Changes to the way care of older people is delivered are happening too slowly, and public money is being spent without any evidence as to whether it is effective, according to Scotland's spending watchdog.

Audit Scotland's report on the Scottish Government's Reshaping Care for Older People programme (RCOP) backs ministers' approach to rethinking services, which currently cost an "unsustainable" £4.5 billion a year, it says.

However, attempts to bring together the work of NHS boards and councils are not delivering results quickly enough, the report says, three years into a 10-year programme the Government says will improve services for older people.

In fact, Audit Scotland says results of the programme are poorly monitored, so ministers cannot be sure a £300 million change fund is being effective. "Without good information it is not possible to determine how RCOP is improving the lives of older people in Scotland," the report concludes.

Most initiatives financed under the change fund have been short-term and small-scale, it says, and few of the health and social care partnerships responsible for spending the money have demonstrated their work will mean fewer old people in institutional care, or better services in the community.

Audit Scotland also says the long-standing problem of how to transfer health board resources such as money from hospital budgets to deliver improved services in the community has not yet been solved. A Government target to double the proportion of the health and social care budget that is spent on care at home is being wildly missed, with the proportion spent currently dropping, not increasing, the report adds.

The report comes after The Herald launched a series of articles asking whether Scotland's health and care services are in the best shape to cope with the rising number of elderly patients.

Auditor General for Scotland Caroline Gardner said: "Reshaping the care Scotland's older people receive is a large and complex programme, involving many organisations and significant amounts of public money. While there has been progress, particularly in bringing bodies together, change has been slow.

"We want to see better information for making decisions and assessing impact, and the Government and its partners to be clearer about how to move resources from institutions, like hospitals, to community-based services."

Theresa Fyffe, director of the Royal College of Nursing (RCN) Scotland, said the report raised serious questions about Scottish Government Policy.

She added: "Pressures on ­hospitals are growing due to increasing admissions of older people yet the Change Fund is yet to have any meaningful impact, and there is no shift of care from hospitals to the community."

Brian Sloan, chief executive of Age Scotland, said the care of older people was a challenge requiring a fundamental shift in approach. Scottish Conservative health spokesman and deputy leader Jackson Carlaw MSP said the report showed the Scottish Government needed to do better.

A spokeswoman for the Scottish Government said: "This report looks at the first two years of a 10-year programme and does not fully reflect some of the excellent work happening in local communities, which the recently published report from the Joint Improvement Team has already highlighted.

"Local partnerships are already developing robust systems for assessing progress locally and are using this information to help inform how they commission services in the future."