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New models of healthcare needed in Scotland

‘Lack of leadership’ holding back change

Jo Carlowe

Friday, 11 March 2016

A lack of national leadership and clear planning is preventing the wider change urgently needed if Scotland’s health and social care services are to adapt to increasing pressures.

This is the finding from Audit Scotland, which in its report: Changing models of health and social care’, published this week, says new ways of working are needed to cope with growing pressures within the health service. Among other challenges, it lists an ageing GP workforce and a tough financial climate for public spending.

The report highlights the increasing numbers of frail, older people with complex health needs, noting that the number of people aged 85 and over in Scotland is expected to rise by two-thirds from 114,375 in 2014 to 187,219 in 2030, and double by 2034.

New approaches to health and social care are emerging in some parts of Scotland and the report features a selection of case studies demonstrating more innovative practice by public bodies. However, it notes that new models are generally small-scale; a widespread shift is not happening fast enough to deliver the Scottish Government's vision of enabling everyone to live longer, healthier lives at home or in a homely setting, by 2020, it concludes.

Caroline Gardner, Auditor General, said: "An ambitious vision can be a catalyst for change but, without a clear and detailed plan of action, there's a risk that ambition is overtaken by circumstances.

“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.”

She added: “The Scottish Government must produce comprehensive long-term plans for realising its 2020 Vision, and work to reduce the barriers that hold local bodies back from creating new ways of working that meet the changing needs of their communities.”

The report also references the pivotal role of health and social care integration in transforming how services are delivered, with new integration authorities (IAs) set to go live on 1 April 2016.

Douglas Sinclair, chair of the Accounts Commission, said: "This report shows that seeds of innovative practice are being sown in some parts of the country. NHS boards and councils must contribute to spreading that knowledge and good practice by working with integration authorities to build a clear picture of what the future of health and social care looks like in their local areas, and what resources must be invested to make that a reality.”

Chair of the British Medical Association, Scotland’s GP Committee, Dr Alan McDevitt said: “These huge challenges that the health service is facing means that changes are needed, but those changes must be resourced adequately if they are to succeed."

He called for more investment in general practice to deliver transformative change within primary care. 

Theresa Fyffe, director at the Royal College of Nursing, Scotland said: “This latest report from Audit Scotland echoes what we have been saying for many months: that the current pressures on our health and social care services are unsustainable and urgent change is needed in how we deliver these services if they are to be fit for the future.

“The whole system is creaking at the seams, with real-time budget cuts and increasing demand creating a perfect storm in health and social care services. And, as this report clearly shows, the transformational change which is needed to ensure services are sustainable is not happening nearly fast enough across the country.”

Earlier this week, a BMA survey revealed a GP recruitment crisis in Scotland

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