260618 IJB Agenda
North Ayrshire Council · 18 June 2026
Back to Integration Joint Board — 18 June 2026 and its agenda
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1 Integration Joint Board Meeting Thursday, 18 June 2026 at 14:00 Council Chambers, Cunninghame House, Irvine / Hybrid via Microsoft Teams Meeting Arrangements - Hybrid Meetings This meeting will be held on a predominantly physical basis but with provision, by prior notification, for remote attendance by Elected Members in accordance with the provisions of the Local Government (Scotland) Act 2003. Where possible, the meeting will be live-streamed and available to view at https://north-ayrshire.public-i.tv/core/portal/home. 1 Apologies 2 Declarations of Interest Members are requested to give notice of any declarations of interest in respect of items of business on the Agenda. 3 Minutes The accuracy of the Minutes of the meeting held on 30 April 2026 will be confirmed and the Minutes signed in accordance with Paragraph 7 (1) of Schedule 7 of the Local Government (Scotland) Act 1973 (copy enclosed). 4 Director’s Report Submit report by Caroline Cameron, Director (NAHSCP), on developments within the North Ayrshire Health and Social Care Partnership (copy enclosed). 5 Director of Public Health Annual Report Submit report and receive presentation by Sally Amor, Public Health Consultant (NHS Ayrshire and Arran) on the Director of Public Health Annual Report (copy enclosed). 6 Children’s Service Plan Performance Report Submit report by Lauren McMath, Policy Officer (Children’s Services) on the Children’s Service Plan Performance Report (copy enclosed). 1
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2 7 2025-26 – Year End Financial Performance Submit report by Eleanor Currie, Chief Finance Officer and Section 95 Officer, on the IJB’s financial performance for the year ended 2025-26 and the implications for the IJB’s overall financial position (copy enclosed). 8 Eligibility Criteria Monitoring Report Submit report by Scott Hunter, Chief Social Work Officer on HSCP’s implementation of the changes to the Eligibility Criteria to critical only (copy enclosed). 9 Self-Directed Support (SDS) Policy Submit report by Scott Hunter, Chief Social Work Officer on the Self-Directed Support Policy (copy enclosed). 10 Ayrshire Transformation Board – Right Care, Right Place Submit report by Caroline Cameron, Director (NAHSCP) on the Ayrshire Transformation Board (ATB), specifically in relation to the Right Care, Right Place programme of work (copy enclosed). 11 Trindlemoss Court Submit report by Thelma Bowers, Head of Service (Mental Health) on the proposal for the future delivery of care provision in Trindlemoss Court Supported Accommodation in Irvine (copy enclosed). 12 Ward 7A Option Appraisal Submit report by Thelma Bowers, Head of Service (Mental Health) on the Option Appraisal process and the commencement of next steps towards delivery (copy enclosed). 13 Whistleblowing Quarter 3 Report: October – December 2025 Submit report for information in relation to whistleblowing concerns raised in Quarter 3 (October – December 2025) (copy enclosed). 14 Strategic Planning Group Meeting Minutes Submit for information the minutes of the Strategic Planning Group Meeting on 26 November 2025 and 25 February 2026 (copy enclosed). 15 Urgent Items Any other items which the Chair considers to be urgent. 2
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3 Webcasting Please note: this meeting may be filmed/recorded/live-streamed to the Council's internet site and available to view at https://north-ayrshire.public- i.tv/core/portal/home,where it will be capable of repeated viewing. At the start of the meeting, the Provost/Chair will confirm if all or part of the meeting is being filmed/recorded/live-streamed. You should be aware that the Council is a Data Controller under the Data Protection Act 2018. Data collected during the webcast will be retained in accordance with the Council’s published policy, including, but not limited to, for the purpose of keeping historical records and making those records available via the Council’s internet site. Generally, the press and public will not be filmed. However, by entering the Council Chambers and using the press or public seating area, you acknowledge that you may be filmed and that any information pertaining to you contained in the video and oral recording of the meeting will be used for webcasting or training purposes and for the purpose of keeping historical records and making those records available to the public. In making this use of your information the Council is processing data which is necessary for the performance of a task carried out in the public interest. If you have any queries regarding this and, in particular, if you believe that use and/or storage of any particular information would cause, or be likely to cause, substantial damage or distress to any individual, please contact dataprotectionofficer@north-ayrshire.gov.uk 3
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4 IJB Sederunt Voting Members Joyce White (Chair) NHS Ayrshire & Arran Cllr Chloe Robertson (Vice- Chair) North Ayrshire Council Cllr Tom Marshall North Ayrshire Council Cllr Anthea Dickson North Ayrshire Council Cllr Nairn Angus-McDonald North Ayrshire Council Linda Semple NHS Ayrshire & Arran Tom Hopkins NHS Ayrshire & Arran Marc Mazzucco NHS Ayrshire & Arran Professional Advisors Caroline Cameron Director Eleanor Currie Interim Chief Finance Officer Aileen Craig IJB Monitoring Officer Iain Jamieson Clinical Director Scott Hunter Chief Social Work Officer – North Ayrshire Thelma Bowers Mental Health Adviser Julie Barrett Associate Nurse Director Vacancy Acute Services Representative Dr Louise Wilson GP Representative Sharon Hackney Lead Allied Health Professional Lisa Davidson Public Health Representative Wendy Van Riet Director of Psychological Services Stakeholder Representatives Lorna Sim Staff Rep - NHS Ayrshire and Arran Lynda MacFarlane Staff Rep Vacancy Carers Representative Vacancy Service User Representative Vacancy Independent Sector Representative Vicki Yuill Third Sector Representative 4
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North Ayrshire Health and Social Care Partnership Minute of Integration Joint Board meeting held on Thursday 30 April 2026 at 10.00 a.m. involving participation by remote electronic means and physical attendance within the Council Chambers, Irvine. Present (Physical Participation) Voting Members Joyce White, NHS Ayrshire and Arran (Chair) Councillor Chloe Robertson, North Ayrshire Council (Vice-Chair) Councillor Anthea Dickson, North Ayrshire Council Tom Hopkins, NHS Ayrshire and Arran Professional Advisers Caroline Cameron, Director of Health and Social Care Partnership Thelma Bowers, Head of Service (Mental Health) (NAHSCP) Eleanor Currie, Chief Finance and Section 95 Officer Scott Hunter, Chief Social Work Officer Sharon Hackney, Lead Allied Health Professional Lisa Davidson, Public Health Representative Stakeholder Representative Lynda McFarlane, Staff Representative Present (Remote Participation) Voting Members Councillor Nairn Angus-McDonald, North Ayrshire Council Professional Advisers Iain Jamieson, Clinical Director In Attendance (Physical Participation) Elizabeth Stewart, Head of Service (Children, Families & Criminal Justice) Kerry Logan, Head of Service (Health and Community Care) Karen Andrews, Team Manager (Governance) Stuart MacMillan, Principal Manager (Planning, Performance and Transformation) Annie Johnson, Principal Manager (Business Support) Ruth Wilson, Team Leader (Litigation) Eilidh Reid, Marketing & Digital Assistant (Communications) Hayley Young, Senior Committee Services Officer Apologies Agenda Item 3 5
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Councillor Tom Marshall, North Ayrshire Council Marc Mazzucco, NHS Ayrshire & Arran Linda Semple, NHS Ayrshire and Arran Julie Barrett, Associate Nurse Director/ Lead Nurse Vicky Yuill, Third Sector Representative Lorna Sim, Staff Representative NHS Ayrshire and Arran Loretta Galloway, Unity Enterprise Aileen Craig, IJB Monitoring Officer 1. Apologies for Absence Apologies for Absence were noted. 2. Declarations of Interest There were no declarations of interest in terms of Standing Order 7.2 and Section 5.14 of the Code of Conduct for Members of Devolved Public Bodies. 3. Minutes The accuracy of the Minutes of the meeting held on 13 March 2026 were confirmed and the Minutes signed in accordance with Paragraph 7(10 of Schedule 7 of the Local Government (Scotland) Act 1973. 4. Director’s Report Submitted report by Caroline Cameron, Director (NAHSCP) on the developments within the North Ayrshire Health and Social Care Partnership. Officers responded to members’ questions on various aspects of the report. Noted. 5. HSCP Locality Planning Arrangements Submitted a report by Stuart Macmillan, Principal Manager (Planning, Performance & Transformation) on the revised locality planning arrangements aligned with Community Planning Partnership (CPP) locality structures. Officers responded to members’ questions on various aspects of the report. The Board agreed to approve the proposed integrated CPP & HSCP locality planning model and the associated implementation approach. 6. Best Value Statement 2025 Submitted report by Eleanor Currie, Chief Finance Officer and Section 95 Officer (HSCP) on the Best Value Statement 2025 – 26, set out at Appendix 1 to the report. Officers responded to members’ questions on various aspects of the report. The Board agreed to approve the Best Value Statement set out at Appendix 1 to the report. 7. Risk Appetite Statement 6
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Submitted report by Eleanor Currie, Chief Finance Officer and Section 95 Officer (HSCP) on the Risk Appetite Statement, set out at Appendix 1 to the report. Officers responded to members’ questions on various aspects of the report. The Board agreed to approve the Risk Appetite Statement set out at Appendix 1 to the report. 8. Strategic Risk Register Submitted report by Eleanor Currie, Chief Finance Officer and Section 95 Officer, on the Strategic Risk Register, set out at Appendix 1 to the report. Officers responded to members’ questions on various aspects of the report. The Board noted that the wording of SRR12 - Clinical Care and Governance would be updated. The Board agreed to approve the updated Strategic Risk Register set out at Appendix 1 to the report. 9. Ayrshire Transformation Board Submitted report by Caroline Cameron, Director (NAHSCP), on the participation 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. The Terms of Reference for the Ayrshire Transformation Board was set out at Appendix 1 to the report. Officers responded to members’ questions on various aspects of the report. The Board agreed to (a) endorse the establishment of the Ayrshire Transformation boar (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; (b) note the agreed governance arrangements, including the ATB’s remit, membership, reporting structures, and its alignment with existing local and national oversight frameworks; (c) approve the initial programme areas identified for system wide redesign; (d) approve the Terms of Reference as set out in Appendix 1 to the report; and (e) note the content of the report. Councillor Angus-McDonald sought clarification on the interim Carers representative. The Legal officer confirmed that a named depute would require to be nominated to attend the IJB. The meeting ended at 11.30 a.m. The full meeting proceedings can be viewed at https://north-ayrshire.public-i.tv/core/portal/home 7
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Integration Joint Board 18th June 2026 Subject : Director’s Report Purpose : This report is for awareness to advise members of North Ayrshire Integration Joint Board (IJB) of developments within North Ayrshire Health and Social Care Partnership (NAHSCP) Recommendation : IJB members are asked to note progress made to date. Direction Required to Council, Health Board or Both Direction to :- 1. No Direction Required X 2. North Ayrshire Council 3. NHS Ayrshire & Arran 4. North Ayrshire Council and NHS Ayrshire & Arran Glossary of Terms NHS AA NHS Ayrshire and Arran IJB Integration Joint Board HSCP Health and Social Care Partnership HMIPS His Majesty’s Inspector of Prison Services SSC Scottish Sentencing Council RCN Royal College of Nursing KFA Kilwinning Football Academy SSSC Scottish Social Services Council SDS Self Directed Support FAQ Frequently Asked Questions CPC Child Protection Committee NAADP North Ayrshire Alcohol and Drug Partnership NADARS North Ayrshire Drug and Alcohol Recovery Service 1. EXECUTIVE SUMMARY 1.1 This report informs members of the Integration Joint Board (IJB) of the work undertaken within North Ayrshire Health and Social Care Partnership (NAHSCP), nationally, locally and Ayrshire wide. Agenda Item 4 8
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2. BACKGROUND 2.1 This report provides IJB with up to date information on recent activity across the HSCP since the last IJB. 3. CURRENT POSITION National Developments 3.1 IJB Membership / Voting Rights With effect from 1 September 2026, members representing the third sector, service users and unpaid carers have full voting rights on the Integration Joint Board, as provided for by The Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Amendment Order 2025 (“the 2025 Order”). National guidance is being developed to support changes to Integration Schemes, Standing Orders, Codes of Conduct and provide further guidance on the principles to support lived experience members. Final national guidance may not be provided until late Summer, early work has started in North Ayrshire in conjunction with our Monitoring Officer and legal advisors to prepare the changes required to key governance documents to be brought back to the IJB after the summer recess. We have gaps in membership of the North IJB for both service user and carers representatives. We aim to address these vacancies over the summer period in conjunction with the Chair and Vice Chair of the IJB and will keep IJB members updated on progress. 3.2 Inspection of Justice Social Work Services – 2026/27 The Care Inspectorate recently advised of their justice social work scrutiny intentions for 2026/2027. A series of online awareness sessions for justice social work strategic and operational leads have been announced which are intended to raise awareness of the intentions and to build familiarity with the inspection methodology. Separate, formal inspection notifications will be sent to the relevant area(s) in due course. During 2026/2027 the Care Inspectorate will undertake single agency inspection of justice social work services. The focus is on the delivery of community payback orders, including: • the efficient identification of, and response to, risk and need • the quality of risk assessment • the effectiveness of case management in supporting desistance from offending and, • reducing/managing risk of harm. The inspection approach in selected local authority areas will include: 9
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• Self-evaluation and supporting documentary evidence • Review of records for people on community payback orders • Anonymised survey to gather the views of staff • In-person and online focus group and discussions 3.3 Prison Based Social Work Review – Phase 2 Report The Care Inspectorate recently shared the ‘Prison-based social work review: phase 2 report’, on their website at: Prison-based-social-work-review-phase-2-report-may- 2026.pdf Undertaken in partnership with colleagues from HMIPS, the review focuses on the use of the LS/CMI assessment and planning method within key SPS decision-making forums. It will also consider how people in custody were involved in the key processes which affect their journey through custody to community and sought to highlight what is working well, and identify any barriers to efficient and effective practice. The report notes improvement actions to be taken forward by the Scottish Government, the Scottish Prison Service, justice social work services, and other key partners. 3.4 Consultation on Draft Sentencing Guidelines or Domestic Abuse Offences The Scottish Sentencing Council (SSC) is running a public consultation on draft sentencing guidelines for domestic abuse offences. The guidelines will apply to all offenders convicted of an offence involving domestic abuse. There can be particular challenges in sentencing these offences, including the potentially broad variety of circumstances, and the need to consider the protection of the victim in a domestic context. The guidelines make it clear that these offences can cause particularly damaging harm to those impacted by the abuse, including children, and can inflict lasting trauma. By listing some of the considerations and factors that should be taken into account, it is hoped that the guidelines will help the courts to decide appropriate sentences and assist public understanding of how these decisions are reached. The public consultation on the draft guidelines is now open, and the SSC is keen to hear from all those with an interest in this work. You can take part in the consultation online until Thursday 6 August. 10
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Ayrshire Wide Developments 3.5 Star Centre Helpline for Women and Girls The Star Centre offers trauma-informed support for women and girls aged 13+ from across Ayrshire who have been affected by sexual violence, abuse, or sexual exploitation. The charity has recently launched a new helpline which aims to provide a safe and confidential space for anyone seeking emotional support, information, or advocacy support - no matter when the experience happened. The helpline is open from 2pm to 5pm on Mondays, and 11am to 2pm on Thursdays, and can be contacted on 07850 214805. Additionally, a text service will run during these hours, which can be contacted on 07850 214803, and instant messaging is also available via the website during the helpline opening hours. The charity can also be contacted by emailing support.mail@starcentreayrshire.org North Ayrshire Developments 3.6 North Ayrshire Mental Health Arts Festival 2026 – Submit your event ideas Planning is under way for this year's North Ayrshire Mental Health Arts Festival, taking place from Tuesday 20 October to Monday 9 November. This year’s festival theme is ‘Reflections’, inviting creative responses that explore mental health, wellbeing, lived experience, and personal or collective reflection. We are now inviting individuals, creatives, groups, services, and partner organisations to submit ideas for events or activities to be included in this year’s festival programme. Proposals were to be submitted via the online registration form by no later than Monday 15 June. Submissions should range from an early concept or idea through to a fully confirmed event. 3.7 Care Inspectorate Inspection – Canmore, Kilwinning A recent unannounced inspection, carried out on 12 and 13 May 2026, took place at Canmore Children’s House in Kilwinning. The service was assessed against the quality indicator “How well do we support children and young people’s rights and wellbeing.” The outcome of the inspection was graded as 5 – Very Good, reflecting a high standard of care with notable strengths. 11
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Inspectors highlighted significant strengths in how care is being delivered, recognising in particular the staff team’s strong commitment to supporting children and young people to maintain meaningful connections with their families and friends. This was identified as a key area of practice, with the service noted to excel in this aspect of delivery. Relationships between staff and young people were also noted to be characterised by trust, warmth and respect, further underpinning the quality of care provided. Overall, Canmore Children’s House was described as both innovative and aspirational, demonstrating a proactive approach to promoting positive outcomes and upholding the rights, wellbeing and relationships of the children and young people in their care. 3.8 Hub Team Lifts Top National Nursing Award The Mental Health Unscheduled Care Assessment Hub, based at Woodland View Hospital in Irvine, was announced as the winner of the Mental Health Nursing Award category at the RCN Scotland Nurse of the Year Awards ceremony recently. The award recognises those who have succeeded in raising standards of care for their patients and clients and have made an outstanding contribution to the care of service users. You can read more on the NHS A&A website. This is a fantastic achievement, so congratulations to all involved. 3.9 Dads Workers Receive Community Champion Award Congratulations to Dads Rock, who won the North Ayrshire Charity Champion of the Year category at the North Ayrshire Community Champion Awards 2026. The event, which was held on Friday 24 April at the Waterside Hotel in West Kilbride, recognises, rewards, celebrates and honours the achievements and endeavours undertaken in our communities throughout North Ayrshire. A huge well done to all involved on this fantastic achievement. 12
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3.10 Funding boost from Unpaid Work Team Our Justice Services Community Payback Unpaid Work team offers a range of hand-built wooden items, including picnic tables, garden benches/chairs, wheelie bin storage sheds, planters and birdhouses, as well as its ever-popular festive reindeer ornaments. While these items are not built for profit, any small surplus accumulated throughout the year is donated to local charities or organisations, with multiple charities having benefitted over the years. The chosen charities this year were Café Solace and Andy’s Man Club in Dreghorn, who were recently each presented with cheques for £1,142.73 to put towards the important work they do in our North Ayrshire communities. If you’d like a catalogue of the available items to browse, please contact unpaidworkreferral@north-ayrshire.gov.uk and use the word ‘Order’ in the subject section of your email. 3.11 Wellbeing Boost for Young People at Tournament The Young Person’s Support Workers within our Kilwinning locality team have been collaborating with Youth Scotland and Kilwinning Football Academy (KFA) on several initiatives to enhance the health and wellbeing of young people at Kilwinning Academy. Staff recently arranged for 14 young people from the school to attend Youth Scotland’s ‘stand up to sectarianism’ football tournament at KFA park, alongside 12 young people from Greenwood Academy. The event was a big success, with four seven-a-side teams competing for trophies. our teams were recognised as ‘star team’ and ‘future rising stars’, with the boys proudly returning to Kilwinning Academy with their trophies and a donation of footballs, bibs and training cones from Youth Scotland. The positive interaction and teamwork between the two schools on the pitch highlighted the real benefits of these events. This continued after the games, as everyone socialised over hotdogs, drinks and snacks provided by KFA. Every young person who attended will also receive a HI5 award and certificate. 13
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The Young Person’s Support Workers are extremely grateful to the staff from Youth Scotland and Kilwinning Football academy for their continual investment in young people within the community. 3.12 Carers Money Matters Programme Success Earlier this year, Carers Gateway North Ayrshire participated in the Carers Money Matters programme, run in conjunction with Carers Trust. This was able to help 267 carers and families from North Ayrshire, with £25,500 in micro-grants from the Carers Gateway and a further £20,000 in benefits and energy efficiency savings. One North Ayrshire family benefited from a brand-new central heating system after being referred to Home Energy Scotland. For every £1 spent, £2.25 was generated in social value, helping carers to access £45,500 in potential income or savings. The programme has now ended, and the Carers Gateway would like to thank everyone who promoted the programme and helped to make it a success. 3.13 New Case Study Looks at Work of Peace of Mind Peace of Mind is an innovative programme operating in North Ayrshire that is aimed at reducing social exclusion and isolation, with a particular emphasis on people who do not receive statutory services but still need support. Through a person centred, social prescribing approach, Peace of Mind supports disabled people and those living with long term conditions to build confidence, improve wellbeing, and take control of what matters to them - whether that’s joining a local group, developing new skills, volunteering, or simply making meaningful connections. The Health and Social Care Alliance Scotland (ALLIANCE) has recently published a Connected Communities case study, which looks at how this flexible, community led support is making a real difference. You can access the article via the ALLIANCE website. You can also find out more about the programme by visiting the Peace of Mind website, emailing jim@peaceofmind.scot or calling 07824 727 694. 3.14 Sponsored Development Opportunity in Leadership and Management Chris Gilmour, Interim Senior Manager for the Community Mental Health Team, has recently successfully completed the Postgraduate Certificate in Management and Leadership at the University of Stirling. Chris is the first manager to be sponsored by NAHSCP to undertake this qualification, which he completed while transitioning into a new senior role within the HSCP. 14
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This qualification is recognised by the Scottish Social Services Council (SSSC) as appropriate for registered managers. It is designed for professionals working across health, social work, education, occupational therapy, and housing, with a strong emphasis on leadership and strategic planning. The programme at the University of Stirling has a strong reputation for supporting both new and experienced managers to build their leadership skills and confidence. Learning alongside peers from a range of sectors provides valuable insight into integrated service delivery and the cross-sector collaboration essential to modern practice. This qualification also complements the Systems Leadership Programme that Chris has completed, delivered by Horizons Research. Huge congratulations to Chris on his achievement. 3.15 New Self-Directed Support website is launched A new North Ayrshire Self-Directed Support website has been launched, offering a comprehensive source of clear information on the SDS options and how they work. The site also provides details around NAHSCP eligibility criteria, FAQs on employing personal assistants, and advice on Guardianship/Power of Attorney, as well as a list of useful links to legislation, guides, and practical tools/resources. A link to the new site can be found on the Care and Support in the Community section of the NAHSCP website. 3.16 ‘Pink March’ celebrates end of Charity Challenge Staff and customers at Trindlemoss Day Opportunities and Trindlemoss House took part in the ‘Walk 100 Miles in May’ challenge for charity Breast Cancer Now, with the ‘Trindle Trekkers’ clocking up the miles in a variety of ways - from walking and dancing, to rolling, bouncing, and even running. For the fundraiser’s grand finale last Friday, staff, customers and their families took part in a ‘Pretty Pink March’ from Trindlemoss into Irvine Town Centre and back, followed by a fun-filled ‘Pretty Pink Party’ in the afternoon. A great day was had by all. An impressive £2000 was raised for the charity, so a huge well done to all involved. 15
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3.17 Survey - Social Media Use in Young People North Ayrshire Child Protection Committee held an information gathering event at Greenwood Academy last year, attended by young people from across the region. Participants advised that they would prefer to see important information from NACPC via the social media platforms that they use, and the CPC is now in the process of designing content that will go out via North Ayrshire Youth Services social media channels. In order to help plan out this content, the social media habits of young people aged 11 and over will be examined to ensure that the content is designed to go out via the platforms they use most, and in a format they are most likely to engage with. A short, anonymous survey has been launched, that should take no longer than 10 minutes to complete. Young people can access the survey online, and the closing date is Tuesday 30 June. 3.18 Mental Health Services Carers Forum – June Event The next in our series of monthly Mental Health Services Carers Forum events will be held on Wednesday 24 June. It will run from 12.30pm to 2.30pm at Saltcoats Town Hall, with information from North Ayrshire Alcohol and Drug Partnership (NAADP) and North Ayrshire Drug and Alcohol Recovery Service (NADARS). For any additional information, email mentalhealthengagement@north- ayrshire.gov.uk or call Sam Hodkinson on 07392 128 928. 4. IMPLICATIONS 4.1 Financial None 4.2 Human Resources None 4.3 Legal None 4.4 Equality/Socio-Economic None 4.5 Risk None 4.6 Community Wealth Building None 4.7 Key Priorities None 16
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5. CONSULTATION No specific consultation was required for this report. User and public involvement is key for the partnership and all significant proposals will be subject to an appropriate level of Consultation. Caroline Cameron, Director [Carolinecameron@north-ayrshire.gov.uk/01294 317723] Appendices Nil 17
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Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 Agenda Item 5 18
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Health challenges Life expectancy not improving Living longer in poorer health Under pressure health care system Anchor Organisation Universal and targeted approaches Preventive potential Realistic Medicine Focus on prevention Safe relationships Education and Healthcare access Fair employment and adequate income Growing Well to Live Well: Understanding the Burden of Disease Introduction Where are we now? How can we improve the health of the community? Where do we hope to be? 19
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Growing Well to Live Well: Understanding the Burden of Disease Health as a Fundamental Human Right Health Inextricably Linked to Community and Planetary Wellbeing Health as a Resource for Life Human rights can also be understood as detailing the underpinning requirements for all people to grow, develop and live well in the context of family, community and civil life. In the absence of rights not being accessed or assured, health and wellbeing are compromised. Planetary health is a concept that focuses not only on human health but wider, on the health of our planet. Health is not only a privilege of human beings. Planetary health emphasises the interconnected nature of human health and environmental health. Understanding health as a resource for life demonstrates the interconnected nature of positive and negative experiences as people grow and develop through life journey experiences. 20
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2024 estimate birth rate Population Breakdown Growing Well to Live Well: Understanding the Burden of Disease Understanding the Population of Ayrshire and Arran 7.8365,256 population in 2022 Lower than the Scottish birth rate 13.9 2024 estimate death rate Higher than the Scottish death rate SIMD Most Deprived Least Deprived Urban/Rural Accessible Rural Accessible Small Towns Other Urban Areas Remote Rural Remote Small Towns 31% live in the most deprived area 61% live in urban areas Population decline 21
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Growing Well to Live Well: Understanding the Burden of Disease Cumulative Effects 19th Century In East Ayrshire, coal mining was the backbone of the local economy with deep pits spread across various towns like Cumnock and Auchinleck. East Ayrshire also thrived in ironworks and textile with mills in Kilmarnock producing carpets and wool goods. 20th Century De-industrialisation hit in the late 20th century and coal mines began to close and major employers moved elsewhere, such as the Johnnie Walker plant in Kilmarnock. 21st Century The economy has shifted towards public services, education, retail and tourism and former mining towns are being supported through rural development initiatives. East Ayrshire South Ayrshire The late 20th century marked the beginning of a sharp downturn. Major industries began to close and jobs went with them. These closures forced many skilled workers to leave the area in search of employment, leading to population decline and a weakening local economy. North Ayrshire thrived as a centre for industry, powered by sectors such as textiles, coal mining, ironstone extraction, and shipbuilding. Towns like Irvine, Kilbirnie and Kilwinning were bustling with mills, factories, and shipyards that provided employment and prosperity. Recently, the shutdown of the Hunterston B nuclear power station in 2022 added to the region’s challenges. Although the decommissioning process offers temporary employment, the long-term loss of a major employer raises serious concerns about future economic recovery. 19th Century 20th Century 21st Century Tourism started to expand in the 20th century with the golf industry expanding and increasing travel to Troon and surrounding areas. In the 19th century, South Ayrshire relied on agriculture and fishing for its economy. Ayr was a vital market town and port in the area, trading with other parts of Scotland and Ireland. Like East and North, South Ayrshire also had a mining sector. Tourism continues in South Ayrshire, alongside the public service, retail and hospitality industries. South Ayrshire is challenged by an ageing population, with increasing demand on services. 19th Century 20th Century 21st Century North Ayrshire Unemployment Mental Health Issues Substance Use Chronic Illness Demand on services 22
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Example of Burden of Disease Growing Well to Live Well: Understanding the Burden of Disease Life Course Opportunities to Realise Preventive Potential: Ayrshire and Arran Burden of Disease Preconception and Pregnancy Infancy Childhood Adolescence Young Adult Adult Older Adult Elderly Congenital Birth Defects Neonatal Disorders Skin & Subcutaneous Disorders Asthma Headache Disorders Under 15s Self-harm & interpersonal violence Drug Use Disorders Headache Disorders Low back & neck pain Depression 15-24 Drug Use Disorders Ischaemic Heart Disease Lung Cancer Depression Cirrhosis & other chronic liver diseases 25-64 Ischaemic Heart Disease Lung Cancer COPD Cerebrovascular Disease Alzheimer’s Disease & other Dementias 65-84 Alzheimer’s Disease & other Dementias Ischaemic Heart Disease Cerebrovascular Disease Lower Respiratory Infection COPD 85+ 23
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Ayrshire and Arran Interventions Growing Well to Live Well: Understanding the Burden of Disease Life Course Opportunities to Realise Preventive Potential Preconception and Pregnancy Infancy Childhood Adolescence Young Adult Adult Older Adult Elderly Safeguarding Midwifery Maternal Obesity Programme in Carrick Pan Ayrshire Practitioner Guide and Pathway ChildSmile Working for Wallacetown Ayrshire Sexual Health Secondary School Programme Youth Vaping Taskforce Migrant TB Screening Community Justice Ayrshire Partnership Ageing Well Spirometry Testing in South Ayrshire Local Conversations in East Ayrshire 24
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All people can thrive when their fundamental relational and basic wants and needs (income, food, housing, health care) are met. This supports the creation of resilience to negotiate and navigate the challenges that undoubtedly exist across life. In the absence of relational certainty, uncertainty over income, food and housing, people do less well; people rarely thrive in environments of enduring scarcity. Growing Well to Live Well: Understanding the Burden of Disease Life course framings bring additional awareness and opportunities to realise the preventive potential within the most challenged communities of Ayrshire where the consequences of societal and economic changes in the 1980s have had such devastating consequences: evidenced as too many young men and women living with the impact of drug and alcohol and mental health needs and distress, evidenced in high rates of drug, alcohol and suicide deaths before the age of 45 years. Realising the preventive potential for the populations of NHS Ayrshire and Arran will lead to benefits in the quality of life and experience of health across all income groups; with the greatest benefits for those experiencing the greatest challenges in family and community life and their experiences of health and wellbeing and premature, preventable death. Realising the preventive potential of health and social care services, where needs and risks are identified early and met in a timeous manner, will further contribute to a motivated and energised workforce and realise additional improvements in the experience of care and health potential of individuals. Actionable Insights 25
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Build a stronger understanding of how poverty and lack of opportunity affect people in the most disadvantaged communities across North, South, and East Ayrshire. Recommendations Growing Well to Live Well: Understanding the Burden of Disease Recommendation One Recognise the benefits of both universal and targeted approaches in using health as a resource for life: from before birth, through all life stages, and across generations: for individuals, families, and communities Recommendation Two Work with purpose, pace, and scale across systems and services to unlock this preventive potential for all Ayrshire citizens. Every partner should take responsibility and act within their sphere of influence to deliver the opportunities outlined in this report. Recommendation Three The 2026 Director of Public Health (DPH) Report will build on these themes. It will guide the planning and design of services that meet the diverse needs of people at different ages and life stages, from urban centres to remote towns and villages. This work will support the Caring for Ayrshire Action Plan: citizens at the centre of care, accessing the right care, in the right place, at the right time. Recommendation Four Key asks of the Public Health Department and all partners/programmes of work involves examining: ⚬ What is being delivering and how we ensure maximum impact (across a prevention continuum) to effect change in this space as a team. ⚬ How we demonstrate leadership and collaboration across the whole system to fully realise preventive potential. ⚬ How we ensure our work reaches those most affected by poverty and inequality, including rural and remote communities. ⚬ The gaps are in our current approach, and what practical steps we can take to close them. ⚬ How we embed prevention across all systems and services, not just in strategic plans. ⚬ What evidence demonstrates progress and impact across communities. Recommendation Five 26
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1 Growing well to live well: Understanding the burden of disease Director of Public Health report – Summary Introduction Scotland, and Ayrshire and Arran in particular, is facing significant challenges in health and wellbeing. Life expectancy is stalling for disadvantaged communities, and more people live longer in poor health. Health services are under strain, and disease burden is expected to rise by 21 per cent, hitting the poorest hardest. The Director of Public Health Report 2025 gives a detailed picture of health challenges, inequalities, and lived experiences across Ayrshire and Arran. It supports local delivery of national policies to improve population health, aligning with Scotland’s Population Health Framework, Public Sector Reform Strategy, and Vision for Health and Social Care. The report takes a life-course approach, showing how health is shaped from before birth through childhood, adulthood, and later life. It looks at the main drivers of disease, disability, early death, and the social and structural factors behind them. A central message is that prevention is possible at every stage of life. By working together, NHS, councils, health and social care partnerships, and communities can improve health outcomes. The report offers practical insights to guide this collective effort. The population of Ayrshire or Ayrshire and Arran Figure 1 shows key facts about Ayrshire and Arran’s population. Ayrshire and Arran’s population is declining, with more deaths than births or people moving in. Almost one in three residents live in the most deprived areas, and many communities are rural or based in small towns. The region is largely rural, with many living in remote or small towns. Ethnic minorities make up 3.6 per cent of the population. Figure 1: Demography of Ayrshire and Arran 27
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2 A life course lens This report looks at the factors that shape health in Ayrshire and Arran over a lifetime. It considers stable life patterns and disruptions within social, historical, biological, and psychological contexts. It highlights the role of families, personal skills, and life choices within constraints, as well as links between life stages. This approach helps identify opportunities to prevent poor health and social outcomes. Health as a fundamental human right Human rights are basic freedoms everyone is entitled to, such as food, shelter, education, and safety. When these rights aren’t met, health suffers. Investing in health is about supporting human potential and wellbeing, not just cutting healthcare costs. Poverty in Ayrshire and Arran is complex, shaped by social, economic, and geographic factors. Early-life poverty can cause lasting biological changes that harm child development and increase disease risk throughout life. Child poverty is a major concern, with all local authorities showing rates above the Scottish average. Figure 4 – Associations with Early Life Poverty Impacts on Child Biology Impacts on Child Health & Developmental Outcomes Long-term implications for adult health & wellbeing • Physiological stress response • Cognition & learning • Risk for mental health problems • Brain structure & function • Language development • Increased susceptibility to infectious diseases • DNA methylation • Behavioural problems • Pro-inflammatory phenotype • Microbiome • Educational outcomes • Increased risk of chronic diseases • Immune responses & inflammation • Susceptibility to infectious diseases • Decreased productivity • Risk of chronic diseases & mental health problems Link between health, community and the environment Planetary health links human wellbeing to the health of natural systems that support life. Scotland’s National Spatial Strategy reflects this by promoting sustainable, biodiverse places for healthier lives and a fairer economy. Across Ayrshire, long-term social and economic changes have shaped health for generations. Industrial growth once brought jobs and stability, but deindustrialisation in the 1970s–80s caused mass job losses, disrupting families and communities. These effects 28
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3 persist, with limited access to secure work, weakened local infrastructure, and deepening health inequalities. Some areas are now among Scotland’s most deprived, with higher rates of mental ill-health, substance use, and chronic disease. Improving health means tackling root causes, investing in housing, education, jobs, and community support, while strengthening local economies. Prevention and inclusive regeneration can help reverse the impact of industrial decline and build healthier, more resilient communities. Understanding the burden of disease across Ayrshire and Arran The Burden of Disease programme measures years of healthy life lost due to illness, disability, or early death using Disability-Adjusted Life Years (DALYs). One DALY equals one year of healthy life lost. Higher DALY rates mean more people are dying early or living longer with illness. This helps compare the impact of different conditions and track changes over time. In Ayrshire and Arran, health is consistently poorer than the Scottish average. The main causes of lost healthy life are stroke, COPD, drug use disorders, heart disease, and lung cancer. Drug use hits hardest at ages 25–44, while chronic conditions dominate in older age groups. Some local DALY rates, such as for severe stroke in men aged 85+, are much higher than the national average, showing significant health challenges in later life. The burden of disease data explains Ayrshire and Arran’s high hospital admissions, many long-term conditions, and serious drug-related harms. These issues are driven by high deprivation in some communities, an older population with greater health needs, and the challenges of providing and accessing care in a mostly rural area. 0 5000 10000 15000 20000 25000 Ischaemic Heart Disease Cerebrovascular Disease COPD Drug Use Disorders Lung Cancer DALY Rate Top 5 Burden of Disease in Ayrshire and Arran by DALY Rate Males Females 29
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4 Prevention across the life course Understanding the local burden of disease shows where change is most needed. A key solution is stronger prevention across NHS services and Health and Social Care Partnerships. As shown in Figure 12 Four Pillars of Health, many factors shape health. Prevention works best through whole-population measures, for example, small actions like supportive schools or routine stop-smoking advice can have big impacts. Success depends on all parts of the system acting together to make health a shared resource, improving outcomes and experiences for individuals and communities. The tiers of prevention below outline how a whole‑system approach can improve health across the life stages. Each tier plays a distinct role, and effective action often involves combining them to build strong foundations, reduce risks, and respond to needs as they arise. Tiers of prevention: • Universal prevention - Builds the foundations for lifelong health by ensuring supportive environments and high-quality universal services from early childhood onwards. • Primary prevention - Reduces exposure to risk and protects against early development of disease or harm. • Secondary prevention - Reduces risks and harms at the point they first present and prevents escalation to more complex or severe needs. • Tertiary prevention - Reduces long-term impact, disability, or complications and supports stability and improved quality of life. Opportunities to shape health across the life course Understanding health as a resource across life means there are opportunities to shape and influence using evidence and knowledge to inform activity. This report explores key 30
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5 analytical insights where a preventive intervention will make a difference to areas of identified need and risk, across a continuum of prevention activity. Life course spotlight circles Preconception and pregnancy Preconception and pregnancy are critical stages that shape a baby’s start in life and long- term health for mother and child. Pregnancy offers a unique chance for education, nutrition, mental health support, and reducing risks. In Ayrshire and Arran, poverty in pregnancy is a major concern, over half of all pregnancies occur in the two most deprived areas. Maternal obesity is also higher than the Scottish average, increasing risks like miscarriage, diabetes, and birth complications. In 2023, a needs assessment in Carrick, South Ayrshire, examined pregnant women’s healthy eating knowledge, barriers to eating well, access to support and physical activity levels. Based on the findings, the Dietetic Health Improvement Team and South Ayrshire Council’s Thriving Communities Team are developing a local support programme. The results have also informed work in North Ayrshire to pilot a maternal practitioner role. Future plans include a care pathway for women with high BMI or complex nutritional needs. Infancy (0 to 3 years) Infancy is a crucial stage, with the first 1,001 days laying the foundation for lifelong health and wellbeing. Investment in this period brings major benefits. Infant feeding: Breastfeeding supports both baby and mother – reducing infection and obesity risk for babies, and lowering cancer, obesity, and heart disease risk for mothers. The World Health Organisation (WHO) recommends exclusive breastfeeding for six months. Ayrshire and Arran’s breastfeeding rate (57.1 per cent) is below the Scotland average (69 per cent), with East Ayrshire lowest at 54.4per cent. Family focussed care: Getting it Right for Every Child (GIRFEC) is Scotland’s approach to ensuring children and families receive the right support at the right time. It is a strengths- based, rights-focused framework guided by the National Practice Model. In Ayrshire and Arran, we have developed a Pan-Ayrshire Practitioner Guide and a Child and Young Person’s Pathway with input from families. Childhood (4 to 11 years) Children at this age are naturally curious and ready to learn. While early adversity can have lasting effects, positive childhood experiences are protective and can offset earlier harms. Children with neither adversity nor positive experiences may still be at risk of poorer outcomes. 31
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6 Child dental health: Ayrshire and Arran has the lowest rate of Primary 1 children with good dental health in Scotland. The Childsmile programme has improved oral health, but progress has slowed. It now targets families most in need, with strong links to health visitors and school nurses. From 2023–2025, nearly 800 three-year-olds in deprived areas without a dentist were referred for support. Child poverty: Around one in four children in Scotland live in poverty. In South Ayrshire, 24.4 per cent (around 4,807 children) are affected, with highest rates in Ayr North Harbour, Wallacetown, and Newton. Local action includes Newton Primary’s food and clothing bank, now supporting around 120 people weekly. Adolescence (11 to 18 years) Adolescence and early adulthood are key periods for lifelong mental health. Rapid brain development can affect mood and behaviour, while positive relationships at home, school, and with peers protect wellbeing. Poor relationships, bullying, and exclusion increase risks like self-harm, violence, and substance use, which is one of the top five health burdens for this age group. Teen pregnancy: Teenage pregnancy has risen in Scotland for the first time in a decade, mainly among 17 to 19-year-olds, though Ayrshire rates have generally declined since 2011. Younger teens are more likely to have pregnancies ending in termination. Local support includes the SHAYR website, school education, pharmacy services, and a recent myth- busting campaign on contraception. Youth vaping: Youth vaping poses significant risks, including nicotine addiction and increased likelihood of later smoking. Evidence suggests rising vaping rates may be slowing progress in reducing youth smoking. NHS Ayrshire & Arran has established a Youth Vaping Taskforce with partners across education, health, Police and others, to focus on prevention, education, consistent messaging, sharing best practices and improved monitoring of trends. Young adult (19 to 24 years) Young adults are still developing decision-making skills, as the brain’s prefrontal cortex matures around age 25. Earlier adversity can increase risks such as impulsivity, self-harm, substance use, depression, and anxiety, making supportive adults important during this stage. Young adult mental health: Mental health issues among young adults have risen sharply, from 2.5 per cent in 2011 to 14.3 per cent in 2019. Ongoing brain development brings both growth opportunities and vulnerability, worsened by COVID-19. Wellbeing scores remain below the Scottish average in East and North Ayrshire, showing a need for more support. Adulthood (25 to 49 years) Adult health is shaped by earlier life skills and resilience. Strong relationships protect wellbeing, but mental health issues often peak in adulthood due to work, family, and financial pressures. Self-harm and violence in men contribute significantly to years of life 32
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7 lost. Drug use disorders are a major concern, with the highest death rates in the most deprived areas. Tuberculosis (TB): TB remains a key respiratory issue, mostly affecting middle-aged, UK- born men in deprived areas. Public health teams focus on case-finding, treatment support, and migrant screening. NHS Ayrshire & Arran was among the first Boards in Scotland to introduce this programme. Substance use: Deaths from drugs, alcohol, and suicide in adults aged 25–49 are of serious concern, with drug-related deaths rising in recent years. These causes contribute heavily to premature mortality, highlighting the need for targeted interventions. Middle age 50 – 69 years Adults are key to Ayrshire and Arran’s communities, and supporting their health improves quality of life and reduces pressure on services. As people age, resilience built earlier in life shapes current health challenges. Biological changes increase the risk of chronic conditions such as cardiovascular disease. Obesity is a major issue – 34 per cent of adults are obese and 70 per cent are overweight. This is among the highest in Scotland. Preventive cancer screening becomes vital, as early detection improves survival. Cancer screening: Bowel and breast screening start at age 50. Uptake in Ayrshire and Arran is slightly below national averages and lower in deprived areas. Cardiovascular disease: The region ranks among Scotland’s highest for heart and circulatory conditions. Early detection of risks like high blood pressure and diabetes is key. NHS Ayrshire & Arran is expanding community-based screening, including pilots using portable tools for earlier diagnosis closer to home. Older adults (70 to 89 years) and the elderly (90+ years): In older adulthood, ageing, social factors, and long-term conditions become more evident. In Ayrshire and Arran, heart disease, stroke, lung cancer, and COPD rise sharply, with COPD among the highest in Scotland, particularly in East Ayrshire, due to deprivation, smoking, and past occupational risks. More people are now living into their 90s, bringing added health challenges. Alzheimer’s disease: Alzheimer’s disease and other dementias place a heavy burden, with rates increasing sharply after age 85. Local initiatives, such as dementia-focused community conversations in East Ayrshire, are helping shape priorities for better care. Recommendations Ayrshire and Arran NHS Board, and the senior leadership within the Health and Social Care Partnerships, Ayrshire Local Authorities and wider Community Planning Partners are challenged, encouraged and invited to: 1. Build a stronger understanding of how poverty and lack of opportunity affect people in the most disadvantaged communities across North, South, and East Ayrshire. 33
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8 2. Recognise the benefits of both universal and targeted approaches in using health as a resource for life: from before birth, through all life stages, and across generations: for individuals, families, and communities 3. Work with purpose, pace, and scale across systems and services to unlock this preventive potential for all Ayrshire citizens. Every partner should take responsibility and act within their sphere of influence to deliver the opportunities outlined in this report. 4. The 2026 Director of Public Health (DPH) Report will build on these themes. It will guide the planning and design of services that meet the diverse needs of people at different ages and life stages, from urban centres to remote towns and villages. This work will support the Caring for Ayrshire Action Plan: citizens at the centre of care, accessing the right care, in the right place, at the right time. 5. Key asks of the Public Health Department and all partners/programmes of work involves examining: a) What is being delivering and how we ensure maximum impact (across a prevention continuum) to effect change in this space as a team. b) How we demonstrate leadership and collaboration across the whole system to fully realise preventive potential. c) How we ensure our work reaches those most affected by poverty and inequality, including rural and remote communities. d) The gaps are in our current approach, and what practical steps we can take to close them. e) How we embed prevention across all systems and services, not just in strategic plans. f) What evidence demonstrates progress and impact across communities. 34
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2 Growing Well to Live Well: Understanding the Burden of Disease Contents Acknowledgements Foreword Introduction Understanding the Population of Ayrshire and Arran A Life Course Lens Health as a Fundamental Right Health Inextricably Linked to Community and Planetary Health Health as a Resource of Life Challenged to achieving health: Understanding the Burden of Disease across NHS Ayrshire and Arran Understanding and Realising Preventative Potential Life Course Opportunities to Realise Preventive Potential Concluding Comments List of Figures References 3 4 5 6 8 9 12 19 19 24 29 64 67 69 NHS Ayrshire and Arran Director of Public Health Annual Report 2025 36
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3 Director of Public Health’s Annual Report 2025 Acknowledgements Sally Amor: Consultant in Public Health: Lead Author Alice Sherwood: Public Health Research Officer: Content and Data Analytics and Graphics Stewart Cardwell: Senior Public Health Research and Data Officer: Data and Analytics Wendy Clark: Project Administrator Case Study Spotlight contributors Esther Aspinall: Consultant in Public Health Lynne Rush: Consultant in Public Health Ruth Campbell: Consultant Dietician in Public Health Jacky Burns: Consultant in Dental Public Health Emily Broadis: Public Health Consultant Kathleen Winter: Child Health Commissioner Fiona McAvoy: Head teacher Newton Primary School Ayr Kerry Gallagher: Public Health Programme Officer Megan MacPherson: Public Health Specialist Registrar Angela Davidson: Public Health Project Manager Kevin Lyle: Health Improvement Officer Phil White: Senior Manager South Ayrshire HSCP Lorna McIlreavy: Partnership Engagement Officer East Ayrshire Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 37
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4 Director of Public Health’s Annual Report 2025 Foreword Health is more than the absence of illness, it is a resource for life that needs care and nurture. Yet, traditional approaches often frame health through a narrow biomedical lens, focusing on diagnosis and treatment rather than prevention. This limits opportunities to create lasting change. Similarly, attributing chronic disease and early death solely to poor lifestyle choices overlooks the deeper social and economic factors that shape health across the life course. Too often, what we call early intervention happens after opportunities have already been lost. In Ayrshire and Arran, the consequences are stark: too many lives cut short by violence, suicide, drug-related deaths, and alcohol harms. These patterns are not random, they reflect decades of structural inequality and adversity, compounded by the collapse of core industries and tourism in the 1980s, the financial crash of 2008, the COVID-19 pandemic and ongoing constraints on public finances. These events have left a profound mark on families and communities. This Director of Public Health Report calls for a different approach, one rooted in curiosity, compassion, and an understanding of health as a shared resource. It offers actionable insights to help translate system intent into real experiences of accessible care, matched to need at the earliest point. By recognising the intersecting challenges faced by those most disadvantaged, we can design services that respond to people’s lives, not just their symptoms. Change is possible, and within our grasp, if we act together. Professionals, communities, and systems all have a role to play in creating conditions where health can flourish. Together, we have the opportunity to turn adversity into progress and create a future where every person in Ayrshire and Arran can live well. Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 38
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5 Director of Public Health’s Annual Report 2025 Introduction Scotland, and Ayrshire and Arran in particular, is facing significant challenges in health and wellbeing. Life expectancy is no longer improving for the most disadvantaged communities, and more people are living longer but in poorer health. At the same time, the healthcare system is under pressure due to limited resources and funding, and public trust in health and social care is being tested. The overall burden of disease is projected to rise by 21%, with the most disadvantaged groups affected the most. To respond effectively, we must focus on prevention and invest in the conditions that empower people to live healthier lives. This includes safe relationships, secure housing, access to education and healthcare and fair employment or adequate income. These factors are especially important in the early years of life, as they shape long-term health outcomes. Strengthening these foundations can improve health across all ages and reduce inequalities. This Director of Public Health Report aims to support the local implementation of national policy in Ayrshire by providing clear, actionable insights. It seeks to guide the best use of finite resources to improve health outcomes for all communities, across all ages, from pre-birth to later life, and across diverse settings including urban, rural, affluent and disadvantaged areas. The report aligns with key national strategies, including Scotland’s Population Health Framework, Scotland’s Public Sector Reform Strategy: Delivering for Scotland and the Vision for Health and Social Care Scotland. These frameworks set out a refreshed direction for improving population health, reducing inequalities, and ensuring public services are sustainable, effective and person-centred. Despite the pressures, there are many opportunities to affect change. The NHS can act as an Anchor Organisation, using its reach and resources to promote prevention through both universal and targeted approaches. There is growing evidence on the value of investing in preventive potential, realistic medicine, and maximising opportunities for proportionate universalism to improve outcomes and reduce inequality. Collaborations, such as with the Centre for Health Equity and the application of Marmot principles, offer practical ways to embed fairness and effectiveness in service design. By further improving the way we work together across sectors and communities, we can build a healthier, more equitable future for Ayrshire and beyond. Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 39
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6 Director of Public Health’s Annual Report 2025 Understanding the Population of Ayrshire and Arran Insights into the population of NHS Ayrshire and Arran are detailed in Figure 1. They show an overall declining population where more people are dying than are being born or moving into the area . At the same time, the population is ageing as less babies are born. Nearly one in three citizens live in the most deprived communities. Rurality is also a main feature of Ayrshire and Arran’s geographical make up, with many people living in remote or small-town areas. There is a small ethnic minority population of 3.6% . (1) (2) Figure 1. Demography 2024 estimate birth rate 7.8365,256 population in 2022 Lower than the Scottish birth rate 13.9 2024 estimate death rate Higher than the Scottish death rate The death rate being higher than the birth rate suggests Ayrshire and Arran’s population is declining According to the 2022 Scotland Census and National Records Scotland 21.7% have a degree level qualification or above 30.5% live in the most deprived areas 38.8% live in a rural or small town area 96.4% born in the United Kingdom Click Here for the Scottish Census In 2024, there were 2812 births in Ayrshire and Arran, accounting for 6.1% of all births in Scotland for that year. The majority of these births occurred in East and North Ayrshire, 1043 and 1012 respectively. In the same year, there were 5178 deaths in Ayrshire and Arran, accounting for 8.3% of all Scottish deaths in 2024 .(1) Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 40
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7 Director of Public Health’s Annual Report 2025 Figure 2. Scottish Index of Multiple Deprivation of Ayrshire and Arran 0 20 40 60 80 100 Urban/Rural % Accessible Rural Accessible Small Towns Other Urban Areas Remote Rural Remote Small Towns 0 20 40 60 80 100 SIMD % Most Deprived Least Deprived The Urban Rural Classification(3) Details the balance of the population living in a range of urban or built-up areas and rural and country areas. Scottish Index of Multiple Deprivation(4) Details the areas of greatest deprivation across Scotland. Together, these measures provide information on the challenges in family and community life. In Ayrshire and Arran, the two measures indicate high levels of population deprivation across urban and rural communities, shown in Figure 2 below. Geographical isolation creates barriers to healthcare and increases the inequalities faced by Ayrshire and Arran’s rural communities. Poor transport links, fuel poverty and length of travel impact on the ease of access to services for rural populations. These issues highlight the importance of efforts to increase primary, secondary and tertiary prevention measures in these rural communities and to improve health outcomes within these populations. The ultimate goal is to reduce unplanned care and manage planned care more effectively in order to reduce the inequalities experienced by Ayrshire and Arran’s rural communities. Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 41
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8 Director of Public Health’s Annual Report 2025 A Life Course Lens This report brings attention to the key risks and influences that have shaped the experience of health for the Ayrshire and Arran population over time, and that continue to influence health outcomes to the current time through a life-course lens. This approach provides texture and context for the experience of both health and illness across a life and between generations. The approach: Captures the consistent features in life as well as the twists and turns in the paths of individual lives. Recognises the influence of historical changes on human behaviour. Recognises the importance of timing of lives, not just in terms of chronological age, but also in terms of biological age, psychological age, social age, and spiritual age. Captures and defines the ways in which humans are interdependent. Understands and focuses on the family as mediator of life experiences and how people learn and acquire the skills to navigate and negotiate the wider world and life. Details that all people have choices in navigating their life journey, even as there can be constraints alongside opportunities. Celebrates diversity in life journeys and the many origins and sources of that diversity. Is clear of the linkages and associations between childhood and adolescence, early adulthood, middle and later years of life. Exploring the intersection of challenge and adversity, alongside opportunities and hope in community and family life, informs an understanding how health is mediated for individuals alongside preventive opportunities to reduce the development of poor outcomes/chronic illness and disease. This is informed by understanding of each of the following and intersections and associations between each of them: Health as a fundamental human right (5) Health inextricably linked to community and planetary wellbeing (6) Health as a resource (physical, mental and spiritual) for and across life (7) This report provides examples of challenges for the populations of Ayrshire and Arran and opportunities being realised for preventive work across the life course. The report provides context for the challenges of the population that translate into challenges for the provision of health and social care and wider partner services (education, housing, police, fire-service, third sector and business). Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 42
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9 Director of Public Health’s Annual Report 2025 Health as a Fundamental Human Right The Universal Declaration of Human Rights details how human rights are the rights and freedoms that all people have, as all are born equal. These include the right to life, to be free from torture and abuse; to go to school and to work; to have the right to shelter and to food; and the right to practise a religion and the right to think, and say what people want to, as long as it doesn’t cause harm to anyone. Human rights can also be understood as detailing the underpinning requirements for all people to grow, develop and live well in the context of family, community and civil life. In the absence of rights not being accessed or assured, health and wellbeing are compromised. Investing in health is not simply about reducing health care costs. Rather it is about investing in human health, happiness and wellbeing, with an understanding of the intersections of family, individual and family and what helps and what hinders for all people to live well and in good health. Spotlight: Poverty Poverty in Ayrshire and Arran is a multifaceted issue influenced by various social, economic and geographical factors. Child poverty is of particular concern, with each of the Ayrshire local authorities experiencing higher levels of child poverty than the Scottish average percentage , as detailed in Figure 3. This can come about from low household income, parental unemployment and high levels of housing insecurity. (8) Figure 3. Child Poverty 24.3% 23.6% 20.7% North Ayrshire East Ayrshire South Ayrshire % of children aged under 16 living in relative poverty, after housing costs Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 43
