Summary of recent Audit Scotland publications 1
Renfrewshire Council · 16 March 2026
Back to Audit, Risk and Scrutiny Board — 16 March 2026 and its agenda
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PUBLIC ___________________________________________________________________ To: Audit, Risk and Scrutiny Board On: 16 March 2025 ___________________________________________________________________ Report by: Director of Finance and Resources ___________________________________________________________________ Heading: Summary of recent Audit Scotland Publications ___________________________________________________________________ 1. Summary 1.1 Audit Scotland regularly publish national reports on matters relating to local government in Scotland. This report provides an overview on two recently published reports relating to health and social care. 1.2 The report “Delayed discharges – A symptom of the challenges facing health and social care” summarises some of the challenges facing all Integration Authorities (IAs) in Scotland and is covered in Section 3. Audit Scotland have collated information to show the number and impact of delayed discharges across Scotland and have set out steps for IAs to take to lessen the number of delays. 1.3 Section 4 gives an overview on the report “Community health and social care: Performance 2025”. It draws out the importance of quality data to allow IJBs and IAs to fully understand their performance and support effective decision making whilst highlighting the lack of comprehensive national performance information available. To aid comparison Audit Scotland have developed an interactive data tool. 2. Recommendations 2.1 It is recommended that members of the Audit, Risk and Scrutiny Board: • Note the content of this report.
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PUBLIC 3. Audit Scotland - Delayed discharges: symptom of the challenges facing health and social care. 3.1 In January 2025, Audit Scotland produced a report summarising the number of delayed discharges across Scotland and the impact these have on wider health and social care systems. The report assesses how well the challenges of reducing hospital delays are being addressed in Scotland and considers how authorities can work together to develop consistent approaches to reducing the number of delays. 3.2 The report notes that the number of delayed patients remains well above pre- pandemic levels with 720,119 clinically unnecessary days spent in hospital in 2024/25 resulting in 11.7% of hospital beds being unnecessarily occupied. Across local authorities there is significant variation in the number of delays. Between October 2024 and October 2025, delays at the monthly census point have ranged between 3.9 per 100,000 population in Renfrewshire (September 2025) and 152.5 per 100,000 population in Eilean Siar (March 2025). 3.3 Audit Scotland estimate the cost of these hospital days alone to be £440 million a year with the full cost to health and social care systems expected to be much higher. It notes reducing delayed discharges would not directly generate a cash saving as cost would transfer to other parts of the health and social care system. 3.4 The report highlights the pressures delays can create in the wider health system. In 2024/25 approximately one in nine hospital beds in Scotland were occupied by someone delayed in their discharge, most of whom are delayed due to the need for appropriate care arrangements. This considerably reduces beds available for incoming emergency and planned patients. The lack of beds also exacerbates pressures across ambulance services and increases stress on the workforce. 3.5 Audit Scotland recognise that the Scottish Government, IAs and their partners have actively targeted reducing delayed discharges to varying levels of success. They believe more needs to be done to effectively measure the impact and value of approaches and highlight inconsistency in the availability of outcome measures or published outcomes. Audit Scotland suggest that IAs should organise services around people’s needs rather than traditional service and professional boundaries however current financial challenges make this difficult. To achieve this collaborative leadership is a necessity.
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PUBLIC 3.6 In the report Audit Scotland reflect on the success of the Hospital at Home programme across Scotland. The programme has been implemented as a strategic response to alleviate delayed discharges by providing acute-level care in patients’ homes. This initiative aims to reduce hospital stays, free up bed capacity, and enhance patient outcomes. The programme has prevented an estimated 15,811 hospital admissions from April 2024 to March 2025, representing a ten per cent increase in the number of patients managed by Hospital at Home between April 2023 and March 2024. The report notes that, while there is some evidence that Hospital at Home can be more cost- effective than hospital-based care, the Scottish Government or Health Improvement Scotland (HIS) have not completed a full assessment to analyse the cost-effectiveness in relation to other models of community or home- based care. The Scottish Government has commissioned Public Health Scotland (PHS) to develop consistent national data on Hospital at Home activity. PHS plan to publish statistics quarterly from spring 2026 alongside updates by HIS on Hospital at Home improvement work. 3.7 The report puts emphasis on the importance on early identification, assessment and management of frailty. Early identification and management of frailty through the provision of community frailty services is important to allow people to live as independently as possible, avoid unnecessary hospital admissions, readmissions, and reduce length of stay, if hospital admission is required. 3.8 The report reflects the various factors that impact time of discharge. The report tells us that discharge planning should start immediately to ensure the right community care is available at the time of discharge. Including unpaid carers in the discharge planning process is crucial to a smoother discharge and reduced delays. Audit Scotland also highlight the importance of supporting people to have power of attorney in place and suggests wider promotion is needed. 3.9 Audit Scotland suggest that artificial intelligence (AI) and digital technology are powerful tools that can transform access to healthcare, improve efficiency and support long-term savings and better integration. With the growing challenge of an ageing population, workforce shortages and rising costs, Audit Scotland suggests IAs should work together to share learning and best practice from digital initiatives, as digital technology and digital innovations will be an important consideration in early intervention and prevention strategies. 3.10 Audit Scotland make recommendations to reduce the number of delayed discharges. Audit Scotland recommends that jointly the Scottish Government, NHS Scotland, COSLA, HIS, IAs and their partner NHS boards and councils should:
