The increasing numbers of frail, older people with complex health needs is among the challenges facing health and social care services. The number of people aged 85 and over in Scotland is expected to rise by two-thirds from 114,375 in 2014 to 187,219 in 2030, and double by 2034.
A new report for the Auditor General and the Accounts Commission looks at the growing need to create new ways of working to cope with the impact of these and other pressures, including an ageing GP workforce and a tough financial climate for public spending.
New approaches to health and social care are emerging in some parts of Scotland and the report features a selection of case studies demonstrating more innovative practice by public bodies.
However, it notes that new models are generally small-scale; a widespread shift is not happening fast enough to deliver the Scottish Government's vision of enabling everyone to live longer, healthier lives at home or in a homely setting, by 2020.
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.
"Current health and social care models are unsustainable but with the right services in place, many people could avoid unnecessary admissions to hospital, or be discharged more quickly. This will have benefits for service users, and for the staff who work extremely hard in challenging circumstances to deliver health and social care.
"The Scottish Government must produce comprehensive long-term plans for realising its 2020 Vision, and work to reduce the barriers that hold local bodies back from creating new ways of working that meet the changing needs of their communities."
The report also references the pivotal role of health and social care integration in transforming how services are delivered, with new integration authorities (IAs) set to go live on 1 April 2016.
In their first in a series of reports on the progress of integration, the Auditor General and Accounts Commission recommended in December 2015 that IAs need to be clear about how they will use resources to integrate services and improve outcomes.
Douglas Sinclair, chair of the Accounts Commission, said: "This report shows that seeds of innovative practice are being sown in some parts of the country. NHS boards and councils must contribute to spreading that knowledge and good practice by working with integration authorities to build a clear picture of what the future of health and social care looks like in their local areas, and what resources must be invested to make that a reality."