Tag: Auditor General for Scotland

Audit Scotland: Care system reform ‘lacks clarity and accountability’

BROKEN PROMISE?

Plans to improve Scotland’s care system have been slow to come together after not enough early delivery planning by the Scottish Government and COSLA.

The Promise, a national commitment to improving the lives of care experienced people by 2030, was made by the Scottish Government in 2020.

Organisations and individuals remain dedicated to achieving that goal. But five years on, there is still confusion about what different bodies should be doing to deliver the changes needed.

Plans to date have lacked detail and direction for individual sectors. New structures set up by the Scottish Government to help deliver The Promise have lacked clarity about their roles and responsibilities.

And Scottish Government efforts to streamline The Promise’s complex governance arrangements have been insufficient. This has contributed to slow progress and made collective accountability challenging.

From the outset, there was no assessment of what resources and skills were needed to deliver The Promise by 2030, or how success would be defined or measured.

A framework to measure progress was agreed in December 2024 but further work remains. The Scottish Government is working on national data, which is not currently good enough to assess if services are improving the lives of care experienced people.

Stephen Boyle, Auditor General for Scotland, said: “Public bodies remain committed to improving Scotland’s care system and the lives of people who go through it. But initial planning about how The Promise would be delivered didn’t provide a strong platform for success.

“The Scottish Government needs to work with its partners to clearly set out the action that will be taken over the next five years to deliver The Promise, and how that work will be resourced.”

Angela Leitch, a member of the Accounts Commission, said: “Despite public bodies working hard to support local and national change to the services underpinning Scotland’s care system, greater pace and momentum is now needed.

“Local bodies need to work with their national partners to clarify roles and responsibilities, and prioritise the work needed to achieve The Promise’s aims.”

Commenting on the latest report on the Promise by the Auditor General and the Accounts Commission, Mary Glasgow, chief executive of Children First, said:  “This report makes it clear that time is running out to keep the Promise.

“Investing in prevention and whole family support is the best way to stop children going into care in the first place. No child should be taken into care because support isn’t available. 

“Real efforts have been made across Scotland over the last five years but as today’s report recognises, lack of clarity and accountability and failure to value and invest in the crucial role of the third sector are standing in the way.  

“Children can’t wait. At Children First our commitment to keeping the Promise is as strong as ever. But unless the recommendations of the Auditor General and the Accounts Commission are acted on immediately the Promise won’t be kept.”  

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Greater urgency needed to tackle flooding in Scotland’s communities

Whilst some public bodies and councils are working well together to tackle flooding, they face gaps in leadership, skills and data, and there is uncertainty about funding. This is limiting what can be achieved and opportunities to maximise the benefit of money spent are being missed.

Climate change is increasing the severity and frequency of flooding in Scotland, with almost 400,000 properties potentially at risk by 2080. But there is a risk that the action needed to prevent and tackle the already clear harms of flooding won’t happen at the scale and speed needed.

With the Scottish Government placing much more emphasis on flood resilience, there remain multiple barriers to effective collaboration across the public sector and to support communities. There is a lack of clarity in roles, responsibilities and funding. More also needs to be done to support communities to prepare for, and recover from, flooding.

The process for allocating funding for major flood schemes is currently not fit for purpose. Existing major flood schemes are taking longer to complete, with expected costs more than doubling to over £1 billion. This means that fewer homes and communities are protected than originally expected.

Stephen Boyle, Auditor General for Scotland said: “The Scottish Government and other public bodies must urgently address critical gaps in roles, responsibilities, information and data. Failing to do this risks ambitions to build communities that can better withstand and recover from flooding.

“Whilst there are good examples of the Scottish Government collaborating with councils, communities and other public bodies, this isn’t sufficient given the scale of future risks.

“It is vital that greater certainty and clarity about the funding available for major flood schemes is provided, with costs and impacts managed and measured, and national agreement on collaborating and engaging with communities secured.”

Andrew Burns, Deputy Chair of the Accounts Commission, said: “Communities are at the heart of future flood resilience. Whilst there are good examples of the work councils are doing, they face significant challenges. There are gaps in the data they need, uncertainty over funding and a shortage of skilled staff.

‘There are inconsistencies in the advice, money and support to enable communities to become both more resilient to flooding events and recover more quickly.

“These challenges need to be addressed by both local and national government.”

Audit Scotland: Clear vision needed for health and social care

The Scottish Government needs to develop a clear national strategy for health and social care to address the pressures on services.

Significant changes are needed to ensure the financial sustainability of Scotland’s health service. Growing demand, operational challenges and increasing costs have added to the financial pressures the NHS was already facing. Its longer-term affordability is at risk without reform.

Activity in hospitals and other secondary care settings has increased in the last year, but it remains below pre-pandemic levels and is being outpaced by demand. This pressure is creating operational challenges throughout the whole system and impacting staff, patient experience and patient safety.

