Ayrshire Transformation Board
North Ayrshire Council · 20 May 2026
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NORTH AYRSHIRE COUNCIL 20 May 2026 North Ayrshire Council Title: Ayrshire Transformation Board Purpose: This report seeks the endorsement of North Ayrshire Council to participate in the Ayrshire Transformation Board (ATB), established to strengthen integrated working across North, East and South Ayrshire Councils, the three Integration Joint Boards and NHS Ayrshire and Arran. Recommendation: Council is asked to :- • Endorse the establishment of the Ayrshire Transformation board (ATB) as the formal senior officer structure for strengthening integrated working across East, North and South Ayrshire Councils, the three Integration Joint Boards and NHS Ayrshire and Arran. • Notes the agreed governance arrangements, including the ATB’s remit, membership, reporting structures, and its alignment with existing local and national oversight frameworks; • Approves the initial programme areas identified for system wide redesign; • Approves the Terms of Reference as set out in Appendix 1, and, • Note the content of the report. 1. Executive Summary 1.1 The Ayrshire Transformation Board (ATB) has been established by senior partners across Ayrshire to respond collectively to increasing financial, operational and performance pressures across health and social care. 1.2 The ATB provides a senior officer forum to oversee whole-system transformation, support improved flow, reduce variation and duplication, and progress shared priorities under a “Once-for-Ayrshire” approach. 1.3 The ATB does not replace existing statutory or local governance arrangements. Accountability for delivery, performance and financial control remains with each partner organisation, including North Ayrshire IJB.
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1.4 Each Council, Integration Joint board (IJB) and the NHS Board will confirm its own internal governance and reporting structure to ensure appropriate grip, control and delivery against agreed priorities. 2. Background 2.1 In February 2026, senior representatives from the three Ayrshire Councils, the three Integration Joint Boards and NHS Ayrshire and Arran met and agreed that further collective action was required to respond to escalating financial, operational and performance pressures across the system. 2.2 In order to deliver this, it is proposed to establish an Ayrshire Transformation Board to support the identification, investigation and recommendations for optimised performance, financial efficiencies and integration opportunities across the whole system in line with the ‘Once for Ayrshire’ ideology. 2.3 Integrated working and associated structures have been in place for over twelve years, beginning with the 2014 shadow year of IJBs and moving to full integration from 1 April 2015. These arrangements have served us well, including throughout the significant pressures of the COVID-19 pandemic. However, the scale and complexity of current challenges – including increasing demand, delayed discharge, Adults with Incapacity (AWI) delays and significant financial constraints – require enhanced system-level coordination. 2.4 Resources across health and social care are increasingly focused on critical need, limiting capacity for prevention and early intervention and placing further pressure on acute and community services. Over the past few years evidence demonstrates it is becoming increasingly difficult to manage financial and performance governance effectively across our current structures. All three Councils, Integration Joint Boards and NHS Ayrshire & Arran are operating within extremely challenging financial circumstances, and both community and acute services are experiencing growing waiting lists for assessment and treatment. 2.5 In communities, health and social care resources are increasingly being focused on critical need to provide essential personal care. Whilst this care is appropriate the increased utilisation of resources leaves a gap to fund preventative supports and early intervention that can improve the health and social circumstances of individuals and communities, and in so doing reduce demand on more acute services. 2.6 Given these pressures, it is essential for Ayrshire to take greater collective control and to work more closely and consistently. To support this, the following revised arrangements are proposed to strengthen integrated working and improve shared oversight and decision-making. The Ayrshire Transformation Board has been established to provide a structured mechanism to address these challenges collaboratively, without altering statutory responsibilities of the different organisations.
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ATB Structure and Programme Priorities 2.7 The diagram below shows the multi-layered governance and operational structure designed to oversee whole system transformation across health, social care and local authority partners within Ayrshire through the ATB. 2.8 The arrangement demonstrates clear hierarchy, flowing from the Ayrshire Executive Group through the ATB, and into the operational leadership provided by four Chief Executives, four Chief Officers, medical, nursing and social work leadership, and financial/digital professionals. This structure is intended to support whole system decision making, improve accountability, and co-ordinate transformation efforts across organisational boundaries. 2.9 At the core of the initial model are five major programmes: Shared Services/Lead Agency work, Right Care Right Place, Adults with Incapacity (AWI), Digital Transformation, and Communications. Together, these programmes reflect the major areas of system pressure and opportunity identified across the region. Shared Services and Lead Agency Approaches The shared-services programme explores opportunities for joint working across local authorities, IJB and health services. The emphasis is on what can already be achieved within existing terms and conditions, acknowledging that workforce policies may constrain progress but should not inhibit innovative proposals such as single management or single health and social care models. This strand reflects national trends in integration and aims to improve efficiency and reduce duplication.