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According to EndPoverty (2025) , relative poverty is: “the level of poverty that changes based on context– it is relative to the economic climate. Relative poverty is when a household receives 60% of the average household income in their own economy. They do have some money, however, not enough to afford anything above the basics.” (9) In 2023/24, North Ayrshire had the highest percentage of children aged under 16 living in relative poverty, after housing costs, in Ayrshire and Arran. The national average of children under 16 years old living in relative poverty, after housing costs, was 19.1%. This results in all three local authorities in Ayrshire and Arran having a higher percentage than the Scottish average. The Scottish Government said :(10) “Poverty and health are deeply interconnected, forming a cycle where poor health exacerbates poverty and poverty makes achieving good health more challenging. The early years are a critical developmental period, marked by heightened sensitivity to environmental influences, including poverty-related stress and deprivation, and increased vulnerability to disruptions in how the genetic code is expressed”. The data in Figure 3 will undoubtedly mask pockets of poverty and deprivation such as in South Ayrshire. South Ayrshire has some of the least deprived areas within the health board, such as Belmont, Muirhead, Prestwick East and Alloway and Doonfoot, however, it also contains some of the most deprived, Ayr North Harbour, Wallacetown and Newton South and Lochside, Braehead and Whitletts. These vast areas of affluence may mask the true poverty occuring within the local authority and so we must remain vigilant and mindful of this when planning services and outreach projects in the area. 10 Director of Public Health’s Annual Report 2025Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 44
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Schmidt, K.L et al from Figure 4 said :(11) “Early life poverty is associated with changes in numerous biological pathways and physiological systems in the body. These biological changes can have pronounced effects on child development and health outcomes in the short term and can also lead to long-lasting effects on health and the risk of disease that last throughout the life course” Such research insights bring understanding as to why the experience of health for so many of the Ayrshire population is so challenging, and why the demand for services and associated costs are high. Necessary preventive work to address child poverty is explored later in this report. 11 Director of Public Health’s Annual Report 2025 Spotlight: Resilience Resilience, in the context of exposure to significant adversity, is “both the capacity of individuals to navigate their way to the psychological, social, cultural, and physical resources that sustain their wellbeing, and their capacity individually and collectively to negotiate for these resources to be provided in culturally meaningful ways” . (12) This is a wider framing of adversity than seeing it as a matter of grit and determination to struggle through tough times. The approach also gives a role and responsibility to systems and services to meet people along the way, capturing the ‘duty bearer’ responsibilities to ensure human rights can be realised. ‘Duty bearers are state or non-state actors, that have the obligation to respect, protect, promote, and fulfil human rights of rights-holders .(13) Figure 4. The Influence of Poverty on Child Health and Development(11) Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 45
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12 Director of Public Health’s Annual Report 2025 Health Inextricably Linked to Community and Planetary Wellbeing Planetary health is a concept that focuses not only on human health but wider, on the health of our planet. Health is not only a privilege of human beings. Planetary health emphasises the interconnected nature of human health and environmental health. The Scottish Government’s National Spatial Strategy recognises the above and seeks to support the planning and delivery of: (14) Sustainable places, where we reduce emissions, restore and better connect biodiversity. Liveable places, where we can all live better, healthier lives. Productive places, where we have a greener, fairer and more inclusive wellbeing economy. Significant social and economic changes across the Ayrshires from the nineteenth to the twenty first century have shaped the experience of health in powerful ways. While the development of mining and heavy industry and related tourism contributed to wealth creation and opportunities for many, the impact of deindustrialisation and the loss of tens of thousands of jobs across the south-west of Scotland from the 1970s and 1980s has had a ripple effect that is still playing out in current times. Within short periods of time many men lost employment and associated income and in an essentially gendered society, the means to provide for their families with associated impacts on the role of women and for the experience of children and young people growing up. It continues to be challenging to ensure the employment opportunities experienced in decades past. These changes have been confounded by the 2008 financial crash, the impact of the COVID-19 pandemic, and the subsequent times of austerity, alongside the impact of war and wider global uncertainty. Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 46
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13 Director of Public Health’s Annual Report 2025 Cumulative Effects 19 Centuryth In East Ayrshire, coal mining was the backbone of the local economy with deep pits spread across various towns like Cumnock and Auchinleck. East Ayrshire also thrived in ironworks and textile with mills in Kilmarnock producing carpets and wool goods. 20 Centuryth De-industrialisation hit in the late 20 century and coal mines began to close and major employers moved elsewhere, such as the Johnnie Walker plant in Kilmarnock. th 21 Centuryst The economy has shifted towards public services, education, retail and tourism and former mining towns are being supported through rural development initiatives. East Ayrshire South Ayrshire The late 20th century marked the beginning of a sharp downturn. Major industries began to close and jobs went with them. These closures forced many skilled workers to leave the area in search of employment, leading to population decline and a weakening local economy. North Ayrshire thrived as a centre for industry, powered by sectors such as textiles, coal mining, ironstone extraction, and shipbuilding. Towns like Irvine, Kilbirnie and Kilwinning were bustling with mills, factories, and shipyards that provided employment and prosperity. Recently, the shutdown of the Hunterston B nuclear power station in 2022 added to the region’s challenges. Although the decommissioning process offers temporary employment, the long-term loss of a major employer raises serious concerns about future economic recovery. 19 Centuryth 20 Centuryth 21 Centuryst Tourism started to expand in the 20 century with the golf industry expanding and increasing travel to Troon and surrounding areas. th In the 19 century, South Ayrshire relied on agriculture and fishing for its economy. Ayr was a vital market town and port in the area, trading with other parts of Scotland and Ireland. Like East and North, South Ayrshire also had a mining sector. th Tourism continues in South Ayrshire, alongside the public service, retail and hospitality industries. South Ayrshire is challenged by an ageing population, with increasing demand on services. 19 Centuryth 20 Centuryth 21 Centuryst North Ayrshire Unemployment Mental Health Issues Substance Use Chronic Illness Demand on services Figure 5. Health Inextricably Linked to Community and Planetary Wellbeing in Ayrshire and Arran Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 47
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14 Director of Public Health’s Annual Report 2025 Spotlight: Change and Challenge for Ayrshire Communities East Ayrshire: Coal Mining The Lost Villages was an oral history project by the Scottish Oral History Centre which ran from March 2021 to August 2024 . The ‘miners’ row villages’ in the Ayrshire coalfield are a remarkable and distinctive man- made feature in the landscape and transformed the upland areas where they were set. When they were built, they played a vital role but could not survive the exhaustion of the mineral resources they were built to exploit. (15) The oral history project set out to reconstruct the social and cultural life of the vibrant coalfield communities that existed in East Ayrshire and the experience of pit closures, depopulation and community disintegration in these so-called ‘lost villages’; telling the story from lived experience; from the memories of those who witnessed working in the coal mines and living in the miners’ rows and what it meant when the pits closed. The work aimed to capture the ‘intangible history’ of life in the ‘row villages and the impact of deindustrialisation into the twentieth century. North Ayrshire: Industry North Ayrshire’s proud industrial heritage once supported strong, interconnected communities. Generations found employment in textiles, chemicals, steel, electronics and energy, with major employers such as Pringle, ICI, Glengarnock Steelworks, Sanmina-SCI and Hunterston B power station anchoring the local economy. Their closures over recent decades have led to widespread job losses, economic instability and population decline, as skilled workers moved elsewhere in search of employment. South Ayrshire: Fishing and Tourism Alongside a coal mining industry similarly impacted by industrial decline into the 1980s, South Ayrshire has a notable marine heritage with Ayr as a major port and centre for import/export and coastal trade. The Carrick coast has had a long-established and thriving fishing industry with reports of fishing boats queuing to get into the harbour at Ayr and a thriving fish market until the 1970s. In more recent years there has been greater regulation of the fishing industry, a move to greater industrialisation with the use of bigger boats requiring different harbour and port facilities and a related decline in fish stocks while the demand for fish types has also changed. Ayr, as well as a thriving centre for rural and industrial commerce also developed as a thriving resort town to serve the demand for leisure and recreation of the Clyde based industrial workforce. The Gaiety Theatre and Station Hotel are current reminders of more prosperous and certain economic times. As industries declined alongside associated economic challenges for families, there was an associated effect and decline of the tourism industry. Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 48
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The rich cultural and industrial heritage of Ayrshire communities as explored in the examples above has been considerably impacted by changes over the last forty years. Deindustrialisation of urban centres, the depopulation of rural communities with the loss of mining and fishing has had a ripple effect far beyond the immediate loss of jobs. Local businesses, shops, and services that depended on the spending power of the local community, have also suffered, leading to further closures and reduced community infrastructure, alongside the development of out-of-town shopping complexes. This economic contraction has deepened deprivation and contributed to poorer health outcomes. These effects are evident in the Burden of Disease Study that informs this report. Discrete populations across Ayrshire and Arran now rank among the most deprived in Scotland, with high rates of mental health issues, substance use, and chronic illness linked to economic stress and social instability. Public Health insights and skills are essential to understanding and responding to the interconnected challenges experienced across Ayrshire and Arran. Tackling the root causes of poor health means investing in the social determinants; secure housing; education; employment and community support, while also strengthening local economies and services. By focusing on prevention, realising untapped preventive potential, early intervention, and inclusive regeneration, Ayrshire communities can begin to reverse the long- term impacts of industrial decline and create the physical and relational environments that will underpin the development of healthier, more resilient communities. 15 Director of Public Health’s Annual Report 2025 Spotlight: Intergenerational Effects Research shows that intergenerational transmission can become evident when a parental trait affects the trait in their child by inheritance of certain genes or by cultural transmission or by through interplay between nature and nurture(16). A wider framing than genetics alone, an understanding of intergenerational effects captures the interconnected nature of many influences and experiences as people grow and develop across life, the risks to health and their associated experience of both health and ill health. Spotlight: Adverse Childhood Experiences Adverse childhood experiences (ACEs) are traumatic and/or stressful experiences that occur in childhood that can impact individuals throughout their lives. ACEs can lead to poor health and social outcomes later in life. The most common ACEs are abuse (physical, sexual and emotional); neglect and growing up in a household affected by domestic violence; or with adults who use alcohol and/or drugs; with adults who live with mental illness; with adults who have spent time in prison; and with parents who have separated .(17) Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 49
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1+ ACEs 71.3% 0 ACEs 28.7% How do ACEs affect people? 0 10 20 30 40 50 Verbal Abuse Physical Abuse Household Domestic Violence Parental separation Household Mental Illness Household Alcohol Abuse Sexual Abuse Household Drug Abuse Incarceration of Household Member % 0 ACE 1 ACE 2-3 ACE 4+ ACE Limiting Long Term Condition Non-limiting Long Term Condition No Long Term Condition 0 50 100 150 200 250 52 61 54 51 The 2019 Scottish Health Survey explored the exposure to childhood adversity in Scotland. The dose response effect of exposure to more than four adverse childhood experiences detailed in Figure 5 leaves people at greater risk of poorer physical and mental health, and of health behaviours that can compromise wellbeing, including problematic alcohol and drug use, being at risk of, or a victim of, violence or mental illness and being at higher risk of suicide. The risk of experiencing at least four or more of the markers of childhood adversity is doubled in the more deprived areas of Scotland, many of which lie within Ayrshire and Arran. (17) Adversity can be understood as a stressor, and not all stress is bad; some stress is needed for healthy growth and development. Stress also indicates the presence of risk and threat that can be protective in nature, even lifesaving if necessary. Toxic stress is produced when the body’s stress response system is activated from prolonged, frequent and strong periods of time and where there are no adult relationships to buffer the impact. This can occur in situations where a higher number of ACEs are being experienced and where there is no adult/s to act as a buffer to the stress being felt. Figure 6. Experience of Childhood Adversity in Scotland 16 Director of Public Health’s Annual Report 2025 Verbal abuse was the most common ACE reported followed by physical abuse and household domestic violence. These were experienced more often by men than women. 28.7% of people in Scotland have not experienced an ACE, whereas 71.3% of people have experienced at least one ACE. What ACEs are experienced in Scotland?How common are ACEs in Scotland? As the number of ACEs increases, so did the percentage of adults living with a limiting long-term condition. Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 50
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Positive Childhood Experiences (PCEs) PCEs in childhood can include closeness, support, loyalty, protection, love, importance and responsiveness to the child's health needs. Here, the contribution to resilience is demonstrated and the mitigating effects against experiences of adversity that buffer against the risk of experiencing toxic stress. PCEs support resilience in children and are protective, offsetting prior exposure to early adversity. Children with more PCEs have lower chances of developing depression and poor mental health into adulthood. It is noted that having no markers of adversity combined with a lack of positive childhood experiences can leave an individual vulnerable, reflecting the benefits that positive relational and wider experiences confer as children grow and develop life skills and resilience to navigate the ever evident challenges of twenty first century living. 17 Director of Public Health’s Annual Report 2025 Spotlight: Toxic Stress Toxic stress occurs when an individual experiences excessive or prolonged activation of their stress response systems in the body and brain. This toxic stress can have damaging effects on various aspects of life such as learning, behaviour and health across the individual’s lifespan .(18) Spotlight: Attachment Attachment theory highlights how important a child’s emotional bond to their primary caregiver is. Any disruption or loss of this emotional bond can affect a child both emotionally and psychologically. This can last into adulthood and have an impact on their future relationships (19). Spotlight: Community Adversity The intersecting influences of childhood, family and community adversity is demonstrated in Figure 7. These can be understood as influencing the considerable burdens of disease experienced by the populations of Ayrshire and Arran and related years of life lost to illness, addiction and premature death explored in this report. Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 51
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Figure 7. Adverse Community Experiences(20) 18 Director of Public Health’s Annual Report 2025Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 52
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19 Director of Public Health’s Annual Report 2025 Health as a Resource for Life Understanding health as a resource for life demonstrates the interconnected nature of positive and negative experiences as people grow and develop through life journey experiences. The origins of adult health and wellbeing and disease can be understood as involving the following: Intrinsic features: personality and genetics Relational experiences in the earliest weeks, months and subsequent years of life The relational and material resources that are available in and across family and community life that intersect to help or hinder the experience of health across life Challenges to Achieving Health: Understanding the Burden of Disease across NHS Ayrshire and Arran As explored in previous sections, community and family experiences shape and influence biology/physiology and the way children grow and develop and how adults experience family life and the workplace as well as ageing and later life. More is known than at any other point in time about how an individual’s unique make up interacts with a wide range of relational and environmental experiences to inform their experience of health and wellbeing, and the risk of experiencing poor physical or mental health and their risk of developing drug or alcohol dependency or chronic illness. Despite this knowledge, across Ayrshire, lives are cut short and living well is compromised through high levels of drug, alcohol and suicide deaths among relatively young adults (24-45 years); all of whom are someone's daughter or son and sometimes parent. For adults and people in their middle and later years, lives are also cut short by preventable non- communicable illnesses such as ischaemic heart disease and stroke. As explored throughout this report, these intersecting and cyclical effects are wide ranging across individual, peer, family and community life. The burden and individual, family and community costs of these conditions are detailed below. The Burden of Disease work programme details the years of good health lost from living with an illness or health condition as well as the years of life lost to premature (early) death . (21) Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 53
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DALY rates A DALY is a disability-adjusted life year, which represents one year of “healthy” life lost to either premature death or living with an illness or disability. DALY rate is the number of DALYs per 100,000 of the population. A high DALY rate means many people are either dying early from a particular cause or are living many years with its effects. DALYs help us compare the burden of different diseases and injuries across ages, genders and geographical areas. They also allow us to monitor how the health of an area is changing and the effectiveness of public health measures that may have been implemented, such as vaccination programmes and targeted health projects in a certain area. Throughout this report, we will refer to the number of DALYs and DALY rates. Figures 8 and 9 detail the top 5 diseases or injuries with the highest number of DALY rates in Ayrshire and Arran in 2019 in comparison to Scotland. Of note, is the near consistent experience of poorer health for men and women in Ayrshire compared to Scotland across different age bands as detailed, with reference to cardiac and stroke related conditions from 45 years, and drug related deaths for people aged 25-45. 20 Director of Public Health’s Annual Report 2025Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 54
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21 Director of Public Health’s Annual Report 2025 0 10000 20000 Under 15 15 to 24 25 to 44 45 to 64 65 to 84 85+ 0 10000 20000 Under 15 15 to 24 25 to 44 45 to 64 65 to 84 85+ 0 10000 20000 Under 15 15 to 24 25 to 44 45 to 64 65 to 84 85+ 0 10000 20000 Under 15 15 to 24 25 to 44 45 to 64 65 to 84 85+ 0 10000 20000 Under 15 15 to 24 25 to 44 45 to 64 65 to 84 85+ MALES Cerebrovascular Disease COPD Drug Use Disorders Ischaemic Heart Disease Lung Cancer Ayrshire and Arran Scotland Figure 8. Understanding the Burden of Disease across Males in Ayrshire and Arran by DALY rate in 2019(21) Figure 8 highlights the top 5 diseases/injuries with the highest DALY rates for males in Ayrshire and Arran. These are cerebrovascular disease, COPD, drug use disorders, ischaemic heart disease and lung cancer. These diseases/disorders affect the male population at different stages within their life course. As Figure 8 shows, cerebrovascular disease, COPD, ischaemic heart disease and lung cancer affect the older male population more whereas the highest burden of drug use disorders is seen in the 25 to 44 year age range for males in Ayrshire and Arran. This figure also highlights the comparison between Ayrshire and Arran and the national Scottish data. This is particularly evident in the burden of cerebrovascular disease in the 85+ year old male age range where Ayrshire and Arran has a DALY rate of 19,514 compared to a Scottish rate of 13,817. Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 55
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22 Director of Public Health’s Annual Report 2025 Ayrshire and Arran Scotland Figure 9. Understanding the Burden of Disease across Females in Ayrshire and Arran by DALY rate in 2019(21) 0 10000 Under 15 15 to 24 25 to 44 45 to 64 65 to 84 85+ 0 10000 Under 15 15 to 24 25 to 44 45 to 64 65 to 84 85+ 0 10000 Under 15 15 to 24 25 to 44 45 to 64 65 to 84 85+ 0 10000 Under 15 15 to 24 25 to 44 45 to 64 65 to 84 85+ 0 10000 Under 15 15 to 24 25 to 44 45 to 64 65 to 84 85+ FEMALES Cerebrovascular Disease COPD Drug Use Disorders Ischaemic Heart Disease Lung Cancer Figure 9 highlights the top 5 diseases/injuries with the highest DALY rates for females in Ayrshire and Arran. These are cerebrovascular disease, COPD, drug use disorders, ischaemic heart disease and lung cancer, similar to their male counterparts. Similarly, these diseases/disorders affect the female population at different stages within their life course. As Figure 9 shows, cerebrovascular disease, COPD, ischaemic heart disease and lung cancer affect the older male population more whereas the highest burden of drug use disorders is seen in the 25 to 44 year age range for males in Ayrshire and Arran. Figures 10 and 11 detail the burden of poor health across the life course for residents of Ayrshire and Arran with the top 5 diseases/injuries for each age group. The greatest numbers of years lost to poor health and premature death for males aged 65-84 is ischaemic heart disease, noting the onset increasing from 45 to 64 years. It is of considerable concern to see the years of life lost to addiction and premature death for males aged 24 to 45 years. Figures 10 and 11 are both measured by the number of DALYs as opposed to the DALY rates in Figures 8 and 9. Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 56
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23 Director of Public Health’s Annual Report 2025 Figure 10. Understanding the Life Course Burden of Disease across Males in Ayrshire and Arran by number of DALYs in 2019(21) For men, the greatest burden of disease is felt by males aged 65-84 with ischaemic heart disease, followed by drug use disorders in males aged 25-44 years old and thirdly males aged 45-64 years old with ischaemic heart disease. Figure 11. Understanding the Life Course Burden of Disease across Females in Ayrshire and Arran by number of DALYs in 2019(21) MALES 0 500 Congenital Birth Defects Asthma Other Unintentional Injuries Skin and Subcutaneous Diseases Epilepsy 379 121 106 105 102 0 200 400 600 800 Self-Harm and Interpersonal Violence Drug Use Disorders Depression Headache Disorders Low Back and Neck Pain 660 646 168 153 141 0 1000 2000 3000 Drug Use Disorders Self-Harm and Interpersonal Violence Depression Alcohol Use Disorders Low Back and Neck Pain 2978 1074 734 522 460 0 1000 2000 3000 Ischaemic Heart Disease Drug Use Disorders Lung Cancer Depression Cirrhosis and Other Chronic Liver Diseases 2482 1333 1074 1018 1018 0 1000 2000 3000 4000 Ischaemic Heart Disease Lung Cancer COPD Cerebrovascular Disease Other Cardiovascular and Circulatory Diseases 4233 2238 1791 1513 1423 0 500 1000 Alzheimer's Disease and other Dementias Ischaemic Heart Disease Cerebrovascular Disease Lower Respiratory Infections Prostate Cancer 953 781 624 403 341 Under 15 15-24 25-44 45-64 65-84 85+ The greastest burden of disease seen in males aged 65-84 with Ischaemic Heart Disease Second highest burden of disease seen in males aged 25-44 with Drug Use Disorders Third highest burden of disease seen in males aged 45-64 with Ischaemic Heart Disease 0 100 200 300 400 Congenital Birth Defects Neonatal Disorders Skin and Subcutaneous Diseases Headache Disorders Other Cancers 342 182 112 90 85 0 100 200 300 400 Headache Disorders Self-Harm and Interpersonal Violence Low Back and Neck Pain Depression Anxiety Disorders 304 220 213 173 142 0 1000 2000 Drug Use Disorders Headache Disorders Low Back and Neck Pain Depression Anxiety Disorders 1924 870 758 710 590 0 1000 2000 Lung Cancer Depression Low Back and Neck Pain Breast Cancer Cirrhosis and Other Chronic Liver Diseases 1133 1095 1076 1011 1000 0 1000 2000 Lung Cancer Ischaemic Heart Disease Cerebrovascular Disease COPD Alzheimer's Disease and other Dementias 2453 2260 2048 2026 1861 0 1000 2000 Alzheimer's Disease and other Dementias Cerebrovascular Disease Ischaemic Heart Disease Lower Respiratory Infections 1855 1011 877 622 457 Under 15 15-24 25-44 45-64 65-84 85+ FEMALES The greastest burden of disease seen in females aged 65-84 with Lung Cancer Second highest burden of disease seen in females aged 65-84 with Ischaemic Heart Disease Third highest burden of disease seen in females aged 65-84 with Cerebrovascular Disease Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 57
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The burden of disease, as explored above, provides insights for why NHS Ayrshire and Arran has higher rates of hospital admissions in comparison to the Scottish average rate , high rates of people with long term conditions and high levels of drug related health harms and deaths . (22) (21) (23) These challenges can be attributed to high levels of deprivation , concentrated in particular communities, and an older age structure , likely leading to higher demand for health care. In addition, the remote and rural nature of the Health Board geography can make accessing health care and providing care at home even more challenging . (22) (24) (21) This is the starting point for effecting change and ensuring a golden thread of preventive activity across the work of the NHS Board, Acute Services and Health and Social Care Partnerships using the Community Planning Partnerships. The challenge is ensuring a preventive approach that transcends organisational, structural and financial boundaries across Ayrshire to best effect. It is instructive to understand the different contributions to health as a resource. As this report details, poor health is more than a result of poor health decisions and lifestyle factors. As detailed in Figure 12 , the respective contributions to health inform a preventive approach. A preventive health approach seeks to maximise the benefits of whole population approaches (universal/primordial prevention) where small contributions can produce scale effects (school cultures and ethos /tobacco cessation advice in primary care ). It asks that the component parts of wider system of services and care understand and seek to maximise the opportunities to support health as a resource for life: how by working together in a myriad of different ways, improvements in health and experiences of health and other services benefit individuals and populations. (25) (26) (27) 24 Director of Public Health’s Annual Report 2025 For women, the greatest burden of disease is lung cancer for women aged 65-84, mostly a legacy effect from the later reduction in smoking by women in recent years. The second greatest burden of disease is for women aged 65-84 years from ischaemic heart disease, noting as for men, the emerging pattern of disease from 45-66 years. Understanding and Realising Preventive Potential Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 58
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Figure 12. Four Pillars of Health(25) 25 Director of Public Health’s Annual Report 2025 Universal (primordial) prevention has a particular contribution to make in reducing the risk of developing long term health conditions and maximising success in school/learning and work through ensuring high quality universal health care and education services (maternity through to health visiting/school nursing and pre- school/nursery, primary secondary school and higher education). Developmentally informed approaches are aware of and are informed by the needs of children and young people at different points in their life. This supports the framing of health as a resource for life that can ebb and flow and benefit from additional inputs and supports as needs present. This is particularly important given the understanding of time sensitive developmental windows in the first 1001 days of life and also, for understanding the challenges of adolescence, as explored elsewhere in this report. Universal Prevention Primary Prevention Primary prevention is action that tries to stop problems happening in the first place and is closely aligned to the functions of universal prevention though may be more topic focused. This can be through actions at a population level that reduce risks or those that address the cause of the problem. Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 59
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26 Director of Public Health’s Annual Report 2025 Taking a universal approach does not offset the need to respond to particular needs and vulnerabilities for children or adults as they present. Secondary prevention is action which focuses on early detection of a problem to support early intervention and treatment and to reduce the level of harm. It seeks to reduce risks and harms at the point of a presenting need, for example early intervention through GIRFEC processes or the timely identification and management of high blood pressure through primary care . (28) (29) Secondary Prevention Tertiary prevention seeks to minimise risks and harms once health care or wider needs are established or at a high threshold of need. This can involve action that attempts to minimise the harm of a problem through careful management, for example, a care experienced child/young person in conflict with the law or by managing a long-term condition like chronic renal disease . (30) (31) Tertiary Prevention None of the preventive tiers are exclusive; needs can escalate and then settle, they may escalate again. The goal of preventive approaches is to reduce the likelihood of a problem developing and reducing the level of presenting need, complexity and risk within as short a time as possible. An individual, family and community can have evidenced needs that move up and down and back again across the preventive continuum. This is where there is scope for better understanding the flow and relationships through the different layers of prevention with a better experience of health for individuals and likely less pressure and sometimes costs for the NHS and partners. Figure 13. A Prevention Focused System(32) A Prevention Focused System Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 60
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27 Director of Public Health’s Annual Report 2025 The timescales involved and the likelihood that investment from some services creates savings for other services can make the realising of preventive spend opportunity quite challenging to realise and evidence. This requires leadership and management commitment as well as long term planning. This can be out of synch with political and funding cycles. The Framework for achieving the preventive potential for individuals, families and communities is detailed in the Population Health Framework with the key preventive drivers that underpin a prevention focused system identified as: (32) Social and Economic Factors Places and Communities Enabling Healthy Living Equitable Health and Care These are familiar framings with a range of associated activity as detailed in this report. There is a considerable preventive role with Community Planning Partners, through for example, ensuring affordable, well-built houses in communities that are served by shops selling affordable quality food, and ‘attuned to need’ high quality universal education services where children benefit from interventions that allow them to learn, as well as attuned to need secondary interventions; for example, people in distress or in contact with police and justice services. Access to Services The World Health Organisation say: “Equity of access to health services is central to universal health coverage, particularly for the most vulnerable and marginalised people in our societies. Too many cannot access the care they need due to economic, geographic, epidemiological or cultural barriers” . (33) Spotlight: Rural Communities People who live in rural areas are often challenged with lengthy public transport commutes to reach services, and for those who have more than one health issue, the number of different appointments can mount up, often creating financial and time pressures to be able to attend them. Tensions can arise within rural areas, as new houses are built and the steadfast community expands, the gap between the old and the new widens. Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 61
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28 Director of Public Health’s Annual Report 2025 The Dalmellington Community Health Hub vision began with an aim to support people to self-manage their diabetes more easily by bringing a wide variety of support services from the NHS, health and social care partnership and voluntary sector together for one day per week at Dalmellington Community Centre. This enabled people to attend Diabetic eye Screening (DES) tests, Community Treatment and Care appointments, foot care services, smoking cessation support, home energy or financial advice, and many other services all at the same central village location. (34) During the course of the initial 2-year pilot, Dalmellington went from an area with the lowest uptake of DES appointments to one of the highest in Ayrshire, demonstrating that breaking down barriers to access enables people to engage with services that they need. Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 62
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29 Director of Public Health’s Annual Report 2025 As explored throughout this report, preventive potential can be most usefully applied across the life course. Understanding health as a resource across life means there are opportunities to shape and influence using evidence and knowledge to inform activity. The rest of this report explores key analytical insights where a preventive intervention will make a difference to areas of identified need and risk, across a continuum of universal, primary, secondary and tertiary activity. Life Course Opportunities to Realise Preventive Potential Preconception and Pregnancy Safeguarding Midwifery Life Course Spotlight Maternal Obesity The first step in the life course, health and wellbeing during preconception and pregnancy is a foundational step for shaping the beginning of the baby’s life while influencing the long-term health trajectories of both the mother and the baby. The health of a mother during pregnancy can directly influence foetal development such as brain development, the immune system, and the risk of developing chronic diseases later in life such as diabetes and heart disease. Pregnancy is often when women are most engaged with healthcare, and antenatal care provides a unique opportunity to provide education, nutritional support, mental health support and risk factor reduction. A mother’s positive experiences during antenatal care can create healthy foundations for motherhood. Family history and the experiences of life that women and partners bring to becoming pregnant inform the likelihood of conception and shape the experience of pregnancy and the growth and development of the foetus. Risk factors for poor pregnancy outcomes include poverty, obesity, dietary deficiencies, alcohol consumption, mental health issues and recreational drug use. Poverty during pregnancy is evident in Ayrshire and Arran with 35.1% of maternities originating in the most deprived area of the health board, SIMD 1, with 21.2% from SIMD 2 . That results in over half of Ayrshire and Arran’s maternities coming from the two most deprived areas. This is further reflected by 33.1% of children under 1 years old living in SIMD 1 in East Ayrshire, 45.2% in North Ayrshire and 22.5% in South Ayrshire . (35) (36) Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 63
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Spotlight: Maternal Obesity Data on Body Mass index (BMI) collected at antenatal booking allow trends in maternal healthy weight to be analysed at health board and local authority level. Over the last 15 years, there has been a steady increase in the percentage of pregnant women recorded with obesity both locally and nationally. Obesity is defined as a BMI of 30 and over. According to Public Health Scotland, obesity in pregnancy poses increased risk of serious adverse outcomes including miscarriage; congenital conditions; gestational diabetes; postpartum haemorrhage; pre-eclampsia; higher Caesarean section rate and complications during birth. Understanding the origins of obesity as an outcome from a range of complex and nuanced life- course influences is important in addressing stigma and shame for women who experience obesity during pregnancy. High levels of obesity for women can be understood in the context of poverty, inequality and limited options for eating healthily. Figure 14. % of Pregnant Women Recorded as Obese (BMI 30 and over) at Antenatal Booking from 2021/22 to 2023/24 (37) 30 Director of Public Health’s Annual Report 2025 What are we doing in Ayrshire and Arran to provide support to pregnant women? The safeguarding midwifery service provides holistic antenatal and postnatal care to women with socially complex needs. Underpinned by GIRFEC principles (a process discussed in the infancy section below), safeguarding midwives will coordinate the appropriate support to optimise the health and wellbeing of mum and baby. When child protection concern is present, safeguarding midwives will work with the lead professional and social work to contribute to the child's plan. Care is individualised to the woman's needs and a comprehensive package of Parentcraft education is provided to support the transition to parenthood. Scotland 27.6% Ayrshire & Arran 31.6% East Ayrshire 31.9% North Ayrshire 32.9%South Ayrshire 29.6% Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 64
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31 Director of Public Health’s Annual Report 2025 Ayrshire and Arran’s maternal obesity % for the previous time period was 31.6%, the highest of any of the Scottish health boards. North Ayrshire ranks joint 2nd highest for maternal obesity in Scotland in terms of council areas. East Ayrshire also ranks in the top 10 council areas for maternal obesity, whilst South Ayrshire ranks within the top 20 out of 32 council areas. What are we doing in Ayrshire and Arran to tackle Maternal Obesity? In 2023, a needs assessment was undertaken in the Carrick area in South Ayrshire to determine the needs of local pregnant women. The survey explored a range of issues including current healthy eating knowledge; barriers to eating healthily; access to support or information and physical activity levels. Based on the findings, the Dietetic Health Improvement Team is working collaboratively with South Ayrshire Council’s Thriving Communities Team to develop a local programme for pregnant women. Findings have also been used to inform work in North Ayrshire to pilot the introduction of maternal practitioner role to offer support to all pregnant women. In 2025/26, work will be undertaken to develop a pathway of care to include support for women with a high BMI and more complex nutritional needs. Keeping well in pregnancy Vitamins, minerals & supplements Portion Sizes Healthy Snacks Physical Activity Key Messages Delivered to Pregnant Women in Ayrshire & Arran Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 65
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Healthy Birth Weight Infancy is a crucial stage during the life course, with major physical and emotional developments occurring during this phase. The first 1001 days (conception to toddlerhood) are understood as foundational for nurturing health and wellbeing . Investment in this time creates a ten-fold benefit from investment across life . (38) (39) The first few years of life are the most active for creating neural connections, and more than 1 million new neural connections are formed every second in these years. By age 3, a child’s brain reaches around 80% of its adult size . These neural connections create the foundation of human adaptability and resilience, the interface between cognitive and emotional skills. Neural connections are primarily mediated by the experiences of relationships with parents/primary carers. Attuned and responsive interactions inform the attachment experience of infants, with a time sensitive developmental window of 24 months. Interactions with key adults also inform speech and language skills taken through life which are established by 13-15 months. While there are always opportunities to make up for missed developmental experiences, time sensitive developmental windows maximise the potential and ensure infants get the best possible start in life. Key interactions during this period of life creates the foundation of human adaptability and resilience and the interface between cognitive and emotional skills. (40) 32 Director of Public Health’s Annual Report 2025 Infancy 0-3 Years Old Life Course Spotlight Infant Feeding Family Focused Care 0 100 200 300 400 Congenital Birth Defects Asthma Other Unintentional Injuries Skin and Subcutaneous Diseases Epilepsy Number of DALYs Cause 379 121 106 105 102 0 100 200 300 400 Congenital Birth Defects Neonatal Disorders Skin and Subcutaneous Diseases Headache Disorders Other Cancers Number of DALYs Cause 342 182 112 90 85 Top 5 Burden of Disease: Under 15 FemalesTop 5 Burden of Disease: Under 15 Males Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 66
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Healthy Birth Weight 33 Director of Public Health’s Annual Report 2025 Spotlight: Healthy Birth Weight Healthy birth weight is an early development biomarker of the life course approach and can be influenced by various factors such as the health and wellbeing of the mother. Babies with low birth weights can experience both short term and long-term outcomes. Babies born with low birth weights have a higher risk of death and illness soon after birth and also have a higher risk of developing non-communicable diseases in the long term. Figure 15. % of Babies Born in 2021/22 to 2023/24 with a Healthy Birth Weight(37) Scotland 80.9% Ayrshire and Arran 80% East Ayrshire 80.6% North Ayrshire 78.7% South Ayrshire 80.7% Ayrshire and Arran’s % of babies born in 2021/22 and 2023/24 with a healthy birth weight was 80.0%, lower than the % for Scotland as a whole (80.9%). Out of the three local authorities, North Ayrshire had the lowest % of babies born with a healthy birth weight at 78.7%. Infant Feeding The WHO and UNICEF both recommend exclusive breastfeeding for the first six months of a baby’s life due to the protective benefits breastfeeding can offer. This includes immunity against infection and secure infant-caregiver attachment. Figure 16. Average % of Babies who have ever been breast fed between birth and the time of review 2024(37) 0 10 20 30 40 50 60 70 Scotland Ayrshire and Arran East Ayrshire North Ayrshire South Ayrshire % of babies who have ever been breastfed 69 57 54 58 59 Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 67
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34 Director of Public Health’s Annual Report 2025 Ayrshire and Arran’s % of babies ever breastfed in 2024 was 57.1%, lower than the Scottish average for 2024 of 69.0%. Out of the three local authorities, East Ayrshire had the lowest % of babies ever breastfed in 2024 at 54.4%. Breastfeeding has both short and long term benefits for both mother and baby. Babies who are breastfed are at a reduced risk of infection and reduced risk of childhood obesity later in their life course. Breastfeeding also reduces the mother’s risk of developing various cancers, obesity and cardiovascular disease .(41) Spotlight: Family Focused Care Getting it right for every child (GIRFEC) is Scotland’s commitment to provide all infants, children, young people and their families with the right support at the right time. This is so every infant, child and young person in Scotland can reach their full potential. GIRFEC, as a strengths-based approach, seeks to realise children’s rights on a day-to-day basis and is underpinned by key values and principles. NHS Ayrshire and Arran recognised the crucial role of children and ensure their voice is heard in line with The UN Convention on the Rights of the Child. The National Practice Model below in Figure 17, sets out a shared framework and approach to identification, assessment and analysis of an infant, child or young person’s wellbeing needs. The National Practice Model brings together the My World Triangle, Resilience Matrix, 8 wellbeing indicators and the 4 contexts for learning within the Curriculum of Excellence , to support overall assessment. (42) Figure 17. The National Practice Model (28) Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 68
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35 Director of Public Health’s Annual Report 2025 What are we doing in Ayrshire and Arran regarding Family Focused Care? Within NHS Ayrshire and Arran, we have developed a Pan Ayrshire Practitioner Guide and Child and Young Person’s Pathway. Interventions have been developed following engagement with families. The National GIRFEC refresh in September 2023 saw NHS Ayrshire and Arran move away from Team around the Child to Team with the Family. The Ayrshire GIRFEC website is accessible to all staff within Ayrshire and Arran, as well as the public. There is an online GIRFEC principles training module that is a prerequisite to other practitioner training e.g. AYRshare. The Practitioner Guide supports practitioners to understand GIRFEC practice across Ayrshire and Arran and improve outcomes for children and young people. It includes information about the role of the named person and the lead professional and covers Children’s Planning including assessment, request for assistance and a Child and Young Person’s Plan. (43) Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 69
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Child Dental Health Children at this age have a disposition to curiosity and an interest to learn. Even as the impact of exposure to negative influences can be pervasive across the life-course, positive childhood experiences are protective and can offset prior exposure to early adversity. Children who do not have experience of adversity as they grow and also lack positive childhood experiences, are at risk of poorer outcomes. Learning is possible and enhanced when early education/childcare, primary school and wider learning environments are attuned to and supportive of a range of needs. The pandemic has had a wide-ranging impact on the health and wellbeing of children in their early years that is working through to school aged children .(44) The cost-of-living crisis and high levels of childhood poverty brings additional pressures for children’s physical and mental health. 36 Director of Public Health’s Annual Report 2025 Childhood 4 to 11 Years Old Life Course Spotlight Child Poverty Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 70
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Healthy Birth Weight 37 Director of Public Health’s Annual Report 2025 Spotlight: Child Dental Health The % of children in P1 with satisfactory dental health in Ayrshire and Arran, 69.9%, is lower than that of the Scottish %, 73.9%. Ayrshire and Arran had the worst Primary 1 dental health of any health board in 2023/24. Figure 18. % of Children in Primary 1 and Primary 7 receiving a letter “C” (no obvious decay experience but should continue to see the family dentist on a regular basis) at basic inspection(37) Primary 1 Scotland Ayrshire and Arran East Ayrshire North Ayrshire South Ayrshire Primary 7 73.9% 70.6% 69.0% 70.0% 76.0% 69.8% 68.5% 70.1% 70.9% 69.9% Primary 1 and Primary 7 pupils in 2023/2024 What are we doing in Ayrshire and Arran to improve Child Dental Health? The Childsmile programme provides a range of interventions to improve oral health for pre-school and school-age children across Scotland. NHS Ayrshire and Arran has seen consistent improvements in the oral health of primary school aged children, but this has slowed in recent years. Lots of work and effort has been put in to ensure the programme is targeted to the families and communities which need the most support. Strong partnerships with other services including health visiting and school nursing means we can identify and support children quickly. Between 2023 and 2025, NHS Ayrshire and Arran offered automatic referral to the dental health support workers team for any 3-year-old child living in a SIMD1 area who is not registered with a dental practitioner. This programme sought to support access to dental care during a period of time when access to dental services has become more challenging. Over a two-year period, nearly 800 children were identified through this pathway and were offered support. Moving forward, the Childsmile team in Ayrshire and Arran will be reviewing the local service in line with a change in the national strategic direction. This will including re-balancing the amount of activity in different interventions. Action towards this will be monitored through the oral health improvement action plan. Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 71
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38 Director of Public Health’s Annual Report 2025 What are we doing in Ayrshire and Arran to tackle Child Poverty? An example of an initiative to address the influence of child is the work being developed in Newton Primary School in Ayr which sits within Ayr North Harbour, Wallacetown and Newton intermediate zone, a very deprived area, highlighted in the spotlight above. With support from a range of services and volunteers, Newton Primary School has responded to the needs of families and community throughout lockdown by setting up its own household, food and clothes bank. This support continually adapts to this day to meet the wide range of needs of the local community. The number of people using the bank has risen to 120 people weekly, with new people utilising the service every week. Various factors can affect the need for the bank, such as prison release, energy costs, benefit changes and seasonal demand. ‘The support bank is a vital lifeline, giving hope within the heart of the community’ Service User Key Components Supervised tooth-brushing in all nursery settings Fluoride varnish in a targeted group of nurseries and schools Prevention advice in dental surgeries Dental health support workers who provide support in the community Spotlight: Child Poverty According to the Scottish Government, around 1 in 4 children in Scotland live in poverty . Studies suggest that early chronic stress linked to child poverty may get “under the skin” and affect physical health later in life . (45) (46) South Ayrshire had the 10 highest child poverty rate in Scotland at 24.4%, which equates to around 4807 children in South Ayrshire living in poverty. Poverty is highest in Ayr North Harbour, Wallacetown and Newton, with two data zones within this area ranking 13 and 20 most deprived areas in Scotland . th th th (4) It is important to highlight that in Scotland, NHS dental treatment is free for anyone under the age of 26 and people who are pregnant or have given birth within the past 12 months. Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 72
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39 Director of Public Health’s Annual Report 2025 Figure 19. Working for Wallacetown Service User Feedback I feel like a king because I can sleep on a bed rather than just a mattress I never thought I was worth a life until you helped me Young Adult in First Tenancy Long-term drug user involved in criminality I don’t know what I would do without this help. I have never had anything like this Young adult fleeing domestic violence I’ve never had to come to anything like this before and I was affronted to begin with but I couldn’t live without it now. Everyone is so nice Older adult struggling with cost of living A further example of work to address child poverty is being undertaken by the NHS Ayrshire and Arran Public Health Department who work with the respective Local Authorities and have led on the development of the Ayrshire and Arran Child Poverty Action Plan. This seeks to prevent and reduce the risk factors of poverty from pre-birth throughout the life course. The plan includes: An Emergency Infant Food Pathway has been finalised and will be circulated to staff working with children and families. The Young Patient Family Fund. This will support the parents and siblings of young inpatients by covering expenses for travel, food and overnight accommodation. Various visuals have been produced to circulate important information such as the “Worried About Money?” leaflet and the “Money Worries” poster displayed in NHS Ayrshire and Arran hospitals. Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 73
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Teen Pregnancy Adolescence and early adulthood are a crucial period in the development of lifelong mental health, where a myriad of co-occurring changes in the brain present both risks and opportunities. These changes take energy and can be understood as an explanation for changes in mood and personality, as resources are diverted to meet the additional demands of brain changes. This is a period when there is an increase in executive function; where literacy and numeracy skills are tested and where self-esteem and a positive sense of self can reflect attachment and early relationship experiences. Positive relationships with family, peers and school protect mental health while poor relationships, bullying and exclusion from school, creates risk which can manifest into risky behaviours such as self-harm and interpersonal violence and drug and alcohol abuse, highlighted in the top 5 burden of disease for this age group. It is also a time when there can be challenges with parent relationships, as young people begin to seek autonomy and independence which can be understood as a healthy developmental task (individuation). 40 Director of Public Health’s Annual Report 2025 Adolescence 12 to 18 Years Old Life Course Spotlight Youth Vaping Corporate Parenting Structure Top 5 Burden of Disease: 15-24 Year Old FemalesTop 5 Burden of Disease: 15-24 Year Old Males 0 200 400 600 800 Self-Harm and Interpersonal Violence Drug Use Disorders Depression Headache Disorders Low Back and Neck Pain Number of DALYs Cause 660 646 168 153 141 0 100 200 300 400 Headache Disorders Self-Harm and Interpersonal Violence Low Back and Neck Pain Depression Anxiety Disorders Number of DALYs Cause 304 220 213 173 142 Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 74
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Healthy Birth Weight 41 Director of Public Health’s Annual Report 2025 Spotlight: Teen Pregnancy In Scotland, there has been an increase in teenage pregnancy for the first time in 10 years, with an increase seen across all NHS boards, mainly in the 17 to 19 age group . (47) Public Health Scotland report that younger teenagers are more likely to have a pregnancy ending in TOP (termination of pregnancy) than older teenagers. From 2011 to 2022, all three Ayrshire local authorities have been on a general decline in the rate of teenage pregnancies in under 16 and 18 year olds per 1000 women. What are we doing in Ayrshire and Arran regarding Teen Pregnancy? Targeted health improvement work continues within NHS Ayrshire & Arran with the updated Sexual Health website (SHAYR) , including a new chat function for young people to chat with sexual health staff and new STI postal testing. Free condom provision is available by post and from community pharmacies across Ayrshire. (48) A programme of work in Ayrshire Secondary Schools is ongoing. The Public Health team run a rolling programme of education sessions within secondary schools, covering relationships; consent; STI’s; pregnancy and how to access services at community pharmacy. Young people have the opportunity to speak 1:1 to staff at the end of the session and seek confidential advice. One of the key challenges in recent years is that women are reluctant to use hormonal contraception as a result of social media and #Greensex campaigns. Public Health launched a ‘myth busting’ campaign in November – December 2024 to try and counteract the misinformation available online. The advert was shown 111,807 times with 997 clicks to the SHAYR website. Figure 20. Ayrshire Sexual Health Secondary School Programme Summary Ayrshire Secondary Schools Programme 2023/24 2024/25 12 Schools Visited 5377 Students Reached so far... 7 Schools Visited 3403 Students Reached Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 75
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Healthy Birth Weight 42 Director of Public Health’s Annual Report 2025 Spotlight: Youth Vaping Youth vaping presents significant health risks, exposing our young people to nicotine addiction, toxic chemicals and respiratory harms. Children who vape are more likely to transition to smoking traditional cigarettes, which risks undoing the efforts that have been made over the last few decades to prevent smoking related harms. Recent evidence suggests that the recent rise in youth vaping may have slowed the decline of children smoking traditional cigarettes and contributing to young people taking up smoking. (49) What are we doing in Ayrshire and Arran to tackle Youth Vaping? The Public Health Department have produced a position statement and accompanying action plan to tackle youth vaping across Ayrshire. Public Health have great momentum and are working closely with our partners across education, alcohol and drug partnerships, police, trading standards, fire, paediatrics, school nursing and the Quit Your Way team. Public Health have established a Youth Vaping Taskforce who have responsibility for delivery of the action plan which aligns to the following aims in Figure 21. Figure 21. Youth Vaping Taskforce Action Plan and Aims Strategic Influence Strengthening Research & Evidence Awareness & Education Sharing Best Practice Prevention & Intervention Raise the profile of youth vaping and advocate for stricter regulation of vapes Identify routine data sources which can be used to monitor trends and opportunities to collaborate with clinical or academic partners to design research to better understand the harms of vaping Support collaboration between partners to develop a unified approach to tackle youth vaping Identify, implement and evaluate initiatives aimed at preventing youth vaping Develop clear and consistent messaging for children and their carers about the harms of vaping Spotlight: Corporate Parenting Ayrshire and Arran understands the responsibility of being a corporate parent with a dedicated corporate parenting structure and action plan within the board which complements the actions laid out in our partner’s corporate parenting plans and facilitates joint progress towards shared goals, which our ICYP (Infants, children and young people) have told us impact upon their experiences. Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 76
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Healthy Birth Weight 43 Director of Public Health’s Annual Report 2025 Corporate Parenting was originally a data driven focus of the ICYPPB (Infant, Children and Young People’s Programme Board) led by the Director of Public Health, which has supported its evolution into a Task Force, with oversight from a programme board. Senior work-stream leads have been supported by a Public Health Project Manager to ensure a population health perspective guides the systems and pathways improvement work which has been developed over the past 3 years. There has been great interest nationally in several of the themes and projects of the Corporate Parenting Task Force Group due to the whole systems and Public Health approach. What are we doing in Ayrshire and Arran regarding Corporate Parenting? In Ayrshire and Arran, there is the Health Safety Check for ICYP Accommodated in an Emergency. This is a new Pan Ayrshire service which aims to mitigate risks to health and wellbeing of children who require to be relocated to a setting outside the family home in an emergency. This is called the Health Safety Check (HSC). The HSC emphasises the need for collaboration between health and care professionals, social workers and carers to safeguard children’s health. It also addresses equality and diversity, ensuring that communication is tailored to the needs of care experienced children and young people and their carers. The HSC service was developed, tested, implemented and rolled out to enhance early identification and support for the health needs of ICYP. By practising Realistic Medicine, we are delivering a personalised approach to care, ensuring the people we care for are involved in shared decision-making, with a focus on what matters most to the children and young people we care for. I am a clinical team leader for school nurses with a specific remit for the school aged children and care experienced children and young people in South Ayrshire. I have been part of the team who carry out HSCs at the request of social work colleagues. Myself and the teams I manage have interrogated health systems and shared relevant, necessary and proportionate information with social care colleagues, to uphold the rights of the children we look after, to good health Clinical Team Leader, Children’s Health, South Ayrshire Health and Social Care Partnership Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 77
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Young adults continue to seek autonomy and independence as part of an ongoing developmental process. The pre-frontal cortex of the brain matures last, not finishing until around the age of 25. This means that executive functions such as reason, long-range planning and impulse control might not be fully operational into early adulthood. This may be more pronounced when prior developmental phases were not completed in optimal conditions. This means that executive functions such as reason, long-range planning and impulse control might not be fully operational into early adulthood. The continued presence of attuned and safe adults is no less important even as peers become more important and influential. ACEs can still have latent effects during this period in a person’s life, which can be reflected in impulsivity, displayed in the top 5 burden of disease for this age range, self-harm, drug use, depression and anxiety. 44 Director of Public Health’s Annual Report 2025 Young Adult 19 to 24 Years Old Life Course Spotlight Young Adult Mental Health Migrant TB Screening Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 78
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Young Adult Mental Health The mental health of young adults has become an increasingly important issue over recent years, as the percentage of young people aged 16 to 24 years old in Ayrshire and Arran reporting to have a mental health condition has increased from 2.5% in 2011 to 14.3% in 2019. Figure 22. % of People Aged 16 to 24 Years Old in Ayrshire and Arran Reporting to have a Mental Health Condition(2) 45 Director of Public Health’s Annual Report 2025 14.3% of Ayrshire and Arran’s 16 to 24 year olds report to have a mental health condition The extent and nature of brain development across adolescence and young adulthood creates opportunities and risks. Opportunities to consolidate positive experiences in life to date and risks that innate vulnerabilities to mental health difficulties may be accentuated or become visible, shaped also, by life experiences and real time circumstances. The mental health needs of young people appear to be increasingly challenging following the COVID-19 pandemic, with notable increases in mental health struggles. This suggests there were influences and impacts on growth and development across this age group during this time. Mental wellbeing is measured using the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS). The questionnaire consists of 14 positively worded items designed to assess: positive affect (optimism, cheerfulness, relaxation) and satisfying interpersonal relationships and positive functioning (energy, clear thinking, self-acceptance, personal development, mastery and autonomy). The total score ranges from 14 to 70 with higher scores indicating greater wellbeing. The average Scottish score was 48.7 for 2019-2023. Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 79
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Figure 23. WEMWBS Scores for Adults of All Ages(37) 46 Director of Public Health’s Annual Report 2025 East Ayrshire scored the lowest for WEMWBS with 46.9, with North Ayrshire also falling below the Scottish average of 48.7 with a score of 48.6. South Ayrshire scored slightly higher than the national figure, with a score of 48.9, highlighting the greater wellbeing felt by those living in South Ayrshire. 46.9 Ayrshire and Arran East Ayrshire North Ayrshire South Ayrshire 48.1 48.9 48.6 48.7 Scotland Spotlight: Tuberculosis In Ayrshire and Arran, tuberculosis (TB), both active and latent, remain a respiratory issue for many individuals. Active TB is an infection which involves symptoms and the person is contagious whereas latent TB is an inactive form of infection and people with latent TB are not infectious and cannot spread TB to others. In Ayrshire and Arran, the most common active TB case looks like the image in Figure 24 below. Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 80
