Watchdog exposes crisis in £3 billion care network

A spending watchdog has attacked the management of community health services in Scotland in a “deeply disturbing” report.

Audit Scotland claims today that the bodies charged with overseeing community care have largely failed to deliver improvements, and that some did not even know how many staff they managed.

Its report paints a chaotic picture of Community Health Partnerships (CHPs), which are aimed at bringing council and health service staff together to plan services.

Audit Scotland called for a fundamental review of the entire CHP system, which is responsible for spending £3.2 billion a year.

Labour and the Conservatives described the findings as “damning and worrying” and urged the Scottish Government to launch a complete review of them.

Health Secretary Nicola Sturgeon said CHPs must change as they care for increasing numbers of elderly people.

The British Medical Association in Scotland said the report highlighted how the partnerships were “bureaucratic monoliths” caught up in their own internal processes rather than helping to organise services to meet patients’ needs.

Dr Dean Marshall, chair of the BMA’s Scottish General Practitioners Committee, said: “This is a highly critical report which confirms our experience of the management and performance of these organisations.

“It is deeply disturbing that, with responsibility for such a significant sum of NHS funding and despite the many bureaucrats that work for these organisations, their financial management, strategy and governance is so poor. That a CHP cannot say how many staff it has working within its structure, or how much it has spent on administration costs, is beyond belief.

“They have also spectacularly failed to bridge the gap between health and social care, a challenge that must be met in order to care for our increasingly elderly population.”

Councils, health boards and CHPs not sharing vision, priorities or resources for health and social care are among the problems, according to Audit Scotland.

It also found that, while funnelling money, CHPs had a lack of influence over the use of NHS funding.

In areas where they might have been expected to make a difference, such as reducing the number of patients blocking hospital beds by ensuring community care packages are in place, data suggests the problem is getting worse.

The number of elderly people rushed into hospital is also rising.

John Baillie, chair of the Accounts Commission for Scotland, said: “For a decade there has been a focus on improving partnership work between councils and NHS boards, however the added value of these partnerships is not clear. The report makes strong recommendations for all partners to address this together. Greater clarity is needed from councils and NHS boards about how money is currently spent and where this could be better targeted to make a positive difference to people’s lives.”

Robert Black, Auditor General for Scotland, said: “Stronger shared leadership is needed from all partners, with good engagement from GPs and other care professionals, to ensure services meet the needs of local people and are efficiently delivered.

“There should also be a fundamental review of the various partnership arrangements. There are certain core principles which are evident in successful partnerships and this report provides a framework to support NHS boards and councils working together to improve health and social care.”

Scottish Labour’s health spokeswoman Jackie Baillie, whose party had pledged a full review of CHPs, added: “The fact that a CHP cannot say how many staff it has working for it is simply staggering and highlights the pressing need for change.

“I urge the Scottish Government to undertake a wide-ranging review of the structure and function of CHPs to ensure they are fit for purpose. Doing nothing is simply not an option.”

Scottish Conservative spokesman Murdo Fraser agreed: “This is a very worrying report which confirms the management and governance of CHPs is extremely poor.

“Based on the findings of this report, we support calls for the Scottish Government to conduct a complete review of the structure and function of CHPs, as soon as possible.”

Jenny Stewart, of auditors KPMG, said: “Audit Scotland, in this very clear report, has highlighted a rather depressing picture of limited progress overall with much duplication; areas of inefficiency and – more fundamentally – health outcomes worsening in many CHP areas.”

Ms Sturgeon said: “Community Health Partnerships have to change. Planning care for increasing numbers of older people is one of our biggest national challenges, and health boards and councils need to work together far more closely.

“We want to see health and social care for adults delivered in an integrated way by NHS and council social work staff, and Community Health Partnerships will have to change to adapt to this.

“The finalised proposals for integration of social care will determine how CHPs are developed.”