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Right Care, Right Place The programme focuses on ensuring hospitals operate at optimal occupancy levels by improving flow, reducing delays, and shifting activity from acute settings into community-based care. The programme highlights the need for coordinated planning around bed numbers, delayed transfers of care, patient flow, commissioning, and the business case implications of releasing resources from acute to community settings. This aligns with ongoing national priorities around unscheduled care performance and demand management. Adults with Incapacity (AWI) Ayrshire is shown as a persistent outlier in the number and duration of transfers from hospital for people with complex care needs including AWI-related delays. The programme aims to address both the time required to progress each step of the AWI process and the underlying legislative constraints. The diagram signals options for further scrutiny of the experience of individuals and families and the potential to enhance clinical and multidisciplinary decision-making to improve patient journeys. The issue remains a significant contributor to delayed discharge pressure, and thus a priority for system transformation. Digital Transformation Digital remains a key enabler, with the diagram identifying data systems, shared platforms, and single patient or care records as areas where significant progress is still required. While national developments will support transformation, the regional opportunity lies in accelerating local integration, improving analytics capability, and modernising infrastructure to support both operational efficiency and clinical quality. Communications The final programme addresses the need for clearer and more coordinated communication across all partner organisations. Financial pressures, complex decision- making, and high levels of public and political scrutiny require improved messaging that enables shared understanding. This will be particularly critical as consultation exercises and community engagement around transformation programmes become more extensive. 2.10 The Terms of Reference (TOR) for the ATB are attached at Appendix 1. These provide clarity on purpose, scope, membership and reporting arrangements. Governance Structures 2.11 The governance structure outlines how assurance, performance, and transformation activity is overseen across NHS Ayrshire & Arran and its partners. The Scottish Government Assurance Board links directly with the NHS Ayrshire & Arran Board, which holds responsibility for organisational performance and oversight. The Board is supported by the Performance Governance Committee, ensuring scrutiny of delivery and risk.
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2.12 The Ayrshire Transformation Board connects the NHS structures with wider system partners including North Ayrshire Council and strengthens shared accountability between the Integration Joint Boards, Local Authorities, and the Health Board, emphasising the collaborative governance required for integrated service delivery across Ayrshire. 2.13 The Board will: • Enhance productivity and value for money through greater collaboration and integration • Ensure resources are directed as effectively and efficiently as possible towards improving resident’s care, safety and health outcomes • Identify redesign and transformation opportunities that will further improve services for the communities we serve • To consider the implications of national decisions through the new regional sub- planning arrangements for the East & West of Scotland for health services and the 3 Integration Joint Boards and NHS Ayrshire and Arran and any subsequent implications for Council services out with delegated functions to IJBs. The Board provides a leadership forum to identify and support the development and review of system-wide efficiency opportunities that focus on collaborative working and transformation/redesign to improve how services are delivered that reduce cost and improve outcomes for the whole Ayrshire Health and Care system. Each involved organisation will retain responsibility for their own strategic objectives and programmes of work aligned to their local delivery plans. 3. Proposals 3.1 North Ayrshire Council is asked to : • Endorse participation in the Ayrshire Transformation Board as a system-level transformation and coordination mechanism. • Note the agreed governance arrangements, Terms of Reference and reporting routes. • Support the initial identified programme areas, which are : • Shared services and lead agency approaches • Right Care, Right Place (flow and unscheduled care) • Adults with Incapacity (AWI) pathways • Digital transformation • Communications and engagement The ATB will make recommendations to partner organisations; any decisions requiring formal approval will continue to be progressed through existing North Ayrshire IJB governance routes.
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4. Implications/Socio-economic Duty Financial 4.1 Participation in system-level transformation activity may require targeted investment, particularly in digital infrastructure and service redesign. There is an expectation that the programme will support improved productivity, reduced duplication and better value for money over time. Any financial commitments arising will be subject to North Ayrshire approval processes and existing schemes of delegation. Human Resources 4.2 Transformation programmes may impact workforce roles, models of working and capacity. Potential benefits include improved workflows, reduced duplication and better use of skills. Risks include workforce pressure during transition and change fatigue. These will be managed through existing HR policies, workforce planning and staff engagement arrangements. Legal 4.3 The Ayrshire Transformation Board operates within existing statutory frameworks, including the Public Bodies (Joint Working) (Scotland) Act 2014. The Board has no delegated authority to make statutory decisions on behalf of North Ayrshire IJB. Legal accountability remains with individual partner organisations. Equality/Socio-economic 4.4 Full Equality Impact Assessments will be completed where proposals are sufficiently developed and where potential impacts on protected characteristics or socio-economic disadvantage are identified. This approach supports the Public Sector Equality Duty and the Fairer Scotland Duty. Climate Change and Carbon 4.5 None. Key Priorities 4.6 None. Community Wealth Building 4.7 None. Islands Communities Impact Assessment (ICIA) 4.8 Impact Assessments will be completed where proposals are sufficiently developed and where potential impacts on the islands are identified.
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United Nations Rights of the Child (UNCRC) 4.9 None. Consumer Duty 4.10 None. 5. Consultation 5.1 Senior officers from North Ayrshire Council, North Ayrshire IJB and NHS Ayrshire and Arran have been involved in the development of the proposals. Ongoing engagement with staff, partners, communities and service users will be progressed through the Communications programme and formal consultation will be undertaken where required. Craig Hatton Chief Executive For further information please contact Caroline Cameron, Director, on Carolinecameron@north-ayrshire.gov.uk. Background Papers 0
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