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Figure 24. NHS Ayrshire and Arran’s most common active tuberculosis patient 47 Director of Public Health’s Annual Report 2025 The most common active TB patient in Ayrshire and Arran: Ayrshire and Arran Data 51.1 years old Male White ethnicity UK born Over 66% of active TB cases in Ayrshire and Arran are male, over 71% are white and over 72% are born in the UK. The majority, 68%, of active TB cases in Ayrshire and Arran live in the two most deprived areas, SIMD 1 and 2. These cases are not defined to any one of the local authorities, in fact, the cases are spread widely throughout East, North and South Ayrshire. What are we doing in Ayrshire and Arran to tackle the spread of tuberculosis? Public health continue to develop and improve an active programme of case-finding, contact tracing, support for individuals diagnosed with TB, and Directly Observed Therapy (DOT) for those struggling to complete medication. Health checks and health screening are offered to the migrant population on their arrival to Scotland. The type of health screening offered is dependent on the country from which the migrant has arrived from as different countries have varying levels of infectious diseases. One health screening programme offered in Ayrshire and Arran is the Tuberculosis Screening Programme. Migrant Public Health Scotland has recommended targeted tuberculosis (TB) screening for individuals seeking refuge or asylum in Scotland. Ayrshire & Arran are also one of the first Boards to develop a programme of TB screening for new migrants. Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 81
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48 Director of Public Health’s Annual Report 2025 To achieve this, NHS Ayrshire and Arran established a Migrant Screening Service in 2021. This has undergone significant development to meet service demands. In the 2-year period of 2023-25, NHS Ayrshire and Arran have offered screening with a trained nurse to all asylum seekers, people arriving on UK Government Resettlement Schemes and unaccompanied young people. The average age of screened individuals is 23 years old, and common countries of origin include Ukraine, Syria, Afghanistan and Vietnam. The arrival of unaccompanied young people is often unanticipated and can lead to difficulties in estimating the likely demands on resources. NHS Ayrshire and Arran works closely with the three local councils to ensure these young people are assessed and are able to access appropriate healthcare for TB, blood- borne viruses and sexual health, if required. The Migrant Screening Service plays an essential role in protecting the health of migrants and the wider Ayrshire population. Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 82
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The relationship skills and resilience acquired through attachment experiences in childhood, adolescence and early adulthood are taken into adult years. They inform adult relationships with family and community. Healthy relationships can be understood as protective for physical and mental health. Some mental health conditions peak in this age group, typically due to life pressures such as work, family, financial and societal. Self-harm and interpersonal violence in men peaks during this age range at 1074 years lost. In Ayrshire and Arran, drug use disorders are a significant issue within this age range. This age range often experiences the highest rate of drug-related deaths in the health board. These high rates can be attributed to multiple factors such as socioeconomic deprivation, with the majority of drug-related deaths occurring in SIMD 1, the most deprived areas. 49 Director of Public Health’s Annual Report 2025 Adults 25 to 49 Year Olds Life Course Spotlight Substance Use Early Prison Release Top 5 Burden of Disease: 25-44 Year Old FemalesTop 5 Burden of Disease: 25-44 Year Old Males 0 1000 2000 3000 Drug Use Disorders Self-Harm and Interpersonal Violence Depression Alcohol Use Disorders Low Back and Neck Pain Number of DALYs Cause 2978 1074 734 522 460 0 1000 2000 Drug Use Disorders Headache Disorders Low Back and Neck Pain Depression Anxiety Disorders Number of DALYs Cause 1924 870 758 710 590 Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 83
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Substance Use In Ayrshire and Arran, deaths due to alcohol, drugs and suicide in adults aged 25 to 49 years remains a significant public health concern. In particular, drug-related deaths have risen in recent years, mirroring national trends in Scotland. Drug, alcohol and suicide related fatalities all contribute substantially to premature mortality in Ayrshire and Arran, highlighting the urgent need for targeted interventions and support. Figure 25. Deaths due to Alcohol, Drugs and Suicide in Adults aged 25 to 49 years old in Ayrshire and Arran(1) 50 Director of Public Health’s Annual Report 2025 Substance Use Rates for 2019-2023 East Ayrshire Alcohol death rate - 21.3 per 100,000 Drug death rate - 31.4 per 100,000 Probable suicide rate - 19.1 per 100,000 Alcohol Use Disorders - 145.0 DALYs lost Drug Use Disorders - 1846.2 DALYs lost Number of DALYs North Ayrshire Alcohol death rate - 25.3 per 100,000 Drug death rate - 32.8 per 100,000 Probable suicide rate - 16.5 per 100,000 Number of DALYs Alcohol Use Disorders - 377.6 DALYs lost Drug Use Disorders - 1968.8 DALYs lost South Ayrshire Alcohol death rate - 18.9 per 100,000 Drug death rate - 22.9 per 100,000 Probable suicide rate - 13.9 per 100,000 Alcohol Use Disorders - 164.0 DALYs lost Drug Use Disorders - 1086.9 DALYs lost Number of DALYs Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 84
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Early Prison Release The relationship between early prison release and drug-related deaths is well-documented and proposes a significant public health issue. Individuals released from prison face a significant elevated risk of drug-related death, particularly within the first two weeks of release. Analysis by the NHS Ayrshire and Arran Public Health Department Research and Data team identified a cohort of individuals who experienced a prison stay and subsequently died due to drug misuse, abuse or overdose . (50) Figure 26. Risk of Drug Death on Leaving Prison in Ayrshire and Arran 51 Director of Public Health’s Annual Report 2025 598 drug- related deaths over 5 year period 52.8% had a prison term In Ayrshire and Arran between 2017 and 2021... of these 17.4% death occurred within 10 weeks of prison release of these 50.9% death occurred within 2 weeks of prison release of these These findings highlight the need for targeted interventions for recently released prisoners to reduce the risk of drug-related deaths, particularly within the first two weeks of release. This could involve enhanced support services; monitoring; and rehabilitation programmes tailored to this vulnerable group. Spotlight: Community Sentencing Community sentences are the collective ways that courts can punish someone convicted of committing an offence other than by imposing a custodial sentence. Research and evidence shows us that community sentences are more effective than short term prison sentences, supporting and addressing people’s needs and avoiding disruption to factors that can prevent re-offending, including housing, employment, relationships and access to services such as healthcare. A sustained focus on prevention and effective interventions, including community sentences, has helped ensure reconviction rates remain at a 20 year low .(51) Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 85
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What are we doing in Ayrshire and Arran to help individuals with community sentences? As a partner of the Community Justice Ayrshire Partnership, the Public Health team are supporting individuals sentenced to unpaid work across East Ayrshire. These individuals receive stress awareness, healthy eating and active living training. This training gives individuals coping mechanisms and structured action plans to support them and help protect the public, promote resistance from offending and enable rehabilitation. Unpaid work has led to reinvigorating the grounds at East Ayrshire Community Hospital and the redesign of the gardens at the Kyle Chemotherapy Unit at Ailsa Hospital. 52 Director of Public Health’s Annual Report 2025Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 86
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Adults play a key role in Ayrshire and Arran’s community, often as caregivers, volunteers and experienced members of the workforce. Prioritising their physical and mental health not only enhances their quality of life but also reduces the pressures on local health and social care services. Many people in this age group are transitioning towards retirement, and a pivotal moment in the life course emerges. The capacity for resilience and coping skills acquired across the life course to date, alongside subsequent traumatic experiences and related life challenges, inform the presence of physical and mental health challenges. Biological ageing and environmental factors intertwine and often result in chronic conditions such as cardiovascular conditions, which are prominent in Ayrshire and Arran. Conditions such as obesity negatively impact the health of this population, with 34% of individuals in Ayrshire and Arran being obese, with 70% being overweight (including obese). This leaves Ayrshire and Arran with one of the highest obesity levels in Scotland for a health board .(17) As a preventative measure, major cancer screening programmes begin during this age group, such as the bowel and breast cancer screening initiatives. Early detection through both of these programmes significantly improves treatment outcomes if cancer is detected. 0 1000 2000 3000 Ischaemic Heart Disease Drug Use Disorders Lung Cancer Depression Cirrhosis and Other Chronic Liver Diseases Number of DALYs Cause 2482 1333 1074 1018 1018 0 1000 2000 Lung Cancer Depression Low Back and Neck Pain Breast Cancer Cirrhosis and Other Chronic Liver Diseases Number of DALYs Cause 1133 1095 1076 1011 1000 53 Director of Public Health’s Annual Report 2025 Middle Age 50 to 69 Years Old Life Course Spotlight Cancer Screening Cardiovascular Conditions Top 5 Burden of Disease: 45-64 Year Old FemalesTop 5 Burden of Disease: 45-64 Year Old Males Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 87
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Cancer Screening In Scotland, bowel and breast cancer screening programmes begin at age 50. Both types of cancer are two of the most common cancers in Scotland, with breast cancer being the most common amongst women. These screening programmes allow the NHS to detect cancerous cells as early as possible, increasing the affected individual’s chance of survival .(52) Figure 27. Bowel Cancer Screening May 2022 - April 2024(53) 54 Director of Public Health’s Annual Report 2025 Bowel Cancer Screening 65.3% screening uptake May 2022-April 2024 3.0% positive test 82.6% positive test go on to have a colonoscopy 0.13% have a cancer detected of these of these of these Ayrshire and Arran ranked 12 out of 14 health boards for bowel screening programme uptake with a percentage uptake of 65.3%, falling short of the national average of 65.7%. Amongst the health boards, the percentage uptake ranged from 61.0% to 73.7%. In terms of deprivation, the bowel cancer screening uptake increased as the deprivation levels improved, highlighting the issues of access to services for those living in the most deprived areas. th Figure 28. Breast Cancer Screening 2020/2023(54) Breast Cancer Screening 76.7% screening uptake 2020/2023 Highest uptake since 2011 Higher than the Scottish Average Ayrshire and Arran had the 9th highest breast cancer screening uptake for a health board in Scotland. The uptake of 76.7% met the acceptable minimum standard of 70% uptake but fell short of the target of 80%. The uptake for the breast cancer screening programme for all health boards ranged from 72.8% to 86.2%. The breast cancer screening uptake for SIMD 1 areas in Ayrshire and Arran fell below the acceptable standard of 70%, an uptake of 68.9%. However, even though Ayrshire and Arran’s uptake within SIMD 1 fell below the standard, it was the second highest uptake for SIMD 1 for all health boards. Ayrshire and Arran’s uptake in the least deprived area, SIMD 5, was also the second highest uptake. Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 88
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Spotlight: Ageing Well As individuals get older, physical and cognitive health tend to decline. However, wellbeing is consistently found to be higher later in life in comparison to young and middle aged adults. However, this high wellbeing declines in the oldest of the older population. The influence of social relationships on the risk of death are comparable to other established mortality risk factors such as smoking and alcohol consumption. The influence of social relationships on the risk of death actually exceeds that of the influence of physical activity and obesity. It has also been found that loneliness has a significant detrimental effect on the health of an individual and can be linked with an increase risk of mortality over a 6 year follow up period in older adults aged 60 and over. What are we doing in Ayrshire and Arran to support health and wellbeing as people age? South Ayrshire has signed up to the World Health Organisation’s Age Friendly Community Model. The outworking of the model locally is sited within the Community Planning Partnership and has led to the development of an Ageing Well Strategy . The strategy was informed by a range of engagement activities and the formation of Ageing Well Champion’s Board. The work is centred around the recognition that frailty is an indicator of ageing, and that a range of preventive approaches will sustain health and reduce the progression of frailty where increasing health and social care inputs are required. Whilst still in its early days of delivery, there has already been some significant work, shown in Figure 29. (55) Figure 29. Ageing Well Strategy 55 Director of Public Health’s Annual Report 2025 Work with Stirling University focusing on housing and physical spaces Ensure new housing developments are future proofed for ageing Supporting the South Ayrshire cycling and walking link to be age friendly A play on frailty developed with The Gaiety informed by lived experience Development of a range of places offering seating and toilet access to older people Widening the reach of early intervention frailty support eg Ayr United Establishment of a small development fund Widespread Chatty and Cosy spaces A range of inter-generational work Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 89
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Spotlight: Cardiovascular Disease In the 65 to 84 age range, Figures 8 and 9 show the number of DALYs lost due to cardiology conditions and diseases dramatically increases. These conditions include ischaemic heart disease, cerebrovascular disease, atrial fibrillation and flutter, peripheral vascular disease and other cardiovascular and circulatory conditions. The data clearly indicates that the burden of cardiovascular disease increases significantly with age. Older populations, 65+, bear the greatest burden, which underscores the importance of focusing healthcare resources and interventions on these age groups . (21) Figure 30. DALY rates for Cardiovascular Conditions in 2019 in Individuals aged 65 to 84 Years Old in Ayrshire and Arran(21) 56 Director of Public Health’s Annual Report 2025 Average Ayrshire and Arran DALY rate 3620.1 8727.0 Ischaemic Heart Disease 4789.8 Cerebrovascular Disease 1301.8 Atrial fibrillation and flutter 301.0 Peripheral vascular disease 2980.8 Other cardio/circulatory issues In terms of cerebrovascular disease, Ayrshire and Arran has a significant burden of disease amongst the population. For Ischaemic Heart Disease, Ayrshire and Arran has the 4 highest burden of disease for any Scottish Health Board, 4 for Cerebrovascular Disease, 1 for Other cardio/circulatory Issues, 6 for Atrial Fibrillation and Flutter and 10 for Peripheral Vascular Disease. Out of all of these conditions, the highest burden disease in the Ayrshire and Arran local authorities is seen in Ischaemic Heart Disease in East Ayrshire with a DALY rate of 9424.4. th th st th th Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 90
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Reducing Cardiovascular Risk Through Person-Centred Prevention High blood pressure, high cholesterol and diabetes or pre-diabetes are important modifiable risk factors for developing ischaemic heart disease and stroke. People are likely to be unaware initially that they carry these often silent risks, which is why early identification is important to reduce risk of adverse outcomes. This is an example of secondary prevention – identifying risk factors at an early stage, allowing effective intervention. Prioritising future health benefits may be more difficult if people have challenges meeting their immediate needs. The cost of living crisis, combined with the changes in local employment patterns outlined in the introduction to this report, confer financial challenges for many individuals and families. Just as there are limited resources in the health service, the personal resources in terms of time, energy and motivation that are available to individuals are finite and it is unfair and unrealistic to expect people to prioritise possible future health impacts when their capacity to meet basic everyday needs, like food security, is uncertain. Health checks offered in traditional healthcare settings are often least accessible to those in the population who have most capacity to benefit. Adopting a proportionate universalism approach means ensuring equitable access to screening by developing person-centred services that take into account what is important to individuals and meets them where they are. The healthcare public health team are developing approaches that offer screening for cardiovascular risk factors in settings where individuals access support for wider determinants of health, for example by working with local authority teams to offer screening at community larder locations. Women’s Heart Health Although higher numbers of men experience cardiovascular disease, it remains the leading cause of mortality in both females and males. It is increasingly recognised that heart disease is often overlooked in women, in part due to its perception as a predominantly male disease. Furthermore, rates of heart disease between men and women converge after menopause, when the protective effect of female sex hormones is lost. Women often experience disproportionate barriers in accessing prevention, for example related to transport or caring responsibilities. We are committed to improving the experience of women in relation to heart health by: Improving awareness about how heart disease presents in women through a targeted campaign for the public and health professionals Developing access to screening to identify cardiovascular risk factors in community settings accessed by women 57 Director of Public Health’s Annual Report 2025Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 91
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What are we doing in Ayrshire and Arran to reduce Cerebrovascular Disease? Atrial fibrillation is a form of cardiac arrhythmia that affects around 1 in 10 people aged over 65. While often symptomless, it is a risk factor for stroke; people with unmanaged atrial fibrillation are five times more likely to have a stroke . Working in collaboration with the stroke team and primary care, the healthcare public health team has developed a screening pilot at Dalmellington Community Hub using a portable Kardia device, with creation of pathways that will allow diagnosis and intervention without the need to travel to hospital. Positioning diagnostic services closer to communities in this way is an important aspect of reforming services to make prevention more person-centred, as identified in the recently published Health and Social Care Service Renewal Framework . There is potential to expand this model to other community settings, with long term benefits for individuals and for the health service. (56) (57) 58 Director of Public Health’s Annual Report 2025Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 92
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As we transition from middle age into older adulthood, the cumulative effects of ageing, social determinants of health and chronic conditions are reflected in the health of the population. The burden of ischaemic heart disease in men and lung cancer in women continues and accelerates within this age range, as highlighted in the top 5 burden of disease for this age group. The burden of chronic obstructive pulmonary disease (COPD) peaks within this age range and Ayrshire and Arran see the highest rates for a health board in Scotland, as discussed next. These high rates of COPD could be due to deprivation, environmental exposure such as years of mining work or high smoking rates in the health board with 20% of the population currently smoking cigarettes and 10% currently smoking e-cigarettes or a vaping device . These numbers of smokers and vapers could be an underestimate due to underreporting. These latent effects of childhood adversity and risky behaviour choices throughout the life course can greatly impact the health of this population. (17) 59 Director of Public Health’s Annual Report 2025 Older Adults 70 to 89 Years Old Life Course Spotlight COPD Top 5 Burden of Disease: 65-84 Year Old FemalesTop 5 Burden of Disease: 65-84 Year Old Males 0 1000 2000 3000 Ischaemic Heart Disease Drug Use Disorders Lung Cancer Depression Cirrhosis and Other Chronic Liver Diseases Number of DALYs Cause 2482 1333 1074 1018 1018 0 1000 2000 Lung Cancer Depression Low Back and Neck Pain Breast Cancer Cirrhosis and Other Chronic Liver Diseases Number of DALYs Cause 1133 1095 1076 1011 1000 Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 93
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Scotland Ayrshire and Arran 85+ 7552.165-84 5146.3 East Ayrshire 85+ 13,689.1 65-84 7145.3 South Ayrshire 85+ 5186.6 65-84 3721.1 85+ 6366.3 65-84 4903.5 North Ayrshire85+ 5159.2 65-84 4856.7 Spotlight: Chronic Obstructive Pulmonary Disease (COPD) Chronic obstructive pulmonary disease (COPD) is a group of lung conditions that cause the individual breathing difficulties. In the older adult population, it can be particularly impactful as ageing lungs are already less efficient and so COPD adds a significant burden. Prompt diagnosis of COPD is important as breathing difficulties worsen over time. Early treatment and support can keep symptoms under control and reduce the chance of developing complications. Figure 31. DALY Rate of COPD in 2019 in Individuals aged 65-84 Years Old and 85 + Years Old in Ayrshire and Arran(21) 60 Director of Public Health’s Annual Report 2025 COPD in Ayrshire and Arran presents a serious issue. Ayrshire and Arran have the highest DALY rate for individuals aged 85 and over for any health board in Scotland and the third highest for individuals aged 65 to 84 years old. The effects of COPD in Ayrshire and Arran appears to significantly affect East Ayrshire, where the burden of COPD is the worst in Scotland for a local authority in the 85 years old and over age range and second highest for the 65-84 year old age range. East Ayrshire has a COPD DALY rate of 13,689.1 for people aged 85 and over, as shown in Figure 31. This could be linked to the mining culture, previously present within East Ayrshire. Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 94
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61 Director of Public Health’s Annual Report 2025 What are we doing in Ayrshire and Arran regarding COPD? Spirometry testing is recognised as the gold standard for the diagnosis, assessment and monitoring of COPD . Removal of spirometry testing from the GMS contract has led to inequities in access for the population, which can further risk widening of health inequalities. (58) Inadequate access to early high quality spirometry testing can result in delayed diagnosis, misdiagnosis and potential for inappropriate treatment pathways that may have side effects and are a waste of resource. The Healthcare Public Health Team are working in collaboration with colleagues in the South Ayrshire Health and Social Care Partnership to pilot a community service that delivers spirometry testing that is accessible for all South Ayrshire residents and as close to home as possible. It is expected that early access to community-based spirometry will support early diagnosis, therefore reducing exacerbations and complications of the disease and reducing front door presentations, as well as reducing the number of people misdiagnosed with COPD. If the pilot is successful, it will provide important learning and information to support building a community spirometry service for all people living in Ayrshire and Arran. Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 95
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As life expectancy increases, the number of people living into their tenth decade has increased, bringing significant health related challenges. Resilience and sense-making cognitive functioning may be the more challenging, alongside multi-morbidity and higher prevalence of long-term conditions. Elderly adults face a range of health issues which can be due to the natural ageing process, which is progressing due to an ageing population in Ayrshire and Arran. Lifestyle and genetic factors will also play a role in the level of health at this stage of life. According to the Burden of Disease, the conditions with the highest DALY rates in Ayrshire and Arran are Alzheimer’s disease and other dementias, cerebrovascular disease and ischaemic heart disease. Ischaemic heart disease remains an issue in individuals aged 85 and over, with it still appearing in the top 5 burden of disease list for both males and females. 62 Director of Public Health’s Annual Report 2025 Elderly 90+ Years Old Life Course Spotlight Alzheimer’s Disease Top 5 Burden of Disease: 85+ Year Old FemalesTop 5 Burden of Disease: 85+ Year Old Males 0 500 1000 Alzheimer's Disease and other Dementias Ischaemic Heart Disease Cerebrovascular Disease Lower Respiratory Infections Prostate Cancer Number of DALYs Cause 953 781 624 403 341 0 1000 2000 Alzheimer's Disease and other Dementias Cerebrovascular Disease Ischaemic Heart Disease Lower Respiratory Infections COPD Number of DALYs Cause 1855 1011 877 622 457 Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 96
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63 Director of Public Health’s Annual Report 2025 Spotlight: Alzheimer’s Disease and Other Dementias Alzheimer’s disease and other dementias, according to the burden of disease, have a DALY rate of 29,670.6 per 100,000 of the population in Ayrshire and Arran. The DALY rate increases dramatically at 85 years old and over in Ayrshire and Arran, with the rate increasing from 4171.4 for 65 to 84 years old to 29,670.6 in 85 years and over. In Ayrshire and Arran, the age-standardised mortality rate for Alzheimer’s and other dementia deaths is 106.5, 12th highest for a health board in Scotland. What are we doing in Ayrshire to care for those with Alzheimer’s and Dementia? In East Ayrshire, Local Conversations events are held to let the local community get informed about what is going on in their local area. Specific dementia-focused Local Conversations have been held in 2024 in Galston, Kilmarnock and Cumnock. Figure 25 below highlights the findings from these meetings and what is most important to the community in regards to Dementia care. (59) Figure 32. East Ayrshire Local Conversations - Dementia Care Findings Importance of social connections Importance of individual’s perspective with dementia Findings Recognition of unpaid carers Better support from services Financial impact of dementia Stigma around dementia Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 97
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64 Director of Public Health’s Annual Report 2025 This Director of Public Health Report details the origins and challenges of the high levels of health and social care need in the NHS Ayrshire and Arran population, from multiply disadvantaged urban communities; to clusters of rural deprivation; isolated communities; and an ageing and frailer population. The Report details how the seeding of poor health risk lies in the complex intersections of socioeconomic factors (40%) the physical environment (10%) that influence health related behaviours (30%) and health care needs (20%). These breakdowns, as demonstrated by Marmot , serve as actionable insights where the preventive potential to reduce demand and mitigate needs lie. (60) When the influences on the creation and sustaining of health as a resource for life are understood through a life course lens, intersecting with family and community experiences, the origins of the high burden of poor health that results in too many Ayrshire citizens not living, or being able to live in their later years becomes more visible. It also presents possibilities to further realise preventive potential through both universal (health and education) and more targeted work as needs become visible: timely understanding and assessment of needs in family life or condition specific disease (a specific and measurable condition) or illness (health needs as experienced by an individual) or risk for a child or a vulnerable adult. The Report details examples of good work and innovation. The challenge lies in the scaling up of universal prevention and the targeted approaches through primary, secondary and tertiary prevention to the point where we see evidence of whole population and targeted population effects. Alongside the good work, are the persistent and devastating consequence of years of life lost to illness and premature death, particularly for young adults (24-45 years) where the toll of addiction, suicide and alcohol are evidenced. This in turn informs an understanding of the financial challenges experienced by the NHS Ayrshire and Arran and the three Health and Social Care Partnerships in response to the burden of poor health across the population. Concluding Comments Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 98
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65 Director of Public Health’s Annual Report 2025 This informs and facilitates the NHS Board and partners in dialogue with families and communities to deliver on necessary public sector reform and achieve the changes identified in the public sector reform goals of the Scottish Government(61) 1.For people who need more support, particularly those experiencing disadvantage, public services will come to you. These services will be person-centred, accessible and you will not be required or expected to navigate different organisations or complex systems. 2.For communities, this will mean shaping local places, with public service organisations sharing power and resources with you to deliver what is needed for individual communities. 3.For public service staff, you will be empowered to provide tailored support and be trusted to work with people to deliver beyond organisational boundaries to best support the person or family in front of you. 4.For public service leaders, this will mean you lead as part of a collective, shaping a system that puts people, communities and places at its heart to meet their needs and maximise public value and ensure fiscal sustainability. Beyond leading your own organisation and sector, you will work collaboratively, forging partnerships that drive lasting change, address root causes and provide support early to avoid long-term, complex and expensive interventions later, rising above individual, organisational and sectoral interests. Actionable Insights All people can thrive when their fundamental relational and basic wants and needs (income, food, housing, health care) are met. This supports the creation of resilience to negotiate and navigate the challenges that undoubtedly exist across life. In the absence of relational certainty, uncertainty over income, food and housing, people do less well; people rarely thrive in environments of enduring scarcity. Life course framings bring additional awareness and opportunities to realise the preventive potential within the most challenged communities of Ayrshire where the consequences of societal and economic changes in the 1980s have had such devastating consequences: evidenced as too many young men and women living with the impact of drug and alcohol and mental health needs and distress, evidenced in high rates of drug, alcohol and suicide deaths before the age of 45 years. Realising the preventive potential for the populations of NHS Ayrshire and Arran will lead to benefits in the quality of life and experience of health across all income groups; with the greatest benefits for those experiencing the greatest challenges in family and community life and their experiences of health and wellbeing and premature, preventable death. Realising the preventive potential of health and social care services, where needs and risks are identified early and met in a timeous manner, will further contribute to a motivated and energised workforce and realise additional improvements in the experience of care and health potential of individuals. Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 99
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66 Director of Public Health’s Annual Report 2025 The Ayrshire and Arran NHS Board, and the senior leadership within the Health and Social Care Partnerships, Ayrshire Local Authorities and wider Community Planning Partners are challenged, encouraged and invited to: 1.Build a stronger understanding of how poverty and lack of opportunity affect people in the most disadvantaged communities across North, South, and East Ayrshire. 2.Recognise the benefits of both universal and targeted approaches in using health as a resource for life: from before birth, through all life stages, and across generations: for individuals, families, and communities 3.Work with purpose, pace, and scale across systems and services to unlock this preventive potential for all Ayrshire citizens. Every partner should take responsibility and act within their sphere of influence to deliver the opportunities outlined in this report. 4.The 2026 Director of Public Health (DPH) Report will build on these themes. It will guide the planning and design of services that meet the diverse needs of people at different ages and life stages, from urban centres to remote towns and villages. This work will support the Caring for Ayrshire Action Plan: citizens at the centre of care, accessing the right care, in the right place, at the right time. 5.Key asks of the Public Health Department and all partners/programmes of work involves examining: a.What is being delivering and how we ensure maximum impact (across a prevention continuum) to effect change in this space as a team. b.How we demonstrate leadership and collaboration across the whole system to fully realise preventive potential. c.How we ensure our work reaches those most affected by poverty and inequality, including rural and remote communities. d.The gaps are in our current approach, and what practical steps we can take to close them. e.How we embed prevention across all systems and services, not just in strategic plans. f.What evidence demonstrates progress and impact across communities. Recommendations Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 100
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67 Director of Public Health’s Annual Report 2025 List of Figures Fig. 1. Demography Fig 2. Scottish Index of Multiple Deprivation of Ayrshire and Arran Fig. 3. Child Poverty Fig. 4. The Influence of Poverty on Child Health and Department Fig. 5. Health Inextricably Linked to Community and Planetary Wellbeing in Ayrshire and Arran Fig. 6. Experience of Childhood Adversity in Scotland Fig. 7. Adverse Community Experiences Fig. 8. Understanding the Burden of Disease across Males in Ayrshire and Arran by DALY rate in 2019 Fig. 9. Understanding the Burden of Disease across Females in Ayrshire and Arran by DALY rate in 2019 Fig. 10. Understanding the Life Course Burden of Disease across Males in Ayrshire and Arran by number of DALYs in 2019 Fig. 11. Understanding the Life Course Burden of Disease across Females in Ayrshire and Arran by number of DALYs in 2019 Fig. 12. Four Pillars of Health Fig 13. A Prevention Focused System Fig. 14. % of Pregnant Women Recorded as Obese (BMI 30 and over) at Antenatal Booking from 2021/22 to 2023/24 Fig. 15. % of Babies Born in 2021/22 to 2023/24 with a Healthy Birth Weight Fig. 16. Average % of Babies Who Have Ever Been Breast Fed Between Birth and the Time of Review 2024 Fig. 17. The National Practice Model Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 101
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68 Director of Public Health’s Annual Report 2025 List of Figures Fig. 18. % of Children in Primary 1 and Primary 7 Receiving a Letter “C” (No Obvious Decay Experience but Should Continue to See the Family Dentist on a Regular Basis) at Basic Inspection Fig. 19. Working for Wallacetown Service User Feedback Fig. 20. Ayrshire Sexual Health Secondary School Programme Summary 2023/24 and 2024/25 Fig. 21. Youth Vaping Taskforce Action Plan and Aims Fig. 22. % of People Aged 16 to 24 Years Old in Ayrshire and Arran Reporting to have a Mental Health Condition Fig. 23. WEMWBS Scores for Adults of All Ages Fig. 24. NHS Ayrshire and Arran’s Most Common Active Tuberculosis Patient Fig. 25. Deaths Due to Alcohol, Drugs and Suicide in Adults aged 25 to 49 Years Old in Ayrshire and Arran Fig. 26. Risk of Drug Death on Leaving Prison in Ayrshire and Arran Fig. 27. Bowel Cancer Screening May 2022 - April 2024 Fig. 28. Breast Cancer Screening 2020-2023 Fig. 29. Ageing Well Strategy Fig. 30. DALY Rates for Cardiovascular Conditions in 2019 in Individuals aged 65 to 84 Years Old in Ayrshire and Arran Fig. 31. DALY Rate of COPD in 2019 in Individuals aged 65 to 84 Year Old and 85+ Year Olds in Ayrshire and Arran Fig. 32. East Ayrshire Local Conversations - Dementia Care Findings Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 102
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69 Director of Public Health’s Annual Report 2025 References 1. National Records Scotland. Births, deaths and other vital events - fourth quarter 2024 [Internet]. National Records of Scotland (NRS). National Records of Scotland; 2024. Available from: https://www.nrscotland.gov.uk/publications/births-deaths-and-other-vital-events-fourth-quarter-2024/ 2.Scottish Census. 2022 results [Internet]. Scotland’s Census. Available from: https://www.scotlandscensus.gov.uk/2022-results/ 3.Scottish Government Urban Rural Classification 2020 [Internet]. www.gov.scot. Available from: https://www.gov.scot/publications/scottish-government-urban-rural-classification-2020/ 4.Public Health Scotland. Scottish Index of Multiple Deprivation (SIMD) - Deprivation - Geography, population and deprivation support - Health intelligence and data management - Resources and tools - Public Health Scotland [Internet]. Publichealthscotland.scot. 2024. Available from: https://publichealthscotland.scot/resources-and-tools/health-intelligence-and-data- management/geography-population-and-deprivation-support/deprivation/scottish-index-of-multiple- deprivation-simd/ 5.World Health Organization. Human rights [Internet]. World Health Organization. 2023. Available from: https://www.who.int/news-room/fact-sheets/detail/human-rights-and-health 6.The Lancet Public Health. No public health without planetary health. The Lancet Public Health. 2022 Apr;7(4):e291. 7.Thomas SL, Kickbusch I, Kökény M, Okan O. 40 years of the Ottawa Charter for Health Promotion— Reaffirming Health for All. Health Promotion International [Internet]. 2025 Jul 1;40(4). Available from: https://doi.org/10.1093/heapro/daaf143 8.Scottish Government. Poverty and Income Inequality in Scotland 2020-23 [Internet]. Gov.scot. 2024. Available from: https://data.gov.scot/poverty/ 9.End Child Poverty. Child Poverty Statistics - End Child Poverty [Internet]. End child poverty. 2022. Available from: https://endchildpoverty.org.uk/child-poverty/ 10.Scottish Government. Understanding the health outcomes of experiencing poverty in the early years: Evidence review [Internet]. Scottish Government. 2025. Available from: https://www.gov.scot/binaries/content/documents/govscot/publications/research-and- analysis/2025/06/understanding-health-outcomes-experiencing-poverty-early-years-evidence- review/documents/understanding-health-outcomes-experiencing-poverty-early-years-evidence- review/understanding-health-outcomes-experiencing-poverty-early-years-evidence- review/govscot%3Adocument/understanding-health-outcomes-experiencing-poverty-early-years- evidence-review.pdf 11.Schmidt KL, Merrill SM, Gill R, Miller GE, Gadermann AM, Kobor MS. Society to cell: How child poverty gets “Under the Skin” to influence child development and lifelong health. Developmental Review [Internet]. 2021 Sep;61(100983):100983. Available from: https://www.sciencedirect.com/science/article/pii/S0273229721000381 12.Ungar M. Resilience across Cultures. British Journal of Social Work [Internet]. 2008 Nov 8;38(2):218– 35. Available from: https://academic.oup.com/bjsw/article/38/2/218/1684596 Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 103
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70 Director of Public Health’s Annual Report 2025 References 13. European Network of National Human Rights Institutions. Human Rights-Based Approach [Internet]. ENNHRI. 2022. Available from: https://ennhri.org/about-nhris/human-rights-based-approach/ 14. Scottish Government. Part 1 – A National Spatial Strategy for Scotland 2045 [Internet]. www.gov.scot. 2023. Available from: https://www.gov.scot/publications/national-planning-framework-4/pages/2/ 15. The Lost Villages | An Oral History of Miners’ Rows and Deindustrialisation in East Ayrshire, Scotland. [Internet]. Thelostvillages.co.uk. 2021. Available from: https://www.thelostvillages.co.uk/ 16. Branje S, Geeraerts S, de Zeeuw EL, Oerlemans AM, Koopman-Verhoeff ME, Schulz S, et al. Intergenerational transmission: Theoretical and methodological issues and an introduction to four Dutch cohorts. Developmental Cognitive Neuroscience [Internet]. 2020 Oct;45:100835. Available from: https://www.sciencedirect.com/science/article/pii/S1878929320300839 17. Scottish Government. Scottish health survey 2019 - volume 1: Main report - gov.scot [Internet]. www.gov.scot. 2020. Available from: https://www.gov.scot/publications/scottish-health-survey-2019- volume-1-main-report/pages/11/ 18. Harvard University. Toxic Stress [Internet]. Center on the Developing Child at Harvard University. The President and Fellows of Harvard College; 2015. Available from: https://developingchild.harvard.edu/science/key-concepts/toxic-stress/ 19. National Society for the Prevention of Cruelty to Children. Attachment and child development [Internet]. NSPCC Learning. 2021. Available from: https://learning.nspcc.org.uk/child-health- development/attachment-early-years 20. Ellis WR, Dietz WH. A New Framework for Addressing Adverse Childhood and Community Experiences: The Building Community Resilience Model. Academic pediatrics [Internet]. 2017;17(7S):S86–93. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28865665 21. ScotPHO. Scottish Burden of Disease [Internet]. scotland.shinyapps.io. Available from: https://scotland.shinyapps.io/phs-local-trends-scottish-burden-diseases/ 22. ISD Scotland. Hospital Care | Inpatient and Day Case Activity | Health Topics | ISD Scotland [Internet]. www.isdscotland.org. Available from: https://www.isdscotland.org/Health-Topics/Hospital-Care/Inpatient- and-Day-Case-Activity/ 23. Public Health Scotland. Drug-related deaths in Scotland reported for 2024 - News - Public Health Scotland [Internet]. Publichealthscotland.scot. 2024. Available from: https://publichealthscotland.scot/news/2025/september/drug-related-deaths-in-scotland-reported-for- 2024/ 24. NHS Scotland Open Data. Acute Hospital Activity - Groups - Scottish Health and Social Care Open Data [Internet]. Nhs.scot. 2025. Available from: https://www.opendata.nhs.scot/group/acute-hospital- activity 25. UCLA Health. Social Determinants of Health - Sustainability | UCLA Health [Internet]. www.uclahealth.org. 2024. Available from: https://www.uclahealth.org/sustainability/our- commitment/social-determinants-health Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 104
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71 Director of Public Health’s Annual Report 2025 References 26. Education Scotland. Nurture and trauma-informed approaches: a Summary of Supports and Resources [Internet]. education.gov.scot. 2021. Available from: https://education.gov.scot/resources/nurture-and-trauma-informed-approaches-a-summary-of- supports-and-resources/ 27. Health Scotland. A guide to smoking cessation in Scotland 2010 Helping smokers to stop Brief interventions [Internet]. 2017. Available from: https://www.healthscotland.scot/media/1097/helping- smokers-to-stop-smoking-2017.pdf 28. Scottish Government. Getting It Right for Every Child (GIRFEC) [Internet]. Scottish Government. 2023. Available from: https://www.gov.scot/policies/girfec/ 29. Scottish Government. Home blood pressure monitoring - gov.scot [Internet]. www.gov.scot. Available from: https://www.gov.scot/news/home-blood-pressure-monitoring/ 30. Working with children in conflict with the law 2021: standards [Internet]. www.gov.scot. Available from: https://www.gov.scot/publications/standards-those-working-children-conflict-law-2021/ 31. NICE. Chronic Kidney disease: Assessment and Management | Guidance | NICE [Internet]. www.nice.org.uk. 2021. Available from: https://www.nice.org.uk/guidance/ng203 32. Scottish Government. Scotland’s Population Health Framework [Internet]. Gov.scot. The Scottish Government; 2025. Available from: https://www.gov.scot/publications/scotlands-population-health- framework/ 33. World Health Organization. Improving service access and quality [Internet]. www.who.int. 2024. Available from: https://www.who.int/activities/improving-service-access-and-quality 34. NHS Ayrshire and Arran. Dalmellington Community Health Hub – NHS Ayrshire & Arran [Internet]. Nhsaaa.net. 2025. Available from: https://www.nhsaaa.net/services/services-a-z/dalmellington- community-health-hub/ 35. Public Health Scotland.Births in Scotland [Internet]. Available from: https://publichealthscotland.scot/media/30265/bis_report.pdf 36. NRS. Population estimates by Scottish Index of Multiple Deprivation (SIMD) [Internet]. National Records of Scotland (NRS). National Records of Scotland; 2022. Available from: https://www.nrscotland.gov.uk/publications/population-estimates-by-scottish-index-of-multiple- deprivation-simd/ 37. Scottish Public Health Observatory. ScotPHO Profiles [Internet]. 2021. Available from: https://scotland.shinyapps.io/ScotPHO_profiles_tool/ 38. Burden J. Parent-Infant Foundation [Internet]. Parent-Infant Foundation. 2019. Available from: https://parentinfantfoundation.org.uk/1001-days/ 39. Public Health England. Cost-effectiveness and Return on Investment (ROI) of interventions associated with the Best Start in Life [Internet]. Available from: https://assets.publishing.service.gov.uk/media/5c408cc040f0b616fba5cb05/BSIL_ROI__report _01.19.pdf Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 105
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72 Director of Public Health’s Annual Report 2025 References 40. Harvard University. Brain Architecture - Center on the Developing Child at Harvard University [Internet]. Center on the Developing Child at Harvard University. Harvard University; 2024. Available from: https://developingchild.harvard.edu/key-concept/brain-architecture/ 41. Scotland PH. Benefits of breastfeeding - Infant feeding - Child health data and intelligence - Early years and young people - Population health - Public Health Scotland [Internet]. Publichealthscotland.scot. 2024. Available from: https://publichealthscotland.scot/population-health/early-years-and-young- people/child-health-data-and-intelligence/infant-feeding/benefits-of-breastfeeding/ 42. Education Scotland. About Curriculum for Excellence [Internet]. education.gov.scot. 2019. Available from: https://education.gov.scot/curriculum-for-excellence/about-curriculum-for-excellence/ 43. GIRFEC Ayrshire. Practitioner Documents - Girfec [Internet]. Girfec. 2025. Available from: https://girfec- ayrshire.co.uk/practitioner-documents/ 44. Schroeder K, Schuler BR, Kobulsky JM, Sarwer DB. The association between adverse childhood experiences and childhood obesity: A systematic review. Obesity Reviews [Internet]. 2021 Jan 27;22(7). Available from: https://onlinelibrary.wiley.com/doi/abs/10.1111/obr.13204 45. Scottish Government. Poverty and Social justice: Child Poverty [Internet]. 2019. Available from: https://www.gov.scot/policies/poverty-and-social-justice/child-poverty/ 46. Evans GW, Chen E, Miller GE, Seeman TE. How Poverty Gets Under the Skin: A Life Course Perspective. Oxford University Press eBooks. 2012 Sep 18;13–36. 47. Public Health Scotland. Teenage pregnancies - Year of conception, ending 31 December 2022 - Teenage pregnancies - Publications - Public Health Scotland [Internet]. Publichealthscotland.scot. 2022. Available from: https://publichealthscotland.scot/publications/teenage-pregnancies/teenage- pregnancies-year-of-conception-ending-31-december-2022/ 48. Sexual Health Ayrshire [Internet]. Sexual Health Ayrshire. 2025. Available from: https://shayr.com 49. Egger S, David M, McCool J, Hardie L, Weber MF, Luo Q, et al. Trends in smoking prevalence among 14–15-year-old adolescents before and after the emergence of vaping in New Zealand; an interrupted time series analysis of repeated cross-sectional data, 1999–2023. The Lancet Regional Health - Western Pacific [Internet]. 2025 Mar 1;101522–2. Available from: https://www.thelancet.com/journals/lanwpc/article/piiS2666-6065(25)00059-8/fulltext 50. Public Health Scotland. PHS Drug Death Database 2024. 51. Scottish Government. Reducing reoffending: Community sentencing - gov.scot [Internet]. www.gov.scot. 2019. Available from: https://www.gov.scot/policies/reducing-reoffending/community- sentencing/ 52. NHS Inform. Breast screening in Scotland [Internet]. NHS inform. Available from: https://www.nhsinform.scot/healthy-living/screening/breast-screening/ Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 106
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73 Director of Public Health’s Annual Report 2025 References 53. Public Health Scotland. Scottish bowel screening programme statistics - For the period of invitations from May 2022 to April 2024 - Scottish bowel screening programme statistics - Publications - Public Health Scotland [Internet]. Publichealthscotland.scot. 2022. Available from: https://publichealthscotland.scot/publications/scottish-bowel-screening-programme-statistics/scottish-b owel-screening-programme-statistics-for-the-period-of-invitations-from-may-2022-to-april-2024/ 54. Public Health Scotland. Scottish bowel screening programme statistics. Scottish breast screening programme statistics - Publications - Public Health Scotland [Internet]. Publichealthscotland.scot. 2022. Available from: https://publichealthscotland.scot/publications/scottish-breast-screening-programme- statistics/scottish-breast-screening-programme-statistics-annual-update-to-31-march-2023/ 55. South Ayrshire Health and Social Care Partnership. Ageing Well in South Ayrshire Strategy. Available from: https://hscp.south-ayrshire.gov.uk/media/12972/Ageing-Well-in-South-Ayrshire-Strategy- 2024/pdf/Ageing_Well_in_South_Ayrshire_Strategy_-_FINAL.pdf?m=1743691770290 56. Stroke Association. Atrial Fibrillation. 2025. Available at: https://www.stroke.org.uk/stroke/managing- risk/atrial-fibrillation 57. Scottish Government. Health and Social Care Service Renewal Framework 2025. Available at: https://www.gov.scot/publications/health-social-care-service-renewal-framework/ 58. NICE. Chronic obstructive pulmonary disease in over 16s: diagnosis and management. NICE guideline [Internet]. 2019 Jul. Available from: https://www.nice.org.uk/guidance/ng115/resources/chronic- obstructive-pulmonary-disease-in-over-16s-diagnosis-and-management-pdf-66141600098245 59. Living Well East Ayrshire. Local Conversations – Living Well East Ayrshire [Internet]. Livingwellea.co.uk. 2022. Available from: https://livingwellea.co.uk/get-involved/communities/local-conversations/ 60. Institute of Health Equity. Scotland - Collaboration for Health Equity (CHES) - Institute of Health Equity [Internet]. Institute of Health Equity. 2021. Available from: https://www.instituteofhealthequity.org/resources-reports/scotland---collaboration-for-health-equity-ches 61. Scottish Government. Scotland’s Public Service Reform Strategy: Delivering for Scotland [Internet]. Gov.scot. The Scottish Government; 2025. Available from: https://www.gov.scot/publications/scotlands- public-service-reform-strategy-delivering-scotland/pages/2/ Growing Well to Live Well: Understanding the Burden of Disease NHS Ayrshire and Arran Director of Public Health Annual Report 2025 107
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Integration Joint Board 18th June 2026 Subject : Children’s Services Plan Performance Report 2025/26 Purpose : • Awareness Recommendation : The Integration Joint Board are asked to: a) Note the key achievements contained in the North Ayrshire Children’s Services Plan Performance Report 2025/26 and; b) Agree that the report will be submitted to the Scottish Government. Direction Required to Council, Health Board or Both Direction to :- 1. No Direction Required X 2. North Ayrshire Council 3. NHS Ayrshire & Arran 4. North Ayrshire Council and NHS Ayrshire & Arran Glossary of Terms CPP Community Planning Partnership CSSP Children’s Services Strategic Partnership HSCP Health and Social Care Partnership RRSA Rights Respecting Schools Award 1. EXECUTIVE SUMMARY 1.1 Every Local Authority and relevant Health Board is required to jointly prepare a Children's Services Plan for local authority area every three years. Plans are developed collaboratively with members of the Community Planning Partnership (CPP), as well as with children, young people and their families at various stages of the development and review of the Plan. North Ayrshire HSCP published it’s current Children’s Services Plan 2023-26 in June 2023. 1.2 The North Ayrshire Children’s Services Plan 2023-26 is part of a suite of child focussed plans which outline how we are actively supporting the wellbeing and wellness of our children and young people, as well as promoting and advocating for the rights of our children and young people. 1.3 The 2025/26 performance report has been prepared in collaboration with the Children’s Services Strategic Partnership (CSSP) which consists of representatives from Community Planning Partners and highlights some of the key achievements and areas of work which impact on babies, infants, children, young people and their Agenda Item 6 108
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families. The 2025/26 Performance Report is the final report associated with this plan cycle and closes off the current Children’s Services Plan. 1.4 The Children’s Services Strategic Partnership agreed that a new style of Children and Families Plan for 2026 to 2029 would be developed to set out our collective strategic responsibility to promote the wellbeing, rights, and outcomes of babies, infants, children and young people and their families in our area. This responsibility is underpinned by three key statutory duties, including: • Children’s Services Planning: Every local authority and its Health Board must jointly prepare a Children’s Services Plan for each three-year period. • Child Poverty Reporting: The local authority and Health Board must jointly produce an annual Local Child Poverty Action Report. • Children’s Rights Compliance: Local authorities and Health Boards, as listed public authorities, must act in a way that is compatible with the UN Convention on the Rights of the Child (UNCRC) and embed children’s rights in their decision-making and service delivery. 1.5 Recognising the links across these areas, we have aligned our planning and reporting, which will be supported by a shared set of child and family wellbeing actions and indicators. This streamlines processes, strengthens accountability, and will enable more effective targeting of resources to improve outcomes for babies, infants, children, young people, and families and aligns to our wider ambitions of strengthening whole family support. We are one of the Scottish Government’s ‘early adopter’ authorities, with that programme established to address the twin barriers of: i) policy complexity and overlap, and ii) funding and reporting approaches. 2. BACKGROUND 2.1 Children’s Services Plan Performance Report 2025/26 Part 3 of the Children and Young People (Scotland) Act 2014 seeks to improve outcomes for all children and young people in Scotland by ensuring that local planning and delivery of services is integrated, focused on securing quality and value through preventative approaches, and dedicated to safeguarding, supporting and promoting child wellbeing. It aims to ensure that any action to meet need is taken at the earliest appropriate time and that, where appropriate, this is taken to prevent need arising. The aims are about creating and maintaining a local environment which facilitates Getting it Right for Every Child Practice (GIRFEC) for individual children and young people. 2.2 Section 13 (1) of the Act requires that as soon as practicable after the end of each one-year period, a local authority and the relevant health board must publish (in such manner as they consider appropriate) a report on the extent to which: a) children’s and related services have, in that one-year period, been provided in accordance with the Children’s Services Plan; and b) that the provision of services has achieved – 109
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i. the aims of children’s services planning (section 9(2)), and ii. such outcomes in relation to the wellbeing of children in the area as the Scottish Ministers may by order prescribe. 2.3 This is our final performance report relating to our 2023-26 Children’s Services Plan which focusses on our vision 'For all our children and young people to have the best start in life and for North Ayrshire to be the best place in Scotland to grow up'. The Performance Report 2025/26 has been structured in line with our five priorities set out in the Plan. These are – 1. The rights of children and young people are promoted and protected. 2. Acting early to improve what happens next. 3. Making Things Fairer. 4. Promoting good mental health and wellbeing. 5. Inspiring children and young people to be active. 2.4 A set of actions was identified to be delivered by CPP partners. Updates on the progress of the actions has been included in Appendix 1 of the report. We have established a set of indicators to measure progress, as attached in Appendix 2 of the report. A summary version of the report will be produced in collaboration with young people to ensure it is fully accessible and engaging for our young people. 2.5 Some of the key highlights from the 2025/26 Performance Report include: • All North Ayrshire schools take part in the UNICEF Rights Respecting Schools Award (RRSA) programme, showing a strong commitment to children’s rights. • 15 local primary and secondary schools have now signed up to the Young Carers Covenant, ensuring that young carer awareness and tailored support are embedded into school culture. • From 1 July 2025, the National Childbirth Trust began providing postnatal breastfeeding support for women discharged from Ayrshire Maternity Unit who were breastfeeding. Between July and March, 1,331 women accessed this support, with around half exclusively breastfeeding at 6–8 weeks. • 89 practitioners are now trained in the Building Positive Relationships programme, embedding a preventative, trauma-informed approach that strengthens parental regulation, relationships and resilience while reducing reliance on crisis intervention. • 12 local projects and services received a share of the £1.19 million Whole Family Wellbeing Fund investment in North Ayrshire, to support the delivery of positive outcomes for children, young people and families across North Ayrshire. • The Duke of Edinburgh’s Award provided a strong wellbeing and achievement pathway, engaging over 1,000 young people and supporting progression through Bronze, Silver and Gold levels. • 9,781 young people participated in sport and physical activity sessions through Active Schools. 110
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2.6 The Children’s Services Strategic Partnership also monitors the Whole Family Wellbeing Fund. The Whole Family Wellbeing Fund is a £500 million investment over the life of the Scottish Parliament (2022 to 2026). Appendix 3 of the Children’s Services Performance Report provides a summary of progress to date including updates on the previously agreed proposals and new developments, as well as the current funding position. It also highlights the annual report which is in line with the North Ayrshire Whole Family Wellbeing Fund Monitoring and Evaluation Framework, as well as the Scottish Government monitoring requirements. 2.7 Children and Families Plan 2026 to 2029 Our new joint approach in our Children and Families Plan 2026-29 was approved by Cabinet in January 2026, where it was agreed that the joint responsibilities for planning and reporting could be brought together into one plan, including: • Children’s Services Planning (Part 3 of Children and Young People (Scotland) Act 2014). The legislation sets out a requirement to develop and publish a Children’s Services Plan every three years, reporting annually on its progress. These plans describe how partners will work together and with local communities, to plan and deliver the right types of services and support so these result in improved life experiences and outcomes for the children and families living in that area. • Child Poverty (Scotland) Act 2017. This legislation sets out a requirement to develop and publish an annual report to: describe measures taken and planned to meet 2030 Scottish Government child poverty targets; include income maximisation supports, advice and financial assistance; and highlight tailored actions for families facing additional challenges due to protected characteristics. • UNCRC Incorporation (Scotland) Act 2024. This legislation sets out a requirement to develop and publish report on actions taken to comply with UNCRC and outline future improvement plans. This supports the integration of children’s human rights into planning, communications, and decision-making. 2.8 Combining these planning approaches is in line with the Scottish Government’s Whole Family Support (WFS) project, where North Ayrshire is one of seven ‘early adopter’ local authorities. The Whole Family Support approach recognises that reporting complexity and overlap acts as a barrier to local authorities and aims to address this by increasing permissions and reducing reporting and bureaucracy burdens. 2.9 The Children and Families Plan 2026-2029 is in an advanced phase of development with the Children’s Services Strategic Partnership and will be a high level, strategic plan, designed to bring together the impact of our collective efforts on child and family wellbeing. This intends to shift traditionally siloed data practices to reveal an interconnected picture of outcomes. With a shared and consistent evidence base, our strategic planning and decision making will be more robust, enabling us to target resources to where they will have the greatest impact. 111
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2.10 The process of strengthening alignment across governance, planning and service provision is complex and multi-faceted. The Scottish Government’s Whole Family Support approach is underway but is operating on a multi-phase basis with real-time learning integrated into the process. Similarly, we are viewing our own local reform as incremental. The opportunity to align these areas now as a result of natural policy cycles is timely. Our overarching goal remains to further strengthen our capacity to deliver integrated and holistic support to those residents who require it. 2.11 It is proposed that the new Children and Families Plan 2026-29 will be presented to Cabinet and to IJB after the summer recess for formal approval. 3. PROPOSALS 3.1 It is proposed that Integration Joint Board: a) Notes the key achievements contained in the North Ayrshire Children’s Services Plan Performance Report 2025/26; b) Agrees that the North Ayrshire Children’s Services Plan Performance Report 2025/26 can be submitted to the Scottish Government; c) Notes that a child friendly version of the Report will be published as soon as possible in the autumn, and; d) Notes the progress relating to the development of the new Children and Families Plan 2026-2029. 3.2 Anticipated Outcomes Publication of the report will meet the statutory reporting requirements laid out in Section 13(1) of Part 3 of the Children and Young People (Scotland) Act 2014. The Report will inform the residents of North Ayrshire about progress related to our Children’s Services Plan and raise awareness the key achievements. 3.3 Measuring Impact Impact is measured by the Performance Indicators and actions contained in the report appendices and also by the use of narrative and case studies to describe impact on families, babies, children and young people. 4. IMPLICATIONS 4.1 Financial None. 4.2 Human Resources None. 4.3 Legal We have a duty under the Children and Young People (Scotland) Act 2014 to produce a Children’s Services Plan Performance report every year detailing the activities undertaken in relation to Children’s Services. 112
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4.4 Equality/Socio-Economic None. 4.5 Risk Low. 4.6 Community Wealth Building None. 4.7 Key Priorities This report directly supports the Health and Social Care Partnership Strategic Plan and Vision ‘To empower people in North Ayrshire to live safe, healthy and active lives with fair and equal access to sustainable health and care services.’. This report directly supports our Council’s vision of creating ‘a North Ayrshire that is Fair for All’ and our mission of ‘Working together to improve the lives our people in North Ayrshire’. It demonstrates how we are contributing all of our priorities ‘Wellbeing’, ‘Communities and Local Democracy’, ‘Climate Change’ and ‘A Sustainable Council’ in ensuring children’s rights are embedded throughout our services. This report directly supports the North Ayrshire Community Planning Partnership Plan and three key themes of ‘Wellbeing’, ‘Work’ and ‘World’. 5. CONSULTATION Contributions from services across our Council and Partners have been included in this report. Services regularly consult with children, young people and families. A Young Person’s version of the report will be developed over the summer months to ensure it is fully accessible for our young people. The Report has been presented to the Children's Services Strategic Partnership, North Ayrshire Council Cabinet and will be presented to NHS Ayrshire and Arran Board in due course. Caroline Cameron, Director (North Ayrshire Health and Social Care Partnership) Lauren McMath, Policy Officer (Childrens Services), 01294 324160 or email: laurenmcmath@north-ayrshire.gov.uk Appendices • Appendix 1: North Ayrshire Children’s Services Performance Report 2025/26 • Appendix 2: Children’s Services Plan Action Report 2025/26 • Appendix 3: Children's Services Plan Performance Indicators Report 2025/26 • Appendix 4: Whole Family Wellbeing Fund Annual Summary Report 2025/26 113
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Children’s Services Plan – Performance Report 2025-26 114
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2 Contents Welcome 3 Introduction 4 Priority 1 – The rights of children and young people are promoted and protected 5 Priority 2 – Acting early to improve what happens next 16 Priority 3 – Making things fairer 25 Priority 4 – Promoting good mental health and wellbeing 37 Priority 5 – Inspiring children and young people to be active 41 115
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3 Welcome Welcome to the 2025-26 Children’s Services Plan Performance Report. In this report we hope to demonstrate some of the key work of the Children's Services Strategic Partnership members and highlight our progress and achievements over the past year. This is the last performance report aligned to our 2023-26 Children’s Services Plan and we close off this Plan hoping to show the improvements that have been made as we worked towards our vision for ‘North Ayrshire to be the best place in Scotland to grow up’ while we continued to focus on promoting children and young people’s wellbeing, underpinned by Getting it Right for Every Child (GIRFEC) and the United Nations Convention on the Rights of the Child (UNCRC). We recognise that our strong partnership foundation in North Ayrshire provides continued commitment to collectively focus on improving outcomes for our babies, children, young people and families. Our aim going forward will now be to join up our key areas of focus and planning into a streamlined Children and Families Plan for 2026-29 and continue to build on all the progress made through our Children’s services Strategic Partnership to drive forward our ambitions for North Ayrshire. We want to make sure that we move seamlessly into a Whole Family Support model of working where we continue to place babies, children, young people and families at the very heart of service delivery so we can provide the right support at the right time. Caroline Cameron Director North Ayrshire Health and Social Care Partnership (Chair of North Ayrshire Children’s Services Strategic Partnership) 116
