to counter them.

Health Secretary Shona Robison MSP told the BBC[iii]: "This report includes recommendations which are very similar to those made in other recent reports from Audit Scotland, to which we are already responding.

"We do not believe the report fully takes into account the further £250m investment we have made in our 2016/17 budget for health and social care partnerships, or the impact that funding will have."

[i] Audit Scotland Report homepage: http://www.audit-scotland.gov.uk/report/changing-models-of-health-and-social-care-0

[ii] Audit Scotland News Release 3 December 2015 http://www.audit-scotland.gov.uk/uploads/docs/report/2015/nr_151203_health_socialcare_pr.pdf

[iii] BBC News Website: http://www.bbc.co.uk/news/uk-scotland-35768504