Better leadership is required from the Scottish government, the NHS and councils to improve community health services, according to a spending watchdog.
An Audit Scotland study said more effort is needed to transfer extra services from hospitals into the community through support for community health partnerships.
Health and social care services need to be joined up, and the watchdog said CHPs must have more authority to influence the spending of resources in their area.
Scotland’s complex and long-standing health and social care issues require all partners to work together on major reforms, the report by Audit Scotland said.
Individuals’ needs must be the focus of attention, with partnership arrangements coming under review.
The 36 CHPs in Scotland have faced major hurdles in achieving their ambitions when managing £3.2 billion in annual spending on health and social work.
While there are examples of good practice on a small scale, there is limited data showing widespread sustained improvements to services, the watchdog said.
The problems faced by CHPs come at a time of worrying health trends on a national level, with more older people and those with long-term problems needing emergency hospital care. These include people with chronic respiratory illness.
There was an initial reduction in delayed discharges from hospital but that is now rising again, adding to the challenge for CHPs.
Accounts Commission for Scotland chair John Baillie said: “In order for partnerships to deliver high quality services to people in their communities, there needs to be leadership and a shared vision at a local level.”
Theresa Fyffe, Royal College of Nursing (RCN) Scotland director, said: “The confusing and cluttered landscape of health and social care provision raises questions about how patients can understand where or how services are delivered. Not only that, and given the fragmentation of services and lack of vision and leadership that this report reveals, how are nurses on the ground supposed to provide a seamless service?”