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4 Introduction This report focuses on the key highlights over 2025/26 and has been organised around the five Priorities set out in the Children’s Services Plan 2023-26. We are currently reporting on the third and final year of our Children’s Services Plan which covers 2025-26. The five Strategic Priorities are shown above. Our Children’s Services Strategic Partnership is the responsible group providing leadership in the delivery of the Children’s Services Plan’s vision of our children and young people having the best start in life and for North Ayrshire to be the best place to grow up. This strategic group includes members from: • North Ayrshire Council • NHS Ayrshire and Arran • North Ayrshire Health & Social Care Partnership • Police Scotland • Scottish Children’s Reporters Administration • Care Inspectorate • Children’s Panel • Third Sector • Scottish Fire and Rescue • Ayrshire College • KA Leisure Appendix 1 to this report provides detailed updates for the 2023-2026 Children’s Services Plan Actions for 2025-26. Appendix 2 provides Performance Indicator data. Appendix 3 provides our Whole Family Wellbeing Support report for 2025-26. For any further information please contact Strategic Planning Team on strategicplanningHSCP@north-ayrshire.gov.uk 117
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5 Priority 1 – The rights of children and young people are promoted and protected Key Highlights and Progress Children’s Rights We have been working to champion the United Nations Convention on the Rights of the Child (UNCRC), ensuring that all children in North Ayrshire have their rights met, protected and advocated for. In July 2024, the United Nations Convention on the Rights of the Child (Incorporation) (Scotland) Act 2024 came into effect. The Act provides protection for the human rights of children and young people in Scotland. Rights Respecting Schools All North Ayrshire schools take part in the UNICEF Rights Respecting Schools Award (RRSA) programme, showing a strong commitment to children’s rights in education. Schools are making good progress — by December 2025, 24 have Bronze, 29 have Silver, and 18 have Gold awards. Schools say the RRSA programme helps children talk about their rights, builds confidence, and improves school life. Pupils are more involved in making decisions and support each other, creating welcoming and safe environments for everyone. North Ayrshire is clearly committed to children’s rights through this work. Case Study: Lockhart Campus was recognised for making good progress towards embedding the principles of the United Nations Convention on the Rights of the Child into their ethos and curriculum by gaining Silver accreditation. 118
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6 The Silver Rights Respecting Schools accreditation is a significant milestone to celebrate how Lockhart Campus is putting children and young people’s rights into the heart of everything that they do. The campus joins others such as Largs Early Years Centre, Springside Primary School, West Kilbride Primary School and St John Ogilvie Primary School who have all progressed to silver in the last year. Assessed at the end of 2025, the silver accreditation has been reached following a number of actions and initiatives developed alongside the Rights Respecting Schools Steering group – with pupil representation from right across the school. Embedding the United Nations Convention on the Rights of the Child (UNCRC) Over the last year, UNCRC principles were embedded through targeted consultation and participation activity with children and young people. Engagement included 114 Primary 7 pupils participating in Youth Council workshops exploring key UNCRC articles, including Article 8 (identity), Article 26 (child poverty), Article 27 (risk-taking behaviour) and language and inclusion (Article 30). Feedback gathered is informing service planning and was shared with partners. Young people co-produced the Pupil Voice Toolkit, providing practical guidance to support inclusive and meaningful pupil participation and delivery of Article 12 of the UNCRC. Connected Communities staff, alongside Education, continued to lead UNCRC implementation through staff training, member briefings, child-friendly reporting and direct engagement with young people, ensuring a consistent rights-based approach across Council services. Care experienced young people were engaged through the Champions Board across all 10 secondary schools, with delivery of the What Is The Promise? programme supporting awareness of rights and The Promise. 119
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7 Young people identified priorities through structured engagement, which were presented directly to staff and senior leaders to inform corporate parenting practice. Strategic consultation also took place through large-scale engagement events, including a Joint Cabinet session involving over 200 secondary pupils, where young people shared views on poverty, wellbeing, risk-taking and employability with elected members and Chief Officers. Additional UNCRC-aligned engagement was delivered through the Joint Youth Forum and Youth Conference, ensuring children and young people’s voices informed policy development, service redesign and decision-making across the Council. Maximising learner participation and voice The new Learner Participation policy and operating procedure (POP) was launched across all establishments. The Young Leaders of Learning programme was piloted by 11 Early Years centres and schools. This programme enhanced opportunities to maximise learner participation and learner voice across the pilot establishments. Young Carers We are committed to identifying Young Carers earlier in their caring journey and increasing the uptake of Young Carers Statements. Significant progress has been made across education settings to embed consistent, meaningful support. • 15 local primary and secondary schools have now signed up to the Young Carers Covenant, ensuring that young carer awareness and tailored support are embedded into school culture. • The number of Young Carers Statements offered and accepted across education continues to grow, reflecting stronger identification pathways and increased confidence among staff in recognising and supporting young carers. • A comprehensive Young Carers Education Information Pack has been developed to strengthen professional understanding and enable a consistent approach to support • Young Carer Statement training sessions have been delivered for staff, helping ensure that statutory duties are met and support is personalised and meaningful. • Through collaborative work, the Carers Gateway and local schools have established a shared working agreement, reviewed annually, which sets out mutual goals for identifying and supporting young carers. These may include: o Regular group sessions within schools o Dedicated one-to-one support for young carers o Developing a Young Carers Charter tailored to each school o Awareness-raising activities for pupils, families, and staff o Providing targeted resources for each school’s needs o Support during key transition points, including P7–S1 and the move to post-school destinations 120
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8 This collaborative, prevention-focused approach ensures young carers are identified earlier, understood better, and supported in ways that make a genuine difference to their wellbeing and educational experience. LGBT Youth Scotland Charter of Education Irvine Royal Academy has become the first school in North Ayrshire and the latest secondary school in Scotland to have achieved the prestigious LGBT Youth Scotland Charter of Education Gold Award. A national award, the LGBT Youth Scotland Charter of Education Gold Award accreditation - awarded by Glasgow based charity, LGBT Youth Scotland - recognises schools that go above and beyond the basic requirements to support LGBT pupils, staff, parents and carers. Being accredited enables schools to share a positive message championing the LGBT community with confidence, where all LGBTQ+ staff, parents and learners can be safe, supported and included. As part of the important work, over the past year, Irvine Royal pupils and the colleagues supporting them have: • Hosted a weekly Pride Group drop-in every Tuesday for LGBT pupils and allies • Created their own LGBT inclusion board in the main foyer of the school • Hosted a Pride Month celebration with film screening of Heartstopper film • Introduced more diverse book titles in the school library • Ran a drop-in session during LGBT History Month 2025 to celebrate queer icons • Enjoyed a picnic outing and scavenger hunt at McGavin Park in Kilwinning in partnership with Kilwinning Academy’s Equalities group • Helped to promote and be involved in weekly wellbeing walking sessions 121
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9 • Worked closely with the school’s leadership team and pupil voice ambassadors to develop initiatives to support pupils who may be self-conscious or finding it difficult to be themselves in school Young people involved in the Irvine Royal Pride Group said: • “I really feel like I can be myself and I know where I can turn to for support.” • “I am proud to be part of a school that celebrates my muchness and gives me safe spaces to express myself and make my voice heard.” • “Although I am not queer, I feel like I have the strategies and knowledge now to help my friends who are if they are struggling so that they know they are not alone.” • “The weekly group has made such a difference to my wellbeing.” Six North Ayrshire secondary schools have now either achieved or are on their journey to achieving their next level LGBT Charter for Education accreditation. Irvine Royal Academy now has Gold. Greenwood Academy and the North Ayrshire Youth Services team follow closely behind, holding Silver Level. Although not a school – North Ayrshire Youth Work is part of the council’s Community Learning and Development team and should still be recognised equally for their accomplishments to achieve the Silver Level. Engagement and Consultation Our Youth Services Team are central to the engagement and consultation with our young people through various methods including community-based youth forums, Executive Youth Council, thematic youth work groups, Joint Cabinet, P7 youth council and various other events. We also actively engage with young people to gather their views and opinions through online methods and social media. Topics are co designed and produced with young people and provide valuable data to inform polices, plans and service delivery. 122
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10 Community learning and Development supported 5,796 young people through active citizenship and community participation through youth forums, Joint Cabinet, Community Councils, Place Framework activity, consultations, climate workshops, community investment activity and issue- based youth work. Engagement strengthened voice, shared decision-making and confidence in shaping local priorities. Democracy and Citizenship We support children and young people to have their voices heard, in line with UNCRC Article 12. They are involved through youth forums, Joint Cabinet, Community Councils, consultations, climate workshops and issue-based youth work. These activities help young people build confidence and take part in decisions about their communities. We worked closely with partners such as Education, the Alcohol and Drug Partnership, Police Scotland, outreach services and third sector organisations. This created more chances for young people to get involved and speak about issues important to them, including wellbeing, substance use, poverty and keeping safe. The Executive Youth Council and MSYPs met regularly and took part in work on budgets, food insecurity, period poverty and equality. Young people also helped shape services through Joint Cabinet sessions, the Youth Forum and the annual Youth Conference. What young people told us continues to shape planning, services and decision-making. Case Study: During National Youth Work Week in November 2025, the bi-annual Joint Cabinet took place at Saltcoats Town Hall welcoming pupils from across our six localities, with Arran joining virtually. This was a landmark #YouthParticipation event for young people between the ages of 12-25, and the meeting was delivered by North Ayrshire Youth Work and the council’s team of Youth Work Modern Apprentices for pupils to tackle a range of hard-hitting issues. The 123
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11 joint meeting involved North Ayrshire Council’s Cabinet, senior education managers and other senior officers alongside Members of Scottish Youth Parliament and the Youth Council Executive. Almost 100 pupils representing the secondary schools of Irvine Royal, Greenwood, St Matthew’s, Kilwinning, Largs, Auchenharvie, Ardrossan, Garnock Community Campus and Lockhart Campus gave it their all in the action-packed session. In a conversation café format, the discussions centred around key themes that had been decided upon by young people prior to the event, including: • Alcohol and drugs, where pupils discussed concerns, health harms and community impact • Risk taking behaviour, discussing consequences and sharing views on early intervention, risk-awareness and restorative justice • Child Poverty, looking at the council’s Child Poverty Action Plan, the impact on young people and how families can access help without stigma • Positive Relationships and Wellbeing, talking about alternatives to exclusion from school and how to maintain relationships with friends, school, and beyond • Employability Pathways, including modern apprenticeships, digital and cyber opportunities, how to access support and what work experience activities young people want The theme of this year’s National Youth Work Week centred around building brighter futures and safe spaces for young people to thrive. Youth voice is an essential part of ensuring our young people have safe and accessible spaces where they can be supported and empowered to speak up on what matters to them and learn more about how their local authority operates and where to find support locally. The energising morning was a brilliant example of the true power that the youth voice in action has, and the council’s commitment to the United Nations Convention on the Rights of the Child. 124
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12 The Promise Champions Board Our Champions Boards place care experienced young people at the heart of decision-making across their schools and the wider community. They provide safe, positive spaces where young people can be heard, build confidence and belonging, and shape the services and supports around them. Supported by the Corporate Parenting Team, the Boards help ensure North Ayrshire fulfils its duties as a Corporate Parent and continues to deliver on its commitment to #KeepThePromise. Across the current school year 2025/26, engagement has strengthened, with all 10 secondary schools now running active Champions Boards. Some of the impact on young people can be seen below: “I have made new friends and can be myself.” – Young person, 2025 “One of our pupils attended the Champions Board for the first time feeling unsure… She realised she wasn’t alone and left feeling connected, understood and comforted.” – Guidance Teacher, 2026 As part of their ongoing Champions Board work this year, young people requested clearer support to understand what The Promise means for them. In response, schools are working through the What Is The Promise? programme (developed with Action for Children), which helps build knowledge, confidence and a shared understanding of rights. Several young people are also completing the Hi5 Award, recognising their achievements and participation through the Champions Board pathway. 125
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13 Champions Board Conference In November 2025, we held our annual joint Champions Board Conference, attended by 9 out of 10 secondary schools and 59 young people. The conference was co-designed with young people and focused on themes they identified as important, including: • Understanding The Promise • Using their voice safely and powerfully • Building connections with peers across schools • Planning the Summer 2026 Programme Their views from the day have been captured in the What Matters To Us poster (pictured above), alongside feedback from other engagement activities. Together, this provides a summary of what matters most to our care experienced young people and will directly inform the next Corporate Parenting Plan. Staff Promise Conference The staff Promise Conference on 20th January 2026 brought together 81 attendees, including 10 care experienced young people, senior leaders, operational managers, and corporate parenting partners. The event focused on reflecting on our responsibilities as corporate parents, strengthening commitment to The Promise, and gathering staff voice to inform the Corporate Parenting Plan refresh. Key Points from the conference included hearing directly from young people and reinforcing the need for collaboration, clarity, and shared ownership across services. Actions from the conference will be taken forward into the refreshed Corporate Parenting Plan. 126
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14 Brighter Pathways Programme The Brighter Pathways Programme of remodelling care options aims to improve outcomes for care experienced children and young people, addressing systemic challenges, and ensuring sustainable care models. The Strategic Vision emphasises collaboration, investment, and a rights-based approach to create a sustainable, responsive, and a nurturing care system for children and young people in North Ayrshire and aligns with The Promise. The Brighter Programmes Programme Board was established in February 2024 and has provided strategic leadership with a strong corporate parenting collaboration. The transformation and service developments were delivered through focussed workstreams on the following areas: 1. Housing and Throughcare 2. Fostering and Kinship 3. Education including Residential School Placements 4. Internal Children’s Houses – Model of Care 5. Early Intervention & Intensive Family Support 6. Strategic Needs Assessment/Data/Workforce 7. Best Practice Models and Research Key themes and challenges emerging from the workstreams are: • Placement Pressures and Over-occupancy. • Workforce Wellbeing and Sustainability. • Fostering Capacity. • Transitions and Continuing Care. • Early and Intensive Support Gaps. • System Complexity and Coordination. • Use of Data and Evidence. • Housing and Throughcare Pressures. The Brighter Pathways work has involved all corporate parents which has assisted in a shared awareness of the challenges and opportunities to improve the provision of services for families, looked after children and care experienced young people. Progress during 2025-26 has included: Our supported accommodation model of care is nearing completion with a proposed opening date of 1st June 2026. This is designed to increase independence whilst maintaining relational support on a phased and gradual basis, rather than young people experiencing the cliff edge of transitioning to adulthood which they often talk about. Fortnightly planning meetings are taking place to discuss matching young people to the supported accommodation. A new Fostering Scheme has been introduced, effective from 1st April 2026 to help retain current foster cares and encourage new foster carers. This will support placement stability by increasing retention of current experienced carers alongside strengthening approaches to local recruitment, reducing reliance on external provision (which is more often than not, not local). 127
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15 The Moving on Forum has been implemented to encourage multi agency working between Throughcare and Housing. The Forum has improved coordination between Housing and Throughcare, with reduced delays in accommodation making decisions resulting in more predictable and better planned transitions for care leavers. This joint approach has helped mitigate impact of increased housing pressures by ensuring earlier planning alongside shared ownership this has resulted in day-to-day collaboration across Throughcare, Housing, internal children’s houses, fostering and kinship services. Care Experienced Leavers educational outcomes 2025 North Ayrshire care experienced school leavers data continued to show improvements. 65% of care experienced leavers achieved at least one qualification at SCQF Leve 5 or better. 42% of care experienced school leavers in North Ayrshire left with at least one qualification at SCQF level six or better. Enhancing digital learning Our Education Service’s Digital Learning Strategy was launched in March 2025 following successful collaborative work of the Digital Service Improvement Group, a group consisting of highly experienced practitioners from across all sectors with responsibility for delivery of the curriculum from 2-18. The Digital Learning Strategy aims to: • develop learners’ digital skills and prepare them for life in an increasingly complex world • ensure that our practitioners are able to use a range of digital technologies confidently and appropriately to deliver exciting, supportive, relevant and engaging learning experiences • support our establishments in achieving strong outcomes in external evaluations There are four main areas within the strategy as outlined below: 1. the vision and aims of the strategy (linked to high quality learning experiences for all children and young people in NAC) 2. the digital skills our children and young people need for learning, life and work (progression tables for each skill) 3. the digital skills our practitioners require to ensure our learners’ digital needs are met (progression tables for each skill) 4. tools and training, as well as examples of good practice at local and national levels Following a successful pilot, the expectation has been that all educational establishments will adopt the strategy from session 2025-26 onwards as part of their raising attainment approaches and across 2025-26 the strategy will become embedded across establishments, from Early Years through to Senior Phase. Underpinning this strategy are the digital skills of our practitioners. Our digital learning offer in 2024-25, delivered by the Digital Development Officer, has resulted in the following: 128
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17 Priority 2 – Acting early to improve what happens next Key Highlights and Progress Child Protection - Children and Young People Engagement Event In May 2025, over 100 children and young people engaged with the North Ayrshire Child Protection Committee (CPC) in relation to child protection messaging. The CPC wanted to learn more about what children and young people knew about accessing support on a range of child protection issues. Gaps in knowledge or sources of information were identified and discussions with children and young people identified the best ways to share child protection messages and information and in accessible formats. During the engagement event children and young people (aged 11-13 years) from schools across North Ayrshire took part in six workshops to share their views and opinions on a safety theme including, general child protection messages, mental health and suicide prevention, alcohol and substance misuse (vaping), bullying and healthy friendships, domestic violence and relationships, and online safety /safer schools. Using feedback and data from this event and consultations with our children and young people will continue to be a focus and also guide next steps to implementation of child protection messaging. North Ayrshire children and young people’s views will influence policy developments and resources required to make improvements. Through the Safer Choices, Safer Futures, progress has been made in working with whole families, whole systems and whole communities to provide early intervention support for children and young people across North Ayrshire. 130
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18 Partnership working with Education, ADP, Police Scotland, extended outreach services and the third sector has strengthened joined-up responses to identified risks, enabling support to be offered at the earliest possible stage. This whole-system approach has focused on prevention, relationship-based practice and community engagement, ensuring that children, young people and families receive the right support at the right time. By aligning universal services with targeted interventions, Safer Choices, Safer Futures continues to support positive outcomes, reduce escalation of need and promote safer, healthier communities. Signs of Safety Signs of Safety was launched in North Ayrshire Health and Social Care Partnership in 2023 and is now fully embedded into professional practice. Signs of Safety (SoS) is described as an approach “to enable children's services to deliver services with a rigorous focus on child safety and wellbeing, and to set up their practice, policy, procedures and organisation so that the practitioners can do everything possible to put the parents, children and everyone naturally connected to the children at the centre of the assessment and decision-making”. Implementation has included briefings and training for relevant staff, baseline audit work and realignment of paperwork. In June 2025, the Health and Social Care Partnership carried out a Signs of Safety audit where 10% of parents and carers were interviewed. Between 70% and 84% reported that their worker showed care, spent time with their children, helped them solve problems, recognised family strengths and followed through on agreed actions. This feedback provides a strong foundation for continued improvement. Children and young people also reported positive experiences. Most said they felt listened to (63%), supported by their social worker (69.5%), and confident that their social worker understood their family circumstances (76%). Importantly, 71% said they felt they had a say in decisions affecting them. Overall, the findings indicate strong, trusting relationships between families and practitioners. Given the central role of effective relationships in achieving positive change for children, this provides a solid and encouraging base for ongoing development of Signs of Safety practice. 131
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19 Social Media We have recently developed a Public Protection Facebook page. In August 2025, North Ayrshire Protecting People Facebook page achieved 2,372 views with 218 followers and 138 likes. This remains under review with a further assessment to be made in 2026 on the efficacy and reach of this channel in supporting Child Protection communications. Children and Families Health Support There are over 5000 children aged 0-4 years in North Ayrshire, all of whom are supported by either a Health Visitor or a Family Nurse. In addition to following the nationally agreed Universal Health Visiting Pathway from the antenatal period through to a child commencing school, within North Ayrshire, children under 5 and their families continue to have access to additional support from the wider, integrated early years team. During 2025/26 (as at March 26), 730 requests for assistance from the various members of the integrated team were made. This included: • 461 (83.6%) for Health Visiting Support Workers for areas such as communication, sleep, toileting, infant feeding and behavior • 64 (8.8%) for the Perinatal Wellbeing Team, supporting new and expectant mums experiencing low level mental health difficulties • 60 (8.2%) for the Family Nurturers who offer support around bonding and attachment, routines, home conditions and community integration • 57 (7.8%) for Early Years Social Workers supporting with domestic violence, parental mental health difficulties amongst others • 38 (5.2%) for specialist infant feeding support • 29 (4.0%) for support to dads via our partnership with national charity Dads Rock 132
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20 • 19 (2.6%) for the Healthcare Support Worker who provides additional support to the Perinatal Wellbeing Team as well as baby massage Childhood Immunisations The most recent childhood immunisation data for 2024/25, shows 75.2% of those in S1 were immunised for HPV in Ayrshire and Arran, compared to a Scottish uptake of 72.6%. HPV immunisation uptake has seen a rise of 10.1% in North Ayrshire from 2022 to 2025. In 2024/25, 67.5% of S3 pupils received a Td/IPV booster and MenACWY vaccines. This compares to a national uptake of 70.1% for both programmes. North Ayrshire has seen a rise of 0.7%. (2025-26 data is not available at time of writing). It is acknowledged that immunisation rates in North Ayrshire have been historically lower than in South and East Ayrshire, closely correlated with deprivation levels. A range of targeted actions have been taken to promote uptake rates. With the targeted interventions and data capture our aspiration is to continue our upward trajectory for Immunisation Uptake in both HPV, Teenage Booster and Meningococcal ACWY across Ayrshire and Arran, and in particular North Ayrshire to lessen the gap in uptake across Local Authorities. Infant Feeding and Support Breastfeeding has clear short- and long-term health benefits for both babies and mothers. It helps protect babies against infections such as ear, chest and gastrointestinal illnesses, as well as conditions including asthma and diabetes. Breastfed babies are also more likely to follow a healthy growth pattern, reducing the risk of overweight in later childhood. As a result, breastfeeding is a key indicator of child wellbeing and remains a priority for children’s services. Although breastfeeding rates have historically been low and closely linked to deprivation, North Ayrshire has seen encouraging improvement. Increases have been recorded at the first health visitor review (10–14 days) and at 6–8 weeks. More babies are now receiving some breastmilk, and the drop-off in breastfeeding between birth and early reviews has reduced. From 1 July 2025, the National Childbirth Trust began providing postnatal breastfeeding support for women discharged from Ayrshire Maternity Unit who were breastfeeding. Between July and March, 1,331 women accessed this support, with around half exclusively breastfeeding at 6–8 weeks. Community-based infant feeding support continues to be strengthened through: • Mandatory, high-quality training for health visiting and support staff, reviewed regularly to reflect best practice • Annual audits involving staff and mothers to inform training and recognise good practice • Clear care pathways to support consistent and standardised delivery • Specialist support for families with more complex feeding needs through the Infant Feeding Support Nurse • Community infant feeding groups, expanded following a successful pilot in Largs 133
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21 • Roll-out of the national Early Learning and Childcare (ELC) Breastfeeding scheme • Ongoing development of the Local Authority Breastfeeding scheme North Ayrshire, together with health visiting and Family Nurse Partnership services in East and South Ayrshire, holds UNICEF Baby Friendly Initiative Gold accreditation. This reflects high standards of infant feeding support, a strong focus on breastfeeding, and a continued commitment to quality improvement. This remains a significant achievement, with only a small number of areas across Scotland holding this status. Ayrshire Bairns app A digital resource providing evidence-based parenting advice and support was piloted by North Ayrshire in 2022 and is now well established across all three Ayrshires Health and Social Care Partnerships. The app provides information on what to expect from the health visiting service as well as information on how to support early years development. Collaboration for Health Equity in Scotland (CHES) North Ayrshire is one of three local authorities who have been working with the Institute of Health Equities (IHE) and Public Health Scotland as part of the Collaboration for Health Equity in Scotland (CHES) programme. Three priority areas were identified in North Ayrshire: Good Start (Irvine), Good Work (Three Towns) and Good Health (Garnock Valley). The Good Start workstream is aiming for all children to have the best start in life and through stakeholder and family engagement has identified areas of work that may help improve wellbeing in early years and wider family support. Work will be taken forward in 2026/27 through a multi- agency approach. North Ayrshire’s involvement in the CHES programme provides an additional opportunity to focus on early years. Indeed, data on developmental concerns was a key driver in the prioritisation of 134
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22 the early years’ principle, and helped identify the Irvine communities of Fullarton, Bourtreehill and Castlepark as the focal point for the work. Nesta and CELCIS family support in pregnancy and early years North Ayrshire is one of six local Children’s Services Strategic Partnerships (CSSP) selected to work with national organisations Nesta and CELCIS to explore existing pregnancy and early childhood supports and infrastructure. The opportunity aims to: • formulate a tailored early years data profile compiling indicators relevant to your area and at intermediate zone level where possible (created by Nesta) • map current support offer for pregnancy and early childhood • identify specific strengths and areas of unmet need to inform local planning • make clear, evidence-based recommendations for our local planning processes • facilitate engagement with peers from five other CSPP areas to share learning and improve systems across Scotland • contribute to national and local policy and practice recommendations Key partners have participated in two workshops to look at what works well and where things could be better for families. Learning will be used locally to improve our family support and will also be shared nationally to influence children’s services’ policy. Speech and Language We have a North Ayrshire Early Language Network group that meets regularly to share information about supports available to children, young people and families seeking support for speech, language and communication. The groups consist of partners from Health, education, early years social work, Family Nurse Partnership, and the 3rd sector. We also have a Communication Champion Network in Early Years in North Ayrshire that links closely with the Speech and Language Therapy team to share practice. Additional training has been provided for Communication Champions to identify children who may require targeted support in early years, share resources with parents and signpost them to the Speech and Language Therapy helpline and our in person drop-in sessions. We run a monthly Social Communication in person drop-in session. Any family with a concern about their child's social communication or activities for daily living can meet with the Speech and Language Therapy team and Occupational Therapy team to receive advice. The NHS Ayrshire & Arran Children's speech and language therapy Facebook page and NHS Ayrshire & Arran app contains lots of useful information for families and practitioners, with many activities to help support children's speech, language and communication. The Helpline is available for anyone with a concern about a child's speech, language and communication. They can speak to a registered Speech & Language therapist and receive advice and resources. 135
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23 Early Learning and Childcare The 1140 funded hours continue to be delivered with flexibility and choice for parents across localities. Our models offer a blend of full year and term time places with various patterns in establishments delivering 8am-6pm and 9am-3pm. Allocations have taken place for session 2025-26 and 85% of parents have been offered their 1st choice for establishment. Work is continuing to raise awareness of eligibility and increase the uptake of eligible 2s. ESOL (English for Speakers of other Languages) and Asylum Seekers and Refugee support The New Scots ESOL (English for Speakers of Other Languages) Hub provides a strong illustration of how education, voice, advocacy, rights, community connection and belonging can be translated into effective practice. It delivers a holistic, rights-based model of support for unaccompanied asylum-seeking children, trafficked young people and refugees across North Ayrshire. Accessible and sustainable language support is key, underpinning engagement with education, health, advocacy, employment and community life which contribute to positive outcomes. Our nurturing and responsive environment supports our young people who have experienced trauma, disruption or displacement. Inclusive practices and culturally responsive approaches ensure that learners’ identities are respected and valued, promoting a sense of identity, belonging and connection. Fourteen learners attended the Hub during 2025-26, representing a wide range of backgrounds. Learners accessed full-time education alongside community-based learning opportunities, supported through strong multi-agency partnership working with education, Outreach Support Services, Community Learning and Development, Health and Social Care Partnership, Aberlour Guardianship, Ayrshire College and other third-sector partners. Learners participated in a range of opportunities including the Gowanbank Residential, with pupils from Extended Outreach, which supported confidence, teamwork and resilience. Other activities included tree planting and a Christmas Multicultural Event. Participation, Attainment and Positive Destinations: A wide range of achievements, including personal development, language acquisition and a range of academic and wider awards were celebrated. • Eight young people achieved SQA National 2 ESOL alongside SQA National 2 Lifeskills Mathematics • A further 2 young people achieved National 3 ESOL at Ayrshire College and National 2 Lifeskills Mathematics 136
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24 • As a result of targeted support and effective partnership working, 8 learners will successfully progress to college courses • Two young people achieved accreditation through the John Muir Award delivered in partnership with Barnardo’s. This supported environmental awareness, responsibility and achievement of a nationally recognised award, contributing positively to confidence and wellbeing. • Effective partnership working with Skills Development Scotland supported career education, employability skills and transition planning, ensuring learners received timely advice linked to post-school destinations. The Hub contributed actively to the Unaccompanied Asylum-Seeking Children (UASC) Working Together group, strengthening information sharing, safeguarding and coordinated planning. Engagement with the Guardianship Pilot drop-in at Saltcoats Town Hall improved access to advocacy and guidance for young people. Collectively, this work contributes to: • Improved safety, advocacy and coordinated support for vulnerable learners • Enhanced wellbeing, confidence and resilience • Increased achievement and progression • Strengthened participation, inclusion and rights-based practice • More robust partnership working and shared accountability Practice from the Hub was shared at The Promise Conference, contributing to national dialogue and supporting wider systems improvement across children’s services and education. 137
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25 Priority 3 – Making things fairer Key Highlights and Progress Educational Attainment Raising Attainment Raising attainment continues to be a focus for all schools and Early Years establishments, with a commitment to ensuring added value across and through all 3 sectors in a child’s learning, attainment and achievement. Senior leaders’ feedback and the Data Service Improvement Group have helped to shape a refreshed approach to collecting Literacy and Numeracy data and how this is then used to create targets for all establishments. A more focused approach in analysing attainment data is helping to shape Service priorities and collaborative working between central staff and schools to ensure that all learners attain and achieve their best outcomes. Achievement of Curriculum for Excellence Levels In 2025, 68.2% of primary aged children in North Ayrshire Council achieved the appropriate attainment level in Literacy. In Numeracy, 73.9% of primary aged children in North Ayrshire Council achieved the appropriate attainment level in 2025. North Ayrshire’s performance has remained lower than the national picture since Covid. Improving leavers’ attainment in literacy and numeracy In 2025, just over 93% of North Ayrshire’s school leavers achieved level four literacy or better. This is in line with the national figure. Similarly, at level five, 81.9% achieved literacy at level five or better. In 2025, 91.3% of school leavers in North Ayrshire achieved level four numeracy, which is again in line with the national figure. 73.3% of school leavers attained level five numeracy which has increased from the previous year. Attainment of School Leavers In 2025, 80.9% of school leavers attained 5 or more awards at SCQF Level 4 or better which is slightly lower than in 2024 (83.4%). 64.5% attained 5 or more awards at SCQF Level 5 or better which is in line with 2024. These levels are slightly below the National figures. School Leavers entering an initial positive destination An initial positive destination means that a school leaver has gone on to one of the following activities immediately after leaving school: further or higher education, training, skills development or employment. At 95.7%, the proportion of leavers in North Ayrshire moving into an initial positive destination in 2025 is in line with the national figure. To maximise the percentage of school leavers entering and sustaining positive destinations, schools continue to work hard in strong partnership with Skills Development Scotland. 138
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26 The Annual Participation Measure for all 16–19-year-olds The Annual Participation Measure (APM) is a measurement of the proportion of 16-19-year-olds participating in education, training or employment over a whole year (1 April-31 March). The indicator provides a measure of the status of the wider aged 16-19 cohort – not just those who have left school. The Annual Participation Measure, covering the year from April 2024 – March 2025 showed that of the 6,028 16-19-year-olds in North Ayrshire, 92.5% were in education, employment or training and personal development. School Inspections – Case Studies Dalry Early Years Centre was praised by the Care Inspectorate for creating a warm, nurturing and safe environment for young people. The unannounced inspection took place in September 2025 and carried out a thorough assessment of the staff and facility and concluded that the experiences of children and families was extremely positive. During their visit, the inspection team spoke to one parent who said: ‘The staff are amazing, always got time to chat and will help any way they can’ while another commented ‘I have been involved in my child's plan from the moment they started at the nursery. All my views are taken into account.’ Some of the findings include: • Children were safe, secure, and emotionally supported • Children's individual needs were well understood • Children who required additional support received timely and effective intervention • Children experienced rich and varied play opportunities indoors and outdoors 139
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27 • Staff were warm, respectful, and purposeful • Indoor and outdoor spaces were thoughtfully arranged to promote independence • Leadership was strong and improvement-focused The inspection also described the facility as a ‘welcoming, spacious, and well-ventilated environment’, while playrooms were equipped with age-appropriate resources and natural materials that supported children's play, learning, and creativity. Springside Primary came under the spotlight in a visit in 2025 – and received a glowing report. In the report, the head teacher and senior management staff were praised for their strong leadership, including consistently driving improvements across the whole school. It also highlighted that ‘a strength of the staff team is their significant work towards improving how they meet children’s needs across the school’. Staff also develop trust and strong relationships with all the pupils Pupils are described as being happy and that they feel safe and secure. Staff are praised for nurturing relationships and understanding the needs of those pupils who need additional support. As well as internally, the report praises the strong relationships that exist with parents/carers and says most are very supportive of the work of the school. Springside Head Teacher Lynsey Boyes said: “We are absolutely delighted with the outcome of our recent inspection which recognises the dedication, effort and commitment of our entire school community. While we celebrate this achievement, we remain committed to the continuous improvement of the school and early years and providing the very best education for our children and young people.” Employability First Steps Programme Launch First Steps is an employability initiative that runs four times over the course of a year for care- experienced North Ayrshire residents aged 16 to 24. It offers opportunities in activities such as food hygiene, cooking, barista skills, team building, First Aid, the Duke of Edinburgh Award and a host of other group and interactive training sessions. 140
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28 Feedback from people who have completed the course has been positive, and 17-year-old participant Axel, from Irvine, said: “The highlight, for me, was getting to learn about First Aid. I am now exploring becoming a volunteer with St Andrew’s First Aid as I feel this is something I would be really good at.” Most participants go on to work experience, further education or training – and tailored work experience is included. It is ideal for young people who are thinking about their future but are unsure where to start and would like support when considering work, college, training and volunteering options. Participants build on existing skills and move forward in a friendly and relaxed environment. Other participants shared: “The programme really helped me feel more confident in myself and in my abilities and also helped me make new friends. I would recommend the course to my friends and any other young people who are perhaps feeling unsure about their future and what type of job they would like as First Steps really helped me feel better about my future. I am now enjoying work experience in Barnardo's … and know I can make a difference.” First Steps is run under the banner of the Council Employability service’s Your Next Move. The Council’s Employability Service delivers a range of support through its Your Next Move, Working North Ayrshire programme. Contracted partners include We Work for Families and CEIS Ayrshire, who all contribute to delivering a wide range of support to help individuals prepare and progress into employment. Poverty - Closing the poverty-related attainment gap Closing the gap in achievement between North Ayrshire’s least and most disadvantaged young people is one of the Education Service’s five main priorities. Around 45% of local learners live in the most deprived parts of Scotland. North Ayrshire’s Education Service is focused on helping children affected by poverty reach their potential. Schools receive £4.2 million every year in Pupil Equity Funding so head teachers can support pupils where help is needed most. Head teachers can choose the best ways to use this money for their learners. 141
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29 Rigorous analysis of data for improvement at all levels includes a focus on closing the poverty- related attainment gap and how educational establishments can support those children and young people most affected by poverty. Education Service priorities ensure that universal approaches to improving learning, teaching and assessment, as well as raising attainment, allow a focus on approaches to closing the gap. Strategic planning and spending of Pupil Equity Funding by schools allows for focused and targeted interventions and supports for learners most affected by poverty, with input focused on Health and Wellbeing, Literacy and Numeracy. There remains a commitment in schools and in the Education Service to mitigating against the Cost of the School Day, with approaches such as uniform banks, Prom dresses and low/no cost trips and excursions. Co-designing approaches to reduce child poverty North Ayrshire Council’s Child Poverty Strategy Team, through the Scottish Government’s Fairer Futures Partnership, launched a local project to better understand and reduce child and family poverty in specific areas. Initial research involved meeting families in libraries during school holidays, speaking with 140 Primary 7 Youth Council members about the cost of living, and asking young apprentices about how easy it is to get support online. After this, two local Third Sector organisations received grants to help design and deliver new ways to support families, working together with the council and community groups. New roles were created to connect families with the right services at community spaces and events, and to spot gaps in support. This work helps families access social and economic support and ensures children and families have a say in decisions that affect them. A shared database is also being developed to list services related to child poverty and wellbeing, which will help staff — and eventually the community — find support more easily. Case Study: Three pupils from Irvine Royal Academy had the chance to meet First Minister John Swinney and discuss a poverty-related issue close to their hearts in Scotland’s first Children and Young People’s Cost of the School Day Summit 2025, held at The Social Hub in Glasgow and hosted by Child Poverty Action Group (CPAG). The young people, who form part of Irvine Royal Academy’s Cost of the School Day (COSD) group discussed with Mr Swinney directly how to make education more inclusive and affordable for all. Savanah, Jacob and Evie also played a key role in shaping the day – helping design sessions, leading discussions and representing pupil voices from across Scotland. During the summit, they delivered confident presentations and took part in engaging workshops. The event provided a powerful platform for pupils to share their lived experiences and ideas for reducing financial barriers in schools. Chiara Sheridan, Youth Worker at Irvine Royal Academy said: “We are so proud of our young people. They showed real leadership, confidence, and compassion, ensuring the voices of pupils 142
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30 are heard at a national level. Their involvement in this summit will help shape positive change across schools in Scotland.” Welfare Rights in Schools Project The Welfare Rights in Schools project expanded significantly during 2025–26, with three Welfare Rights Officers embedded across all educational establishments, including early years centres. Schools have provided trusted, stigma-free access to advice, enabling early intervention. During the year, the project has secured significant financial gains for families. Child Poverty and Early Intervention Fund Across its first two years, the Child Poverty and Early Intervention Fund has now committed over £1 million, supporting both direct financial relief and innovative, co-designed test-of-change initiatives. This includes investment in integrated data through Smart Data Foundry and piloting a Family Enterprise Programme in partnership with Ayrshire College. Financial Inclusion Our 2025 ambitions to deliver services through an Advice Line and a single point of contact are now fully embedded. Client-centred surveys are routinely issued to strengthen our understanding of impact and ensure service improvement. In-house debt advice is fully operational, providing seamless access to both debt and welfare rights support. The Financial Inclusion Partnership Communications Subgroup was established during the year and successfully delivered the Partnership’s first multi-agency event in October. The event, themed around winter preparedness, brought together a range of services with the aim of increasing awareness of support available across North Ayrshire and improving understanding of how services connect and refer between one another. Workshops were delivered by Citrus, Community Link Workers and Christians Against Poverty (CAP). The Financial Inclusion Partnership continues to grow and strengthen, with new members joining throughout the period. Collaborative working with third sector organisations and partner agencies remains central, with a shared focus on developing clear referral pathways and delivering coordinated, joined-up support for residents. Rosemount Crisis Service The Rosemount Crisis Service has built strong collaborative partnerships across North Ayrshire by operating as a highly integrated, multi-agency service focused on supporting children and young people with complex needs and significant levels of risk, with the clear aim of keeping children safely at home with their families and out of local authority care wherever possible. The service mainly works with the four Children & Families Social Work teams in North Ayrshire - but also accepts referrals from the Families for Children, Children & Families (Disabilities), Kinship and Young Person Support teams - and plays an important role in the wider multidisciplinary response to family crisis, escalating risk, and instability. Rosemount is embedded within statutory planning and decision-making processes. 143
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31 Partnership working extends beyond social work to include Education, CAMHS, Police Scotland, health services, and community-based supports, ensuring that children and families receive a holistic, coordinated, and responsive service. This integrated model enables Rosemount to respond effectively to overlapping issues such as family breakdown, distressed behaviour, trauma, school non-attendance, mental health concerns, and contextual risks. A key measure of the service’s impact is its consistent success in keeping over 90% of the children involved with the service each year out of local authority care. This demonstrates the effectiveness of intensive, relationship-based crisis intervention when delivered in close partnership with families and professionals. Overall, the service’s strong local partnerships are central to delivering high-quality, child- centred, and family-focused support, ensuring that children and young people with the most complex needs receive the right help at the right time, while reducing the likelihood of escalation into care. Building Positive Relationships The Building Positive Relationships (BPR) programme has been successfully implemented, adapted and evaluated. Staff have been training and supporting facilitators, updating resources and responding flexibly to family and service needs. As a result, 89 practitioners across the authority are now trained in the Building Positive Relationships programme, embedding a preventative, trauma-informed approach that strengthens parental regulation, relationships and resilience while reducing reliance on crisis intervention. The Education Psychology Service has delivered large-scale, evidence-based professional Neurodevelopmental learning (e.g. We Were Expecting You, Supporting Neurodevelopmental Needs, NAIT resources) that reached hundreds of practitioners across Early Years and schools, with over 97% of participants reporting the training met their needs. This work is improving inclusive, neuro-affirming practice, strengthening anticipatory planning and consistency, and enabling many families to experience more predictable, supportive environments across home and education. Whole Family Wellbeing Fund The Whole Family Wellbeing Fund (WFWF) has supported a shift towards preventative, trauma informed and whole family approaches, in line with Scottish Government ambitions, GIRFEC and The Promise commitment to reduce the number of children and young people in care by addressing challenges earlier. During the reporting period, 12 local projects and services received a share of the £1.19 million WFWF investment in North Ayrshire, to support the delivery of positive outcomes for children, young people and families across North Ayrshire. Three of the funded activities are detailed below. Dads Support Workers Dads Support workers are strengthening preventative approaches by intervening at key transition points, addressing underlying risks early and helping families break cycles of trauma to improve long-term outcomes for children. For example, 20 referrals through Safeguarding Midwifery enabled multi-agency support before birth; 13 families were care experienced, highlighting significant intergenerational vulnerability. Reflective, relationship-based support alongside 144
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32 antenatal care helped parents build insight, emotional regulation and confidence, contributing to safer early environments. Preventative impact is also evident in father-inclusive work, where tailored one-to-one support enabled meaningful change, rebuilt trust and led to a supported, child-led reunion—reducing the need for escalation and supporting family permanence. Peer support further strengthens prevention, with Dads Rock networks offering ongoing informal support beyond services. Five Dads Antenatal Workshops (launched July 2025) were delivered during the reporting period, engaging 18 dads. Several participants went on to connect with peer support through the WhatsApp community and weekly in-person groups following the birth of their children, strengthening continuity of support during the early parenting journey. Engagement is underpinned by non-judgemental, consistent relationships that build trust and encourage earlier, sustained participation. A major success was the service’s expansion, increasing capacity to 1.8 FTE, widening delivery from Ardrossan, Saltcoats and Stevenston to include Irvine and Kilwinning, alongside the introduction of a second group activity delivered outside standard 9–5 hours. This led to a 90% exceedance of engagement targets, with 103 families supported and over 400 one-to-one sessions delivered. Impact was further recognised through awards nominations and strong peer networks that continued beyond formal involvement. The Family Centred Wellbeing Service The Family Centred Wellbeing Service (FCWS) plays a key preventative role across North Ayrshire, supporting families early to reduce escalation to crisis and statutory intervention. Partners across education and social work consistently report that, without FCWS, more families would reach crisis point, increasing demand on child protection and specialist services. The fact that cases are often retained within FCWS following Initial Referral Discussions (IRDs) reflects strong partner confidence in the service’s ability to manage risk proportionately and provide effective early intervention. During 2025/26, FCWS received 212 referrals, with 81% relating to primary-aged children, indicating that needs are increasingly being identified and addressed 145
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33 earlier, before difficulties become entrenched. Education remains the main referral route, demonstrating a wider cultural shift towards proactive, early help within universal services. This preventative impact is further evidenced through both qualitative feedback and outcomes. Families report improved relationships, better communication and greater understanding of their child’s needs, leading to increased confidence in managing challenges. Case study evidence highlights how coordinated, whole-family support improves stability and prevents escalation to statutory thresholds, while group-based interventions reduce isolation and build social connections—key protective factors against crisis. FCWS also plays an important role in supporting the “missing middle”: families experiencing emerging neurodevelopmental, emotional or behavioural needs that do not meet statutory thresholds. By responding early with holistic, flexible support—including home visits, group programmes and community-based activity—FCWS helps prevent gaps in provision and reduces longer-term reliance on higher-cost services. The non-judgemental, relationship-based model is central to engagement, with families reporting that they feel more comfortable seeking help earlier and sustaining involvement. A key strength of FCWS is its collaborative, whole-system approach. The service works in close partnership with education, health, social work and third sector organisations, contributing to multi-agency planning such as Team Around the Child (TAC) and acting as a bridge between services. This ensures coordinated, holistic support tailored to the strengths and needs of each family, including access to community-based opportunities that promote inclusion and reduce isolation. This model has contributed to improved outcomes across a range of areas, including school attendance and engagement, emotional wellbeing, parenting capacity and access to mental health, financial and community supports, particularly for families experiencing disadvantage. Workforce development has also strengthened early intervention across the system. Input from Educational Psychology and Speech and Language Therapy, alongside interventions such as Building Positive Relationships, has increased practitioner confidence in identifying and responding to emerging need. Weekly consultation with Educational Psychology has been particularly valued, enhancing problem-solving skills and the use of practical tools such as goal setting, scaling and emotion coaching. Overall, sustained demand for the service, alongside strong qualitative and quantitative evidence of impact, highlights FCWS as a key contributor to early intervention and prevention, improving outcomes for children and families while reducing pressure on statutory services. EmpowerED The EmpowerED programme demonstrates a strong preventative impact by engaging young people before difficulties escalate into crisis, particularly those at risk of disengagement from education, emotional distress or more intensive intervention. Evidence from surveys, session reflections and school feedback consistently indicates that many participants were struggling with school engagement and wellbeing when referred. Preventative impact is evident in the programme’s relationship based and flexible delivery model. Session reflections show that early stages often involved a period of settling in, with young people initially hesitant or disengaged. Over time, however, there was a clear and sustained shift towards increased participation, confidence and motivation. This progression illustrates the 146
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34 value of consistent, trusted relationships in preventing problems from becoming entrenched and reducing the likelihood of escalation to statutory or crisis services. The programme also strengthens preventative outcomes by supporting emotional regulation, resilience and social connection. Young people frequently reported feeling calmer and more able to cope after sessions, especially following outdoor and active learning experiences. Opportunities to build friendships, share activities and support peers reduced isolation and enhanced protective factors. Importantly, EmpowerED contributes to longer-term prevention, with some young people progressing into peer mentoring roles, indicating growing confidence, aspiration and leadership. Modern Apprenticeships The Modern Apprenticeship programme is being used as a peer support model by creating visible, relatable role-model opportunities for young people within their own communities. Apprentices, many of whom have lived experience of local challenges, support younger peers through informal mentoring, shared learning and positive role-modelling, helping to build confidence, aspiration and engagement. By positioning apprentices within community and youth work settings, the programme supports peer-led learning, early intervention and prevention, enabling young people to access advice, reassurance and support from someone they can identify with. This approach strengthens relationships, promotes positive behaviours and supports children and young people to make safer choices, while also building skills, confidence and progression routes for the apprentices themselves. 147
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35 Island Communities Work has continued to strengthen equity of access to youth work support and participation opportunities for children and young people in North Ayrshire’s island communities. Partnership working with Arran Youth Foundation has supported the development of a local youth work offer on Arran, ensuring provision is responsive to local need while remaining connected to wider Council priorities. Island communities are routinely included in all youth voice structures and engagement activity, including the Youth Council, Joint Cabinet events and wider consultation processes, ensuring young people from Arran have opportunities to influence local and strategic decision-making. The appointment of an MSYP from Arran has further strengthened parity of access, enabling regular feedback from island young people and ensuring their views are represented consistently at both local and national consultations. 148
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36 Young Carers We are committed to ensuring that young carers can access support in ways that are flexible, familiar, and responsive to their needs. A range of access routes have now been embedded across education and community settings, ensuring a no wrong door to support model. Dedicated Young Carers Champions are now in place within every primary and secondary school. These Champions act as a first point of contact for identification, support, and information-sharing within their school communities. Three Young Carer Workers are aligned to clusters of three secondary schools and their associated primary schools. This structure ensures consistent partnership working, proactive engagement, and timely support for young carers and their families. A termly Young Carer Newsletter is shared with education staff, providing updates on supports available, upcoming events, awareness activities, and practical resources for working with young carers. This helps maintain visibility and ensures staff remain informed throughout the year. An upgraded Carers Gateway digital self-help portal for young carers was launched in August 2025, offering 24/7 access to a wide range of information, resources, wellbeing tools, and guidance. The platform significantly enhances accessibility - enabling young carers to seek help at any time, in a format that suits them. Together, these access points ensure that young carers can engage with support through trusted adults in school, dedicated staff, digital tools, or wider community activities. This blended model strengthens early identification, reduces barriers, and offers young carers multiple pathways to information, advice, and personalised support. 149
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37 Priority 4 – Promoting good mental health and wellbeing Key Highlights and Progress Counselling support and community wellbeing supports Our school counselling service supports children and young people aged 10–18 in school settings. This year, 500 young people accessed the service, with 98.6% reporting an improvement in CORE-YP scores. Area Inclusion Workers and additional support staff continue to deliver Let’s Introduce Anxiety Management (LIAM), with positive impact. Mental and emotional wellbeing remains one of the ten priority pathways within the school nursing service, with all staff nurses trained in LIAM and work underway to improve recording and reporting. Through Children and Young People’s Community Mental Health and Wellbeing Supports and Services Framework grant funding, 6,527 children and young people and 1,212 family members were supported through a range of programmes, with 94% reporting improved outcomes. Early intervention continues to be delivered across primary and secondary settings, with pathways in place to school counselling, LIAM and conflict resolution sessions, and onward referral to CAMHS where required. Collaboration with third sector partners has further strengthened local provision. The revised wellness model is now in place across all localities except the Three Towns, with full rollout planned early next session. Education and primary healthcare colleagues report positive partnership working, supporting timely access to mental health and wellbeing support. Support materials for delivery of the SQA Award in Mental Health and Wellbeing at Levels 4 and 5 were provided this session, with 343 young people achieving the full award. The refreshed Be Amasin’ anxiety resources were shared via education and community mental health blogs, attracting over 11,000 views combined. Project Restore continues to develop, with early feedback showing improved wellbeing and engagement, particularly through breathing and grounding strategies. Area Inclusion Workers supported 5,541 children and families through individual and group interventions to improve engagement with education and wellbeing. This included 64 reflections groups and Building on Positive Relationships family groups for 35 families, using relational approaches to address conflict and support positive family relationships Nurture A nurturing approach is being embedded across Children’s Services through shared trauma-informed and relational practice. In Education teams this is evolving into a New Authority model that combines compassion with clear, supportive boundaries. Professional learning in nurturing, Emotion Coaching, Positive Behaviour Support and CALM is supporting consistent adult responses focused on safety, regulation and repair. This year there are examples of joint problem-solving with Psychological Services, Children’s Houses and CAMHS - growing a community of practice for care-experienced young people enabling shared learning and consistency across services. 150
