Significant risks must be addressed if a major reform of health and social care is to fundamentally change how services are delivered, and improve outcomes for the people who use them.
Integrating health and social care services is a key Scottish Government policy, focussed on meeting the challenges of Scotland's ageing population by shifting resources to community-based and preventative care at home, or in a homely setting.
A new report for the Accounts Commission and Auditor General has reviewed the progress made to establish new integration authorities (IAs), which will be responsible for planning joint health and social care services and managing budgets totalling over £8 billion by 1 April 2016.
While all 31 IAs are expected to be operational by the 1 April deadline, the report states that significant risks must be addressed if integration is to provide the substantial changes needed to health and social care.
These risks include difficulties with agreeing budgets, complex governance arrangements, and workforce planning. The report states that IAs must set clear targets and timescales to demonstrate how integrated services will deliver care differently, to better meet people's needs.
There is also evidence to suggest that IAs won't be able to make a major impact in their first year.
Douglas Sinclair, chair of the Accounts Commission, said:
"Millions of people in Scotland need and rely on health and social care services, and we know that demand is likely to increase in the years to come.
"Integration has the potential to be a powerful instrument for change, and the Scottish Government, NHS boards and councils have done well to get management arrangements in place. However, there's a real and pressing need for integration authorities to take the lead now and begin strategically shifting resources towards a different, more community-based approach to healthcare."
The report makes detailed recommendations to help the Scottish Government, IAs, councils and NHS boards address the issues identified.
Caroline Gardner, Auditor General for Scotland, added:
"The creation of new bodies responsible for £8 billion of public money is a significant and complex process, so it's important to recognise the early progress that's been achieved to date.
"If these new bodies are to achieve the scale and pace of change that's needed, there should be a clear understanding of who is accountable for delivering integrated services, and strategic plans that show how integration authorities will use resources to transform delivery of health and social care."