THE lack of leadership provided by the Scottish Government to realise their own vision for the future of the NHS has been exposed in a stinging report.

Audit Scotland, the nation's official public spending watchdog, says the government had not explained how it expected its grand plan to be delivered and its cost implications remain "unknown".

They warn the overarching aim of caring for the frail better in the community to help keep them out of hospital "is not happening fast enough to meet the growing need".

Real terms decreases in NHS spending over the last five years and on-going cuts to council budgets "pose risks" to making progress with this aim, according to the report which notes the number of over 75s in Scotland will soon be growing by 16,000 every year.

Even the Scottish Government's much trumpeted policy of merging NHS and council social care budgets under new care partnerships appears to be off to a shaky start. With just weeks to go before the new authorities take control of millions of pounds the report says they are struggling to agree how much money they have to spend.

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...

"The Scottish Government must produce comprehensive long-term plans for realising its 2020 Vision".

The 2020 Vision is the name given to the Scottish Government's strategy for looking after the growing elderly population by enabling people to live more healthily in their own homes. Priority areas for action were set out under this umbrella in 2013. However, the Audit Scotland report says: "This lacked a clear framework of how it expects NHS boards and councils to achieve this in practice, and there are no clear measures of success, such as milestones and indicators to measure progress. The cost implications of implementing the 2020 Vision are unknown and there is a lack of detail about the main principles of the policy. There is also slow progress in developing the workforce needed for new models of care and a lack of information about capital investment to support the 2020 Vision."

In bold type the report, called "Changing Models of Health and Social Care," says the transformational change required to make the vision a reality is not happening and the "Scottish Government needs to provide stronger leadership and a clear plan for implementing" it.

Communities which are trying new ways of working to shift the balance of care away from emergency hospital stays are highlighted in the report, with particular focus on the work of East Lothian Council.

But the report expresses concern about the lack of analysis of these initiatives to show what they cost and how well they work.

It notes the Scottish Government has provided "multiple short-term

funds to help local bodies implement change" but adds "these do not provide the level of funding or certainty to make large-scale sustainable changes".

Report author Jillian Matthew said: "We did expect them to be further ahead if they wanted to meet their ambitious vision and have more community based services in place by 2020."

Theresa Fyffe, director of the Royal College of Nursing Scotland, said the report echoed messages the college had been issuing for months. She said: “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.”

Prof Derek Bell, president of the Royal College of Physicians of Edinburgh, said the report brought into "sharp relief" the challenges faced by the new care partnerships.

However, Cllr Peter Johnston, health and social work spokesman for local authority body Cosla, said the report contained "little that is new".

Health Secretary Shona Robison said: "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. We are also making £13m available next year so that patients can get better access to general practice and mental health services in the community.

“The integration of health and social care is the most significant reform of care since the creation of the NHS. This transformational change is well on track, with all health and social care partnerships becoming fully operational on April 1. The integration of these services will allow people to move more effectively between hospitals and care settings, reducing delays in patients being discharged from hospital into more appropriate care settings – a key aim of our 2020 Vision."