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38 Physical activity and Social Participation Targeted and universal programmes supported mental health, resilience and positive relationships across schools and communities. Evidence-based and creative approaches such as Your Resilience, Bounceback, Drama for Wellbeing and outdoor and physical activity programmes developed emotional literacy, coping skills and self-regulation. Early intervention addressing suicide, alcohol and vaping risks was complemented by workforce development in neurodiversity, trauma and complex behaviours, improving the quality and consistency of support. The Duke of Edinburgh’s Award provided a strong wellbeing and achievement pathway, engaging over 1,000 young people and supporting progression through Bronze, Silver and Gold levels. Alongside this, targeted programmes and partnerships supported care experienced young people, young New Scots and those facing additional barriers to sustain engagement, build confidence and progress to positive destinations. Active Schools played a key role in promoting positive mental health through year-round extracurricular activity, events and leadership opportunities that reduce stress, boost mood and enhance self-esteem. A dedicated guidance resource for schools and comprehensive mental health training for coaches and volunteers strengthened inclusive, supportive practice. Together, these approaches demonstrate a coherent, strengths-based model combining participation, prevention and progression to improve wellbeing outcomes at scale. Public Health Public Health have worked over the 2025-26 period to produce a suite of life course evidence briefings. The mental health and suicide prevention briefing will be used in the coming year to shape conversations with partners regarding the preventive potential of a life course approach and opportunities based on evidence across the life course and across all stages of prevention (universal, primary, secondary, tertiary). 151
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39 During 2025-26, Public Health has continued to strengthen and embed mental health improvement activity across Education and wider children’s services in North Ayrshire. Examples of activity include: Promotion and Utilisation of Mental Health and Wellbeing Resources in Practice- The Guide for Children, Guide for Young People and Children’s Workbook for Mental Wellbeing continue to be actively promoted across Education and to partners who support children, young people and families. Work this year has focused on reinforcing awareness of these resources, supporting staff to build them into everyday practice, and ensuring consistent access to practical tools that help initiate and sustain wellbeing conversations. Mental Health Improvement – a Practical Approach (MHI-apa) training is now being delivered across Education by the MHWB Operational Lead, building capacity at school level and ensuring staff have the knowledge and skills to support children, young people and families. Area Inclusion Workers continue to use and cascade this learning within their roles, contributing to more consistent approaches across schools. This training is available through Public Health for other groups who wish to participate. There continues to be a network of facilitators delivering Time, Space, Compassion (TSC) workshops which are open to staff working across children's and young people's services. During April 2025 and March 2026, Public Health has organised and delivered 12 TSC workshops across Ayrshire and Arran. Four of these sessions were in North Ayrshire. Staff from North Ayrshire have accessed a number of sessions, with attendance including staff working with children and young people within both public and third sector organisations. Initial discussions and awareness raising regarding the Enabling Conversations Toolkit has taken place through the Strategic Suicide Prevention Group. In the coming year Public Health would like to see further awareness raising and engagement with this toolkit as a guide which was created by and for young people, to find help and support when experiencing painful feelings about suicide. Enabling conversations toolkit - Suicide Prevention Scotland. Supporting Young Carers We continue to prioritise opportunities that enable young carers to experience a positive quality of life beyond their caring responsibilities, while ensuring they are fully supported during key transitions in education and life. • Young Carers Education Fund (£15K–£20K annually) provides flexible financial support to meet identified needs through Young Carers Statements. This includes opportunities for breaks from caring, participation in hobbies and activities, and access to life-enhancing experiences that contribute to wellbeing, resilience, and personal development. • KA Leisure memberships are available for young carers, giving them regular access to health, fitness, and wellbeing activities within their local community and supporting them to take time for themselves. • Eligible young carers have been supported by Carers Gateway to apply for the ILF Scotland Transition Fund, helping them build independence, confidence, and opportunities to engage socially, explore interests, and become more active in their communities. 152
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40 • Time to Live funding, accessed via Carers Gateway, provides young carers with the opportunity to apply for personalised short breaks—helping reduce stress, improve wellbeing, and create positive time away from their caring role. • To support key educational transitions, Carers Gateway actively participates in enhanced transition planning from primary to secondary school, ensuring young carers are identified early and their needs are understood. Young carers preparing to leave secondary school can access a 1:1 Young Adult Carers Transition Plan, offering tailored guidance around their caring responsibilities, available supports, future aspirations, and the move into further education, training, or employment. This multi-layered approach ensures that young carers are supported not only in their caring role, but also in experiencing a balanced life, developing their potential, and moving confidently into adulthood. 153
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41 Priority 5 – Inspiring children and young people to be active Key Highlights and Progress Jumpstart - Child Healthy Weight Services During 2025–26, 40 children and young people aged 5–17 were supported through our Child Healthy Weight programme (JumpStart) in North Ayrshire. Referrals showed a balanced gender profile (21 male, 19 female), indicating equitable access across genders. Referrals were largely concentrated in early and middle childhood. Children aged 5–9 accounted for 45% (18/40) of referrals, those aged 10–13 comprised 37.5% (15/40), and 17.5% (7/40) were aged 14+. This reflects strong early identification through school-based pathways. Service delivery strongly aligns with health inequalities priorities. 62.5% (25/40) of referrals were from the most deprived (SIMD 1) communities, with a further 20% (8/40) from SIMD 2. Overall, 82.5% of referrals came from the two most deprived quintiles, demonstrating effective targeting of families experiencing the greatest socioeconomic disadvantage. Referrals were driven primarily by core health partners. School Nurses accounted for 27.5% (11/40) of referrals, GPs for 20% (8/40), and Dietitians for 17.5% (7/40). This highlights strong multi-agency engagement, particularly within universal and primary care services. 66 group-based sessions were delivered within community settings. In addition, seven young people (teens) were supported through one-to-one interventions, making use of KA Leisure facilities. All participating children were provided with a KA Leisure card, offering a minimum of three months’ free access to KA Leisure facilities to support ongoing physical activity and sustain engagement beyond the intervention. Outdoor Play Case Study: Children and their families have been taking advantage of updates to local playparks in Kilwinning and Irvine. The welcomed playground upgrades have been unveiled at Bourtreehill Playpark and Eglinton Country Park. Each of the popular outdoor playgrounds have been assessed and upgraded by the council’s Streetscene team and refreshed to create exciting spaces that are more accessible and inclusive for all. Funded by the Scottish Government’s Capital funding programme with support from Eglinton Country Park’s fund, the upgrades are the latest of several playpark upgrades across North Ayrshire since 2021. 154
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42 Completely revamped, the new additions to Bourtreehill Playpark, located just a few minutes’ walk from the main bus route and village include: • An obstacle course with stepping stones, climbing stilts and rope walk • Impressive tower slide with wobble bridge, climbing wall and low-level hammock swinging seats • Accessible bench for wheelchairs, strollers and prams • Dynamic single-user dish roundabout and sculptural spinning platform • New freestanding swing seat • Motorbike wobble seat • Wheelchair and stroller accessible roundabout with seating for children • Engaging Neurodivergent games boards at main entrance • Protective playground surface underfoot for added protection • Re-painted and upgraded basketball court One child shared: “I love how high up the slide is because we didn’t have one before! I really am king of the castle!” At Eglinton Country Park, in the main playpark children can enjoy: • A new, impressive multi-sensory climbing dome • Kaleidoscope-inspired sensory play boards for sensory exploration • Low level climbing options for all abilities to hone their skills • Wheelchair accessible toddler play corner with small slide, interactive clock and number boards to encourage imaginary play and learning • Improved perimeter fencing • Neurodivergent boards for non-verbal members of our communities Eglinton Park will welcome other improvements in the coming months as maintenance on other pieces of equipment is currently underway. The popular playground at Eglinton Park has also been complimented by parents and carers, with one sharing: “I like it because there’s a lot more for the children to do now and something for all ages. 155
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43 “It feels safe too because there’s perimeter fencing added in and the new equipment is also very inclusive and has added variety and excitement for children visiting the country park. It’s really nice to see it all freshened up and everyone having fun exploring the new options together.” Improvements to the playparks are part of North Ayrshire Council’s wider investment strategy to make all play facilities in North Ayrshire more inclusive and accessible. Safe Spaces for Young People Youth work programmes continued to create safe, inclusive and purposeful outdoor spaces that support children and young people’s physical health, mental wellbeing and social connection. Outdoor learning remains a key delivery approach, enabling young people to build confidence, resilience and a sense of belonging through structured, supported activity in community and natural environments. Programmes are deliberately inclusive, ensuring access for care-experienced young people, young New Scots and those facing additional barriers to participation. The Duke of Edinburgh’s Award continues to be a cornerstone of this work, engaging large numbers of young people in regular outdoor activity, skills development and expeditions across Scotland. Duke of Edinburgh expeditions, day trips and overnight experiences provide well-managed, safe environments where young people develop teamwork, leadership and problem-solving skills while enjoying the outdoors. 156
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44 Alongside this, Outdoor Learning, Outdoors for Wellbeing and residential opportunities offer accessible entry points for young people who may not engage with traditional settings, including targeted provision for at-risk groups. Complementary initiatives such as Gardening for Wellbeing, mountain biking, football and outdoor creative activities further enhance safe outdoor provision by promoting routine physical activity, positive mental health and connection to place. Gardening and nature-based activities support emotional regulation, responsibility and mindfulness, while team sports and outdoor challenges strengthen social connections and confidence. Together, these approaches ensure children and young people have regular access to safe, supportive outdoor spaces that encourage play, exploration and wellbeing, while contributing to wider prevention, participation and achievement outcomes. 354 Children and young people participating in outdoor residential learning through DofE Bronze, Silver and Gold awards, camping residentials and AYA residentials reported positive experiences, supporting confidence, resilience, teamwork and personal achievement. 183 Young people participated in CLD supported employability activity through Duke of Edinburgh Bronze and Silver awards, including sectional achievements, and PDA in Youth Work programmes. Active Schools and KA Leisure Active Schools and KA Leisure have continued to work collaboratively to increase opportunities for children and young people to be active across both school and community settings. Through strong partnership working, we have ensured that each of the six localities has well-established links between school-based activity and wider community provision. Over the past year, our joint efforts have also focused on identifying and addressing gaps in local provision. This has allowed us to create a more equitable offer across all areas, ensuring that every young person, regardless of where they live, has access to a broad range of activity and sporting opportunities. As a result, the pathways from school participation into local clubs and community sport have been strengthened, supporting smoother transitions and encouraging sustained engagement. 157
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45 Furthermore, Active Schools has maintained a strong commitment to supporting young people who face the greatest barriers to participation. By prioritising targeted programmes and coordinated support, we continue to ensure that those who need our help most are able to access and benefit from positive, inclusive sporting experiences, particularly for young people who are care-experienced, living in poverty, at risk of disengagement, non-attenders, or otherwise identified for targeted support. Our overarching ambition of achieving “More Kids, More Active, More Often.” supports all schools across North Ayrshire to deliver high-quality, inclusive extra-curricular programmes that are accessible to every child and young person. Throughout the year, participation trends across our schools have highlighted the continued popularity of several key sports. The top five most actively engaged activities were football, netball, racket sports, dance and multi-sports, reflecting a broad range of interests and demonstrating the strength of provision offered across our localities. 158
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46 KA Leisure continues to deliver a broad and inclusive programme of sport and physical activity opportunities. Working closely with communities and partner organisations, we offer a varied calendar of term-time sessions alongside an extensive holiday programme. Our term-time offer spans all localities, delivering more than 150 classes each week and ensuring that young people and families have access to high-quality, community-based activity opportunities throughout the year. Our annual events calendar has also continued to grow in both scale and impact. This year, more than 5310 young people took part in a diverse programme of 75 competitive and participative events, showcasing their skills, representing their schools and experiencing the excitement of large-scale sporting occasions. These events play an essential role in developing teamwork, resilience and confidence while providing memorable experiences for participants. We have worked closely with partners to ensure pupils with additional support needs (ASN) can participate in meaningful and appropriate competitive opportunities. This includes supporting ASN young people to attend both the Ayrshire Sportsability events and activities within the Scottish Disability Sport calendar. By providing tailored pathways and ensuring representation at these events, we continue to uphold our ambition that every young person has the chance to perform, compete and celebrate their achievements at a level that is right for them. 159
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47 Engagement levels have been strong. A total of 9,781 young people participated in sport and physical activity sessions during the year—representing over 53% of the entire school-aged population in North Ayrshire. This reflects both the reach of our programme and the value placed on physical activity by our schools, families and communities. Across the year, 13,065 individual sessions were offered, generating an impressive 271,061 participant visits. This figure illustrates the depth of engagement within the programme: for example, ten pupils attending ten sessions each equates to 100 recorded visits. These levels of participation highlight the consistency with which young people return to Active Schools activities. This year, 703 individuals contributed to the delivery of Active Schools sessions, and 98% of them were volunteers. This represents the highest proportion of volunteer deliverers recorded anywhere in Scotland. Their commitment, time and passion are critical to the success of the programme. During the last academic year, Active Schools worked closely with 60 community sports clubs across North Ayrshire, strengthening partnerships and increasing the breadth of provision available to children and young people. These clubs contributed significantly to school engagement by delivering a variety of high-quality activities, including: • Curriculum enhancement sessions, providing additional PE input beyond the statutory two hours • Health week activities, supporting whole-school wellbeing initiatives • One-off taster days, offering pupils the chance to try new sports and activities • Visits to local clubs, helping young people experience community-based environments • Promotion of club opportunities, such as distributing flyers and raising awareness of routes into long-term participation In addition to this strong school-club collaboration, our North Ayrshire Community Sport Hubs continue to thrive. Working in partnership with KA Leisure, we have provided extensive support to local clubs, including access to training opportunities, facility provision, and tailored one-to-one development sessions aimed at strengthening governance, sustainability and volunteer capacity. 160
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48 To further enhance community engagement, we have collaborated with selected affiliated clubs to deliver satellite club programmes, enabling more localised and accessible participation options for young people. These satellite sessions are helping bridge the gap between school activity and long-term involvement in community sport. Leadership Programmes At primary level, the P6 Move and Improve Programme has made a significant impact, with 1,006 pupils trained as young leaders this year. These pupils play a key role in their school communities by planning and delivering high-quality lunchtime sport and physical activity sessions for their peers. To strengthen the sustainability of the programme, 34 teaching staff have also been trained, enabling them to support leadership development and ensure consistency across all participating schools. In secondary schools, the Young Ambassador Programme continues to thrive, with 126 S1–S6 representatives actively championing sport and promoting the importance of being active within their school communities. These young leaders act as role models, supporting events, raising awareness of opportunities and helping influence positive attitudes toward sport and wellbeing. 161
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49 Leadership development is further enhanced through the North Ayrshire Sports Academy, aimed at senior pupils in S5–S6. This year, 147 young people took part in the programme, gaining between 8 and 12 recognised qualifications each. These include Saltire Awards, National Governing Body coaching qualifications, and, at the highest level, the SQA Higher Leadership Award. The breadth of accreditation provides participants with valuable skills and nationally recognised credentials that support future education, employment and volunteering pathways. This equates to more than 5000 volunteer hours within schools and the wider community. This comprehensive leadership pathway not only builds capacity within North Ayrshire’s sporting landscape but also empowers young people with lifelong skills, confidence and a sense of civic responsibility. Active Girls Committees This year marked the successful introduction of Active Girls Committees across all nine secondary schools in North Ayrshire, representing an important step forward in promoting gender equity in sport and physical activity. A total of 45 motivated young leaders were appointed to these committees, each entrusted with the responsibility of encouraging increased participation among female pupils and helping to remove the barriers that often limit girls’ engagement in physical activity. Throughout the year, these young leaders have demonstrated exceptional commitment and maturity, acting as positive role models within their school communities. They have collaborated closely with PE departments, Active Schools staff and wider school teams to identify areas for improvement and to contribute to the development of more inclusive, girl-friendly environments. Their work has included advocating for the needs and preferences of female pupils, improving visibility of opportunities, and championing a culture where girls feel confident and supported to be active. In addition to their strategic contributions, the committees have played an active role in designing and delivering bespoke girls-only programmes and events, tailored specifically to increase engagement and create safe, welcoming spaces for participation. These initiatives have included lunchtime and after-school sessions, awareness campaigns, taster activities and targeted interventions to encourage girls who may be less physically active. The creation and success of the Active Girls Committees have strengthened the voice of young 162
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50 women in shaping school sport, contributing meaningfully to North Ayrshire’s wider commitment to inclusion, empowerment and lifelong participation. Quote: “Active Girls was one of the best experiences I’ve ever been a part of. It helped me build strong relationships with other girls and keep those friendships going. It also improved my communication skills and helped me feel more confident, relaxed, and able to enjoy every moment. I loved meeting new people and learning how to encourage other girls to enjoy sport the same way I do. I would honestly recommend this experience to anyone because it has helped me grow as a person through sport and physical activity. One of the tasks I enjoyed most was finding out what girls at my school liked and disliked about sport. Getting this feedback allowed me to help make changes within the PE department so that every girl felt included and comfortable taking part. This motivated me to get to know the girls better and understand the barriers they face, so I can hopefully help tackle them and make sport more enjoyable for everyone.” Quote: “I have enjoyed planning and creating change in an around sport for girls to feel more comfortable when participating in Sport. From my experience being in active girls for 2yrs it has helped me develop my confidence as I know speak up and use my voice to make change for other girls in sport.” Care Experienced Young People By adopting a Whole Systems Approach, the programme supports individuals to access sport and physical activity opportunities that contribute to healthier, more active lifestyles. 373 young people participated in a wide range of experiential opportunities. These experiences were diverse and engaging, including activities such as water sports, climbing, sailing, residential trips, and community fun days. To ensure equitable access, the team worked closely with internal and external partners to address individual barriers, including transport, appropriate clothing, food provision, and activity access. This coordinated support enabled seamless participation for those who may otherwise have been excluded. Following their initial experiential opportunity, young people were encouraged and supported to transition into regular physical activity within their school or local community. As a result, 84% chose to continue their involvement in ongoing sport or activity programmes. Of the 373 participants, 53% were living in the two most deprived SIMD quintiles (SIMD 1 and 2), demonstrating the programme’s strong reach into communities experiencing significant inequality. 163
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51 Appendix 1 contains the detailed action updates for 2025-26 for the Children’s Services Plan Actions. Appendix 2 contains the most recent Performance Indicator data for the associated PIs. Appendix 3 contains the Whole Family Wellbeing Fund Report which covers the detailed information associated with the fund. 164
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Appendix 1 – Children’s Services Plan Action Updates 2025-26 Priority 1: The rights of children and young people are promoted and protected No. Action Update 2025-26 1 Implement the North Ayrshire UNCRC Plan actions, ensuring the rights of all children and young people are protected. North Ayrshire Council has continued to put children’s rights at the heart of how services are planned and delivered. Staff across the council have taken part in training to understand their responsibilities under the new UNCRC law, including a mandatory online course. The council has also reviewed tools like the Equalities and Children’s Rights Impact Assessment and made the complaints processes more child-friendly so young people can speak up more easily. Work to combine the Children’s Services Plan, Child Poverty Action Plan and UNCRC Plan into one joint plan—shaped and overseen by young people—means children’s rights are now further embedded in children's services planning and delivery. Children and young people have been more involved in shaping services and decisions that affect them. They have taken part in budget consultations, contributed to health and social care planning, and influenced school and council priorities through groups like Youth Voice and Champions Boards. The UNCRC Steering Group has supported this work by raising awareness, providing training, and checking progress across services. Now that the group has completed its main tasks, ongoing work to protect children’s rights will continue through existing partnerships and the new joint plan, helping make sure all children and young people are listened to, included and protected. 2 Ensure the voices of children and young people are heard and influence the work of the Community Planning Partnership. Community Learning and Development supported 5796 young people through active citizenship and community participation through youth forums, Joint Cabinet, Community Councils, Place Framework activity, consultations, climate workshops, community investment activity and issue-based youth work. Engagement strengthened voice, shared decision-making and confidence in shaping local priorities. 3 Provide opportunities for children and young people to develop their citizenship skills, including active democratic participation opportunities. Over the year, North Ayrshire Council has continued to strengthen youth participation and rights-based practice through the Champions Board, Executive Youth Council, Members of the Scottish Youth Parliament (MSYPs) and a range of engagement activity. This work has supported delivery of The Promise, UNCRC duties and Council Plan priorities by ensuring young people are informed of their rights and meaningfully involved in decision-making. Care experienced young people were supported across all secondary schools through the Champions Board, including delivery of the What Is The Promise? programme and strategic input from Champions Board Representatives, whose priorities were shared directly with staff and senior leaders. The Executive Youth Council and MSYPs met regularly throughout the year, contributing to Council engagement on key issues including budget consultation, food insecurity, period poverty and equality campaigns. MSYPs continued to represent young people locally and nationally, with one North Ayrshire MSYP successfully proposing a national motion on access to free school breakfasts. Youth voice was further strengthened through large-scale engagement, including a Joint Cabinet session with elected members and senior officers, a refreshed Joint Youth Forum model, and the annual Youth Conference delivered during National Youth Work Week. Feedback gathered across these activities continues to inform service planning and policy development. Significant progress was also made in embedding participation structures and children’s rights. Young people co-produced the Pupil Voice Toolkit in partnership with Education, providing practical guidance to support 165
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2 No. Action Update 2025-26 inclusive and meaningful pupil participation and delivery of Article 12 of the UNCRC. Connected Communities, alongside Education, continued to lead UNCRC implementation through staff training, member briefings, child-friendly reporting and direct engagement with young people, ensuring a consistent rights-based approach across Council services. 4 Equality and Children’s Rights Impact Assessment (ECRIA) will be carried out on all new policies that affect the lives of our children and young people. During 2025/26, eight full Equality and Children’s Rights Impact Assessments (ECRIA) and seventeen pre-assessment screening forms were completed, each assessment asks about the potential impact on protected characteristics including age (incorporating young people) and on which Children’s Rights could be affected by any policy or proposal being reviewed or developed. Mitigations are identified to counteract any impacts identified through the assessment process; some of the mitigations required further research or exploration or identified other processes to reduce or negate any potential impacts. During 2025, six training sessions took place on how to carry out an ECRIA, each session included an overview of the Children’s Rights process. Briefing sessions were delivered in conjunction with our legal team. We also continue to support services by providing advice and guidance on an on-going basis in relation to completing impact assessments. 5 Through the engagement workstream of the care experienced task force, work proactively with Children and Young People. Significant progress has been made this year in strengthening engagement with care experienced young people across secondary schools and through wider corporate parenting work. All 10 schools now have active Champions Boards; young people co-designed two major Promise Conferences; and the Boards continue to shape service priorities through “What Matters to Us”. Large-scale events, including the Employability & Skills Fair, the Summer Programme, Care Experienced Week, and the Christmas Dinner, further broadened opportunities for participation and connection. The Promise Champions staff network has supported learning and improved Corporate Parenting practice across services. Feedback gathered from staff and young people throughout 2025–26 will inform the refreshed Corporate Parenting Plan, ensuring it is inclusive and grounded in lived experience. 6 Co-create with children and young people new, systematic mechanisms for maximising learner participation and voice and create a new Learner Participation Policy. The new Learner Participation policy and operating procedure (POP) was launched across all establishments. The Young Leaders of Learning programme was piloted by 11 Early Years centres and schools. This programme enhanced opportunities to maximise learner participation and learner voice across the pilot establishments. 7 Ongoing consultation with children and their families on service design and delivery. Over the year, we engaged a significant number of young people through structured consultation and events to gather views on key issues. This included the 2 Joint Cabinet event, where over 200 secondary pupils engaged directly with elected members and senior officers on priorities such as child poverty, wellbeing, risk-taking behaviour and employability. Engagement was further strengthened through the 3 Joint Youth Forum (almost 40 young people), the Youth Conference (94 young people), and targeted budget consultation at youth-led events. Additional consultation was delivered through the Champions Board, engaging care experienced young people across all secondary schools, and Primary 7 engagement, involving 114 pupils focusing on UNCRC themes including identity, language and poverty. Feedback from all engagement has informed service planning, strategy development and policy discussions, ensuring young people’s views are embedded in decision-making at local and strategic levels. 8 Ensure that Children’s engagement forums focus on rights, helping children and Over the year, UNCRC principles were embedded through targeted consultation and participation activity with children and young people. Engagement included 114 Primary 7 pupils participating in Youth Council workshops exploring key UNCRC 166
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3 No. Action Update 2025-26 families understand UNCRC and what this means. articles, including Article 8 (identity), Article 26 (child poverty), Article 27 (risk-taking behaviour) and language and inclusion (Article 30). Feedback gathered informed service planning and was shared with partners. Care experienced young people were engaged through the Champions Board across all 10 secondary schools, with delivery of the What Is The Promise? programme supporting awareness of rights and The Promise. Young people identified priorities through structured engagement, which were presented directly to staff and senior leaders to inform corporate parenting practice. Strategic consultation also took place through large-scale engagement events, including a Joint Cabinet session involving over 200 secondary pupils, where young people shared views on poverty, wellbeing, risk-taking and employability with elected members and Chief Officers. Additional UNCRC-aligned engagement was delivered through the Joint Youth Forum and Youth Conference, ensuring children and young people’s voices informed policy development, service redesign and decision-making across the Council. 9 Work with local partners/members to identify opportunities for children and young people to become involved locally. Throughout the year, strong partnership working with Education, Alcohol and Drug Partnership (ADP), Police Scotland, extended outreach services and third-sector organisations has supported increased opportunities for children and young people to become involved locally. Joint approaches enabled young people to engage meaningfully on issues such as substance use, risk-taking behaviour, wellbeing, child poverty and safeguarding. This partnership approach was evident through strategic engagement including the Joint Cabinet event, Joint Youth Forum, Youth Conference and targeted outreach activity, providing young people with direct access to elected members, senior officers and partner services. Collaborative working has strengthened early intervention, widened participation and ensured young people’s views are embedded in local decision-making, service planning and community responses across North Ayrshire. 10 Through our Advocacy Strategy prioritise community-based advocacy to children and young people ensuring they are aware of their rights and are appropriately represented. Independent, community based, advocacy continues to be provided via Barnardo’s Hear 4U service. It provides one to one advocacy to children and young people from North Ayrshire and priority is given to children and young people, who: • Are involved in the Child Protection process and/or Children’s Hearing system • Are care experienced in Foster Care, Residential Care and/or Kinship Care • Are on the periphery of Secure Care • Were previously looked after and accommodated • Have additional support needs They continue to support young people to ensure they are aware of their rights, as defined within the United Nations Convention on the rights of the Child (UNCRC). They are committed to ensuring that the voices of children and young people are heard, in a way which builds their confidence, also ensuring that they are listened to and their rights are appropriately represented, when decisions are made 11 Implement learning and improvements identified through the HSCP SDS Learning Phase 1 activity is largely complete. The SDS Policy has been finalised and accompanying SDS Practice Guidance has been completed to support consistent and proportionate application in practice. A North Ayrshire Directory of Services has also 167
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4 No. Action Update 2025-26 Review Board for the Children with a Disabilities Team. been produced to support signposting. The SDS website has also been fully developed and is now live, providing updated and accessible information for children and families, adults and practitioners. Work is at the final stage in relation to Level 1 SDS Awareness and Training. Further development work is still required in relation to the ethical care framework to ensure full alignment with SDS principles and revised operational practice under the Eligibility Policy. 12 Include young carers in the planning and shaping of their services. A peer-led approach, such as the Young Carers Champions Boards now being delivered across all secondary schools, creates meaningful opportunities for young carers to influence decisions that affect them. These initiatives amplify young carers’ voices and ensure that a diverse range of experiences is represented, including those of young carers from minority ethnic backgrounds, LGBTQ+ communities, and young carers who have their own disabilities or health needs. 13 Develop a young people users forum for KA Leisure and ensure their views and opinions are considered when developing programmes and initiatives. Delay in implementation due to a governance review. Following recent board approval, the panel will be established in 2026/27. Priority 2: Acting early to improve what happens next No. Action Update 2025-26 14 Work with our partners to keep all children and young people safe, with the robust implementation of the new National Guidance for Child Protection. In collaboration with our Pan Ayrshire Colleagues, the North Ayrshire Child Protection Committee have developed the Ayrshire Child Protection Procedures. These procedures were updated following the publication of the National Guidance for Child Protection, 2021 (updated 2023). Changes in North Ayrshire practice have been embedded in accordance with the guidance across the partnership and are reviewed via the Management Information Sub-group and Evaluation and Improvement Sub- group of the Committee. 15 Support families with children aged 0-5 through our integrated universal early years’ service. There are over 5000 children aged 0-4 years in North Ayrshire, all of whom are supported by either a Health Visitor or a Family Nurse. In addition to following the nationally agreed Universal Health Visiting Pathway from the antenatal period through to a child commencing school, within North Ayrshire, children under 5 and their families continue to have access to additional support from the wider, integrated early years team. During 2025/26 (as at 17 March 26), 730 requests for assistance from the various members of the integrated team were made. This included: • 461 (83.6%) for Health Visiting Support Workers for areas such as communication, sleep, toileting, infant feeding and behaviour • 64 (8.8%) for the Perinatal Wellbeing Team, supporting new and expectant mums experiencing low level mental health difficulties • 60 (8.2%) for the Family Nurturers who offer support around bonding and attachment, routines, home conditions and community integration • 57 (7.8%) for Early Years Social Workers supporting with domestic violence, parental mental health difficulties amongst others 168
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5 • 38 (5.2%) for specialist infant feeding support • 29 (4.0%) for support to dads via our partnership with national charity Dads Rock • 19 (2.6%) for the Healthcare Support Worker who provides additional support to the Perinatal Wellbeing Team as well as baby massage 16 Increase access to early learning and childcare. The 1140 funded hours continue to be delivered with flexibility and choice for parents across localities. Our models offer a blend of full year and term time places with various patterns in establishments delivering 8am-6pm and 9am – 3pm. Allocations have taken place for session 25-26 and 85% of parents have been offered their 1st choice for establishment. Work is continuing to raise awareness of eligibility and increase the uptake of eligible 2s. 17 Work together with parents or carers to provide support to their children. We have continued to roll out the Building on Positive Relationships Families groups. This financial year 17 groups have taken place with 22 families taking part. All participants have reported that the programme was either extremely useful or very useful and it has had a positive impact on family life. 18 Improve outcomes for care-experienced young people. Our Brighter Pathways transformation programme to improve outcomes and opportunities for care experienced children and young people has been progressing since April 2024. The transformation and service developments were delivered through focussed workstreams on the following areas: 1. Housing and Throughcare 2. Fostering and Kinship 3. Education including Residential School Placements 4. Internal Children’s Houses – Model of Care 5. Early Intervention & Intensive Family Support 6. Strategic Needs Assessment/Data/Workforce 7. Best Practice Models and Research The Brighter Pathways work has involved all corporate parents which has assisted in a shared awareness of the challenges and opportunities to improve the provision of services for families, looked after children and care experienced young people. Progress during 2025-26 has included: 1. Our supported accommodation model of care is nearing completion with a proposed opening date of 1st June 2026. This is designed to increase independence whilst maintaining relational support on a phased and gradual basis, rather than young people experiencing the cliff edge of transitioning to adulthood which they often talk about 2. Fortnightly planning meetings are taking place to discuss matching young people to the supported accommodation. 3. A new Fostering Scheme has been introduced, effective from 1st April 2026 to help retain current foster cares and encourage new foster carers. This will support placement stability by increasing retention of current experienced carers alongside strengthening approaches to local recruitment, reducing reliance on external provision (which is more often than not, not local). 4. The Moving on Forum has been implemented to encourage multi agency working between Throughcare and Housing. The Forum has improved coordination between Housing and Throughcare, with reduced delays in accommodation making decisions resulting in more predictable and better planned transitions for care leavers. This joint approach has helped mitigate impact of increased housing pressures by ensuring earlier planning alongside shared ownership this has resulted in day-to-day collaboration across Throughcare, Housing, internal children’s houses, fostering and kinship services. 169
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6 19 We continue to develop and implement the Childsmile programme, focussing on early referral and preventive advice for all families. In 2025 along with all boards in Scotland, NHS Ayrshire and Arran embarked on a programme to reorientate the Childsmile programme. This included changing how the Fluoride Varnish programme is delivered in educational establishments. The team are working to an action plan which is reported through the Oral Health Improvement Plan. Additionally a review of the Dental Health Support Worker programme has provided a clear direction for improving this service working alongside health visiting colleagues and other stakeholders. 20 We will continue to deliver Jumpstart, a family centred healthy lifestyle programme for children aged 2-17, who are above a healthy weight. During 2025/26, 40 children and young people aged 5–17 were supported through our Child Healthy Weight programme (JumpStart) in North Ayrshire. Referrals showed a balanced gender profile (21 male, 19 female), indicating equitable access across genders. Referrals were largely concentrated in early and middle childhood. Children aged 5–9 accounted for 45% (18/40) of referrals, those aged 10–13 comprised 37.5% (15/40), and 17.5% (7/40) were aged 14+. This reflects strong early identification through school-based pathways. Service delivery strongly aligns with health inequalities priorities. 62.5% (25/40) of referrals were from SIMD 1 communities, with a further 20% (8/40) from SIMD 2. Overall, 82.5% of referrals came from the two most deprived quintiles, demonstrating effective targeting of families experiencing the greatest socioeconomic disadvantage. Referrals were driven primarily by core health partners. School Nurses accounted for 27.5% (11/40) of referrals, GPs for 20% (8/40), and Dietitians for 17.5% (7/40). This highlights strong multi-agency engagement, particularly within universal and primary care services. During the reporting period, 66 group-based sessions were delivered within community settings. In addition, seven young people (teens) were supported through one-to-one interventions, making use of KA Leisure facilities. All participating children were provided with a KA Leisure card, offering a minimum of three months’ free access to KA Leisure facilities to support ongoing physical activity and sustain engagement beyond the intervention. 21 Expand our peer support service to all breastfeeding mothers as part of our integrated infant feeding service working alongside the Breastfeeding Network. From 1st July 2025, The National Childbirth Trust took over the contract with the third sector to provide postnatal breastfeeding support to all women who were breastfeeding on discharge from Ayrshire Maternity Unit. Between 1st July - 31st March, 1,331 breastfeeding women engaged in the support offered. Of those, around 50% were exclusively breastfeeding at 6-8 weeks. 22 Continue working with whole families, whole systems and whole communities to provide early intervention support to all of North Ayrshire’s Children. Through Safer Choices, Safer Futures, continued progress has been made in working with whole families, whole systems and whole communities to provide early intervention support for children and young people across North Ayrshire. Partnership working with Education, ADP, Police Scotland, extended outreach services and the third sector has strengthened joined-up responses to identified risks, enabling support to be offered at the earliest possible stage. This whole-system approach has focused on prevention, relationship-based practice and community engagement, ensuring that children, young people and families receive the right support at the right time. By aligning universal services with targeted interventions, Safer Choices, Safer Futures continues to support positive outcomes, reduce escalation of need and promote safer, healthier communities. 23 Providing training/guidance to families, schools, partners and communities that enhances the understanding of early intervention and provides skills needed for families to feel confident and equipped to manage family life. 1801 children and young people engaged with programmes delivered by the Mental Health and Wellbeing Project Delivery Officers. These activities prioritise supporting children and young people to develop ways to keep mentally well and promotes positive wellbeing practices. Examples of programmes delivered include, Drama for Wellbeing, Outdoors for Wellbeing, TakeTime Families and Your Resilience at The Hive in Ayrshire College. The BounceBack programme continues in Primary 170
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7 Schools with one young person aged 11 reporting “I liked the resilience exercise, I learned to believe in myself and try not to give up.” The CLIMB programme has been introduced in Secondary Schools where young people develop skills to positively manage their mental wellbeing and also gain some qualifications. Staff involved report substantial improvements in several areas including - Confidence and Self-Belief, Emotional Regulation and Wellbeing and Social Skills and Teamwork. Please see response to No. 15 and No 17. 24 We will implement the Signs of Safety approach to social work practice. Signs of Safety was launched in North Ayrshire HSCP in 2023 and now is fully embedded into professional practice. Signs of Safety (SoS) is described as an approach “to enable children's services to deliver services with a rigorous focus on child safety and wellbeing, and to set up their practice, policy, procedures and organisation so that the practitioners can do everything possible to put the parents, children and everyone naturally connected to the children at the centre of the assessment and decision-making”. Implementation has included briefings to CPC members, 5-day training for HSCP Social work children and families staff, baseline audit work and realignment of paperwork. In June 2025 an audit was undertaken. Activity involved a random sample across all open social work Children and Family cases on which at that point were 956. Within this audit, 10% of parents /carers of all open cases in children and families’ teams were interviewed and 70%-84% of the cohort interviewed felt that their workers show care, spend time with the children, help solve problems, recognise strengths within the family and are following through on actions. This is very positive feedback and an excellent base from which to build and improve practice. There is strong evidence from the responses gathered from children and young people that they feel listened to (63%), feel their social worker helps them (69.5%), feel their social worker knows their family (76%) and 71% of the children and young people interviewed feel they have a say in what happens to them. This data provides strong indications that there are positive working relationships between families and practitioners. Given how important working relationships are in evoking change for children this is an excellent starting point for implementation. 25 Improve planning for transitions of care to ensure children and young people are able to thrive moving into adulthood. A series of Short Life Working Groups (SLWGs) were completed between September and December 2025. The SLWGs looked at areas including resource allocation, Self-Directed Support, eligibility criteria and assessment formats. The conclusion of these groups provided actions to drive forward for future implementation. The following will be taken forward: • One resource allocation group for children with disabilities and adult learning disabilities. • Revise the current SDS model to bring up to date the budget structure. • Re-write the eligibility criteria for an All-Age Disability Team. • Continue to use Signs of Safety in CFDIS, however, to review the current paperwork format as was in period of review. Not to use the Signs of Safety Pathways Assessment as a transition assessment. Seek to move towards the use of GIRFE for transition and adult LD assessments. Since these decisions were agreed, changes outwith our control has meant that there are further amendments to make. Social Work Scotland Self Directed Support Children's Peer Space has provided a draft Scottish Government document which moves away from indicative budget-based supports to needs led. Further work is now required in relation to our current model. 171
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8 26 Invest in premises infrastructure to support children and young people experiencing distress in appropriate environments. The service approach is strongly aligned with the core principles of the Bairns’ Hoose national model. This includes a commitment to trauma-informed practice, ensuring children do not have to repeatedly retell their experiences, and providing coordinated, multi-agency support that prioritises safety, dignity and wellbeing. Joint Investigative Interviews (JII) and the Scottish Child Interview Model (SCIM) – Staff trained in SCIM undertake interviews using trauma-informed, child-led approaches designed to reduce distress, support memory accuracy and uphold children’s rights throughout the justice process. This ensures that the child’s voice is captured safely and respectfully, while supporting improved investigative and decision-making outcomes. The alignment between SCIM, JII and Bairns’ Hoose principles means that our workforce is already operating within the national direction of travel. We have established processes that reduce duplication, strengthen cross-agency communication and ensure that children have access to advocacy, therapeutic support and a consistent professional network. As the local Bairns’ Hoose model becomes fully operational, these foundations will enable seamless integration, ensuring that children’s journeys through care, protection and justice pathways remain centred on participation, protection and recovery. 27 Work across partners to develop robust pathways of support for infants, children and young people and their families seeking support for speech, language and communication development support. North Ayrshire Early Language Network group meets regularly to share information about supports available to children, young people & families seeing support for Speech, language and Communication (SLC). Health, education, early years social work, Family Nurse Partnership, 3rd sector representative are part of the network. Communication Champion Network in Early Years in North Ayrshire link closely with the SLT team and as a group quarterly to share practice. Communication Champions have received additional training from SLT to identify children who may require targeted support in early year, can share resources with parents and signpost them to SLT helpline and in person drop in session with SLT. A Social Communication in person drop in runs monthly. Any family with a concern about their child's social communication or activities for daily living can receive advice. The NHS Ayrshire & Arran Children's speech and language therapy Facebook page and app contains information for families and practitioners to access with many activities to help support children's speech, language and communication. There is a Helpline available for anyone with a concern about a child's speech, language and communication. They can speak to a registered Speech & Language therapist and receive advice and resources. Annual meetings with our Health Visitor colleagues ensure that they are familiar with the SLT pathways and build relationships with colleagues. 28 Improve access to Speech and Language therapy for children and young people who require specialist support. If families contact us through the helpline or attend an in person drop in with Speech and Language Therapy (SLT), they will receive advice and resources from the service. If a Request for Assistance is required because the child needs a complex SLT assessment they will be added to the waiting list. While the child is waiting for this complex SLT assessment the family will be offered support at a targeted level. They can continue to access the in person drop in, they may be offered a one off assistant demonstration session, for example, on Makaton. 29 Develop a trauma informed workforce by rolling out trauma aware and trauma skilled resources North Ayrshire Health and Social Care Partnership has invested in providing the majority of trauma informed training on a face- to-face basis. At this moment in time, many other organisations are relying on an online format. The positives of providing training in this manner is that staff are having the opportunity to have the discussions around what is working and what is not. This is crucial for services to start the process of looking at where changes need to occur. In partnership with Connected 172
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9 Communities we have developed a guide on Trauma informed Language for staff within the residential care setting. This has involved working with young people on how language has impacted them and what they would like to see improved. This informed training for residential staff along with a guide on language use. This has been rolled out to Canmore Children's House, but it is hoped that the other three houses will also get involved. Additional trauma inputs also take place for all newly qualified social workers and student social workers. Input is now also incorporated into the 5-day Child Protection Training Course. Education’s recently launched Supporting Relationships and Behaviour Policy and Professional Learning Programme supports the development of a trauma-informed workforce by providing a clear, graduated pathway from Trauma Aware to Trauma Skilled practice across universal, targeted and intensive levels. Universal professional learning, including CALM Theory, New Authority, Emotion Coaching, Expectations and Consequences develops workforce awareness of the impact of trauma, stress and adversity on relationships and behaviour, establishing a shared relational, compassionate and preventative approach that prioritises safety, predictability and emotional regulation. Targeted and intensive elements, including Positive Behaviour Support, CALM Physical Intervention, re-accreditation and structured train-the-trainer delivery with ongoing locality-based coaching, deepen the ability of education teams’ to respond safely and in a neuroaffirming way to dysregulated behaviour using low-arousal, dignity-preserving and trauma-informed strategies. Sustained coaching, peer reflection and access to national trauma, nurture and relationships-based resources ensure practice is embedded, consistent and reflective, supporting team wellbeing and resilience while enabling children and young people to experience emotionally safe, regulated and supportive learning environments. Develop an evaluation framework to maximise resources to support children and young people, to enable system partners to invest and sustain early intervention approaches. A monitoring and evaluation framework has been developed to support implementation of the Whole Family Wellbeing Fund. All funded elements provide 6 monthly reports setting out how they are meeting the aims and outcomes of the WFWF, involvement and impact on children, young people and their families, and sustainability. This is in line with the annual Scottish Government reporting expectations. 31 Reach and identify all young carers earlier in their caring role and promote increased uptake of Young People’s Carer Support Plans. We are committed to identifying young carers earlier in their caring journey and increasing the uptake of Young Carers Statements. Significant progress has been made across education settings to embed consistent, meaningful support. • 15 local primary and secondary schools have now signed up to the Young Carers Covenant, ensuring that young carer awareness and tailored support are embedded into school culture. • The number of Young Carers Statements offered and accepted across education continues to grow, reflecting stronger identification pathways and increased confidence among staff in recognising and supporting young carers. • A comprehensive Young Carers Education Information Pack has been developed to strengthen professional understanding and enable a consistent approach to support. • Young Carer Statement training sessions have been delivered for both education and HSCP staff, helping ensure that statutory duties are met and support is personalised and meaningful. • Carers Gateway Young Carer staff now able to offer and complete Young Carers Statements where appropriate. • Through collaborative work, Carers Gateway and local schools have established a shared working agreement, reviewed annually, which sets out mutual goals for identifying and supporting young carers. These may include: o Regular group sessions within schools 173
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10 o Dedicated one-to-one support for young carers o Developing a Young Carers Charter tailored to each school o Awareness-raising activities for pupils, families, and staff o Providing targeted resources for each school’s needs o Support during key transition points, including P7–S1 and the move to post-school destinations This collaborative, prevention-focused approach ensures young carers are identified earlier, understood better, and supported in ways that make a genuine difference to their wellbeing and educational experience. Priority 3: Making things fairer No. Action Update 2025-26 32 Implement the North Ayrshire Child Poverty Action Plan. Significant progress has been made this year in strengthening governance, delivery and system change to reduce child poverty in North Ayrshire. Child poverty is now embedded as a core priority of the Community Planning Partnership, strengthening strategic oversight and accountability. The Child Poverty Strategy Team, initially established through Fairer Futures Partnership funding, is now fully embedded and staffed through permanent roles, providing sustained leadership and coordination across partners. The No Wrong Door approach has transferred into the Child Poverty Strategy Team, ensuring closer alignment with strategic objectives. Fairer Futures Partnership activity has prioritised co-designing place-based tests of change with third sector partners and community members with lived experience as equal partners. This has led to the creation of new third sector posts within co-identified priority communities and the commencement of feasibility work on a community directory to improve access to local supports and services. A new Project Board has been established in recognition of the intersectional work and impact of child poverty, and to drive delivery at pace across three priority workstreams: Single Shared Assessment, No Wrong Door, and Data and Evidence. This structure will enhance collaboration, reduce fragmentation and improve the targeting of support. The Welfare Rights in Schools project expanded significantly during 2025–26, with three Welfare Rights Officers embedded across all educational establishments, including early years centres. Schools have provided trusted, stigma-free access to advice, enabling early intervention. During the year, the project secured £1.5 million in financial gains, with 240 families achieving positive outcomes. Continued funding is required to sustain and further develop the model, including testing more intensive support in selected schools. 174
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11 No. Action Update 2025-26 Across its first two years, the Child Poverty and Early Intervention Fund has now committed over £1 million, supporting both direct financial relief and innovative, co-designed test-of-change initiatives. This includes investment in integrated data through Smart Data Foundry and piloting a Family Enterprise Programme in partnership with Ayrshire College. Youth participation has been strengthened through engagement with the P7 Youth Council and Joint Cabinet, while modern apprentices have shaped the content of family friendly versions of the 24/25 Child Poverty Progress Report. Looking ahead, the development of the joint Children and Families Plan brings together children’s services, child poverty and UNCRC statutory duties. A focused youth panel with scrutiny and oversight responsibilities will be established as a key component of governance to ensure actions and implementation accurately reflect the needs of the communities they are intended to serve. 33 Improve attainment and achievement for all. There has been a focus on raising attainment for all children and young people across session 2025-26, including: • Key discussions and planning of attainment priorities with senior leaders across Early years, Primary & Secondary • Use of data for improvement, raising attainment and closing the poverty-related attainment gap • Relevant and purposeful uses of Play in EY and Primary • Involvement in the CYPIC National Writing programme for Achievement of a Level in Writing • Professional learning delivered by NAC Professional Learning Academy • Target-setting and monitoring of progress towards targets through attainment meetings across all 3 sectors • Focused and targeted support from Education Scotland Attainment Advisor • Data clinics for staff across all 3 sectors to support improved use of data to raise attainment • Embedded use of approaches and tools to gathering and analysing attainment data in Literacy and Numeracy from Early Years to S3, including input from EY Funded Providers and Childminders • Analysis of Senior Phase data with Secondary senior leaders to provide key priorities for next academic session • Looking outwards at national level as well as sharing strategy nationally • Development of a NAC Reading Programme which will begin to be implemented in academic session 2026-27 34 Close the poverty related attainment gap. Rigorous analysis of data for improvement at all levels includes a focus on closing the poverty-related attainment gap and how educational establishments can support those children and young people most affected by poverty. With 46% of learners residing in SIMD Q1, Education Service priorities ensure that universal approaches to improving learning, teaching and assessment, as well as raising attainment, allow a focus on approaches to closing the gap. Strategic planning and spending of Pupil Equity Funding by schools allows for focused and targeted interventions and supports for learners most affected by poverty, with input focused on Health and Wellbeing, Literacy and Numeracy. Quality assurance of this is included in annual PEF impact reports as well as Improvement Plans and Standards and Quality reports. Senior Education Authority staff attended national events on Scottish Attainment Challenge and PEF and delivered input to highlight effective practice in NAC schools. 175