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PUBLIC • In the next six months publish guidance to clarify and strengthen the role of Integration Joint Boards and HSCPs in the governance and delivery of the health and social care service renewal framework. • Over the next twelve months develop a consistent approach to evaluating and reporting on initiatives to improve delayed discharges. Evaluation should be reported annually and include assessing effectiveness, value for money and whether the initiatives are improving the balance of care. • Over the next twelve months provide guidance on and better promote power of attorney and guardianship orders. • Over the next twelve months develop and action an implementation plan to share learning and practice from digital solutions used for tackling delayed discharges, early intervention and prevention. 3.11 Audit Scotland recommends that IAs and their partner NHS boards and councils should: • In the next six months ensure the full implementation of the Carers (Scotland) Act 2016 by understanding the discharge planning process and where this is failing to happen. Delayed Discharge: Renfrewshire Context 3.12 Renfrewshire HSCP has maintained its position as the highest performing Local Authority area in Scotland for standard delayed discharges for four years running and will continue to engage with national learning and share local good practice. 3.13 The latest monthly reporting for Renfrewshire at December 2025 shows a rate of 95.8 per 100,000 population for Standard Delays, and 737.5 Standard Delays per 100,000 for the financial year to date (Apr-November). This is 26.6% lower than the same period the previous year and is the lowest rate in Scotland. 3.14 In recognition of the national success of Hospital at Home Service, Renfrewshire HSCP, working in partnership with the Royal Alexandra Hospital (RAH) commenced a frailty-focused pilot in May 2025. By 31 December 2025, 91 patients had been supported by the service, delivering an estimated saving of 605 acute bed days, with an average length of stay of 5.8 days. The pilot was initially supported by a nine-month period of fixed-term funding from HIS alongside partner investment. However, based on the success of the pilot, the model is now being extended across NHSGGC.
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PUBLIC 3.15 The impact of Hospital at Home was highlighted at the IJB Meeting in January 2026 by sharing testimony from a lady who had first-hand experience of the new service. This example not only demonstrates the benefits of the Hospital at Home Service, but also shows how in times of need, different services across the system work in harmony to protect the most vulnerable people in our communities. The recording is available here. 3.16 In Renfrewshire, the importance of carers’ involvement in the discharge process is already reflected in the IJB’s Adult Carers Strategy. Hospital staff play a vital part in recognising carers. Raising awareness across hospital teams of their statutory rights remains a central focus. Our continued partnership working with the Social Work team at the RAH and Renfrewshire Carers Centre has resulted in the team consistently generating the highest number of referrals to the Carers Centre of all referral sources. This success demonstrates the impact of our joint approach, and the HSCP will look to reflect any further national guidance and learning as part of its refreshed Strategy, which is currently out for consultation. 3.17 Renfrewshire remains committed to maintaining its excellent discharge record through continuous improvement. Most recently the HSCP and NHSGGC have worked in partnership as part of a ‘system reset’ to support home recovery and reduce hospital occupancy. This included the launch of a new system-wide escalation process alongside new clinical pathways to help deliver and sustain this reduction so patients can access the care they need when they need it, and in the most appropriate setting. 3.18 More broadly, the HSCP has established a Foundations of Transformation Programme. This will inform the IJB’s new Strategic Plan, developing Renfrewshire’s longer-term response to system-wide challenges, including hospital pressures and the recognised need to change how the health and social care sector operates. Aligning with national direction, there will be a focus on prevention, whole system working, digital enablement and empowering both staff and service users. 3.19 Specifically for Older People Services the HSCP is initiating a whole system review to emphasise reablement and technology and digitally enabled proactive support. The new service model will aim to maximise people’s independence, improve outcomes whilst also reducing hospital admissions and demand for long term care. 4. Audit Scotland - Community Health and Social Care: Performance 2025 4.1 In January 2025 Audit Scotland published a briefing to accompany their online data tool. The briefing summarises the main findings as well as the limitations
