Many of the promised benefits of integrating health and social care in Scotland are yet to materialise, with patients only seeing “modest” improvements, an independent thinktank has said.

The Nuffield Trust said introducing shared structures like Integration Joint Boards has failed to promote a more fundamental culture shift towards joint working, with councils and the NHS sticking to “distinct accountabilities”.

In an assessment of integration in each of the four UK nations, the thinktank says: ‘For Scotland, satisfaction with social care and delayed transfers of care worsened over time, while there was no change in emergency admissions.’

The analysis found a similar pattern across the UK, finding a 'persistent mismatch' between stated objectives and what could realistically be achieved. ‘Over 20 years of reforms have translated into only modest improvements for patients across each country, which raises important questions about what integrated care can realistically achieve,’ it said.

A series of initiatives to promote partnerships between the NHS and local authorities have taken place in the last 20 years in Scotland, culminating in the move in 2014 to set up integration authorities from 2016.

The shared structures – most commonly known as Integration Joint Boards – brought together health boards and councils to manage community health and care services.

When they were introduced then-Health Secretary Alex Neil said the reforms would “make it easier for local systems to deliver joined-up, effective and efficient services.”

But seven years on, progress has been patchy and fragile, as the Scottish parliament’s health committee detailed earlier this year.

Mark Dayan, policy analyst at the Nuffield Trust, said Scotland had been a “pathfinder” on integration but some early goals have not been realised.

“There [has been] some shift towards community health services, but actually a shift out of social care as run by councils. So, the vision that health boards necessarily would transfer their money to social care services through IJBs has probably proven to be a bit optimistic.

“…I don't think that was exactly the ultimate aim of integration. But it would have been a sign that those structures were making really big difference.”

The Feeley review earlier this year recommended a further round of changes that would give IJBs direct funding and more responsibilities, ultimately answering to a new National Care Service.

Report author Derek Feeley said the changes would not be necessary if ‘more progress had been made…integrating health and social care’.

The proposals were welcomed by the head of the body representing IJBs, who admitted that complicated funding processes had led to “tension” between partners.

The Nuffield Trust said creating the joint boards may have not been enough to overcome “competing interests, pressures and obligations” of partner organisations, which “tend to default to distinct accountabilities rather than system working.”

The Scottish government’s proposals for a national care service replace IJBs with community health and social care boards and remove the direct role of overseeing them from the NHS and councils.

Mark Dayan said: “I think it's clear that IJBs have not really achieved the original aspirations for them, hence the renewed interest in another iteration of reform in Scotland.

“It's certainly possible that a more radical form of structural change could have more positive effects. And that, in a sense, is the experiment that Scotland will be trying with the National Care Service.”

But he added that Northern Ireland, which has had “radically integrated” health and social care for decades, is “really a warning about the idea that having health and social care under one organisational roof is going to lead to improvements – I think you’d be quite hard pressed to find somebody who would argue that in a Northern Irish context.

“That brings you back to the importance of people's culture and priorities – not just which HR system they're in. And also, a real sense of honesty and clarity about what exactly health and social care integration can or is wanted to achieve.”

Read more: What can England learn from Scotland on integration?; ‘Top down’ care review plans branded ‘huge mistake’; ‘Covid showed ministers should be in charge of care’

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