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12 No. Action Update 2025-26 There remains a commitment in schools and in the Education Service to mitigating against the Cost of the School Day, with approaches such as uniform banks, Prom dresses and low/no cost trips and excursions. 35 Implement the recommendations from the Independent Care Review (Scotland), The Promise. We are fully committed to #KeepThePromise which provides a benchmark for corporate parents, carers, practitioners, managers, care experienced community, and decision makers in fulfilling the goal to meet the collective and individual needs of all of our Care Experienced infants, children and young people. A staff Promise Conference was held on 20th January 2026 and brought together care experienced young people, senior leaders, operational managers, and corporate parenting partners. The event focused on reflecting on our responsibilities as corporate parents, strengthening commitment to The Promise, and gathering staff voice to inform the Corporate Parenting Plan refresh. In November 2025, we held our annual joint Champions Board Conference, attended by 9 out of 10 schools and 59 young people. The conference was co-designed with young people and focused on themes they identified as important, including: Understanding The Promise Using their voice safely and powerfully Building connections with peers across schools Planning the Summer 2026 Programme Their views from the day have been captured in the “What Matters To Us” poster, identifying the six shared young people’s priorities: Feeling Safe and Secure Trust and Relationships Having a Voice and Being Listened To Friendships and Social Connections Opportunities and Aspirations Understanding and Respect Together, this provides a summary of what matters most to our care experienced young people and will directly inform the next Corporate Parenting Plan. The HSCP and multi-agency partners continue to promote and implement The Promise locally. The Corporate Parenting Steering Group continues to meet quarterly to drive the work of the Corporate Parenting Action Plan which captures all activity associated with The Promise. The action plan has been aligned with the 5 key foundations upon which The Promise is built - Care, Voice, Family, People and Scaffolding. 36 Implement the recommendations from the Additional Support for Learning Review (Scotland). Educational Psychology Service continues to contribute to recommendations from the ASL review, building workforce capacity through trauma-informed, inclusive professional learning and coaching, strengthening inclusive leadership, mindsets and practice, improving attendance and participation, and securing equitable outcomes for neurodivergent learners through consultation , assessment, intervention and research. 176
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13 No. Action Update 2025-26 37 Build strong collaborative partnerships in local areas to ensure we deliver high-quality services for all of our children, young people, and families. Rosemount: The Rosemount Crisis Service has built strong collaborative partnerships across North Ayrshire by operating as a highly integrated, multi-agency service focused on supporting children and young people with complex needs and significant levels of risk, with the clear aim of keeping children safely at home with their families and out of local authority care wherever possible. The service mainly works with the four Children & Families Social Work teams in North Ayrshire - but also accepts referrals from the Families for Children, Children & Families (Disabilities), Kinship and Young Person Support teams - and plays an important role in the wider multidisciplinary response to family crisis, escalating risk, and instability. Rosemount is embedded within statutory planning and decision-making processes and contributes to Child Protection processes and plans, Looked After and Accommodated Children (LAAC) processes, Children’s Hearings, and wider young person protection pathways, including Vulnerable Young People (VYP) and CARM arrangements. Partnership working extends beyond social work to include Education, CAMHS, Police Scotland, health services, and community-based supports, ensuring that children and families receive a holistic, coordinated, and responsive service. This integrated model enables Rosemount to respond effectively to overlapping issues such as family breakdown, distressed behaviour, trauma, school non-attendance, mental health concerns, and contextual risks. A key measure of the service’s impact is its consistent success in keeping over 90% of the children involved with the service each year out of local authority care. This demonstrates the effectiveness of intensive, relationship-based crisis intervention when delivered in close partnership with families and professionals. Rosemount’s collaborative approach strengthens risk management, improves family functioning, and creates the conditions for safer, more stable home environments. Overall, the service’s strong local partnerships are central to delivering high-quality, child-centred, and family-focused support, ensuring that children and young people with the most complex needs receive the right help at the right time, while reducing the likelihood of escalation into care. Family Centred Wellbeing Service: The Family Centred Wellbeing Service (FCWS) has built strong, effective partnerships across North Ayrshire by embedding a whole-system, relationship-based approach to early intervention and family support. Working collaboratively with education, health, social work, and a wide range of third sector and community partners, FCWS ensures that children, young people, and families receive coordinated, holistic support that responds to complex and interconnected needs. Practitioners actively engage in multi-agency planning, including Team Around the Child (TAC) processes, and play a key role in bridging gaps between services, advocating for families, and improving communication across the system. 177
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14 No. Action Update 2025-26 Partnerships are also shaped by the needs and voices of children and families, with flexible approaches that connect individuals to supports aligned with their strengths, interests, and circumstances, including community-based opportunities that promote inclusion and reduce isolation. This collaborative model has contributed to tangible improvements in outcomes, including: • improved school attendance and engagement, • increased emotional wellbeing and confidence, • strengthened family relationships and parenting capacity, and • improved access to mental health, financial, and community supports. By working in this integrated and responsive way, FCWS has strengthened local service delivery, enhanced access to early support, and contributed to preventing escalation to crisis or statutory intervention - particularly for families experiencing the greatest levels of disadvantage. An example of this is the first year of joint delivery of the SCQF level 5 Performing Engineering Operations Award between NAC Education Service and Ayrshire College. Learners from over 5 different NAC Secondary schools are taught the course at Ardrossan Academy and Ayrshire College, resulting in an increased number of pupils being able to access the course. other benefits have been upskilling of school staff in the delivery and assessment of the Award, improved partnership working with the College and a direct link to opportunities within the Ayrshire Growth Deal. 38 Create a new 3 year Raising Attainment Strategy. Raising attainment continues to be a focus for all schools and Early Years establishments, with a commitment to ensuring added value across and through all 3 sectors in a child’s learning, attainment and achievement. Senior leaders’ feedback and the Data Service Improvement Group have helped to shape a refreshed approach to collecting Literacy and Numeracy data and how this is then used to create targets for all establishments. A more focused approach in analysing attainment data is helping to shape Service priorities and collaborative working between central staff and schools to ensure that all learners attain and achieve their best outcomes. 39 Maximise opportunities to work with Third Sector providers to provide early intervention and prevention supports, with a particular focus on primary prevention approaches. Through Whole Family Wellbeing Funding, the Children’s Services Strategic Partnership has awarded grants to third sector organisations during this financial year with the aim of testing or expanding early intervention projects which support a whole family approach. Some of these projects include support to kinship families, transition support to young people with additional support needs and support to dads. Through Children and Young People’s Community Mental Health and Wellbeing Funding, small grants have been awarded to a range of Third Sector partners. Examples of programmes include, using judo to promote wellbeing, KA Leisure have developed programmes and work in collaboration with schools, nature based programmes, and programmes that promote financial stability. 178
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15 No. Action Update 2025-26 40 Providing a robust ‘peer’ support model that upskills parents and carers, providing training and volunteering opportunities and enhances employability skills as well as building self-esteem and confidence. In 2025/26, the Employability service has registered 811 new parents who are engaging, developing skills, confidence, and resilience to secure and sustain employment in the future. In this period 85 parents have secured paid work experience through placements created from the Skills for Life initiative. We Work for Families have supported 134 parents to progress to sustainable employment as well as increasing their household incomes. Two new Peer Navigators have been recruited to engage and support parent to engage in training, volunteering and the range of opportunities provided by Your Next Move Working North Ayrshire to prepare people to progress to employment. 41 Take an asset-based approach to communities/children and families and build upon the skills and strengths that exist. North Ayrshire has been implementing Safe and Together since 2021, a model which is designed to improve our practice and how we work together with families where there is domestic abuse and concerns about children. 42 Establish a Financial Inclusion Partnership in North Ayrshire to better support access to support for families. Our 2025 ambitions to deliver services through an Advice Line and a single point of contact are now fully embedded. Client- centred outcomes surveys are routinely issued at case closure, strengthening our understanding of impact and ensuring continual service improvement. In-house debt advice is fully operational, providing seamless access to both debt and welfare rights support across all tenures. The Financial Inclusion Partnership Communications Subgroup was established during the year and successfully delivered the Partnership’s first multi-agency event in October. The event, themed around winter preparedness, brought together a range of services with the aim of increasing awareness of support available across North Ayrshire and improving understanding of how services connect and refer between one another. Workshops were delivered by Citrus, Community Link Workers and Christians Against Poverty (CAP). The Financial Inclusion Partnership continues to grow and strengthen, with new members joining throughout the period. Collaborative working with third sector organisations and partner agencies remains central, with a shared focus on developing clear referral pathways and delivering coordinated, joined-up support for residents. 43 Develop peer support models. The Modern Apprenticeship programme is being used as a peer support model by creating visible, relatable role-model opportunities for young people within their own communities. Apprentices, many of whom have lived experience of local challenges, support younger peers through informal mentoring, shared learning and positive role-modelling, helping to build confidence, aspiration and engagement. By positioning apprentices within community and youth work settings, the programme supports peer-led learning, early intervention and prevention, enabling young people to access advice, reassurance and support from someone they can identify with. This approach strengthens relationships, promotes positive behaviours and supports children and young people to make safer choices, while also building skills, confidence and progression routes for the apprentices themselves. 44 Strive for parity of access to support and services for our Island Communities including for Children and Young People. Work has continued to strengthen equity of access to youth work support and participation opportunities for children and young people in North Ayrshire’s island communities. Partnership working with Arran Youth Foundation has supported the development of a local youth work offer on Arran, ensuring provision is responsive to local need while remaining connected to wider Council priorities. Island communities are routinely included in all youth voice structures and engagement activity, including the Youth Council, Joint Cabinet events and wider consultation processes, ensuring young people from Arran have 179
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16 No. Action Update 2025-26 opportunities to influence local and strategic decision-making. The appointment of an MSYP from Arran has further strengthened parity of access, enabling regular feedback from island young people and ensuring their views are represented consistently at both local and national consultations. 45 Provide multiple points of access for young carers into carer support services. We are committed to ensuring that young carers can access support in ways that are flexible, familiar, and responsive to their needs. A range of access routes has now been embedded across education and community settings, ensuring no wrong door to support. • Dedicated Young Carers Champions are now in place within every primary and secondary school. These Champions act as a first point of contact for identification, support, and information-sharing within their school communities. • Three Young Carer Workers are aligned to clusters of three secondary schools and their associated primary schools. This structure ensures consistent partnership working, proactive engagement, and timely support for young carers and their families. • A termly Young Carer Newsletter is shared with education staff, providing updates on supports available, upcoming events, awareness activities, and practical resources for working with young carers. This helps maintain visibility and ensures staff remain informed throughout the year. • An upgraded Carers Gateway digital self-help portal for young carers was launched in August 2025, offering 24/7 access to a wide range of information, resources, wellbeing tools, and guidance. The platform significantly enhances accessibility - enabling young carers to seek help at any time, in a format that suits them. Together, these access points ensure that young carers can engage with support through trusted adults in school, dedicated staff, digital tools, or wider community activities. This blended model strengthens early identification, reduces barriers, and offers young carers multiple pathways to information, advice, and personalised support. Priority 4: Promoting good mental health and wellbeing No. Action Update 2025-26 46 Develop our nurturing approach across all Children’s Services. A nurturing approach is being embedded across Children’s Services through shared trauma-informed and relational practice. In Education teams this is evolving into a New Authority model that combines compassion with clear, supportive boundaries. Professional learning in nurturing, Emotion Coaching, Positive Behaviour Support and CALM is supporting consistent adult responses focused on safety, regulation and repair. This year there are examples of joint problem-solving with Psychological Services, Children’s Houses and CAMHS - growing a community of practice for care-experienced young people enabling shared learning and consistency across services. 47 Work with children, young people, families, and communities to improve mental health and wellbeing through physical activity and social participation. Youth work activity continued to make a significant contribution to improving the health, wellbeing and life chances of young people across North Ayrshire. A sector-leading approach to youth voice and participation enabled young people to influence decision-making on issues including rights, equalities, mental health and community priorities through Youth Forums, Champions Boards and the Joint Cabinet. This work strengthens confidence, belonging and civic participation, ensuring services are shaped by young people’s lived experience, including care-experienced young people and young New Scots. 180
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17 No. Action Update 2025-26 Targeted and universal programmes supported mental health, resilience and positive relationships across schools and communities. Evidence-based and creative approaches, including Your Resilience, Bounceback, Drama for Wellbeing and outdoor and physical activity programmes, helped young people develop emotional literacy, coping strategies and self-regulation. Early intervention and prevention activity addressing suicide, alcohol and vaping risks was complemented by workforce development on neurodiversity, trauma and complex behaviours, strengthening the quality and consistency of support available to young people. The Duke of Edinburgh’s Award continued to provide a strong wellbeing and achievement pathway, engaging over 1,000 young people across schools and communities and supporting progression through Bronze, Silver and Gold awards. Alongside this, targeted programmes and partnerships supported care-experienced young people, young New Scots and those facing additional barriers to build confidence, maintain connections to education and progress to positive destinations. Together, these approaches demonstrate a coherent, strengths-based model that combines participation, prevention and progression to improve wellbeing outcomes at scale. All Active Schools activities are designed to support and promote positive mental health and wellbeing for every child and young person who takes part. Our year‑round programme of extra‑curricular opportunities, events and leadership initiatives plays a vital role in reducing stress, boosting mood, and enhancing self‑esteem among participants. To further strengthen our approach, the Active Schools team has developed a comprehensive guidance resource for schools. This guide raises awareness of how our programmes contribute to improved mental health outcomes and provides practical examples of the ways physical activity and leadership experiences can positively influence wellbeing. In addition, all coaches and volunteers involved in Active Schools delivery participate in a robust mental health training programme. This training equips them with the knowledge and confidence to recognise signs of poor mental health, create inclusive and supportive activity environments, and respond appropriately to the needs of young people during their weekly sessions. Through this combined focus on participation, education and staff development, Active Schools continues to play a significant role in nurturing healthier, happier and more resilient young people across our communities. 48 Continue to have appropriate pathways in place for supporting mental wellbeing. Our school counselling service supports children and young people aged 10-18, in the school setting, this year 500 children and young people accessed the service with 98.6% reporting an improved CORE-YP score. Our Area Inclusion workers and additional support staff continue to deliver Let’s Introduce Anxiety Management (LIAM) with positive impact. Mental and emotional wellbeing is one of the 10 priority pathways in the school nursing service. We are currently exploring ways to record this to allow more accurate reporting. All staff nurses supporting the school nursing service are trained in LIAM. 49 Work together with children, young people, and their families to help build resilience. Education and Social Work teams have worked together in the following areas – see WFWF report for greater detail. • Building parental confidence and capacity: The Building Positive Relationships (BPR) programme strengthens adult presence, helping parents regulate, de-escalate and repair relationships, reducing reliance on crisis intervention and supporting sustained family resilience. Pre-programme assessment, readiness processes and flexible delivery enable families to access timely support before challenges escalate, building coping strategies and emotional regulation skills. Emotion coaching, neurodevelopmental understanding and co-parenting inputs support parents to 181
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18 No. Action Update 2025-26 better understand their child’s needs, improving relationships and reducing family stress. There is evidence that the BPR approach is helping some families feel less alone, fostering peer connections and shared problem-solving that strengthens family resilience. • Consistent, joined-up support around families: Weekly Educational Psychology consultation with the Family Centred Wellbeing Service (FCWS) has enhanced problem-solving, goal-setting and reflective practice, enabling tailored, strengths-based support for families. • Supporting attendance and anxiety: Development of targeted resources (e.g. animation groups and attendance-related anxiety supports) helps children and families build confidence and coping skills linked to engagement and participation. • Empowering families of neurodivergent children: Training and resources shared with practitioners and families promote understanding of sensory, emotional and communication needs, enabling consistent approaches across home, early years and school. Psychological Services are working in partnership with NEST and the new Learning and Development Advisor. • Proactive planning and transitions: Use of NAIT resources such as Let’s Not Just See How It Goes and We Were Expecting You with school teams supports anticipatory planning and predictable environments, reducing stress at key transition points for children and families. 50 Improve services for children with neuro- developmental conditions, implementing a whole system approach with partners across Health, Education, Social Services and the Third Sector. (Implementation of the National CAMHS and Neurodevelopmental Specifications). The Business Case for a pan-Ayrshire diagnostic Neurodevelopmental service for children and young people is currently being finalised and will be presented to Chief Officers. In North Ayrshire, there has been a focus on training and development of the children’s services’ workforce through WFWF monies to NEST, including the recruitment of an Learning & Development Adviser for Neurodevelopmental Delay (NDD), who has been delivering a programme of opportunities to upskill the workforce. This was a recommendation from a NDD training needs analysis undertaken in North in 2024. 51 Public Health will implement a life course approach to Mental Health and Wellbeing, focusing on the first thousand and one days, infancy and Children and Young People. Public Health have worked over the 25-26 period to produce a suite of life course evidence briefings. The mental health and suicide prevention briefing will be used in the coming year to shape conversations with partners regarding the preventive potential of a life course approach and opportunities based on evidence across the life course and across all stages of prevention (universal, primary, secondary, tertiary). During 2025 - 26, Public Health has continued to strengthen and embed mental health improvement activity across Education and wider children’s services in North Ayrshire. Examples of activity include: • Promotion and Utilisation of MHWB Resources in Practice – The Guide for Children, Guide for Young People and Children’s Workbook for Mental Wellbeing continue to be actively promoted across Education and to partners who support children, young people and families. Work this year has focused on reinforcing awareness of these resources, supporting staff to build them into everyday practice, and ensuring consistent access to practical tools that help initiate and sustain wellbeing conversations. • Supporting a Whole School Approach – Public Health continues to work with the North Ayrshire Education Mental Health and Wellbeing Operational Lead to promote a Whole School Approach to mental health. 182
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19 No. Action Update 2025-26 • Mental Health Improvement – a Practical Approach (MHI‑apa) – training is now being delivered across Education by the MHWB Operational Lead, building capacity at school level and ensuring staff have the knowledge and skills to support children, young people and families. Area Inclusion Workers continue to use and cascade this learning within their roles, contributing to more consistent approaches across schools. This training is available through Public Health for other groups who wish to participate. • Time, Space, Compassion – There continues to be network of facilitators delivering Time, Space, Compassion workshops which are open to staff working across children's and young people's services. During April 2025 and March 2026, Public Health has organised and delivered 12 TSC workshops across Ayrshire and Arran. Four of these sessions were in North Ayrshire. Staff from North Ayrshire have accessed a number of sessions, with attendance including staff working with children and young people within both public and third sector organisations. Enabling Conversations Toolkit – Initial discussions and awareness raising regarding the Enabling Conversations Toolkit has taken place through the SSPG and Young People's Taskforce. In the coming year Public Health would like to see further awareness raising and engagement with this toolkit as a guide which was created by and for young people, to find help and support when experiencing painful feelings about suicide. Enabling conversations toolkit - Suicide Prevention Scotland. 52 Establish a Community Planning Partnership led Health and Wellbeing Alliance to bring key partners together to co-ordinate approach to targeting support to improve individual, family and community health and wellbeing. Work continues to align the Alliance to the strategic programmes including CHES and Active Communities. Updates to follow 53 Build on services that encourage parenting skills and interactions with between family members. Please see responses to No. 15 and No. 23. 54 Build on the National CAMHS Specification through the 3 established pathways (core, unscheduled care, neuro), ensuring young people are on the correct pathway at a much earlier stage. Pathways have been established and are now in place. 55 Continue to provide ‘worry workshops’ e.g. identifying key issues raised as worries by North Ayrshire children and young people and using this to develop targeted workshops on these issues. This action was cancelled as no longer required. 56 Be responsive and pro-active in responding to and learning from Young Person’s Suicide through our Young People’s Suicide Prevention Taskforce. Our Young People’s Suicide Taskforce (YPST) has been a well-established group that has very successfully delivered positive outcomes for suicide prevention. The Taskforce was focussed of ensuring that a professional, cohesive and effective multi-agency response was taken in the event of a child or young person completing suicide. This work resulted in the creation and maintenance of a multi-agency Crisis Response Plan, that ensures all partners respond and contribute to 183
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20 No. Action Update 2025-26 supporting young people, families, teachers and any other parties who require support at a very vulnerable time. In April 2025, the Taskforce considered what actions were required to be taken forward in the forthcoming period; the conclusion being that the substantive objectives of the group had been achieved. A bespoke meeting of the YPST on 07 May 2025 agreed that the YPST had achieved its main purpose – the development of the Crisis Response Plan (CRP). The CPR remains effectual and operational to date and continues to serve as a trauma informed framework for responding to a young persons suicide, ensuring timely support for families, schools, communities etc. Collectively this work demonstrates a shift from individual service responses to a more coordinated , relationship based system built around what matters to infants, children, young people and their families. As the YPST was aligned to the Strategic Suicide Prevention Group (SSPG) it was proposed that the responsibilities of the YPST would be subsumed by the SSPG, with the Terms of Reference being amended to reflect that change. The excellent and important work of the YPST was recognised by all members; and it was agreed that the tradecraft developed would not be lost during the transition of responsibilities. On 26 May 2025 the proposal to stand down the YPST and transfer responsibilities to the SSPG was presented at the Child Protection Committee (CPC). The proposal was unanimously agreed. This approach was endorsed by COG in June 2025. 57 Deliver the new National Secure Adolescent Inpatient Secure Unit (Foxgrove) for children across Scotland, which will also benefit young people in North Ayrshire. The service has been delayed in opening due to the facility not having been handed over by the main contractor as 'complete'. We are working with all parties to remedy this and it is hoped that the facility will be ready for handover in late summer/ early autumn 2026. At this point there is a projected 8-week period of post-handover works to be completed. It is anticipated, based on current projections, that we will be ready to receive admissions by December 2026. 58 Explore opportunities to ensure young people are not admitted to non-specialist environments including options to develop and in-house CAMHS inpatient provision. Working with the West of Scotland Tier 4 Regional Board to develop intensive home treatment services building on the existing CAMHS Unscheduled Assessment Intensive Treatment Team (CUAIT). 59 Building on the success of the Kilwinning Wellness Model, the Revised Wellness Model working group will now seek to roll out the approach across all North Ayrshire localities. The Wellness Model is now in place in all localities. Partnerships between the Education Service and local GPs have been strengthened and CAMHS are receiving more robust referrals when necessary. 60 Enable young carers to have a quality of life outside caring and ensure support when moving through key life stages. We continue to prioritise opportunities that enable young carers to experience a positive quality of life beyond their caring responsibilities; while ensuring they are fully supported during key transitions in education and life. • Young Carers Education Fund (£15K–£20K annually) provides flexible financial support to meet identified needs through Young Carers Statements. This includes opportunities for breaks from caring, participation in hobbies and activities, and access to life-enhancing experiences that contribute to wellbeing, resilience, and personal development. • KA Leisure memberships are available for young carers, giving them regular access to health, fitness, and wellbeing activities within their local community and supporting them to take time for themselves. 184
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21 No. Action Update 2025-26 • Eligible young carers have been supported by Carers Gateway to apply for the ILF Scotland Transition Fund, helping them build independence, confidence, and opportunities to engage socially, explore interests, and become more active in their communities. • Time to Live funding, accessed via Carers Gateway, provides young carers with the opportunity to apply for personalised short breaks—helping reduce stress, improve wellbeing, and create positive time away from their caring role. • To support key educational transitions, Carers Gateway actively participates in enhanced transition planning from primary to secondary school, ensuring young carers are identified early and their needs are understood. Young carers preparing to leave secondary school can access a 1:1 Young Adult Carers Transition Plan, offering tailored guidance around their caring responsibilities, available supports, future aspirations, and the move into further education, training, or employment. This multi-layered approach ensures that young carers are supported not only in their caring role, but also in experiencing a balanced life, developing their potential, and moving confidently into adulthood. Priority 5: Inspiring children and young people to be active No. Action Update 2025-26 61 Create innovative physical activity and sports opportunities with communities and partners. Active Schools and KA Leisure have continued to work collaboratively to increase opportunities for children and young people to be active across both school and community settings. Through strong partnership working, we have ensured that each of the six localities has well‑established links between school‑based activity and wider community provision. Over the past year, our joint efforts have also focused on identifying and addressing gaps in local provision. This has allowed us to create a more equitable offer across all areas, ensuring that every young person—regardless of where they live—has access to a broad range of activity and sporting opportunities. As a result, the pathways from school participation into local clubs and community sport have been strengthened, supporting smoother transitions and encouraging sustained engagement. Furthermore, Active Schools has maintained a strong commitment to supporting those young people who face the greatest barriers to participation. By prioritising targeted programmes and coordinated support across our system, we continue to ensure that those who need our help most are able to access and benefit from positive, inclusive sporting experiences. The Active Schools and Communities Partnership Officers have been instrumental in widening access to participation, particularly for young people who are care‑experienced, living in poverty, at risk of disengagement, non‑attenders, or otherwise identified for targeted support. Their work has effectively removed barriers and created meaningful pathways that ensure these groups can participate in sport and physical activity with confidence and consistency. In addition, the team has continued to provide valuable support to the HSCP, third sector organisations and children and young people with additional support needs, strengthening collaboration across the wider system. 185
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22 No. Action Update 2025-26 KA Leisure continues to deliver a broad and inclusive programme of sport and physical activity opportunities. Working closely with communities and partner organisations, we offer a varied calendar of term‑time sessions alongside an extensive holiday programme. Our term‑time offer spans all localities, delivering more than 150 classes each week and ensuring that young people and families have access to high‑quality, community‑based activity opportunities throughout the year. 62 Adopt a whole systems approach to diet and healthy weight. This action is no longer being progressed as it has been superseded by work on the requirement to develop a Good Food Nation Plan. 63 Design opportunities into the whole system to enable children, young people, and their families to access supported physical activity opportunities and have a healthy lifestyle. Active Schools remains firmly committed to its core priority of supporting all schools across North Ayrshire to deliver high‑quality, inclusive extra‑curricular programmes that are accessible to every child and young person. This commitment underpins everything we do and ensures that opportunities to be active, build skills and experience new sports are open to all, regardless of background or ability. Throughout the year, participation trends across our schools have highlighted the continued popularity of several key sports. The top five most actively engaged activities were football, netball, racket sports, dance and multisports, reflecting a broad range of interests and demonstrating the strength of provision offered across our localities. Our annual events calendar has also continued to grow in both scale and impact. This year, more than 5310 young people took part in a diverse programme of 75 competitive and participative events, showcasing their skills, representing their schools and experiencing the excitement of large‑scale sporting occasions. These events play an essential role in developing teamwork, resilience and confidence while providing memorable experiences for participants. Importantly, our commitment to inclusion extends across all aspects of the programme. Active Schools has worked closely with partners to ensure pupils with additional support needs can participate in meaningful and appropriate competitive opportunities. This includes supporting ASN young people to attend both the Ayrshire Sportsability events and activities within the Scottish Disability Sport calendar. By providing tailored pathways and ensuring representation at these events, we continue to uphold our ambition that every young person has the chance to perform, compete and celebrate their achievements at a level that is right for them. 64 Ensure all our early years indoor and outdoor learning environments and activities enable children to be physically active. All early year’s establishments provide learning environments which provide opportunities for physical play both indoors and outdoors. All staff are aware of the importance of developing gross motor skills and ensure experiences offered support development of core strength, stability, balance, spatial awareness, co-ordination and agility. 65 Promote access to leisure services for children and young people to encourage participation in physical activities. KA Leisure continues to promote inclusive access to leisure facilities through targeted programmes, concessions and outreach, increasing participation among children and young people across a range of physical activities. 66 Promote the introduction of the INSPIRE programme to improve opportunities for alternative activities, including arts, drama and music. KA Leisure has supported the rollout and promotion of the INSPIRE programme, widening access to alternative activities such as arts, drama and music to engage children and young people with diverse interests. We currently provide 105 classes across all localities in North Ayrshire. 186
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23 No. Action Update 2025-26 67 Create and protect safe spaces for children to play and enjoy being outdoors. Youth work programmes continued to create safe, inclusive and purposeful outdoor spaces that support children and young people’s physical health, mental wellbeing and social connection. Outdoor learning remains a key delivery approach, enabling young people to build confidence, resilience and a sense of belonging through structured, supported activity in community and natural environments. Programmes are deliberately inclusive, ensuring access for care-experienced young people, young New Scots and those facing additional barriers to participation. The Duke of Edinburgh’s Award continues to be a cornerstone of this work, engaging large numbers of young people in regular outdoor activity, skills development and expeditions across Scotland. DofE expeditions, day trips and overnight experiences provide well-managed, safe environments where young people develop teamwork, leadership and problem-solving skills while enjoying the outdoors. Alongside this, Outdoor Learning, Outdoors for Wellbeing and residential opportunities offer accessible entry points for young people who may not engage with traditional settings, including targeted provision for at-risk groups. Complementary initiatives such as Gardening for Wellbeing, mountain biking, football and outdoor creative activities further enhance safe outdoor provision by promoting routine physical activity, positive mental health and connection to place. Gardening and nature-based activities support emotional regulation, responsibility and mindfulness, while team sports and outdoor challenges strengthen social connections and confidence. Together, these approaches ensure children and young people have regular access to safe, supportive outdoor spaces that encourage play, exploration and wellbeing, while contributing to wider prevention, participation and achievement outcomes. 68 Support parents to understand the importance of movement and enjoyment for children and young people. Social Media campaigns have highlighted the importance of regular movement, enjoyment and positive experiences in supporting children and young people’s wellbeing and development. 69 Work with local small business/ fitness team to provide access to activity and nutrition information. As above. 70 Creation of new and local growing spaces to support communities to grow foods, to upskills families, enhance family time and connection. Work continues to progress positively at the Three Towns Growers, with the HUB nearing completion. Final-stage planning is now underway to agree operational arrangements for groups and individuals wishing to access and use the space. A further successful Potato Day was held in March, attracting hundreds of visitors to the allotment site to purchase seed potatoes. Community Roots have completed Phase One of their build and are currently securing funding to complete the remaining elements. Once finished, the space will support education activities, holistic therapies, and provide a dedicated rest area for volunteers. In parallel, preparations are underway to support local larder users to grow potatoes at home, with resources including grow bags, compost, and seed potatoes being gathered for distribution. Eglinton Community Gardens are preparing for the forthcoming growing season and will host their annual Potato Planting Party, inviting local families to participate and engage in food-growing activities. The Organic Growers of Fairlie are once 187
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24 No. Action Update 2025-26 again planting and growing potatoes for the benefit of the local community and community larders. Springside Community Association is developing a local network of growers, with plans to cultivate space surrounding the community centre to grow a variety of vegetables for local residents and the community larder. An initial meeting has taken place with Facilities Management to discuss the proposal, and the group is now exploring funding opportunities to enable the work to progress. 71 Ensure all primary, secondary and ASN schools are provided with quality extra- curricular opportunities in sport and physical activity that are open to all. Active Schools has remained firmly committed to its overarching ambition of achieving “More Kids, More Active, More Often.” This focus continues to underpin our planning, partnerships and delivery across North Ayrshire. Throughout the year, we have ensured that high‑quality extra‑curricular opportunities have been available across all primary, secondary and ASN establishments, providing children and young people with a broad range of accessible, engaging activities. Engagement levels have been exceptionally strong. A total of 9,781 young people participated in sport and physical activity sessions during the year—representing over 53% of the entire school‑aged population in North Ayrshire. This reflects both the reach of our programme and the value placed on physical activity by our schools, families and communities. In terms of delivery, the scale of provision has continued to grow. Across the year, 13,065 individual sessions were offered, generating an impressive 271,061 participant visits. This figure illustrates the depth of engagement within the programme: for example, ten pupils attending ten sessions each equates to 100 recorded visits. These levels of participation highlight the consistency with which young people return to Active Schools activities, demonstrating the positive experiences and meaningful connections being created. Our programme is powered by a dedicated network of deliverers. This year, 703 individuals contributed to the delivery of Active Schools sessions—and notably, 98% of them were volunteers. This represents the highest proportion of volunteer deliverers recorded anywhere in Scotland. Their commitment, time and passion are critical to the success of the programme and play an essential role in ensuring sustained, high‑quality opportunities for children and young people. 72 Ensure all young people have the opportunity to compete and perform regardless of what level they are at. This year, our Active Schools Events Calendar has continued to grow in both scale and impact, providing a wide range of meaningful sporting experiences for children and young people across North Ayrshire. More than 5310 participants engaged in a diverse programme of 75 events, demonstrating the strong appetite for competition, participation and school‑to‑school collaboration. These events are delivered across cluster, locality and authority‑wide levels, ensuring pupils have opportunities to take part in sport close to home as well as within larger, North Ayrshire‑wide settings. This tiered structure not only widens access but also allows young people to progress through different levels of competition and develop confidence in a supportive environment. A key focus of our events programme is ensuring that all young people, regardless of ability or need, have access to appropriate and meaningful sporting pathways. We are particularly proud of the continued support offered to pupils with additional support needs (ASN). Throughout the year, Active Schools has actively facilitated ASN participation in Ayrshire Sportsability events as well as opportunities within the Scottish Disability Sport calendar. In addition to this, this year we have establish a three Ayrshire approach to ASN competition and programming. This has allowed wider access and more 188
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25 No. Action Update 2025-26 opportunities for our ASN young people to attend. All these partnerships enable pupils to compete, perform and experience success at a level tailored to their individual needs, ensuring fairness, inclusion and the chance to celebrate personal achievement. Through this comprehensive and inclusive approach, our events programme continues to play a vital role in promoting participation, encouraging healthy competition, and ensuring that every young person across North Ayrshire can experience the enjoyment and benefits of taking part in sport. 73 Create and support a school to community club pathway for sport across North Ayrshire. During the last academic year, Active Schools worked closely with 60 community sports clubs across North Ayrshire, strengthening partnerships and increasing the breadth of provision available to children and young people. These clubs contributed significantly to school engagement by delivering a variety of high‑quality activities, including: • Curriculum enhancement sessions, providing additional PE input beyond the statutory two hours • Health week activities, supporting whole‑school wellbeing initiatives • One‑off taster days, offering pupils the chance to try new sports and activities • Visits to local clubs, helping young people experience community‑based environments • Promotion of club opportunities, such as distributing flyers and raising awareness of routes into long‑term participation In addition to this strong school‑club collaboration, our North Ayrshire Community Sport Hubs continue to thrive. Working in partnership with KA Leisure, we have provided extensive support to local clubs, including access to training opportunities, facility provision, and tailored one‑to‑one development sessions aimed at strengthening governance, sustainability and volunteer capacity. To further enhance community engagement, we have collaborated with selected affiliated clubs to deliver satellite club programmes, enabling more localised and accessible participation options for young people. These satellite sessions are helping bridge the gap between school activity and long‑term involvement in community sport. We have also prioritised the development of inclusive opportunities and have been working with the other Ayrshire’s to provide more opportunities for our ASN young people to take part in at Club leave. 74 Ensure an effective leadership pathway is developed for P6 through to S6 and beyond to develop transferable skills. At primary level, the P6 Move and Improve Programme has made a significant impact, with 1,006 pupils trained as young leaders this year. These pupils play a key role in their school communities by planning and delivering high‑quality lunchtime sport and physical activity sessions for their peers. To strengthen the sustainability of the programme, 34 teaching staff have also been trained, enabling them to support leadership development and ensure consistency across all participating schools. In the secondary sector, the Young Ambassador Programme continues to thrive, with 126 S1–S6 representatives actively championing sport and promoting the importance of being active within their school communities. These young leaders act as role models, supporting events, raising awareness of opportunities and helping influence positive attitudes toward sport and wellbeing. 189
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26 No. Action Update 2025-26 Leadership development is further enhanced through the North Ayrshire Sports Academy, aimed at senior pupils in S5–S6. This year, 147 young people took part in the programme, gaining between 8 and 12 recognised qualifications each. These include Saltire Awards, National Governing Body coaching qualifications, and, at the highest level, the SQA Higher Leadership Award. The breadth of accreditation provides participants with valuable skills and nationally recognised credentials that support future education, employment and volunteering pathways. The commitment and enthusiasm of these young leaders is demonstrated through their collective contribution of more than 5000 volunteer hours within schools and the wider community. Their involvement has enriched local programmes, expanded opportunities for younger pupils, and strengthened community engagement in sport. This comprehensive leadership pathway not only builds capacity within North Ayrshire’s sporting landscape but also empowers young people with lifelong skills, confidence and a sense of civic responsibility. This year marked the successful introduction of Active Girls Committees across all nine secondary schools in North Ayrshire, representing an important step forward in promoting gender equity in sport and physical activity. A total of 45 motivated young leaders were appointed to these committees, each entrusted with the responsibility of encouraging increased participation among female pupils and helping to remove the barriers that often limit girls’ engagement in physical activity. Throughout the year, these young leaders have demonstrated exceptional commitment and maturity, acting as positive role models within their school communities. They have collaborated closely with PE departments, Active Schools staff and wider school teams to identify areas for improvement and to contribute to the development of more inclusive, girl‑friendly environments. Their work has included advocating for the needs and preferences of female pupils, improving visibility of opportunities, and championing a culture where girls feel confident and supported to be active. In addition to their strategic contributions, the committees have played an active role in designing and delivering bespoke girls‑only programmes and events, tailored specifically to increase engagement and create safe, welcoming spaces for participation. These initiatives have included lunchtime and after‑school sessions, awareness campaigns, taster activities and targeted interventions to encourage girls who may be less physically active. The creation and success of the Active Girls Committees has strengthened the voice of young women in shaping school sport, contributing meaningfully to North Ayrshire’s wider commitment to inclusion, empowerment and lifelong participation. 75 Ensure we remove any barriers to participation for care experienced young people to take part in sport and physical activity. The Active Schools and Community Partnership plays a critical role in collaborating with key partners and stakeholders to remove barriers faced by young people and families with Care Experience across North Ayrshire. By adopting a Whole Systems Approach, the programme supports individuals to access sport and physical activity opportunities that contribute to healthier, more active lifestyles. Throughout the 2025–2026 period, 373 young people participated in a wide range of experiential opportunities. These experiences were diverse and engaging, including activities such as water sports, climbing, sailing, residential trips, and community fun days. To ensure equitable access, the team worked closely with internal and external partners to address 190
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27 No. Action Update 2025-26 individual barriers, including transport, appropriate clothing, food provision, and activity access. This coordinated support enabled seamless participation for those who may otherwise have been excluded. Following their initial experiential opportunity, young people were encouraged and supported to transition into regular physical activity within their school or local community. As a result, 84% chose to continue their involvement in ongoing sport or activity programmes. Of the 373 participants, 53% were living in the two most deprived SIMD quintiles (SIMD 1 and 2), demonstrating the programme’s strong reach into communities experiencing significant inequality. Over the four-year duration of the programme (Roles), the team delivered over 150 bespoke opportunities, engaging 1,124 young people with Care Experience. These experiences created meaningful pathways into sustained activity, with 72% of participants moving into more frequent participation supported by their school or community settings. In addition, the team delivered targeted support for 435 young people within ASN provision, ensuring that they too had access to high-quality experiential opportunities. Impressively, 89% of these young people transitioned into regular, sustained participation following their initial engagement. Collectively, these achievements highlight the significant impact of the Active Schools and Community Partnership in reducing barriers, widening access, and improving health and wellbeing outcomes for young people with Care Experience across North Ayrshire. Unfortunately, these dedicated roles will come to an end in March 2026. 76 Expand and develop the Health and Wellbeing Service to accommodate children and young people, with a focus on partnership working within the Mind and Be Active programme to establish an early intervention approach that provides supported physical activity opportunities for children and young people who are experiencing poor mental health. Funding for the Mind and Be Active Programme was withdrawn by the Health and Social Care. Empower is a programme that supports young people to engage in regular physical activity with the aim to improve their mental health, confidence and life skills. The programme targets young people facing mental health challenges such as stress, anxiety or social isolation. These individuals are referred through healthcare professionals, schools or self-referrals with delivery taking place within a school environment or local leisure centres. 77 We will work with Community Planning Partners to establish a set of outcome indicators to measure progress on each of the priorities and actions. A set of performance indicators were established and have been used to monitor the progress of the Children’s Services Plan 2023-26 as can be seen in Appendix 2 of the Children’s Services Plan 2025-26 Performance Report. 191
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APPENDIX 2: Childrens Services Plan Performance Indicators 2025-26 Priority 1: The rights of children and young people are promoted and protected Indicator 2022/23 2023/24 2024/25 2025/26 Children and Young People receiving Advocacy Support 282 284 240 352 Number of young people taking part in influence and engagement through CLD (Community Learning and Development) (e.g. engagement, youth participation and citizenship work) 20,694 15,202 11,746 11,185 Proportion of child protection re-registrations within 18 months 10.8% 11.4% 7.2% N/A Priority 2: Acting early to improve what happens next Indicator 2022/23 2023/24 2024/25 2025/26 Percentage of children reviewed with at least one developmental concern recorded at their 27-30 month review (PHS Dashboard) 20.5% 22.6% 20.0% N/A Babies who have always been exclusively breastfed (reported at 6/8 weeks) 20.3% 25.6% 25.9% N/A Children referred to Reporter for offences (aged 12-16) (rate per 1000) 10.0 14.7 10.1 N/A Children referred to Reporter for care and protection (aged under 16) (rate per 1000) 15.0 16.8 13.2 N/A Immunisation uptake for 6-in-1 - children (aged 24 months) (annual, calendar year) 96.6% 97.1% 96.2% N/A Immunisation uptake for MMR - children (aged 24 months) (annual, calendar year) 92.2 % 94.6% 93.9% N/A Number of Requests for Assistance received - referred to Specialist Services - for Speech and Language 26 46 12 29 Number of Requests for Assistance received – referred to HV support workers within UEY (Universal Early Years) team in the period for Speech and Communication 139 157 171 100 Percentage of Primary 1 Children free from dental decay 73.32% 69% N/A N/A Percentage of Primary 7 Children free from dental decay 77.34% 70.1% 71.9% N/A Uptake of the HPV vaccine in S3 girls (annual, school year) 84.1% 78.8% 80.5% N/A Deaths from suicide (aged 11-25) (rate per 100,000) (5 year rolling average) 10.3 11.2 N/A N/A Alcohol-related hospital admissions (aged 11-25) (rate per 100,000) (3 year rolling average) N/A 151.9 N/A N/A Drug-related hospital admissions (aged 11-25) (rate per 100,000) (3 year rolling average) 147.1 116 N/A N/A Smoking during pregnancy as reported at antenatal booking (Calendar year) (2022) 15.4 (2023) 13.2 (2024) 11.2 N/A Priority 3: Making things fairer Indicator 2022/23 2023/24 2024/25 2025/26 Proportion of Looked after Children with more than 1 placement in the last year 17.4% 18.3% 17.8% N/A Children looked after by the local authority as at 31st July (aged 0-17) 404 405 416 N/A Children on the child protection register as at 31st July (rate per 1,000 children) 3.5 3.9 4.6 N/A School attendance rate for whole population 89.0% 89.1% 89.6% N/A School attendance rate for looked after children 84.2% 83.7% N/A N/A Number of families receiving cash payments for Free School Meals during holiday periods (school year, snapshot of data) 2,706 2,626 2,690 2,497 Combined Numeracy achievement for P1, P4 & P7 (expected CFE level) 75.9% 76.2% 73.9% N/A Combined Literacy achievement for P1, P4 & P7 (expected CFE level) 68.5% 68.6% 68.2% N/A Percentage of pupils gaining 5+ awards at SCQF Level 5 (LGBF) 63% 65% 64% N/A 192
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Indicator 2022/23 2023/24 2024/25 2025/26 Percentage of pupils from 20% most deprived areas gaining 5+ awards at SCQF Level 5 52% 53% 54% N/A Annual participation measure for all 16-19 year olds (calendar year) 92.0% 91.7% 92.5% N/A School leavers entering an initial positive destination 96.5% 95.6% 95.7% N/A Percentage of Children living in poverty after housing costs N/A (not comparable due to method change) 18.1% 18.0% N/A Priority 4: Promoting good mental health and wellbeing Indicator 2022/23 2023/24 2024/25 2025/26 Number of referrals to CAMHS (ISD Child and Adolescent Mental Health Services in Scotland) (Pan Ayrshire) 2,166 2,741 1,194 1,252 Percentage of referrals to CAMHS started treatment within 18 Weeks 95% 99% 99.6% 100% Number of children and young people accessing Community Mental Health and Wellbeing Supports and Services 6,038 5,962 6,527 TBC Total number of children accessing counsellors (school year) 666 379 477 500 Percentage of children who have reported an improved outcome following access to a counsellor 100% 100% 99.4% 98.6% Priority 5: Inspiring children and young people to be active Indicator 2022/23 2023/24 2024/25 2025/26 Child healthy weight in Primary 1 (2% to 85% centile) 76.7% 74.8% 70.9% N/A Number of young people (Distinct participants) engaged with Active Schools during Extra Curricular (school year) 9,285 9,201 9,781 N/A Number of Young people who are leaders in our key Active Schools programmes (school year) 1,171 1,327 1,132 N/A Number of Active Schools experiential opportunities offered to Care experienced young people (school year) 9 31 31 25 Number of ASN (Additional Support Needs) pupils engaging with Active Schools extra-curricular and through experiential opportunities (school year) 55 140 213 435 KA Leisure memberships distributed either free or funded by partners 69 TBC 201 136 Active travel to school 47.49% 48% 42.4% N/A Please note – data that is not available yet is due to timescales of national data releases or variations in reporting schedules, for example, academic years. Data will be reviewed and updated when available. 193
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1 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 Author: Fiona Pow, WFWF Programme Lead - Children and Families Health Team Accountable Head of Service: Elizabeth Stewart - Children, Families & Justice May 2026 Whole Family Wellbeing Fund Annual Monitoring Report 1st April 2025 – 31st March 2026 194
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2 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 # The Whole Family Wellbeing Fund (WFWF) has now completed the fourth year of its five-year implementation period. The Fund has supported a shift towards preventative, trauma informed and whole family approaches, in line with Scottish Government ambitions, GIRFEC and The Promise commitment to reduce the number of children and young people in care by addressing challenges earlier. In early 2025, the Scottish Government reaffirmed its commitment to WFWF and confirmed a Ministerial decision to extend the programme from four to five years. This extension has provided vital additional time to embed learning, strengthen partnerships and support longer term system change. During the current reporting period, 12 local projects and services received a share of the £1.19 million WFWF investment in North Ayrshire, to support the delivery of positive outcomes for children, young people and families across North Ayrshire. Funding has enabled both service expansion and workforce development, including the appointment of the Neurodevelopmental Employment and Strategy Team (NEST) Learning and Development Adviser, which has strengthened practitioner confidence and capability in supporting neurodevelopmental needs. The majority of funded activity aligns strongly with local priorities, typically addressing three to four priorities per project. Whole Family Wellbeing Fund Programme Year 4 Annual Report 195
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3 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 As organisations are planning on the basis that WFWF funding will conclude in March 2027, there is an increased focus on exit strategies and the sustainability of key elements. On the following pages are responses to the Scottish Government’s Whole Family Wellbeing Fund (WFWF) Programme – Year 4 Guidance and Reporting Template, completed as part of the 2025–2026 Children’s Services Plan annual report. It outlines the progress, impact and key learning arising from WFWF funded activity over the reporting period. 196
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4 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 Activity title and description (a) Which WFWF Logic Model outcome(s) does this activity contribute to? (b) For each outcome above, what specific qualitative or quantitative evidence from this financial year (2025- 2026) shows how these outcomes are progressing? In your response, please describe how this has happened (processes/ mechanisms) and who has been involved (i.e. CSPP staff roles and, where applicable and available, the types and numbers of families receiving support – particularly the six priority family types of the Tackling Child Poverty Delivery Plan). Estimate of funding spent on this activity in this financial year Activity 1: Family Centred Wellbeing Service (FCWS) FCWS is an existing partnership between North Ayrshire HSCP and Education, which targeted early intervention support to children of primary school age (5-12 years) and their families in two of North Ayrshire’s localities. The original proposal was to scale-up the test of change to (a) Early outcome: More families will receive this universally available whole family support and will be provided with early help and support. Intermediate outcome: The expected outcome of this project is that support will be stigma free/rights led, recognising the needs of all parents. It will also remove barriers for support for this group of individuals. (b) Evidence Quantitative: 212 referrals received during 2025/26, with 81% relating to primary-aged children, demonstrating early identification of need. £600,000 Questions 1-3 Activities, WFWF Logic Model Outcomes and Estimated Budget Allocated 197
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5 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 another localities; however, further discussions over the summer of 2023 expanded the remit of the FCWS to also include support for children (5- 18 years) with Neurodevelopmental Differences (NDD) and their families. This supports North Ayrshire’s transformational approach to the national neurodevelopmental service specification. The service expanded to all localities in North Ayrshire, including Arran. 86 parents/carers completed end of support evaluations, with most rating the service 9/10 for feeling listened to, respected and supported. 94% of parents taking part in Building Positive Relationships (BPR) groups reported the programme as useful, with 97% reporting improved parent-child relationships. Qualitative: Families reported; • Improved communication and reduced conflict • Increased parental confidence • Better emotional regulation and school engagement for children • Schools reported improved wellbeing, behaviour and reduced pressure on education staff. How This Happened (Processes / Mechanisms): • Relationship-based, whole family working, informed by continuous service user feedback. • Flexible engagement (practical and emotional support) adapted to family circumstances. • Strong multi-agency coordination, especially with education and third sector partners, preventing escalation to statutory services. Who Has Been Involved: 198
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6 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 • FCWS practitioners, Educational Psychology, youth work staff. • Partner agencies: schools (86% of referrals), health and third sector. • Families in areas of higher deprivation • Families experiencing early stress but not yet statutory thresholds. Activity 2: Intensive and Therapeutic Counselling Support for Care Experienced and Vulnerable Young People In April 2025, written notification was received from the Notre Dame Centre that, following the withdrawal of a £500,000 investment by NHS Greater Glasgow and Clyde and Glasgow City Council, the service would close on 30th June 2025. Consequently, North Ayrshire’s contract with the Centre was terminated. (a) Early outcome: Increase in the number of children seen by this service by removing the criteria barriers for children who require this support. This redesign of this model removes barriers to the most appropriate support for children who have been abused. Intermediate outcome: Services are more accessible – CYPF know where to go, receive help when needed. Quantitative: The service formally commenced delivery in January 2026, following preparatory work during 2025/26. In its initial phase, the service successfully accepted 7 referrals without a waiting list, indicating timely access to therapeutic support at points of emerging risk. Qualitative evidence: During 2025/26, progress was made in establishing a locally governed, trauma-informed counselling service, designed as a credible and sustainable £27,327 199
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7 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 An alternative model has been developed that will utilise the existing contract value to fund a 24 month pilot programme. alternative to the Notre Dame model. Early evidence from the initial months of delivery (from January 2026) indicates effective multi-agency engagement, supporting timely decision-making around referrals and care pathways. Initial caseload activity focused on stabilising vulnerable placements and providing therapeutic support to children and carers where risk was escalating. While still at an early stage, the service has demonstrated a strong operational footing, with clear governance and safe boundaries agreed across partners. Priority family types reached: • Lone parent families • Families with three or more children • Families where the mother is under 25 years The service is specifically designed to support: • Care experienced children and young people, both looked after at home and looked after away from home • Vulnerable young people at points of emerging risk, particularly where placement or care stability is under pressure How This Happened: Significant preparatory work was undertaken during 2025/26 to ensure safe, ethical and sustainable delivery, including: 200