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PUBLIC of the data available. Audit Scotland challenges members of IAs and HSCPs to consider how they can better use data to support planning, decision- making, improvement and public reporting of performance. 4.2 From the data Audit Scotland have collated a long-term picture of declining performance and satisfaction has been established as IAs and HSCPs are struggling to keep up with the increasing demand on health and social care. To address this the report tells us more progress is needed to shift the balance of care to the community with preventative approaches. 4.3 It reports that, unlike secondary care where waiting lists and times are monitored, it is not easy to define or measure demand for community health and social care. The lack of relevant data, or analysis of community health and social care data has been a common theme across many Audit Scotland reports. However, proxy measures can be used to indicate that pressures on services are growing such as the growing population, the number of unpaid carers and the enduring and widening of health inequalities. 4.4 The report highlights that the lack of an individual social care record puts limitations on the ease of gathering and processing information across all areas. The Scottish Government, alongside COSLA, have committed to address this as part of a wider programme to improve health and social care data and to digitalise access to health and social care services. The Health and Social Care Service Renewal Framework launched in June 2025, states that ‘We will build on the work already undertaken to identify gaps in our data landscape and make improvements’. It also states ‘We will work with partners across Local Government and more widely to adopt the use of CHI (Community Health Index) in Local Government, ensuring that there is a common identifier for verification and data matching to support better information sharing across organisations. This is a welcome development from Audit Scotland but will take time to fully develop. 4.5 Audit Scotland understands from the data collated there is considerable variation of performance across IAs and HSCPs for many indicators. The briefing tells us that this cannot be fully explained by local contextual differences nor is it explained in local performance reporting. They believe that IAs and HSCPs should report publicly on relative performance, including the impact of local priorities, policy and operational decisions. 4.6 Audit Scotland recommends that over the next six months IAs and HSCPs should: • Understand, explain and publicise their relative performance in terms of local context, priorities, policy and operational decisions.
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PUBLIC • Analyse performance alongside local data to support benchmarking, self-assessment and the development of improvement plans. Community Health and Social Care Performance: Renfrewshire Context 5.2 While the report highlights a long-term picture of declining performance and satisfaction nationally, Renfrewshire HSCP has worked hard to maintain its strong performance across the breadth of its services. However, as the report states, this is becoming increasingly challenging in light of increasing demand and complexity, at a time where IJBs are facing unprecedented resource pressures. 5.3 The performance reporting and localised data challenges outlined in the report are recognised locally, and the HSCP’s newly established Foundations of Transformation Programme will look to address these through a range of activities including: • Care designed around people and places: data and performance information will be core to establishing the baselines for transformation. The programme will focus on developing more detailed population profiles for all care groups across Renfrewshire. Work will also continue to build a more robust integrated overview of our data for all service users that can assist in exploring the most effective support models for the people of Renfrewshire. • Prevention across the continuum of care and proactive community- based interventions: developing the business case and evidence base to make a more fundamental shift to fully embed these practices across the beyond localised successes will be critical going forward. As the report acknowledges, it is less straightforward to measure prevention and early intervention performance compared to more traditional formal care services. Therefore, the programme will focus on baselining existing local preventative interventions and evaluating the evidence base for current interventions both within Renfrewshire and showcased in other areas. • Improvements to the Performance Framework: while robust IJB performance reporting is in place locally, including our Performance Scorecard and benchmarking of performance, there is always a need to review performance monitoring arrangements. With the clear national focus on prevention and shifting the balance of care, the performance framework will be refreshed and strengthened to demonstrate effective
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PUBLIC progress and improvement in our outcomes and to reflect new Strategic Plan priorities. 5.4 HSCP colleagues also continue to work with colleagues within Renfrewshire Council and NHSGGC to identify and address data quality challenges in a coordinated and consistent way, for example through membership of the Council’s Data Advisory Group. More widely, officers are also closely involved in working with Digital Office and Scottish Government colleagues through the Health & Social Care Digital subgroup to identify and develop national solutions to the data and reporting challenges highlighted within Audit Scotland’s report. __________________________________________________________________ Implications of the Report 1. Financial – none arising from the report, but Audit Scotland publications note the financial challenges facing local government in Scotland. 2. HR & Organisational Development – none 3. Community/Council Planning – none 4. Legal - none 5. Property/Assets – none 6. Information Technology - none 7. Equality & Human Rights – none 8. Health & Safety – none 9. Procurement – none 10. Risk – none 11. Privacy Impact – none 12. COSLA Policy Position – none, but the report makes reference to Audit Scotland recommendations impacting COSLA 13. Climate Risk- none 14. Children’s Rights: none
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PUBLIC _______________________________________________________ List of Background Papers: Audit Scotland - Delayed discharges: A symptom of the challenges facing health and social care Audit Scotland – Community health and social care: Performance 2025 __________________________________________________________________ Author: Hanna Dearie – Senior Policy Officer hanna.dearie@renfrewshire.gov.uk