There are a range of strategies, plans and policies in place for the future delivery of healthcare, but no overall vision. The absence of a shared national vision, and a clear strategy to deliver it, makes it more difficult for NHS boards to plan for change.

Stephen Boyle, Auditor General for Scotland, said: “Without change, there is a risk Scotland’s NHS will take up an ever-growing chunk of the Scottish budget. And that means less money for other vital public services.

“To deliver effective reform the Scottish Government needs to lead on the development of a clear national strategy for health and social care.

“It should include investment in measures that address the causes of ill-health, reducing long-term demand on the NHS. And it should put patients at the centre of future services.”

Responding to the Auditor General’s report on the state of Health and Social Care in Scotland Dr JP Loughrey, Royal College of Emergency Medicine Vice President for Scotland, said: “We welcome this report which addresses many of our recent and ongoing concerns – particularly around a lack of long-term planning and poor Emergency Department performance.

“The Scottish government must do more to address capacity and demand pressures. Hospitals are dangerously overcrowded and do not have the space, staff, or resources to provide safe and timely care for the number of patients who need it.  

“There needs to be long term strategies to maintain an adequate baseline in capacity and staffing, and deal with predictable surges in pressure.

“As we have seen time and time again across Scotland, there are simply not enough beds to meet demand and our hospitals are routinely almost fit to burst, with patients enduring long, undignified waits and demoralised staff forced to deliver treatment in inappropriate areas, such as corridors and car parks.  

“We urge the government to move away from short-term firefighting towards long term fundamental change to #ResuscitateEmergencyCare in Scotland.”

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Urgent action needed to address critical issues in delivery of social care

Action is needed now to change how Scotland’s social care services are delivered so that it meets the needs, and improves the experience of, people relying on care and support, say Scotland’s spending watchdogs.    

The joint briefing by the Accounts Commission and the Auditor General for Scotland says fundamental issues and threats to the future sustainability of Scotland’s social care system need to be addressed. The pandemic has exacerbated long-standing challenges, highlighting the precarious situation of many vulnerable people who rely on social care or support.  

Over £5 billion a year is spent on delivering social care services, yet some services are at near crisis point. There needs to be a shift in how this money is used, with a far greater emphasis needed on preventative care that meets the needs of individual people. Service users do not always have a choice or say about what support works best for them. Nor are carers getting all the support and advice they need, despite existing legislation.  

Now the Scottish Government, together with its partners, must listen and bring together the views and experiences of service users and carers. This will support the delivery of their long-held ambitions for social care. 

The 200,000-strong workforce is under immense pressure and feels undervalued. There is a high vacancy rate and a continuing problem of recruiting and retaining this workforce into roles which often have low pay and poor conditions of employment. At the same time demand for social care services continues to increase. 

Commissioning social care services tends to focus on cost, rather than quality or outcomes. Worrying limitations in social care data has created major gaps in the information needed to inform improvements.  

William Moyes, Chair of the Accounts Commission, said: “There are significant problems with the delivery of social care services. These services are vital, yet we have a workforce that’s not adequately valued or regarded.

“Staffing shortages are a major issue across the sector and not all people’s needs are being met. Too often a focus on costs comes at the expense of delivering high quality services that aren’t at the heart of the needs of individuals. The additional funding to achieve this will be significant. Not taking action now presents a serious risk to the delivery of care services for the people who depend on them.

Stephen Boyle, Auditor General for Scotland, said: “We cannot wait another five years until the planned National Care Service is in place. Action must happen now, and at speed, by the Scottish Government.

“There must be clear timescales for delivery, demonstrating that lessons have been learnt from previous reforms of health and social care services. This will create a strong foundation for the government’s vision to create a National Care Service.”

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COSLA’s Health and Social Care Spokesperson, Councillor Stuart Currie, responded to the Audit Scotland report on social care: ‘The Audit Scotland report sets out many of the challenges that Local Government has consistently highlighted for many years now.

“There is an urgent need to address these challenges – many of which have been exacerbated by the pandemic – by working with our partners across Scottish Government, in the third and independent sector, and most importantly, people with lived experience.  

“We agree with Audit Scotland  that Social Care reform cannot wait for a National Care Service to be implemented. Local authorities are central to delivering the right care at the right time in the right place.

“Local Government recognises that we cannot stand still if we want to create meaningful change for our communities. We continue to work with Scottish Government to progress our shared commitments outlined in our Joint Statement of Intent so that we can now begin to implement much of the reform that was called for in the Independent Review of Adult Social Care.

“Fundamental to these shared commitments is a recognition that through empowering people, valuing our workforce and embedding a human rights-based approach in social care, we can begin to deliver real solutions for our local communities, unpaid carers, and our workforce.”