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8 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 • Development of a clearly defined service remit, specifying the children and young people the service is designed to support. • Agreement of eligibility criteria and referral pathways that align with local authority and NHS requirement and to ensure robust governance, clinical oversight and trauma informed practice. Early delivery benefited from strong multi-agency collaboration, allowing for shared understanding of thresholds and risk, co-ordinated responses to vulnerable situations and swift mobilisation of therapeutic input where placements were at risk of breakdown. Who Has Been Involved: • Children and Families services contributing to referral pathways and decision making • Health and multi agency partners: • NHS colleagues contributing to governance alignment Activity 3: Dads Support Workers A gap in service provision was recognised in terms of engagement with dads. There is a very traditional and historical (a) Early outcome: More families will receive this universally available whole family support and will be provided with early help and support. Intermediate outcome: Support will be stigma free/rights led, recognising the needs of all parents. It will also remove barriers for support for this group of individuals. £ 68.314 201
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9 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 gender bias within children and families’ health services which sees a focus on mother and child. The post is responsible for developing and delivering specific programmes for dads, including practical parenting workshops; working in partnership with Dads Rock and learning from the established programmes and approaches they have developed. Through links within the North Ayrshire Children and Families Health Team, community midwifery and children and families’ social work, the two postholders have worked alongside dads to improve their relationships with their children and other family members, by (b) Evidence Quantitative: • 103 families supported, including 151 children. • 89% reported improved mental health; 60% reported improvement in parent-child relationships. Qualitative: Fathers described a non-judgemental, trusted space enabling honest discussion and sustained engagement. Case studies evidence reunification and strengthened contact between fathers and children following targeted advocacy support. How This Happened: • Person centred, father led model, with flexible one-to-one and peer support. • Dad led WhatsApp community sustaining support beyond formal sessions. • Advocacy for fathers within child protection and multi - agency processes. Who Has Been Involved: • Dads Rock. • Multi-agency partners (social work, employability, financial advice services). Priority family types reached: • families with children under 1 202
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10 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 supporting their confidence and parenting skills. • families with parents under 25 • Families with disabilities • Families in or at risk of child protection • Families experiencing financial insecurity Activity 4: Vicarious Trauma Support and Specialist Counselling for Staff Staff across health, social work and education currently support a number of families experiencing distress, including but not exclusive to bereavement, domestic violence, child neglect and abuse. There is very little support available to support vicarious trauma currently. (a) Early outcome: Increased workforce wellbeing is at the heart of this workstream and as wellbeing is improved, workers will be more able to respond to a child or their family’s needs. Intermediate outcome: Cross-sectoral commitment to collaboration and innovation which empowers and supports the workforce to provide family centered holistic support. (b) Evidence Quantitative: Take up of one-to-one counselling has increased substantially over time, from 2 appointments for 1 client in September 2024 to a peak of 22 appointments in January 2026, evidencing growing awareness, trust and demand. During this reporting period 135 counselling sessions were offered to 20 individual clients. As of March 2026, the waiting list stood at 4 clients. Qualitative: The data demonstrates sustained and increasing engagement, exceeding forecast demand and indicating that the service is meeting a real and £16,834 203
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11 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 ongoing workforce need. Feedback indicates that counselling provided a safe and confidential space to process the emotional demands of working with children and families experiencing trauma. Staff reported that access to the service has supported emotional coping, self-care and resilience and has helped some to remain in work, rather than taking sickness absence or withdrawing from front-line roles. How this happened: Strong partnership working with the third sector provider (Break The Silence) has been central to shaping delivery. The provider supplied regular intelligence on demand levels and referral patterns, cancellation rates, delivery challenges and cost pressures. This information directly informed service redesign and commissioning decisions, including revisions to cancellation procedures and introduction of capped counselling blocks. Who Has Been Involved: • Break The Silence - counselling provider delivers therapeutic support and provides detailed operational and financial insight used to shape service development. • Children and Families workforce including front line practitioners working with children and families. 204
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12 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 • Children and families do not access the service directly; however, the intended and evidenced impact is indirect but significant. By supporting staff wellbeing, the service aims to reduce sickness absence and workforce burnout. This supports continuity, stability and quality of relationships between practitioners and families. Activity 5: Neighbourhood Networks Transition Network Expansion of the two existing adult neighbourhood networks to include a transitions network supporting 16–25-year-olds based on the needs of service users with additional support needs. (a) Early outcome: Services maintain respectful relationships with CYPF by supporting those with additional support needs to make a smooth transition between services. Intermediate outcome: A better collective awareness of the available support amongst young people. (b) Evidence Quantitative: • Referrals received from social work, schools, Learning Disability team, Service Access and third sector organisations. • 9 Families impacted by the proposal • 22 children impacted by the proposal Qualitative: Families and young people reported reduced isolation and increased empowerment when navigating transitions from child to adult services. How this happened: £52,777 205
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13 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 • Stakeholder led design responding to gaps in transition planning and lack of information. • Focus on preventative, community based support for families who may not meet statutory thresholds. Who has been involved: • Partners across education, health, social care and third sector. • Families of young people with additional support needs, a priority group facing increased poverty risk during transition periods. Activity 6: Expansion of Barnardos Stronger Families programme Barnardo’s scale-up of their existing Stronger Families service provides a focus on Kinship Families who have been affected by substance use. Stronger Families is a trauma- responsive service and adopts a whole family approach, aligning with the National Principles of Holistic Whole Family Support, (a) Early Outcomes: Families will be aware of the service and able to access support within an appropriate time; Kinship families will receive the right support, at the right time; Partnership and networking opportunities will be developed/enhanced to maximise support opportunities for kinship families. Intermediate Outcomes: Improved family wellbeing; Improved family relationships; Adults/young people will have access to peer support through the drop-in/groups. (b) Evidence Quantitative: 52 families supported, including 85 children. £90,065 206
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14 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 The Promise and Children’s Rights. The Stronger Families Programme provides dedicated support for children aged 8–14 years who are in kinship care or looked after at home, particularly within families affected by drug and alcohol issues. With two staff members leading the initiative, the programme aims to prevent families from being referred to statutory services and continues to go from strength to strength. Qualitative: Outcome Star assessments show improvements across; emotional wellbeing, relationships, education and learning and family routines. Young people and families felt listened to and empowered through; youth forum participation, recruitment involvement and creative/arts based activities. How This Happened: Meaningful participation of children and families in service design and decision making centred practice. Who Has Been Involved Barnardo’s practitioners, Education, children with emotional and behavioural needs and families at risk of statutory escalation. Activity 7: Ko-nekt Family support for children with additional support needs Delivery of weekly “Nurturing and Positive Parenting” Courses for parents/ carers who are currently awaiting referrals, are on the periphery of social work (a) Early outcome: More families will have access to support; Children, young people and families know where to access support. Intermediate outcome: Services are more accessible; services are stigma-free and meet the needs of children and their families. (b) Evidence £36,188 207
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15 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 care and/ or are at the point of crisis. This is a new element to the existing work of Ayrshire Children’s Services with the overall aim of developing a Family Wellbeing Service. Quantitative: Feedback gathered using standardised pre and post questionnaires including wellbeing scale completed at the start and end of the course, and parenting questionnaires revisited at week 9 to measure change. Weekly session feedback and final evaluations also evidence progress over time. Qualitative: Parents shared improvements in confidence, understanding of their child’s behaviour and family wellbeing through case studies and session feedback. Stakeholders reported improved clarity around referrals and stronger whole family approaches. How this happened: • Continuous feedback used to adjust sessions, inform teaching plans and ensure continuity with referrers. • Strong partnership working with schools, health and social work to embed a whole family model. Who has been involved: • Partners across education, health and social work. • Families include parents experiencing stress, family instability and behavioural challenges, aligning with priority family types affected by poverty. Activity 8: Three Towns Baby Bundles (a) Early outcome: Alleviating financial and practical pressures families face affording baby and toddler clothes, £52,500 208
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16 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 The former Garnock Valley Helping Hands was a project that focuses on recycling baby and toddler clothes, toys and childcare necessities and gifting them to families in need of such items via referrals from healthcare professionals and schools. The WFWF has enabled Beith Trust to employ a project worker for an additional 25 hours per week, to ensure the Baby Bundles project is accessible outwith the Garnock Valley and expand into the Three Towns locality (Saltcoats, Stevenston and Ardrossan). toys and childcare necessities. Intermediate outcome: Community Empowerment and Inclusion; improved parental/carer mental and emotional capacity to engage with their children. (b) Evidence Quantitative: 47 families provided structured feedback: • 39/47 reported improved mental health and wellbeing • 43/47 increased parenting confidence • 41/47 reported prevention of financial hardship. Qualitative: Families reported reduced stress, feeling supported early and increased trust in services. Case studies and volunteer feedback evidence stronger engagement with wider support systems. How This Happened: • Community-based delivery, shaped through ongoing family and volunteer feedback. • Strong multi-agency referral pathways, integrating with employability, financial advice and health services. Who Has Been Involved: Third sector staff (Beith Trust) and volunteers (many with lived experience). Priority family types reached include: • Families with babies under 1 209
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17 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 • Young parents • Lone parents • Black and Minority Ethnic families. Activity 9: Educational Psychologist (EP) A new full time Educational Psychologist post provides ongoing support to the Family Centred Wellbeing Service as well as the neurodevelopmental agenda. The post will also be able to deliver training and support to the workforce in relation to particular therapeutic programmes. (a) Early outcome: Build capacity and support within the Family Centred Wellbeing Team Intermediate outcome: Deliver effective support to families and young people (b) Evidence Quantitative: Formal quantitative data from families is not collected due to EP working through FCWS. However, regular structured evaluation is completed with FCWS staff each term. Qualitative: FCWS staff reported increased knowledge, confidence and wellbeing as a result of EP led group sessions and consultations. Staff highlighted improved peer support, practical tools and strategies implemented directly in family work, with positive perceived impact on family outcomes. How this has happened: • Termly feedback and planning sessions shaped by frontline experience and questions raised by FCWS staff and families. • Flexible, needs-led topics rather than fixed programmes. £80,982 210
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18 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 • Individual EPS consultations to support complex family circumstances and practitioner decision-making. Who has been involved: • FCWS team members, Education • Indirect reach to families supported by FCWS, including families facing multiple disadvantages and early intervention needs. Activity 10: EmpoweredED Alternative Curriculum Programme A test of change project for an alternative curricular offer that is creative and engages children who have or are at risk of disengaging from learning. The Community Brokerage Network has developed collaborative opportunities with the Third Sector and other partners to support children and their families. The target areas are the Three Towns, the Garnock Valley and Irvine/Kilwinning. (a) Early outcome: A safe, engaging environment where students develop critical life skills, building a foundation for improved family wellbeing and reduced inequalities Intermediate outcome: Children have increased coping skills social skills and resilience among young people who are disengaging from mainstream education. Empowering families and young people in service design and community engagement. Long-term outcome: Sustained family resilience Progression into employment (b) Evidence Quantitative: Young people reported: • 84% increased confidence • 78% reduced stress £54,259 211
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19 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 Secondary schools in these areas are able to refer into these sessions, which will run over three 12-week blocks. The CBN has appointed a coordinator to act as liaison and lead discussions with referring schools, third sector and community organisations, children and their families. • 56% increased school engagement. Qualitative: Evidence of improved peer relationships, emotional regulation and sustained engagement. Schools reported improved attendance, wellbeing and reduced risk of exclusion. How This Happened: • Co-production with young people, adapting content to interests and strengths. • Practical, outdoor and community based learning, improving engagement. • Strong school partnerships supporting targeted identification and attendance. Who Has Been Involved: • Schools, peer mentors, families. • Young people at risk of disengagement from education Activity 11: Neurodevelopmental Learning and Development Officer – NEST This investment has facilitated the recently appointed NEST Learning and Development Adviser, to work with children’s (a) Early outcome: Increased workforce wellbeing is at the heart of this workstream and as wellbeing is improved, workers will be more able to respond to a child or their family’s needs. Intermediate outcome: Cross-sectoral commitment to collaboration and innovation which empowers and supports the workforce to provide family centered holistic support. (b) Evidence £53,723 212
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20 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 services staff across North Ayrshire, building confidence and competence in supporting neurodevelopmental disorders Quantitative Evidence: 28 workshops delivered between Oct 2025–March 2026, with 320 total attendances (acknowledging repeat attendance across sessions), demonstrating sustained workforce engagement Core workshops delivered: • Introduction to Neurodivergence: 91 attendees • Introduction to ADHD: 36 attendees • Introduction to Autism: 38 attendees • Inclusive Communication: 53 attendees • Understanding Complex Behaviour: 84 attendees • Bespoke Pre-School Inclusive Communication: 60 attendees. Across all workshops, pre and post evaluation data shows moderate or significant improvement for the majority of participants, for example: • Introduction to Neurodivergence: 80% showed moderate/significant improvement; 89.4% rated it extremely helpful. • Introduction to Autism: 96% showed moderate/significant improvement; 100% extremely helpful. • Inclusive Communication: 90% showed This data provides clear quantitative evidence of progress toward workforce readiness and improved responses. 213
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21 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 Qualitative Evidence: Consistent qualitative themes across workshops include: • Shift from behaviour focused to needs led practice, particularly recognising behaviour as communication of unmet need. • Increased confidence in adapting environments, expectations and communication rather than expecting children to adapt. • Practitioners reporting immediate application of strategies such as visual supports, sensory regulation, flexible routines and neuro-affirming language. How this Happened: New workshops (Inclusive Communication and Understanding Complex Behaviour) were developed directly in response to practitioner feedback. Piloting with inclusion focused roles (e.g. area inclusion workers) before wider rollout ensured relevance and quality. Flexible delivery models, including shortened sessions, bespoke workshops and locality based delivery (e.g. Dalry and Kilwinning GP practices), improved access. Who Was Involved: Workforce roles engaged included: Health visitors, Area inclusion workers, Youth workers (including 40 sessional youth workers in one bespoke session), teachers and pupil support assistants, modern 214
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22 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 apprentices, third sector practitioners and Early years and preschool staff. While direct family numbers are not reported, the roles reached are those most likely to support priority family types within the Tackling Child Poverty Delivery Plan (e.g. lone parent families, families with disabled children and families affected by health inequalities) through frontline universal and targeted services. Activity 12: WFWF Programme Lead The Programme Lead continues to oversee the monitoring and evaluation arrangements and work with all funded approaches to share learning via the WFWF Forum and quarterly newsletter and work towards the whole system, transformational change required by the WFWF. Not applicable £64,781 215
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23 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 Activity title Evidence of shift towards more (1) preventative support and (2) early support Activity 1: Family Centred Wellbeing Service (FCWS) 1. Shift Towards More Preventative Support Across 2025/26, the activities funded through the Whole Family Wellbeing Fund (WFWF), particularly the Family Centred Wellbeing Service (FCWS), are clearly supporting a preventative approach within North Ayrshire’s children and family services system. Preventative impact is evidenced through referral patterns, outcomes and consistent stakeholder feedback. Preventative support is demonstrated by the service’s ability to reduce escalation to statutory intervention. Partners across education and statutory services consistently report that, without FCWS, families would be more likely to reach crisis point, increasing demand on social work, child protection and schools. The fact that cases are often retained within FCWS even following Initial Referral Discussions (IRDs) illustrates statutory partners’ confidence in FCWS to manage risk and provide proportionate early intervention, rather than escalating unnecessarily. Question 4 Based on evidence provided in Section 1, describe how the activities of the WFWF Programme overall are supporting services to shift towards (1) more preventative support and (2) early support. Only add new evidence or findings available during this current year. 216
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24 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 Service-user feedback further evidences this preventative role. Families report improved family relationships, better communication and increased understanding of their child’s needs, leading to greater confidence in managing challenges at home. These outcomes indicate strengthened family resilience, reducing reliance on higher-level and more costly services over time. Qualitative evidence gathered throughout 2025/26 reinforces this preventative impact. Case studies show that coordinated, whole family support improves stability and prevents concerns from escalating to statutory thresholds. Group-based interventions also reduce isolation and build social connections, which are key protective factors against crisis. Together, this evidence demonstrates that WFW funded activity is contributing to a system shift away from reactive responses and towards prevention, in line with WFWF priorities and The Promise. 2. Shift Towards Earlier Support WFWF activity has also strengthened earlier identification and access to support. During 2025/26, FCWS received 212 referrals, with approximately 81% relating to primary-aged children. This indicates that needs are being identified and addressed at an earlier stage, before patterns of difficulty become entrenched. Education remains the main referral route, reflecting increased confidence within universal services to recognise emerging need and refer families early. This 217
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25 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 demonstrates a cultural shift within frontline services towards early help and proactive support. Early access is further supported through FCWS’s flexible, non-stigmatising delivery model, including home visits, community-based work, group programmes and coordinated multi-agency input. Families report feeling more comfortable seeking help earlier due to the relational, non-judgemental nature of the service, particularly those who may previously have been reluctant to engage. FCWS also plays a critical role in supporting the “missing middle”. Families experiencing emerging neurodevelopmental, emotional or behavioural needs who do not meet statutory thresholds. By responding early to these needs through holistic, whole family support, FCWS helps prevent escalation and avoids gaps in provision. Workforce development has further enabled early support. Educational Psychology and Speech and Language Therapy input, alongside interventions such as Building Positive Relationships, have increased staff confidence in identifying and responding to emerging need, embedding early intervention practice across the system. Activity 2: Intensive and Therapeutic Counselling Support for Care 1. Shift Towards More Preventative Support During 2025/26, the development of the Intensive and Therapeutic Counselling Support for Care Experienced and Vulnerable Young People represents a 218
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26 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 Experienced and Vulnerable Young People significant move towards a preventative, trauma-informed model of support. Although delivery formally commenced in January 2026, the groundwork laid during the reporting period focused on establishing a robust, locally governed alternative to the Notre Dame model, now delivered through the North Ayrshire Trauma Service (NATS). The service has been designed to intervene at points of emerging risk, supporting children and young people who are looked after at home or formally, alongside their carers. By providing targeted therapeutic support at an earlier stage, the service aims to stabilise placements, address trauma related needs, and reduce the likelihood of placement breakdowns or escalation to more intensive residential or crisis provision. 2. Shift Towards Early Support The establishment of NATS has strengthened early access to therapeutic support for care experienced and vulnerable young people. In its initial months, early caseload development focused on children and carers requiring support at critical transition or stress points. This early engagement allows therapeutic work to begin while placements are still viable and relationships can be strengthened, rather than waiting until crisis thresholds are met. The service’s clarity of remit and accessibility has supported confidence across partner agencies to refer earlier, knowing that young people can be seen promptly. 219
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27 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 Although still at an early stage, the service has established a strong operational footing, positioning it as a credible and sustainable early intervention alternative to previous models. As staffing capacity is fully realised in 2026/27, the service is expected to further enhance early access to trauma informed therapeutic support, contributing to improved outcomes and reduced demand on higher cost crisis and residential services. Activity 3: Dads Support Workers 1. Shift Towards More Preventative Support The Whole Family Wellbeing Fund (WFWF) programme is supporting a shift towards preventative support by intervening at key transition points and addressing underlying risk factors before concerns escalate. The Dads workers are supporting the families to break cycles of trauma, reduce future harm and improve long term outcomes for children. A key example is engagement with families through the Safeguarding Midwifery service, where 20 referrals during the year led to multi agency support prior to the birth of a child. Thirteen of these families were themselves care experienced, indicating a high level of vulnerability and intergenerational risk. By supporting reflective conversations about parents’ own childhood experiences alongside antenatal and perinatal support, services helped families build insight, emotional regulation and confidence, contributing to safer, more stable family environments from the earliest stage. 220
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28 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 Preventative impact is also demonstrated through father inclusive, relationship- based work. Case study evidence shows how sustained, tailored one-to-one support enabled a father to demonstrate meaningful change, rebuild trust with professionals and ultimately achieve a supported, child led reunion with his son. This outcome reflects the preventative value of consistent, relational support in reducing long term family separation, avoiding further statutory escalation and supporting permanence through family relationships. Peer support has emerged as an additional preventative factor. Feedback from Dads Rock participants highlights that peer networks created through workshops, WhatsApp groups and in person sessions provide informal, ongoing support that continues beyond formal service involvement, strengthening resilience and reducing reliance on crisis responses. 2. Shift Towards Earlier Support The activity is also driving earlier identification and engagement, particularly during the perinatal period. The referrals from Safeguarding Midwifery demonstrate that families are accessing support before crises emerge, enabling early, proportionate intervention at a critical developmental stage. The introduction of Dads Antenatal Workshops in July 2025 further illustrates this early support shift. Five workshops engaged 18 expectant fathers, many of whom continued to access peer and group based support following the birth of their children. This continuity of engagement through pregnancy and early parenthood 221
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29 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 supports early bonding, emotional wellbeing and confidence at a time when families are most receptive to support. Qualitative evidence reinforces that early engagement is strengthened by non-judgemental, relational approaches. Feedback from dads, partners and professionals consistently identifies trust, clarity and consistency as central to engagement. These factors enable fathers, many of whom may previously have been reluctant to engage with services, to seek support earlier and sustain involvement. Activity 4: Vicarious Trauma Support and Specialist Counselling for Staff 1. Shift Towards More Preventative Support Evidence from this year indicates that the service has supported prevention by providing staff with timely access to therapeutic support before difficulties escalated to crisis point. Continued demand, including re referrals, suggests that staff are using the service proactively to manage the emotional impact of their work rather than waiting until they become unwell. Anecdotal feedback during 2025/26 highlights that having access to a confidential therapeutic outlet has helped staff remain at work, supporting emotional regulation, resilience and confidence in managing ongoing exposure to trauma. The development of coping strategies and self care tools through the service has contributed to preventing deterioration in wellbeing and reducing the likelihood of sickness absence linked to stress or vicarious trauma. 2. Shift Towards Earlier Support 222
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30 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 The service has increasingly operated as an early support mechanism, particularly during this year, by enabling staff to access targeted, time limited counselling at an early stage. Overall, learning from 2025/26 shows that the service has increasingly supported a shift towards prevention and early intervention by offering timely, accessible and proportionate support to staff, strengthening coping capacity, reducing escalation, and helping sustain workforce resilience within children and families’ services. Activity 5: Neighbourhood Networks Transition Network 1. Shift Towards More Preventative Support During 2025/26, the activity has supported a preventative approach by enabling individuals and families to build resilience, confidence and wellbeing before needs escalate into crisis. Central to this has been the Parent and Carers Network and wider peer based activity, which has provided structured, ongoing opportunities for social connection, mutual support and skills development. Regular peer support groups and wellbeing activities have helped members build confidence, form friendships and improve overall wellbeing. Parents and carers have described feeling more confident navigating services, advocating for their child and managing their own emotional wellbeing. Importantly, parents also reported reduced household stress as a result of practical strategies, shared experiences and reassurance gained through peer connection. Qualitative evidence gathered through conversations consistently highlights the preventative impact of coming together regularly in a supportive environment. 223
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31 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 The Parent and Carers Network has also enabled families to connect with wider support services, strengthening prevention. Input from organisations such as the Carers Gateway improved parents’ mental health and wellbeing, while also raising awareness of sibling needs, with some siblings recognising themselves as young carers and accessing support earlier as a result. This joined up approach increases protective factors across the whole family. Wellbeing workshops further reinforced preventative outcomes. Delivered by a wide range of third sector and statutory partners, these workshops increased young people’s understanding of mental health, self-care and healthy relationships. Staff observations showed increased confidence in discussing wellbeing, reduced isolation and stronger engagement, particularly through interactive and activity based sessions. A key development this year was the introduction of a digital skills outcome, supporting members to become more digitally connected. Improved digital confidence enhanced access to information, services and social connections, contributing to stability and reduced isolation, key preventative factors that reduce the likelihood of crisis. 2. Shift Towards Early Support This activity has also strengthened early support by creating trusted spaces where changes in need can be identified and addressed quickly. Consistent attendance 224
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32 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 at groups and activities allows staff and peers to notice early signs of difficulty and respond in a timely way. Digital inclusion has played a particularly important role in early intervention. Improved digital skills have enabled members to access online services and seek help independently. One example demonstrated how developing digital confidence allowed a member to independently order prescriptions online, reducing stress, preventing last minute crises and easing pressure on family members. This illustrates how early, practical support can prevent avoidable escalation. The Parent and Carers Network has also supported earlier engagement. Strong relationships and trust built through regular meetings have enabled parents to raise concerns sooner and seek advice earlier. Sharing information on tools such as the Compass app helped families better navigate transitions and support pathways, empowering parents and carers to act earlier when challenges arise. Activity 6: Expansion of Barnardos Stronger Families programme 1. Shift Towards More Preventative Support The activity is supporting a shift towards preventative support by strengthening non-statutory, relational services that intervene early and reduce the likelihood of crisis escalation for kinship families. Delivery through Barnardos, in close partnership with statutory services such as social work and education, creates a trusted and accessible route for families who may otherwise delay seeking help due to fear, stigma or mistrust of statutory services. 225
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33 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 A key preventative feature is the co-design of the service with kinship families. Families actively shape both service delivery and individual support plans, ensuring that interventions are relevant, responsive and aligned with what families themselves identify as most helpful. This participatory approach increases engagement, strengthens trust and supports families to access help earlier, preventing issues from escalating to crisis point. Qualitative evidence reinforces preventative impact. Outcome Star assessments completed collaboratively with children, young people and carers support early identification of strengths and needs, enabling proportionate, person-centred responses. Creative and participatory activities, including kinship art groups and Youth Arts Fund projects, reduce isolation, build confidence and strengthen protective factors for young people. These approaches promote emotional wellbeing and resilience, reducing longer term reliance on statutory intervention. Preventative capacity is further strengthened through families’ involvement in service governance, recruitment and design. Participation in visits with senior leaders, youth forums and interview processes empowers families to influence decision making, reinforcing a sense of ownership and trust in services that supports sustained engagement over time. 2. Shift Towards Early Support The activity is supporting a shift towards earlier identification and access to support. Partnership working between Barnardos and statutory services has improved referral pathways and timeliness of support for kinship families. The use 226
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34 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 of creative and group based activities provides non-threatening entry points into support, particularly for young people who may struggle to engage in traditional service settings. Engagement in local and national forums, including the Barnardos Scotland Youth Forum, has amplified young people’s voices and ensured lived experience informs service development. This has led to services that are more accessible, responsive and aligned with families’ needs, encouraging earlier help seeking. Activity 7: Ko-nekt Family support for children with additional support needs 1. Shift Towards More Preventative Support Evidence from 2025/26 demonstrates that working with parents at an earlier stage enables them to identify stressors sooner and apply practical strategies to improve wellbeing within the home. This early skill-building reduces reliance on more intensive or statutory interventions later. Preventative impact is further strengthened through ongoing contact beyond structured programmes, including follow up support and refresher sessions. This continuity provides reassurance to families and enables early responses when new challenges emerge, helping to prevent deterioration in family circumstances. Group based nurture approaches also contribute to prevention by reducing isolation, improving parent/child relationships and strengthening family resilience. Increased multi agency signposting has been a further preventative development. Referrals from social workers, school nurses and community link workers increased during the year, demonstrating improved shared understanding of early 227
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35 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 help pathways and quicker access to support. This reflects a wider system shift towards prevention, where concerns are addressed proportionately rather than escalating through crisis-driven routes. Community based delivery models also support prevention. Planned pop up sessions in partnership with primary schools aim to reach families in familiar, accessible settings, reducing barriers to engagement and normalising help seeking. This reinforces prevention by embedding support earlier within everyday community environments. 2. Shift Towards Earlier Support The activity is also driving a shift towards earlier identification and access to support, particularly through proactive engagement with parents and strengthened partnership working. By engaging families at an earlier point, services are enabling support to be offered when parents are most receptive and when changes can have the greatest long term impact. Nurture information sessions delivered to stakeholders across health, education and the third sector have improved awareness of programme aims, referral routes and thresholds. This has strengthened partner confidence to refer families earlier and ensured clearer, more timely pathways into support. Preparatory work to deliver a nurture group at Hayocks Community Centre, in partnership with Hayocks Primary School, reflects a targeted early intervention 228
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36 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 approach focused on specific local communities. This model aims to build trust and engagement within the school community and, if successful, will be used as a template for wider rollout across North Ayrshire. During programme delivery, facilitators complete case studies with parents to document progress and evidence change. These case studies consistently demonstrate improvements in parenting confidence, family wellbeing and early responsiveness to children’s need. Activity 8: Three Towns Baby Bundles 1. Shift Towards More Preventative Support The Baby Bundles project is making a clear and measurable contribution to preventative support by addressing families’ needs before challenges escalate into crisis, particularly in relation to poverty, financial hardship and social isolation. During the reporting period, Baby Bundles supported 170 children and young people across 156 families, with many families accessing the service more than once. This repeated engagement demonstrates that Baby Bundles is operating as an ongoing preventative intervention, rather than a one-off crisis response. Practitioner feedback from health visitors, midwives and third sector partners highlights that many referred families are experiencing significant adversity, including homelessness and acute financial pressure. In these circumstances, Baby Bundles provides an immediate and practical response at a point where statutory practitioners often have limited options available. 229
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37 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 Baby Bundles also acts as a gateway into wider support, strengthening its preventative impact. Families are routinely signposted to Beith Trust services such as employability programmes, toddler groups, nature based activities and volunteering, as well as Citizens Advice and partner organisations including TACT and Dads Rock. This joined up approach increases awareness of available support, reduces isolation and supports longer-term stability, key protective factors against crisis escalation. Further development of this preventative approach is demonstrated through involvement in the Money Max project, a partnership between TACT, First Alliance Credit Union, Right Options, CHAP, Beith Trust and the Scottish Illegal Money Lending Unit. Plans are in place for the Money Max team to deliver support from the Stevenston hub from May 2026. This will strengthen early financial inclusion and debt-prevention support, reinforcing Baby Bundles’ role within a broader preventative system. 2. Shift Towards Earlier Support Baby Bundles is also contributing to earlier identification of need and earlier access to support. There has been a noticeable increase in early referrals, including referrals for expectant mothers, indicating that partners are identifying need sooner and increasingly using Baby Bundles as an early intervention tool. Referrers report that Baby Bundles is frequently used as a first point of support, rather than families waiting until difficulties escalate. 230
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38 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 The service’s rapid response model, with an average turnaround of approximately one week from referral to bundle collection, ensures families receive support at the point of need. This timeliness supports early intervention by addressing challenges while they remain manageable and before financial or emotional pressures intensify. Many families (34/47) expressed interest in accessing additional support, reinforcing Baby Bundles’ role as a trusted early entry point into wider services. Referrer surveys show 100% agreement that Baby Bundles fills a gap in provision and enables families to be supported earlier than would otherwise be possible. Activity 9: Educational Psychologist 1. Shift Towards More Preventative Support The Building Positive Relationships (BPR) programme plays a key preventative role by strengthening positive adult presence and relational practice before challenges escalate. BPR is delivered both within the Family Centred Wellbeing Service (FCWS) and increasingly within educational establishments, supporting a shared language and collective approach to planning and supporting children and families. Preventative impact is evidenced through early needs assessment using pre-programme questionnaires and readiness processes, allowing facilitators to tailor support proactively. Professional learning sessions build practitioner confidence to deliver upstream interventions that strengthen family resilience, while ongoing evaluation and feedback loops ensure delivery remains responsive to emerging need rather than crisis. 231
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39 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 Within FCWS, team feedback highlights improvements in knowledge, confidence and wellbeing, enabling staff to intervene earlier and more effectively with families. This strengthened professional capacity directly benefits children and families by improving the quality and consistency of support. Preventative practice is further reinforced through Neurodivergent Learners training and coaching, which prioritises proactive environmental adaptations, early identification of need and improved transition planning. By equipping practitioners with practical strategies and a deeper understanding of neurodivergence, this work reduces reliance on reactive behaviour management and supports long term positive outcomes. 2. Shift Towards Earlier Support The activity also demonstrates a strong shift towards earlier identification and access to support, particularly within universal and community settings. BPR supports early intervention by enabling facilitators and practitioners to identify emerging concerns through structured assessments and respond before difficulties become entrenched. Families’ qualitative feedback highlights increased understanding of their children’s needs, improved wellbeing and reduced isolation, indicating early benefits that reduce the likelihood of escalation. The consultation based approach adopted within the Educational Psychological Service has further strengthened early support. This model allows a greater number of children and young people to be discussed, enabling earlier strategies 232
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40 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 and interventions to be put in place. Whole establishment consultations, for example exploring nursery environments where multiple children have neurodivergent profiles, support earlier, systemic change rather than late individual intervention. Neurodivergent Learners training and coaching supports early intervention at key transition points, particularly from early years into primary education. Practitioner feedback evidence improved anticipation and planning for transitions, increased use of environmental and sensory adaptations and greater confidence in identifying need early. Activity 10: EmpowerED Alternative Curriculum Programme 1. Shift Towards More Preventative Support The EmpowerED programme demonstrates a strong preventative impact by engaging young people before difficulties escalate into crisis, particularly those at risk of disengagement from education, emotional distress or more intensive intervention. Evidence from surveys, session reflections and school feedback consistently indicates that many participants were struggling with school engagement and wellbeing when referred. Preventative impact is evident in the programme’s relationship based and flexible delivery model. Session reflections show that early stages often involved a period of settling in, with young people initially hesitant or disengaged. Over time, however, there was a clear and sustained shift towards increased participation, confidence and motivation. This progression illustrates the value of consistent, 233
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41 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 trusted relationships in preventing problems from becoming entrenched and reducing the likelihood of escalation to statutory or crisis services. The programme also strengthens preventative outcomes by supporting emotional regulation, resilience and social connection. Young people frequently reported feeling calmer and more able to cope after sessions, especially following outdoor and active learning experiences. Opportunities to build friendships, share activities and support peers reduced isolation and enhanced protective factors. Importantly, EmpowerED contributes to longer-term prevention, with some young people progressing into peer mentoring roles, indicating growing confidence, aspiration and leadership. 2. Shift Towards Early Support EmpowerED is also supporting services to intervene earlier, by identifying and engaging young people at the first signs of difficulty rather than waiting for issues to escalate. Participants are typically referred at a point when engagement in school is declining but before statutory thresholds are met. School feedback highlights that EmpowerED complements existing supports, offering timely, early help that allows schools to maintain relationships and attendance. Early support is reinforced through regular feedback and reflection, including weekly session ratings and staff reflections. This enables practitioners to adapt delivery quickly in response to emerging emotional, behavioural or engagement needs. Practical, hands-on activities, such as outdoor learning, gardening, 234
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42 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 self-defence and community visits, provide accessible entry points for young people who struggle in traditional classroom settings. Family level impacts further highlight early intervention benefits. Parents reported reduced stress at home, improved morning routines and greater enthusiasm for school on programme days. These early changes helped stabilise family routines and reduced pressure on parents and schools at an early stage. Strong demand for the programme and positive peer-to-peer promotion by young people, reflects high confidence in EmpowerED as an effective early support provision. Activity 11: Neurodevelopmental Learning and Development Officer – NEST 1) Shift Towards More Preventative Support Strong practitioner uptake of preventative strategies, particularly through the Understanding Complex Behaviour workshop, which explicitly focused on: • Early triggers • Windows of tolerance • Preventing escalation rather than reacting to crisis. • Reported practice shifts toward environmental adaptation, emotional regulation, and unmet need identification, reducing reliance on reactive or punitive responses. 2. Shift Towards Early Support Feedback evaluation evidenced that the training improved practitioners’ ability to: • Identify early neurodevelopmental need • Explain needs to parents/carers • Put supports in place before formal diagnosis or crisis escalation. 235
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43 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 Activity title Main successes to delivery and how specific factors enabled these Activity 1: Family Centred Wellbeing Service (FCWS) A major success during the reporting period has been the sustained demand for the service alongside clear evidence of early intervention impact. A total of 212 referrals were received, with the majority relating to primary aged children, demonstrating that needs are being identified and supported at an early stage. Education remains the primary referral pathway and reflects strong partnership working and high levels of confidence from schools as an accessible and effective early help resource. The service has continued to deliver consistently positive outcomes for children and families. Feedback gathered from approximately 86 service users shows very high satisfaction levels, with most respondents rating the service 9 out of 10. Families reported increased understanding of their children’s needs, improvements in emotional regulation and behaviour, strengthened parenting confidence and improved family relationships. These outcomes reflect not only short term improvements but also increased resilience and capacity within families. Another significant success has been the ability to engage families who may otherwise disengage from services. The relationship based, trauma informed approach has supported trust building and sustained engagement, particularly for Question 5 Describe the main successes to delivery and how specific factors enabled these 236
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44 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 families with previous negative experiences of services. This has enabled continued participation and progress where disengagement would otherwise be likely. Strong multi-agency working has further enhanced delivery. Schools and partner agencies report improvements in home school communication, increased capacity to meet children’s needs and reduced pressure on frontline staff. FCWS has played an important coordination role, bridging gaps between families and services and supporting shared planning around children’s needs. A further success has been the service’s effectiveness in supporting the “missing middle” - families whose needs do not meet statutory thresholds but who require targeted early support. Through holistic, whole family intervention, FCWS has ensured that these families receive timely and appropriate help, reducing escalation to statutory services. The integration of specialist expertise, including Educational Psychology and Speech and Language Therapy, has strengthened assessment, intervention planning and workforce capability. The use of evidence based interventions, including group work, alongside flexible one-to-one support, has allowed the service to respond proportionately to family needs. Activity 2: Intensive and Therapeutic Counselling During 2025/26, a key success was the establishment of the intensive and therapeutic counselling support for care experienced and vulnerable young people 237
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45 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 Support for Care Experienced and Vulnerable Young People as a locally governed, trauma-informed alternative to the Notre Dame model, now delivered through the North Ayrshire Trauma Service (NATS). Delivery was enabled by strong foundational work, including a clearly defined service remit, agreed eligibility criteria and robust referral pathways aligned with local authority and NHS governance, ensuring safe, ethical and non-duplicative provision. In its initial months from January 2026, the service demonstrated early impact through effective multi-agency engagement, timely decision making and the ability to accept referrals without a waiting list, allowing support to be provided at points of emerging risk. Early caseload activity focused on stabilising vulnerable placements and delivering therapeutic support to children, young people and carers, evidencing the service’s preventative intent. Although still at an early stage, these factors have enabled the service to establish a strong operational footing and provide a credible, sustainable local alternative, with further progress anticipated as staffing capacity is fully realised in 2026/27. Activity 3: Dads Support Workers A major success during the reporting period was the significant expansion and increased reach of the service, enabled by the successful integration of a second Dads Worker, increasing capacity to 1.8 FTE and almost doubling delivery compared to the previous year. This enabled geographical expansion beyond Ardrossan, Saltcoats and Stevenston to include Irvine and Kilwinning, alongside the introduction of a second group activity delivered outside standard 9–5 hours, improving accessibility for working dads. As a result, the service exceeded its projected family engagement target by 90%, engaging 103 families, with 88 receiving bespoke one-to-one support across more than 400 sessions. 238
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46 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 Families experienced meaningful outcomes including improved household income through welfare advice, stronger parenting confidence and progression into employment. These successes were enabled by strong integration within the Children and Families Health Team, which enhanced communication, joint working and coordinated support, as well as a strengths based, relationship led approach that prioritised trust, empowerment and peer connection. The impact and quality of delivery were further evidenced through external recognition, including nomination for the Scottish Health Awards Unsung Hero and shortlisting of group members for the North Ayrshire Community Champion Awards, alongside the development of strong peer networks that continued beyond formal service involvement. Activity 4: Vicarious Trauma Support and Specialist Counselling for Staff The staff Vicarious Trauma support service has demonstrated clear value by providing consistent, accessible and well utilised therapeutic support in response to sustained demand, maintaining continuity of care for staff and operating with a flexible, well governed delivery model. Anecdotal feedback indicates the service has supported staff to remain at work by offering a safe outlet to process impact, develop coping strategies and strengthen self care practices, helping prevent escalation to sickness absence. Activity 5: Neighbourhood Networks Transition Network A key success in delivery has been the strengthened, outcomes focused support for young people transitioning into adulthood, alongside improved whole-family support and reduced isolation. Young people aged 16–25 with additional support needs or who are neurodivergent experienced increased confidence, reduced anxiety around transitions, improved understanding of post school pathways and 239
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47 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 stronger community connections, including independent travel skills. This was enabled by flexible, personalised transition planning, illustrated by tailored one-to- one travel training and familiarisation that supported young people to successfully transition into college and thrive in a new environment. Families also benefited from responsive, relationship based engagement, with the introduction of a Parent and Carer Support Group creating a trusted space for shared learning, peer support and increased confidence around complex transition issues such as guardianship and assessments. Strong partnership working, particularly with the Carers Gateway and wider third sector, education, health and CLD partners, enabled timely access to additional supports, improved sibling wellbeing and strengthened outcomes for whole families. Group activities and wellbeing workshops further reduced isolation by providing safe, non-stigmatising spaces for social connection, leading to increased confidence, trust and friendship building for young people who may otherwise experience loneliness. Activity 6: Expansion of Barnardos Stronger Families programme During this reporting period, a key success was the delivery of a wide range of engagement focused, relationship building activities that created safe, inclusive spaces for kinship families to connect, reduce isolation and access early support. Family activity sessions, community based family fun days, targeted youth programmes and ongoing kinship carer and family groups enabled children, young people and carers to build positive relationships and engage in support in a non-stigmatising way. These activities directly contributed to strong outcomes, 240
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48 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 including kinship families being supported to remain together, early trauma informed responses to emotional and behavioural needs and timely advocacy helping families navigate complex systems such as meetings and hearings. Success was enabled by strong multi agency partnerships, particularly with education and social work, which supported effective referrals and coordinated responses; a trusted third sector delivery model that increased engagement and reduced barriers to support; and co-design with kinship families, ensuring activities and support were shaped by lived experience and responded directly to identified needs. Together, these factors enabled early, preventative intervention and sustained engagement, reducing escalation and improving outcomes for children and families. Activity 7: Ko-nekt Family support for children with additional support needs A key success of this programme has been the creation of a safe, confidential and supportive space where parents feel able to speak openly about their challenges, reducing isolation and increasing confidence through shared experiences and peer support. This has been enabled by a skilled, consistent facilitator who provides ongoing support before, during and after the group sessions, helping to build trust, reduce stress and improve parental wellbeing. The continuity of support, including timely signposting to additional services where needed, has contributed to calmer, more positive home environments and sustained improvements for families. Another significant success has been the development of strong peer relationships between parents, with families forming informal support networks and arranging 241
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49 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 activities together beyond the programme. These lasting connections reflect the programme’s relationship based approach and have strengthened community support, ensuring parents continue to feel confident and supported in their day-to-day family lives. Activity 8: Three Towns Baby Bundles During this reporting period, the project achieved strong delivery outcomes through effective partnership working, increased capacity and community engagement. Key successes included strengthened referral pathways through collaboration with North Ayrshire Foodbank, Family Wellbeing, refugee support staff, Early Years Practitioners and Dads Rock, alongside Breastfeeding Network accreditation and the introduction of drop-in sessions, expanding early support for families. Volunteer engagement also increased significantly, supported by additional staffing and partnership working with TACT. New initiatives such as the knitting group contributed to improved volunteer wellbeing, skills development and progression, including one volunteer moving into employment. Increased visibility through social media and a podcast led to higher quality donations and rising referrals. Citizens Advice sessions at the hub continue to be well accessed following Baby Bundle support, reinforcing the hub’s role as a gateway to wider preventative services. Activity 9: Educational Psychologist A key success of the WFWF-funded post has been its impact on strengthening system capacity, enabling sustained, preventative and early intervention practice across services rather than through direct delivery. Educational Psychology has successfully embedded and extended Building Positive Relationships (BPR) through a structured yet flexible model of facilitator training, coaching and 242
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50 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 continuous improvement, resulting in increased workforce confidence, consistent quality and expanded reach, with 89 trained facilitators across North Ayrshire. Delivery was enabled by responsive, needs led coaching approaches and the development of additional BPR aligned resources that broadened relevance to areas such as attendance anxiety and neurodivergence. Within the FCWS, weekly EP consultations have strengthened reflective practice and translated directly into improved family support through strategies such as goal setting, sensory consideration and emotion coaching; this was further enhanced by the introduction of joint EP and NEST consultations, supporting integrated, multidisciplinary working. Significant success has also been achieved through training and coaching for practitioners supporting neurodivergent learners, where an authority-wide, capacity building approach equipped Early Years and Primary staff with practical strategies, improved planning for transitions and increased confidence in inclusive, neuro-affirming practice. Activity 10: EmpowerED Alternative Curriculum Programme A key success of the programme has been its ability to engage and retain young people at risk of disengagement, many of whom were struggling within mainstream education and, for some, this was the only provision they were able to engage with. Over time, participants demonstrated increased attendance on programme days, greater participation and a growing willingness to engage with learning in a non-traditional environment. This success was enabled by a flexible, responsive 243
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51 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 delivery model that adapted to individual needs and group dynamics, alongside practical, hands on activities that provided clear purpose and visible outcomes. A significant further success was supporting young people to achieve recognised awards and accreditations, including outdoor learning, heritage and personal development awards, which built motivation, confidence and a sense of achievement while supporting future education, training and employment pathways. Improvements in wellbeing and confidence were also evident, with young people becoming more willing to communicate, try new activities, take responsibility and support peers, reflecting increased resilience and independence. Strong demand for the programme, positive feedback from schools, parents and young people and the development of waiting lists further demonstrate its impact. These outcomes were enabled by consistent, relationship-based staff support, meaningful progression routes and an approach that combined flexibility with structured achievement, allowing young people to build trust, sustain engagement and progress beyond initial involvement, including movement into peer mentoring roles for some participants. Activity 11: Neurodevelopmental Learning and Development Officer – NEST Key successes achieved include: a) High satisfaction and impact ratings across all workshops, with repeated demand for extended and mandatory delivery. b) Rapid development and successful rollout of new workshops in response to system need (Inclusive Communication and Understanding Complex Behaviour). c) Strong engagement from health visitors and area inclusion workers 244
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52 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 Activity title Main challenges to delivery and how these have been mitigated Activity 1: Family Centred Wellbeing Service (FCWS) Delivery during the reporting period has been affected by a combination of complex family needs and wider system pressures, particularly challenges engaging socially isolated families who may be anxious or reluctant to access support due to previous negative service experiences or limited networks, alongside difficulties engaging some children and young people in group based interventions due to anxiety, trauma or neurodevelopmental differences. Additional pressures included limited access to timely mental health and CAMHS support, inconsistencies in coordination with partners, including schools, constraints around suitable venues for groupwork and barriers for working parents in attending structured programmes. These challenges have been mitigated through flexible and adaptive delivery approaches, including tailored engagement strategies (such as visual supports and differentiated communication), the introduction of twilight groups with childcare and the use of alternative community venues. Ongoing partnership working and responsiveness in adapting delivery models continue to be key to reducing Question 6 Describe the main challenges to delivery, and how these have been mitigated or plans to mitigate them. 245
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53 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 barriers, strengthening engagement and ensuring families can access support despite systemic constraints. Activity 2: Intensive and Therapeutic Counselling Support for Care Experienced and Vulnerable Young People The main challenges to delivery related to establishing a new, locally governed therapeutic service while transitioning away from the Notre Dame model and beginning delivery part way through the year. As formal delivery only commenced in January 2026, initial challenges included setting up governance arrangements, agreeing a clear remit and eligibility criteria, aligning referral pathways with both local authority and NHS requirements. These challenges were mitigated through robust planning and strong multi agency collaboration, which enabled timely decision making, shared ownership and clarity of roles from the outset. Workforce capacity was also a limiting factor in the early stages; however, this was managed through phased implementation, prioritising high risk cases and focusing early caseload activity on stabilising vulnerable placements. The ability to accept referrals without a waiting list from the point of launch further mitigated risk by ensuring young people and carers could access therapeutic support at points of emerging need. As staffing capacity continues to be built during 2026/27, these foundations place the service in a strong position to fully realise its preventative and early intervention potential. Activity 3: Dads Support Workers During the reporting period there were relatively few challenges to delivery, with the most significant development being the successful mitigation of a key challenge identified in the previous year, being the limited engagement with maternity services, which had restricted opportunities for the earliest intervention. 246
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54 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 This barrier has now been effectively addressed through sustained relationship-building and strategic partnership working. As a result, Dads Rock is now fully embedded within both the Maternity Voice Working Group and the Pre-Conception Health Working Group, ensuring fathers’ perspectives are represented in service development. In addition, the introduction of bi-monthly Dads Antenatal Workshops has strengthened early engagement during the perinatal period and referrals from midwifery have increased significantly, with over 30 referrals made through safeguarding and maternity pathways. These developments demonstrate how proactive collaboration, inclusion in strategic forums and visible contribution to early years planning have successfully mitigated previous challenges, enabling earlier, more coordinated and preventative support for fathers and families. Activity 4: Vicarious Trauma Support and Specialist Counselling for Staff The main challenge identified has been cancellations, both from staff accessing the service and from counsellors during periods of absence. In response to a higher rate of staff initiated cancellations during the early part of the year, changes were made to the cancellation procedures. These revisions proved effective, resulting in a significant reduction in the chargeable cancellation rate from around 20% to approximately 10%. Activity 5: Neighbourhood Networks Transition Network During this reporting period, the main challenges to delivery related to increased demand and capacity constraints, alongside the time intensive nature of building trust with neurodivergent young people and their families during key transition points. Rising referrals, particularly for young people transitioning out of school who do not meet thresholds for formal support, resulted in a waiting list for 247
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55 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 Neighbourhood Networks, creating risks of social isolation, disengagement and crisis for some individuals, including those living independently with limited life skills. A further challenge was the time required to establish meaningful relationships with young people who have had previous negative experiences of services, which can limit the number of individuals supported at any one time. These challenges have been mitigated through a flexible, relationship based approach, prioritising quality and sustainability of engagement over speed, including meeting young people in environments they feel comfortable in and offering consistent, patient one-to-one support. Close partnership working with referrers has also been critical in maintaining contact during early non-engagement. Key learning has reinforced the importance of allowing sufficient time for trust building, which will continue to inform future planning, while ongoing review of capacity and referral management will be essential to respond to continued demand and prevent escalation for those on waiting lists. Activity 6: Expansion of Barnardos Stronger Families programme The main challenges to delivery reflected the complex lived experiences of kinship families, including engaging families who may be fearful or mistrustful of statutory services, carers prioritising children’s needs over their own wellbeing, the additional health and mental health needs of older carers and the impact of multi-generational trauma and complex family dynamics, often alongside legal and financial uncertainty for those in informal arrangements. These challenges were mitigated through a relationship-based, non-judgemental approach that prioritised trust building over time, alongside flexible delivery models 248
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56 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 that met families where they were both practically and emotionally. A stronger focus on carer wellbeing, alongside child focused interventions, helped carers recognise and access their own entitlement to support, while ongoing reflective practice informed service development and workforce learning. This responsive approach reduced barriers to engagement, supported sustained participation and is shaping future planning to ensure services remain accessible, trauma informed and aligned with the needs of kinship families. Activity 7: Ko-nekt Family support for children with additional support needs During the reporting period, the main challenge to delivery related to engagement and retention, with some families experiencing competing pressures or changing circumstances that led to drop out from group sessions despite overall strong demand. While this was anticipated, it highlighted the limits of fixed, centre-based group models for families managing complex needs. To mitigate this, delivery has been adapted to become more flexible and locally accessible, including the development of pop-up nurture sessions delivered in community settings and in partnership with schools, enabling parents to participate more easily alongside their children at the end of the school day. Plans with Hayocks Community Centre and Hayocks Primary School, alongside further pop-up sessions with Beith Trust in Kilbirnie and potential expansion across North Ayrshire and Arran, reflect learning from this period and are intended to reduce barriers to attendance, improve consistency of engagement and ensure the nurture offer reaches families who may struggle with regular structured programmes. 249
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57 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 Activity 8: Three Towns Baby Bundles During the reporting period, the main challenges to delivery related to staffing changes, volunteer recruitment, local awareness and initial property issues, all of which impacted early momentum but were successfully addressed. A change in staffing resulted in a short settling in period and a temporary gap without a dedicated worker; this was mitigated through interim management support and a review of the role, leading to the appointment of a Project Supervisor with stronger third sector experience, which improved delivery, leadership and partnership working. Volunteer recruitment was initially slower than anticipated, particularly due to reluctance to travel from the Garnock Valley. This was addressed by refocusing recruitment within the Three Towns, strengthening partnership working with TACT and creating clearer pathways into volunteering through links with Beith Trust employability programmes. Limited local awareness among practitioners initially restricted referrals, but targeted outreach activity, including open days, direct engagement with services and increased social media presence, has since strengthened relationships and led to increased new and repeat referrals. Early challenges with utilities and building maintenance also affected the hub “shop” but have been resolved through improved communication with the landlord. Key learning from these challenges highlights the importance of early outreach in new areas, relationship based referral pathways, sustainable volunteer recruitment strategies and having the right staffing structures in place to support consistent delivery. 250
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58 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 Activity 9: Educational Psychologist Across the delivery period, key challenges have centred on capacity, consistency and complexity of need, particularly within BPR, FCWS and neurodivergent learners workstreams, alongside system pressures affecting families and professionals. For BPR, family drop out from intensive parenting programmes and limited staff time reduced opportunities for regular coaching and reflection, while variation across teams made consistent implementation and impact measurement more challenging. This has been mitigated through extended pre-programme wellbeing support where capacity allows, responsive ad-hoc Educational Psychology coaching and ongoing collaboration with central teams to improve consistency and sustainability, alongside plans to strengthen family voice in evaluation. Within FCWS, a key challenge has been evidencing Educational Psychology’s distinct contribution to outcomes, which is being addressed through further consultation with practitioners and managers to agree priorities and overcome barriers to consistent outcome measurement. For neurodivergent learners, increasing demand, complexity, resource constraints and training gaps have placed pressure on practitioners and affected consistency of practice; mitigation has included capacity-building training and coaching, strengthened partnership working, phased implementation of inclusive strategies, and plans for continued targeted professional learning in identified priority areas (e.g. ADHD, sensory regulation and de-escalation), as well as improved engagement with families to support shared understanding before and after diagnosis. 251
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59 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 Activity 10: EmpowerED Alternative Curriculum Programme As the programme was delivered across multiple schools, an initial bedding-in period was required to build relationships, understand individual school contexts and establish effective group dynamics, particularly in settings new to the programme. This was managed through close collaboration with schools, allowing relationships to develop over time, leading to stronger engagement and fewer challenges as delivery progressed. Engagement with parents and carers was also more limited than originally planned. Rather than pursuing a model with low uptake, this was mitigated by adapting to more flexible approaches, including signposting to wider peer-support opportunities such as Carers Connect, offering broader engagement activities and providing individual contact where interest was expressed. Despite these challenges, feedback indicates that programme benefits are being felt across families, with improvements in young people’s confidence, engagement and wellbeing contributing to reduced pressure at home. Activity 11: Neurodevelopmental Learning and Development Officer – NEST The main challenges have been cancellations and reduced attendance due to competing statutory pressures (e.g. child protection, urgent health visiting work), which has led to lower engagement from social work, some school staff and primary care, despite identified need. To mitigate this, the Development Officer increased direct outreach to teams to maximise uptake in remaining delivery period. 252
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60 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 The sustained pressures across the HSCP and wider public sector create a high risk environment which, without planned investment, the gains achieved through WFWF are unlikely to be maintained. The absence of sustainable funding presents not only a risk to individual services but a systemic risk to the broader shift towards early intervention and prevention. Any reduction or discontinuation of this provision would not remove demand but instead displace it, leading to increased pressure on already stretched statutory services. This would likely result in higher levels of unmet need, delayed intervention and shift towards more reactive and crisis driven responses. Families currently supported below statutory thresholds would be particularly affected, which issues escalating to the point where more intensive and costly interventions are required. This would be to the contrary of Scottish Government policy such as Getting it Right for Every Child and The Promise, to which WFWF is so closely linked. At a system level, the withdrawal of WFWF funded capacity would significantly undermine the progress made towards integrated, multi-agency models of support. Increasing demand coupled with existing workforce capacity constraints would exacerbate pressure across education, health and social care services. Several service areas including educational psychology and neurodevelopmental support are currently bolstered by WFWF funded specialist roles. Without forward planning and sustained investment, there is a risk of losing both this specialist expertise and the wider workforce development gains achieved. This would not only reduce service quality but also weaken the system’s ability to respond early and also prevent escalation. Question 7 Describe any specific updates on local progress or challenges towards planning for sustainable delivery of holistic family support beyond WFWF 253
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61 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 The risks at service level are equally significant and, in many cases, relate directly to vulnerable and harder to reach groups. For example, the Dads Support provision offer a trusted and accessible point of engagements for fathers who may otherwise remain disconnected from services. Similarly, the discontinuation of EmpowerED would remove a key pathway for young people who are not engaging with traditional education, increasing the likelihood of further disengagement and poorer wellbeing outcomes. The loss of funding for poverty responsive projects such as the Three Towns Baby Bundles would remove an immediate and practical source of early support for families in need, while also eliminating a valuable tool for partner agencies to intervene early. Across kinship care and nurture based services, the risks extend beyond service access to the erosion of trusted relationships, that are fundamental to engaging families who may have low trust in statutory services. The loss of continuity in these relationships could lead to delayed help seeking and an increased likelihood of families only presenting when in crisis. While there has been proactive work to mitigate some of the risks, such as the development of self-directed learning modules, they support knowledge retention but cannot replicate the relational, intensive and specialist nature of direct service delivery. During the final year of funding, mitigation planning will include early and transparent sustainability discussions, phased and safe case closures and managed transitions. Third sector funded organisations are actively exploring alternative funding routes but as they are pre-existing projects, this limits opportunities to access funding. Further for some of the smaller organisations, there can be additional challenges in accessing funding routes often dominated by larger, better equipped organisations. It must be recognised that these measures can only partially mitigate the impact and do not address the fundamental gap that would be created by the loss of dedicated funding. 254
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62 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 Participation in the WFWF has generated a range of positive outcomes beyond those originally anticipated, particularly in relation to partnership working, community embedding and learning about effective engagement approaches with families and young people. A significant success has been the strengthening of partnership working across North Ayrshire. Regular WFWF forums have created valuable opportunities for shared learning, relationship building and collaboration. These connections have supported improved referral pathways, reduced silo working and helped services establish a stronger presence in new areas. Over time, this has increased partner confidence in WFWF funded services and enhanced the overall coherence of local early intervention provision. Community embedding has been a notable and positive outcome. The Baby Bundles project is now well established within the Stevenston community and is recognised locally as a supportive, accessible and responsive service. Strong relationships have been developed with local residents, partner organisations and neighbouring services. Volunteer involvement has emerged as a particular strength, with individuals contributing not only to delivery but also to shaping the service through lived experience, helping ensure it remains relevant, dignified and responsive to families’ needs.The Stevenston base is increasingly viewed as a shared hub, creating opportunities for more joined up, preventative support. Question 8 Any other comments, innovative work, relevant learning, or unexpected changes or unanticipated outcomes/results identified during this year? 255
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63 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 The EmpowerED programme has produced important learning around innovative approaches to engaging young people who are at risk of disengagement from school and services. Key insights include the value of flexible, relationship based delivery that gives young people time to build trust, confidence and readiness to engage. Practical, hands on and community based learning approaches have consistently resulted in improved engagement, participation and wellbeing for young people who do not thrive in traditional classroom environments. More broadly, the programme has highlighted an ongoing and growing gap in provision for young people who do not meet statutory thresholds for support, particularly in the context of shifting eligibility criteria towards critical need. Many young people supported through WFWF acitivities in North Ayrshire would not qualify for formal interventions despite experiencing significant challenges. This reinforces the value of early, targeted programmes that build confidence, skills and community connections for children and families. Overall, WFWF delivery has generated learning that will continue to inform future service design, workforce practice and strategic discussions around early intervention, alternative learning models and holistic family support across North Ayrshire. 256
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64 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 During this reporting period, a total of 757 children and young people across North Ayrshire accessed WFWF funded services or programmes. Furthermore, 631 families have been impacted by the WFWF activities during the 12 month period. 757 Children 631 Families How many children and families have been impacted by WFWF activities in North Ayrshire within this reporting period? 257
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65 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 Many of the activities support in the region of three to four local priorities which is encouraging. Only the WFWF Programme Lead and Staff Vicarious Support Service do not directly address the locality priority areas. 9 7 9 7 5 7 2 0 1 2 3 4 5 6 7 8 9 10 Which of the local priority areas have been targeted by the funded activities activites, within the reporting period 258
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66 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 In terms of the geographical spread of the WFWF activities, the majority are operating on a North Ayrshire wide basis and in the Three Towns locality. Although Arran does not have any specific services delivered on the island, Arran is covered by the North Ayrshire wide services. 0 3 5 1 7 5 7 0 1 2 3 4 5 6 7 8 Arran Garnock Valley Kilwinning North Coast and Cumbrae Three Towns Irvine North Ayrshire wide Which of the locality areas have been targeted by the activites, within the reporting period 259
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67 Whole Family Wellbeing Fund Annual Monitoring Report 2025-26 Only three activities do not directly target priority groups; the Staff Vicarious Trauma Support Service, Neurodevelopmental Learning and Development Office, and the WFWF Programme Lead. However, each delivers indirect benefits by strengthening staff capability and resilience, improving the quality of support for families. 2 3 8 6 2 7 3 0 1 2 3 4 5 6 7 8 9 Which of the priority groups have been targeted by the activities, within the reporting period? 260
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Integration Joint Board 18th June 2026 Subject: 2025-26 – Year End Financial Performance Purpose: To provide an overview of the IJB’s financial performance for the year ended 2025-26 and the implications for the IJB’s overall financial position Recommendation: It is recommended that the IJB: (a) Notes the overall integrated financial performance for the financial year 2025-26 and the overall year-end underspend of £2.235m pre-earmarking, adjusted to £0.696m underspent after earmarking of £1.805m. (b) Notes the progress with delivery of agreed savings. (c) Approves the budget reductions detailed at paragraph 2.10. (d) Approves the proposed earmarking as detailed in the report, leaving a balance of £2.126m in earmarked funds and £0.696m in unearmarked funds. Direction Required to Council, Health Board or Both Direction to: - 1. No Direction Required X 2. North Ayrshire Council 3. NHS Ayrshire & Arran 4. North Ayrshire Council and NHS Ayrshire & Arran Glossary of Terms NHS AA NHS Ayrshire and Arran HSCP Health and Social Care Partnership MH Mental Health CAMHS Child & Adolescent Mental Health Services BRAG Blue, Red, Amber, Green UNPACS UNPACS, (UNPlanned Activities) – Extra Contractual Referrals NRAC NHS Resource Allocation Committee PAC Performance and Audit Committee MHOF Mental Health Outcome Framework MDT Multi-Disciplinary Team 1. EXECUTIVE SUMMARY 1.1 The report provides an overview of the financial position for the IJB and outlines the unaudited year-end outturn position for 2025-26. Agenda Item 7 261
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1.2 The outturn is an overall year-end underspend of £2.235m on an IJB basis, which, when adjusted for new earmarked reserves of £1.805m, is reduced to £0.696m (0.2%). This represents a favourable movement of £3.498m from month 10. There was significant progress throughout 2025-26 in containing costs through the financial recovery plan. As in previous years, the impact of financial recovery actions has been offset by new demand and pressures, particularly in relation to social care, low-volume high-cost placements and areas where service occupancy is high and supplementary staffing costs are incurred. Between period 10 and 12 there were less unexpected cost events than had been experienced in-year and most areas across the HSCP delivered further on financial recovery actions which supported the delivery of financial balance by the year-end. The graph below illustrates the movement in the financial outturn throughout the year: 1.3 This favourable movement reflects a combination of additional funding, corrections to earlier forecasts, recognition of earmarked balances, and better-than-expected movements in several areas of service expenditure. Key reasons for the improvement are as follows: • Additional pay award funding of £777k was recognised by month 12, this funding was a pass through for the local government pay award increase from Scottish Government via the Council, improving the overall position. • Payroll turnover was more favourable than forecast at month 10, contributing a significant improvement. 262
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• Previously unreported earmarked balances were brought into the forecast, including Whole Family Wellbeing Fund (£906k), Alcohol and Drug Partnership funding (£147k), and Telecare / Community Alarms (£175k). • Unscheduled Care funding improved the position, this included an allocation of funding to protect existing social care capacity. • Forecasts for care packages improved across Physical Disability, Learning Disabilities, Supported Accommodation, and Community Mental Health, reflecting lower demand, delays in providers accepting care packages, increased clawbacks, and more accurate year-end data. • additional in-year funding for the Reduced Working Week of £0.373m. 1.4 The Integration Scheme outlines that there is an expectation that the IJB takes account of the totality of resources available to balance the budget in year. Following this approach, an integrated view of the financial position should be taken. However, it is useful to note that this overall net position consists of an underspend of £0.459m in social care services and an underspend of £0.237m in health services. 1.5 The Integration Scheme describes the required approach where there is a projected overspend on the IJB integrated budget, including the requirement to agree a recovery plan to balance the overspending budget. Only if the recovery plan is unsuccessful will the Health Board and Council consider making interim funds available. At month 9, the IJB requested that the Chief Officer write formally to North Ayrshire Council and NHS Ayrshire and Arran to request additional in-year funding. At month 12, this is no longer required due to the improved outturn. Both the Council and Health Board have been advised of the final outturn position. 1.6 Projecting the IJB financial position continued to be challenging during 2025-26 as there were a number of areas of uncertainty throughout the year. Social care service provision in particular is difficult to project, with variability due to capacity and demand, and can move significantly with low-volume high-cost packages of care. The ongoing financial risks were reported to the IJB during the year. These challenges will continue into 2026-27. 1.7 The IJB outturn position has been adjusted to reflect the impact of Lead Partnership services. The overspend in relation to North Lead Partnership services for Mental Health is not fully attributed to the North HSCP, as a share has been allocated to East and South HSCPs. Similarly, the impact of the outturn on East and South-led services has been shared with North, both on an NRAC basis in line with the agreed risk- sharing mechanism. There is a requirement for the three IJBs to be aware of the position for Lead Partnership services and plans to deliver services from within the allocated budget. On that basis, further information will be brought forward on Lead Partnership services. 263
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1.8 Significant progress in reducing the in-year overspend in the latter months of the year has resulted in financial balance being achieved in 2025-26. However, financial modelling continues to emphasise a very challenging position in subsequent years. 1.9 Since the setting of the budget in March 2025, the 2025-26 financial position has been adversely impacted by the following factors outwith the control of the IJB. • National Care Home Contract (NCHC) – the increase to the NCHC rate to reflect the impact of the nursing pay award resulted in an additional unfunded cost of £0.175m. • NHS Board allocation for the Employers National Insurance increase confirmed at 60% of funding – full year impact £0.664m. • The allocation for the Agenda for Change costs in relation to the reduced working week was queried with the NHS finance team to ensure that the HSCP received its fair share of the funding. The original allocation was £0.659m and, following this review, information collated from services on the actual impact and cost indicated that the cost of cover was £1.210m (84% of staff covered), which was £0.551m higher than the original allocation. This exercise formed the basis for a revised allocation offer of £1.032m (£0.373m higher than the original allocation), which was accepted as a reasonable position. The reduction from £0.551m relates to excluding posts graded Band 8+ and admin support posts. This position was accepted alongside a more favourable funding allocation for 2026-27 recognising the impact of a further hour reduction as part of the Reduced Working Week. The Agenda for Change Pay Reform impacts will continue to be monitored to ensure the IJB receives a fair share of funding available and where there is a gap this is reported to the IJB, including the ongoing impact of the Band 5 review. 1.10 The delivery of financial balance is to be welcomed, as it reduces the risk exposure to North Ayrshire Council and NHS Ayrshire and Arran of an additional financial in-year contribution, and demonstrates the effectiveness of the financial recovery actions and financial governance controls across the HSCP. However, it should be stressed that short term measures to contain costs are not without impact, for example we have had teams carry more vacancies due to recruitment scrutiny and delays, more time and effort invested in financial governance including for the approval of new care packages and a negative impact on service waits, including for example the highest level of delayed discharges experienced to date in North Ayrshire. This stresses the importance of the delivery of the transformation plan and recurring planned savings as a way to reduce spend in a safe, planned and sustainable way. 264
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2. 2025-26 UNAUDITED BUDGET OUTTURN POSITION 2.1 The report includes an overview of the financial position, explanations for the main budget variances and an update on progress in terms of savings delivery. 2.2 FINANCIAL OUTTURN 2025-26 Against the full-year budget of £344.167m there is an underspend of £2.235m pre- earmarking. After earmarking, the underspend of £0.696m consists of an underspend of £0.459m in social care services and an underspend of £0.237m in health services. In line with the Integration Scheme any underspend is retained by the IJB in reserves. Appendix A provides the financial overview of the partnership position. This details the outturn on an HSCP managed basis, on an IJB delegated basis (following Lead Partnership recharge adjustments) and the final adjusted outturn position after accounting for new earmarked reserve balances. The sections that follow outline the most significant variances in service expenditure compared to the approved budgets. 2.3 Health and Community Care Services Against the full-year budget of £101.333m there is an overspend of £0.906m (0.9%), which is a favourable movement of £1.072m. The main variances are: • Care home placements – overspend of £0.278m (£0.020m favourable). This includes an overspend on placements of £0.824m (£0.064m adverse). This also reflects the recent increase to the NCHC to reflect the impact of the nursing pay award, resulting in an additional unfunded cost of £0.175m. The budgeted number of permanent placements was 765 and, at month 12, there were 768 placements, leading to a more sustainable position moving into 2026-27. It was assumed as part of 2026-27 budget planning that care home placements would be brought back into line for the start of the financial year. The plan to manage down the number of permanent placements to reach the target continues to be challenging due to the need to respond to referrals from hospital and to continue to support those in critical and substantial need in the community. This has led to a growing waiting list for access. The overspend is partially offset by income recovered from charging orders and gross funded placements, which is £0.546m over-recovered (£0.086m favourable). This income has been challenging to predict, as it depends on the length of the legal process, the time taken to sell the property that the charging order is registered to, and access to the funds or estate of service users. 265
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• Care at home – underspend of £0.033m (£0.052m favourable). The position reflects the cost of meeting the significant demand and level of provision for care at home support. The favourable movement is due to action being taken to reduce the overall level of provision and reflects the contribution to specific SDS care packages from the Unscheduled Care funding received by NHS AA. The level of vacancies in the service has increased and, whilst favourable, this is coupled with increased levels of unmet need. • Care at home (non-employee costs) – transport overspend of £0.085m, PPE underspend of £0.159m, and uniforms underspend of £0.069m. • Telecare – underspend of £0.180m due to delays in receiving orders at the year end. This underspend is requested as earmarking for use in 2026-27. • Adaptations – underspend of £0.114m (£0.092m favourable) across stairlifts, adaptations and joint funded projects. • Physical Disability Services – underspend of £0.152m (£0.382m favourable), split as follows: £0.818m overspend in residential placements, £0.583m underspend in direct payments due to increased clawbacks, and £0.387m underspend in community care packages. • Long-term conditions – overspend in employee costs of £0.066m (£0.018m adverse) at Anam Cara. • Integrated Island Services – overspend of £0.432m (£0.033m favourable). The most significant variance is a projected overspend at Montrose House of £0.454m (£0.096m adverse), which relates to the net overspend on agency staff after offsetting underspends in employee costs. This position is anticipated to be reduced moving into 2026-27 as Montrose House resident numbers are now aligned with the reduced level of 10 with agency staffing levels reducing. There is also an under-recovery of income and a write-off of aged debt. Day Services were £0.111m underspent, as the funding was not used pending the outcome of the option appraisal in 2026-27. In addition, outwith Montrose House, there are overspends across property, continence and medical supplies, administration, transport and the Arran Patient Transfer contract. • Specialist Rehab wards – overspend of £0.267m (£0.061m adverse) (Redburn Ward £0.214m overspend and Douglas Grant £0.053m overspend). The overspend is due to cover costs for vacancies, as well as supplementary staffing for patients who require one-to-one support. • Wards 1 and 2 – overspend of £0.774m (£0.024m adverse). The overspend is due to increased use of supplementary staffing. All rehabilitation wards are operating at 100% occupancy, supporting a high level of patient need and 266
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complexity, which places pressure on staffing levels and the use of bank and agency staff to support additional patient observations. • Unscheduled Care – underspend of £0.277m. 2.4 Mental Health Services Against the full-year budget of £119.856m there is an underspend of £0.266m (0.2%), which is a favourable movement of £1.640m prior to the re-allocation of the Lead Partnership variance to East and South HSCPs and earmarking. The main variances are: • Learning Disabilities are overspent by £0.658m (£0.530m favourable). This covers children’s and adults’ residential placements, community packages, direct payments, property costs and an under-recovery of charging income. The favourable movement relates to increased clawbacks and more accurate year- end information. • Community Mental Health services are underspent by £0.318m (£0.205m favourable movement). The main reason for the underspend in community packages is the availability and capacity of adult community providers to deliver new packages of care. The favourable movement relates to increased clawbacks and more accurate year-end information. • There is an underspend of £0.353m in relation to the cost of Hospital Based Complex Continuing Care (HBCCC). This reflects the impact of changes in provision for these services. There were plans to reinvest this in the service, but these plans are on hold, as retaining the funding was agreed as part of the recovery plan at month 3. • The Lead Partnership for Mental Health is £0.118m underspent (£0.759m favourable) and the main variances are as follows: • Adult Inpatients – overspend of £1.155m (£0.318m favourable) due to very high levels of occupancy, patient mix and complexity, and levels of continuous intervention which require additional supplementary staff and enhanced observations (1:1 and 2:1), together with the use of bank staff. The favourable movement is due to a recharge to another health authority for a patient. • The UNPACS (Unplanned Activities) budget – overspend of £1.018m (£0.085m favourable) based on current placements. UnPACS placements are for individuals with very specific needs that require a higher level of security and/or care from a staff group with a particular skill set and competence. There are no local NHS secure facilities for 267
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women, people with a learning disability or people with neurodevelopmental disorder. This can necessitate an UNPACS placement with a specialist provider which can be out of area. The nature of mental health UNPACS spend is that it is almost exclusively on medium- or long-term complex secure residential placements, which are very expensive, so a small change in placements can have a high budgetary impact. Due to the complexity and risk involved, transitions between units or levels of security can take many months. Applications to approve a placement are made to the Associate Medical Director for Mental Health, who needs to be satisfied that the placement is appropriate and unavoidable before this is agreed. Part of the additional control measures agreed in month 3 was to expand the high-cost care package review group to include all UNPACS placement requests. • Learning Disability Services – overspend of £0.655m (£0.187m adverse). The overspend relates to the delay in achieving the saving from Ward 7A. Whilst the ward closed, there are still legacy costs as staff are still being redeployed and some patients remain within Woodland View. Additionally, the recharges in relation to moving from a health to a social care model at Trindlemoss House were higher than projected. • Elderly Inpatients – overspend of £0.153m (£0.050m adverse) due to the use of supplementary staffing. The elderly mental health wards continue to operate at full occupancy with waiting lists, with several patients on enhanced observations and bank costs remaining high. • Eating Disorders – overspend of £0.136m (£0.001m favourable) due to the staffing level being higher than the funding allocation. This is being considered alongside the overall resource allocation. • Enhanced Mental Health Outcome Framework (EMHOF) – underspend of £0.624m (no movement). There was £0.624m of reserves held for EMHOF and the recovery plan approved the drawdown of these reserves. • Psychiatry – overspend of £0.233m (£0.122m favourable). The favourable movement is due to receiving additional dean funding. A whole-scale workforce review has been commissioned to determine longer-term solutions for sustainability. • MH Pharmacy/Substitute Prescribing – underspend of £0.260m (£0.041m favourable). The favourable movement is due to a further pharmacy rebate for which no advance notice is received. Prior to rebates there was an overspend due to increased demand and the cost of medicines, particularly Buvidal. This position is after investing £0.510m on a Pan Ayrshire basis (£0.170m per HSCP). 268
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• Action 15 – underspend of £0.455m (£0.043m favourable). There was £0.487m of reserves held for Action 15 and the recovery plan approved the drawdown of these reserves, which is the main reason for the underspend. The underspend is after considering the legacy costs from the 2024-25 review of funding. • The turnover target for vacancy savings for the Lead Partnership is held within the Lead Partnership, as this is a Pan-Ayrshire target. There is an over-recovery of the vacancy savings target of £1.406m (adverse movement of £0.006m) in 2025-26. Further information is included in the table below: Vacancy Savings Target (£1.160m) Actual Achieved to March 2026 £2.566m Overachievement £1.406m 2.5 Children and Justice Services Against the full-year budget of £41.437m there is an overspend of £0.353m (0.9%), which is a favourable movement of £1.060m prior to earmarking. The main variances are: • Care Experienced Children and Young People are overspent by £1.835m (£0.161m favourable). Some of these costs are offset by the contribution from the Home Office for Unaccompanied Asylum-Seeking Children, which is detailed below. The main areas within this are noted below: • Children’s residential placements are overspent by £2.836m (£0.038m favourable) based on 28 placements at month 12. There are several factors contributing to this challenging position: • There are 32 places available in internal children’s houses and, due to demand, these have been operating at 100% occupancy or above for some time, leading to increased use of external placements where residential care is required. • There remains an acute shortage of foster carers, leading to residential care being necessary in emergency placement situations. • There is a requirement to support Unaccompanied Asylum-Seeking Children (UASC) under the National Transfer Scheme and to support trafficked young people who have been identified in North Ayrshire. • A number of young people in residential care have requested Continuing Care, whereby a young person can remain in their placement until age 21. 269
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• Where appropriate, young people are placed to meet their educational needs, and the cost of residential school placements is, in most cases, shared 50/50 with Education Services. • Children’s Services continue to work with other services, including Education and Housing, to address these challenges through the Brighter Pathways Programme and associated workstreams. Note that the costs associated with mobilising Boyle Street will continue into 2026-27 and will be funded by the Service Redesign Fund. • Looked After and Accommodated Children (fostering, adoption, kinship etc.) are £0.877m underspent (£0.057m favourable). • Residential respite placements are overspent by £0.097m (£0.041m favourable). These short-term placements are used to prevent an admission to full-time care or to avoid placement breakdown. • Employee costs are overspent by £0.096m (£0.041m favourable), largely due to staffing levels in the children’s houses and the outcome of job evaluation for posts. • Care Leavers – underspend of £0.046m (no movement) in rent costs. • Section 29 Payments (Throughcare Team) are overspent by £0.083m (£0.047m favourable). • Head of Service – underspend of £0.708m (£0.016m adverse). This consists of an overspend of £0.158m in relation to the previous staff reconfiguration saving in the children’s houses, which was not achieved in 2023-24 or 2024-25. • This is offset by grant funding in relation to Unaccompanied Asylum- Seeking Children (UASC), which is projected to amount to £0.748m (£0.031m adverse) and contributes to costs incurred across a number of Children and Families service areas. It is estimated that the level of Home Office income received when compared to the direct placement and throughcare costs, leaves a shortfall in funding in excess of £500k for supporting this vulnerable group. • C&F Health Team – overspend of £0.125m (£0.002m favourable), mainly in relation to the Band 6 to 7 regrade for Health Visitors and the progression of posts up the Band 7 scale. In line with the Brighter Pathways Re-Modelling Care Options Plan approved by the IJB in November 2025, the budget for care experienced children and young people has been re-aligned for 2026-27, with progress to be monitored in line with the planned reduction and re-alignment of placements. 270
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2.6 ALLIED HEALTH PROFESSIONALS (AHP) AHP services are in balance as all underspends in employee costs have contributed to payroll turnover. 2.7 CHIEF SOCIAL WORK OFFICER Underspend of £0.139m (£0.030m favourable). This is due to contract savings and a reduction in spend for young carers. 2.8 MANAGEMENT AND SUPPORT Management and Support Services are underspent by £3.120m (£1.213m favourable), which is primarily due to additional vacancy savings. The overall main areas of variance are: • There is projected slippage on the LD and MH transition funding of £0.680m (£0.049m favourable) due to delays in children transitioning into adult services. This involves complex planning by services with service users and families and can change over time based on assessed need when moving into adult services. • There is also a balance of over-achieved savings of £0.134m (£0.047m adverse) and contractual inflation of £0.257m (£0.011m favourable). • Additional funding of £0.221m was received in month 12 for the Living Wage. • NHS shortfall in savings of £0.063m (£0.061m favourable), which is not coded to specific areas and is held centrally until recurring savings can be identified. • An over-recovery of payroll turnover of £1.030m (£0.580m favourable) for social care services and an over-recovery of £0.488m (£0.019m favourable) for health services, as outlined in the table below. The turnover targets and achievement for the financial year for Health and Social Care services outwith the Lead Partnership are noted below: Social Care Health Vacancy Savings Target (£3.400m) (£1.567m) Actual achieved to March 2026 £4.430m £2.055m Over/(Under) Achievement £1.030m £0.488m The areas contributing to the health and social care vacancy savings are spread across a wide range of services with vacancy savings being achieved in most areas. As part of the recovery plan, the vacancy scrutiny group has been enhanced with the Heads of Service and professional leads attending. Each post is scrutinised and filled only where deemed necessary with a recruitment freeze now implemented for all non- essential posts. 271
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In 2025-26 there was a further recruitment delay with vacancy scrutiny approved vacancies being held for four weeks before they are advertised to create more payroll turnover. This was for all vacancies except clinical or registered services vacancies or those which will incur cover costs. The turnover target for the North Lead Partnership for Mental Health services is detailed separately within the Lead Partnership information at section 2.4. 2.9 Savings Progress The approved 2025-26 budget included £4.019m of savings. BRAG Status Position at Budget Approval £m Position at Month 12 £m Red - 1.000 Amber 2.984 1.027 Green 1.035 - Blue - 1.992 TOTAL 4.019 4.019 Appendix B provides an overview of those service changes which do have financial savings attached to them and the BRAG status around the deliverability of each saving. The only red status saving is in relation to Brighter Pathways. In line with the Brighter Pathways Re-Modelling Care Options Plan approved by the IJB in November 2025, the budget for care experienced children and young people has been re-aligned for 2026-27, with progress to be monitored in line with the planned reduction and re- alignment of placements. 2.10 Budget Changes The Integration Scheme states that “either party may increase its in-year payment to the Integration Joint Board. Neither party may reduce the payment in-year to the Integration Joint Board nor Services managed on a Lead Partnership basis … without the express consent of the Integration Joint Board.” Appendix C highlights the movement in the budget position from month 10 following the initial approved budget. Reductions Requiring Approval: Ref Description Amount (£000) 1 ICT transfers 3 2 Foxgrove 86 272
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3 Training Grade Funding Adjustment - March 71 4 Revenue to Capital transfer North SLT AAC Communication Aid 7 5 Return Chest Heart & Stroke funds to South 1 6 Reduction to Global Sum HD501 - Prescribing 5 7 Virement to Acute AXH359 Breastfeeding Admin 0.6 WTE post 16 8 GP Prescribing balanced to zero 411 2.11 Pan Ayrshire Lead Partnership services and Large Hospital Set Aside Lead Partnerships: - There is a requirement for the 3 IJBs to be aware of the position for Lead Partnership services and plans to deliver services from within allocated budget, on that basis the new Lead Partnership reporting template is included as Appendix F. Set Aside: - Work has been undertaken with partnerships to progress and develop set aside arrangements to fully implement the legislative requirement. This includes arrangements in relation to the use of Directions, Joint Commissioning Plans and overall progression towards fair share allocations of resources. Further work has been undertaken through the Ayrshire Finance Leads group to establish baseline resources for each partnership and how these compare to the NRAC “fair share” of resources. Ayrshire Finance Leads have now agreed a baseline methodology for set aside budgets which involves using the four full years prior to the pandemic, 2016/17 – 2019/20 inclusive. The HSCPs require to agree their final share of the baseline with each other, however the aggregate will remain unchanged. The table below shows the cost at 2025/26 prices. The 2025/26 actual usage information is not known until later in the year. IJB Baseline 2024/25 at 2025/26 prices (£) East 33.336 North 41.833 South 34.161 Total 109.330 The annual budget for Acute Services is £500.4m. The directorate is overspent by £37.5m at the year end including legacy CRES of £2.3m. 273
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This was caused by overspends on medical and nursing staff, together non pay overspends on equipment and supplies. These are required due to the level of operational pressure experienced. Unfunded wards contributed an overspend of £6.4m in the year. Within the overall £37.5m overspend Medicine are over by £14.7m, Emergency Care by £12.4m, Surgery by £6.0m, Labs and Diagnostics by £4.2m and Women and Children by £2.8m. There is a material underlying deficit caused by: • Length of Stay (LoS) and emergency admission rates in NHS Ayrshire and Arran acute hospitals are above the Scottish average. • High expenditure on medical and nursing agency staff, high rates of absence and vacancies causing service pressure. • Delayed transfers of care and high acuity of patients. The IJBs and the Health Board work closely in partnership to maintain service and improve performance. 2.12 FINANCIAL RISKS There were a number of financial risk areas during the year that impacted on the financial position. Some of these will continue into 2026-27 and there are increased risks as a result of the 2026-27 budget settlement. • 2025-26 overspend areas, especially in low-volume high-cost services, for example children’s residential placements, UNPACS, and supplementary staffing across community, mental health and learning disability wards. • Growing demand for services. • Staff recruitment and retention challenges across a number of service areas. • The expectation that performance will continue to be maintained or improved despite the significant resource challenges. • Ongoing delivery costs of Scottish Government policy directives, particularly where these are not fully funded or inflation-proofed. • Unearmarked reserves remain at a low level, limiting the Partnership’s ability to absorb in-year variances, with any overspends likely to require additional funding from partners. • The ongoing review of the Integration Schemes, where there is a focus on financial arrangements and risk share. • The wider system financial challenges and impact across the whole system, for example the financial position of NHS AA and decisions taken to reduce the Board’s deficit may have impacts on other parts of the health and care system. • Removal of brokerage for NHS Boards. NHS AA has been asked by the Scottish Government to deliver further financial improvement beyond its Board- 274
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approved financial plan and has now been escalated to Level 4 of the NHS Scotland Support and Intervention Framework. • The overall sustainability of commissioned care providers remains a significant risk, with increased employer National Insurance costs compounding existing financial pressures and increasing the possibility of providers handing back packages of care or contracts. • The ongoing ability to source packages of care for service users. • Progress with the work to develop set aside arrangements and the risk-sharing arrangements agreed as part of this. • The recurring underlying levels of overspend, which may impact on the Partnership’s ability to continue to sustain service levels in the future. • The use of supplementary staffing for enhanced observations across a number of service areas and the use of high-cost agency staff to support frontline service delivery in areas where there are recruitment challenges. • Agenda for Change Pay Reform programme, including Nursing Band 5-6 re- grade, protected learning time and reduction to the working week. • Scotland Excel inflationary increases for children’s services have been significantly higher than assumed. • Risk related to NHS Reform investment and the allocation decision for recurring and non-recurring funding. These risks will continue to be monitored into 2026-27. There are significant risks moving into 2026-27 attached to the delivery of the Policy implementation for Critical Adult Social Work and Social Care Eligibility Criteria with the full financial impact of the policy not being known until the reviews of existing packages of care are completed. Audit Scotland’s most recent audit of the IJB Annual Accounts concluded that North Ayrshire IJB has effective financial management and reporting arrangements in place. The audit also highlighted success in achieving approved recurring savings. This demonstrates that the current financial recovery situation is not a result of inadequate financial oversight, poor reporting, or an inability to deliver efficiencies. Instead, the ongoing challenge relates to rising levels of need within the North Ayrshire population and the wider national issue of ensuring the long-term financial sustainability of health and social care services. It is essential that the IJB works with all partners to accelerate and resource service redesign and transformation in order to provide sustainable care for the future. An Internal Audit review of IJB transformation submitted to the September 2025 Performance and Audit Committee gave an opinion of substantial assurance in relation to the governance of the Transformation Plan. The next planned IJB audit is underway with and is focussing on Financial Sustainability. 2.13 RESERVES The IJB closing reserves position is summarised in the table below. 275
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General Fund Reserve Earmarked Reserves Total Unearmarked External Funding HSCP £m £m £m £m Balance – 1 April 2025 0 2.381 0.780 3.161 Drawdowns 0 (2.381) (0.459) (2.840) Transfer in – underspend 0.696 0 0 0.696 New earmarking 0 1.805 0 1.805 Balance – 31 March 2026 0.696 1.805 0.321 2.822 The unearmarked reserves of £0.696m represent 0.2% of the 2025/26 budget, which is significantly below the recommended reserve level of 2-4% of the budget (£6.88m to £13.76m). Further detail on the reserves is given in Appendix D. 2.14 Financial Recovery Plan Since the initial recovery plan was agreed in June 2025, there has been a £3.498m reduction in costs. Whilst the full benefit of this has not been realised in-year in the bottom-line outturn, it has helped to mitigate a further deterioration in the position arising from other unexpected in-year financial pressures of £1.006m. This has resulted in a net recovery improvement of £2.492m, as set out below: Main favourable recovery action - Care at Home 1.674 - Care Homes 0.300 - Ward 1 and 2 0.053 - Physical Disabilities - care 0.557 - Mental health 0.223 - Transition slippage 0.434 - Contract inflation 0.257 3.498 Offset by adverse movements - Specialist Rehab Wards (0.053) - LD (0.216) - Lead Partnership (0.258) 276
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- Children's Res Placements (0.150) - Payroll turnover (0.085) - Chief Social Work Officer (0.066) - Agenda for Change (0.178) (1.006) Net Improvement 2.492 It is anticipated that the management and recovery actions developed during 2024-25 and 2025-26 will require to continue into 2026-27. It should be stressed that short term measures to contain costs are not without impact. For example we have had teams carry more vacancies due to recruitment scrutiny and delays, more time and effort invested in financial governance including for the approval of new care packages and supplementary staffing requests, and a negative impact on service waits, including for example the highest level of delayed discharges experienced to date in North Ayrshire. This stresses the importance of the delivery of the transformation plan and recurring planned savings as a way to reduce spend in a safe, planned and sustainable way and shifting reliance away from short term financial recovery actions. PROPOSALS 3.1 Anticipated Outcomes Continuing to closely monitor the financial position will allow the IJB to take corrective action where required to deliver services from within the available resource, thereby limiting the financial risk to the funding partners. Delivering financial balance at the end of 2025-26 overall does not resolve the financial challenge for future years, but does positively mean the IJB does not require to seek additional in-year support from NAC or NHS AA and reduces spend in some areas to leave a more favourable opening position in terms of financial commitment, primarily for those areas that the financial recovery plan was put in place to address. The 2026- 27 budget paper estimated a new budget gap of £6.1m in total with an opening gap of £3.0m leading to an overall savings requirement of £9.1m. The 2025-26 does not materially change these planning assumptions. The main areas of assumed recurring pressure remain, including supplementary staffing and the cost of existing care packages including residential placements and UNPACs. The approved savings for 2026-27, including the eligibility criteria reviews, will have the greatest impact on the financial sustainability of the Partnership. The IJB therefore requires a clear understanding of progress with delivery of the savings and transformation plan projects. The 2026/27 approved savings, including the eligibility criteria reviews, will have the greatest impact on the financial sustainability of the partnership, the IJB require to 277
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have a clear understanding of progress with the delivery of the savings and transformation plan projects. 3.3 Measuring Impact The financial position reported is the unaudited year-end outturn position for 2025-26, further information will also be contained within the unaudited IJB annual accounts. Ongoing updates to the financial position including the reserves position will be reported to the IJB throughout 2026-27. 4. IMPLICATIONS 4.1 Financial The outturn is an overall year-end underspend of £2.235m, which, when adjusted for new earmarked reserves of £1.805m, is reduced to £0.696m. The report outlines the main variances for individual services. The IJB unearmarked reserve balance is £0.696m and the earmarked balance is £2.126m. 4.2 Human Resources The report highlights vacancy or turnover savings achieved during the year. Services will review any staffing establishment plans and recruitment in line with normal practice when implementing service change and reviews as per agreement with the IJB. Tight vacancy scrutiny management arrangements remain in place for the HSCP. 4.3 Legal None. 4.4 Equality/Socio-Economic None. 4.5 Risk Para 2.12 highlights the financial risks. The report is in line with the agreed risk appetite statement, which sets a low-risk appetite in respect of adherence to standing financial instructions, financial controls and statutory financial duties, and a high-risk appetite in relation to finance and value for money. The ‘financial viability of the HSCP’ risk is included on the strategic risk register. 4.6 Community Wealth Building None. 4.7 Key Priorities The ability to deliver on our strategic priorities may be compromised due to the greater financial risk faced in 2026-27 and the increased focus required on financial rather than service improvement. This will be kept under close scrutiny throughout 2026-27. 278
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If we are unable to successfully develop a financial recovery plan to achieve financial balance, consideration may be given to revising the strategic commissioning plan. 5. CONSULTATION 5.1 This report has been produced in consultation with relevant budget holders and the Partnership Senior Management Team. 5.2 The IJB financial monitoring report is shared with the NHS Ayrshire and Arran Director of Finance and North Ayrshire Council’s Head of Finance after the report has been finalised for the IJB. Caroline Cameron, Director Author – Eleanor Currie, Chief Finance Officer [eleanorcurrie@north-ayrshire.gov.uk] 279
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PUBLIC INFORMATION 2025-26 Budget Monitoring Report–Objective Summary as at 31st March 2026 Appendix A Budget Outturn Over/ (Under) Spend Variance Budget Outturn Over/ (Under) Spend Variance Budget Outturn Over/ (Under) Spend Variance £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 COMMUNITY CARE AND HEALTH 80,315 80,157 (158) 21,018 22,082 1,064 101,333 102,239 906 1,978 (1,072) : Locality Services 32,112 31,983 (129) 5,830 5,831 1 37,942 37,814 (128) 728 (856) : Community Care Service Delivery 43,229 42,811 (418) 0 43,229 42,811 (418) (227) (191) : Rehabilitation and Reablement 2,076 1,989 (87) 0 2,076 1,989 (87) 9 (96) : Long Term Conditions 905 971 66 10,649 11,690 1,041 11,554 12,661 1,107 1,004 103 : Community Link Workers 311 311 0 0 311 311 0 (1) 1 : Integrated Island Services 1,682 2,092 410 4,539 4,561 22 6,221 6,653 432 465 (33) MENTAL HEALTH SERVICES 41,885 42,090 205 77,971 77,500 (471) 119,856 119,590 (266) 1,374 (1,640) : Learning Disabilities 32,558 33,216 658 733 733 0 33,291 33,949 658 1,188 (530) : Community Mental Health 6,939 6,621 (318) 1,784 1,784 0 8,723 8,405 (318) (113) (205) : Addictions 2,388 2,253 (135) 1,868 1,868 0 4,256 4,121 (135) 11 (146) : HBCCC 0 0 0 353 0 (353) 353 0 (353) (353) 0 : Lead Partnership Mental Health NHS Area Wide 0 0 0 73,233 73,115 (118) 73,233 73,115 (118) 641 (759) CHILDREN & JUSTICE SERVICES 35,560 35,862 302 5,877 5,928 51 41,437 41,790 353 1,413 (1,060) : Irvine, Kilwinning and Three Towns 3,133 3,162 29 0 0 0 3,133 3,162 29 43 (14) : Garnock Valley, North Coast and Arran 3,463 2,641 (822) 0 0 0 3,463 2,641 (822) 92 (914) :Intervention Services 1,235 1,233 (2) 0 0 0 1,235 1,233 (2) (2) 0 : Care Experienced Children & Young people 22,771 24,606 1,835 0 0 0 22,771 24,606 1,835 1,996 (161) : Head of Service - Children & Families 1,413 704 (709) 0 0 0 1,413 704 (709) (724) 15 : Justice Services 3,101 3,100 (1) 0 0 0 3,101 3,100 (1) 0 (1) : C&F Health Team 444 416 (28) 5,016 5,126 110 5,460 5,542 82 73 9 : Lead Partnership NHS Children's Services 0 0 0 861 802 (59) 861 802 (59) (65) 6 CHIEF SOCIAL WORK OFFICER 1,910 1,763 (147) 0 0 0 1,910 1,763 (147) (108) (39) PRIMARY CARE 0 0 0 52,996 53,035 39 52,996 53,035 39 (3) 42 ALLIED HEALTH PROFESSIONALS 0 11,480 11,480 0 11,480 11,480 0 0 0 MANAGEMENT AND SUPPORT COSTS 11,258 9,238 (2,020) 3,897 2,797 (1,100) 15,155 12,035 (3,120) (1,907) (1,213) OUTTURN ON A MANAGED BASIS 170,928 169,110 (1,818) 173,239 172,822 (417) 344,167 341,932 (2,235) 2,747 (4,982) Over/ (Under) Spend Variance at Period 10 Movement in variance from Period 10 TOTAL Partnership Budget - Objective Summary Council Health 2025/26 Budget 280
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Budget Outturn Over/ (Under) Spend Variance Budget Outturn Over/ (Under) Spend Variance Budget Outturn Over/ (Under) Spend Variance £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 Return Hosted Over/Underspends to East 0 0 0 0 (26) (26) 0 (26) (26) (210) 184 Return Hosted Over/Underspends to South 0 0 0 0 (25) (25) 0 (25) (25) (183) 158 Receive Hosted Over/Underspends South 0 0 0 0 57 57 0 57 57 33 24 Receive Hosted Over/Underspends East 0 0 0 0 (272) (272) 0 (272) (272) 415 (687) OUTTURN ON AN IJB BASIS 170,928 169,110 (1,818) 173,239 172,556 (683) 344,167 341,666 (2,501) 2,802 (5,303) Adjusted for Earmarking 0 a) ADP 0 147 147 0 0 0 0 147 147 0 147 b) Whole Family Wellbeing Fund 0 906 906 0 0 0 0 906 906 0 906 c) Telecare / community alarms 0 180 180 0 0 0 180 180 0 180 d) Magic Notes - one year based on Tier 3 take up 0 88 88 0 0 0 88 88 0 88 e) Adult Social Work Restructure resource G12 6mths 0 38 38 0 0 0 38 38 0 38 f) LD Funds - Coming Home funding 0 0 0 212 212 0 212 212 0 212 g) Early Intervention in psychosis (linked to a post) 0 0 0 51 51 0 51 51 0 51 Earmarking for East LP services 0 0 0 0 183 183 0 183 183 0 183 FINAL OUTTURN POSITION 170,928 170,469 (459) 173,239 173,002 (237) 344,167 343,471 (696) 2,802 (3,498) Movement in variance from Period 10 Partnership Budget - Objective Summary 2025/26 Budget Council Health TOTAL Over/ (Under) Spend Variance at Period 10 281
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2025-26 Savings Tracker Appendix B Social Care: Ref Description Deliverability Status at budget setting Deliverability Month 12 2025/26 Saving Previously Agreed Savings (Full year impact) 1 Review of Day Care provision Green Blue 0.100 2 Service redesign (CAAST Team and Corporate Parenting team) Green Blue 0.034 Adjustments 3 Payroll Turnover Green Blue 0.099 Mental Health 4 LD Responder Service Amber Amber 0.150 Children, Families & Criminal Justice 5 Brighter Pathways Amber Red 1.000 Community Care & Health 6 Review of Day Care provision Amber Blue 0.107 7 Care at Home Amber Blue 0.500 8 Care Package Review (all services) Amber Blue 0.200 9 Deletion of vacant posts Green Blue 0.056 10 Increase to charging Green Amber 0.186 11 Admin Post Savings Green Blue 0.114 12 Financial Inclusion Green Blue 0.357 TOTAL SOCIAL CARE SAVINGS 2.903 Cross Service 282
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Health: Ref Description Deliverability Status at budget setting Deliverability Month 12 2025/26 Saving Adjustments 13 Increase recharge to East Ayrshire for beds at Woodland View Green Blue 0.010 14 Payroll Turnover Green Blue 0.079 Other Savings 15 Admin Savings Amber Blue 0.186 16 Trindlemoss House - move to social care model Amber Amber 0.250 17 EICT/Rehab Amber Blue 0.150 18 Community MH/Wellbeing Review Amber Amber 0.100 19 Ward 7A - Woodland View Amber Amber 0.341 TOTAL HEALTH SAVINGS 1.116 TOTAL NORTH HSCP SAVINGS 4.019 283
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2025-26 Budget Reconciliation Appendix C COUNCIL Period Permanent or Temporary £'m Initial Approved Budget 137.739 Adjustments to baseline 0.015 Revised Budget 137.754 Resource Transfer 25/26 1-3 28.252 Additional Funding - 24/25 Adult Social Care RLW 1-3 P 0.073 Additional Funding RLW 1-3 P 0.126 Additional Funding - Money Smart 1-3 P 0.094 ICT Transfers 1-3 P (0.005) Additional Funding - Whole Family Wellbeing Funds 1-3 T 0.179 CJSW - S27 1-3 P 3.280 Development of People working in Childrens SW 1-3 P (0.390) Change Fund Allocation - HSCP FIO Team 7 T 0.021 Internal Commerical Waste 7 P 0.009 ICT Transfers 9 P (0.004) CSC Pay Uplift 10 P 0.163 SRA Kinship 10 P 0.058 Change Fund Allocation - HSCP FIO Team 10 T 0.047 ICT Transfers 10 P (0.004) Change Fund BEAM inv 11 T 0.025 ICT Transfers 11 P (0.002) Change Fund Allocation - HSCP FIO Team 12 T 0.025 2526 Strategic Budget - FI Team 12 T 0.067 Change fund ref 24-07 HSCP adaptations 12 T 0.020 Change fund ref 24-07 HSCP adaptations 12 T 0.063 ICT Transfers 12 P (0.001) Insurances / Property Excess / Uninsured Covers etc 12 T 0.301 Pay Uplift 12 P 0.777 170.928 HEALTH Period Permanent or Temporary £'m Initial Budget exc set aside 161.934 Month 10-12 Adjustments and adjusting for the full year impact of part years amounts and temporary funding. 8.532 Revised Budget 170.466 Resource Transfer 24/25 24.640 Resource Transfer 25/26 (28.252) NORTH NATIONAL INS 25-26 AMBUS 1 0.997 PRESCRIBING 25-26 AMBUSH 1 2.754 PRESCRIBING CRES 25-26 AMBUSH 1 (0.715) Training Grade Adj - April 1 (0.058) Training Grade Rates Adj - April 1 0.030 MH: Anticipate PDS Dementia (North) 25/26 1 0.094 MH: Anticipate Delivery of Veteran Specific 25/26 1 0.105 Anticipated RWW from SG 1 0.659 Anticipate 20% Tranche 2 ADP 1 0.174 Social Care Budget Reported at Month 12 284
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HEALTH Period Permanent or Temporary £'m Training Grade Adj - May 2 (0.013) Bwp 25-26 East Chest Heart Stroke 2 0.001 Bwp 25-26 East Nest Expansion 2 0.023 Bwp 25-26 East - Sds Advice Service 2 0.013 Bwp 25-26 East Sub Prescribing 2 0.170 25-26 South Budget Paper - North Substitute Prescribing 2 0.170 25-26 South Budget Paper - Pan Ayrshire Chest Heart And Stroke 2 0.001 25-26 North Budget Paper - Pan Ayrshire (vision Support Service 2 (0.005) 25-26 North Budget Paper - Pan Ayrshire (communitystore) 2 (0.155) HD52: EARLY INTERVENTION PSYCHOSIS 3 0.100 25-26 Pay Award Increase North 3 1.179 Training Grade Adjustment (Dean Funding) 4 0.011 Medical Pay Award - Senior Medical - Additional 1% 4 0.086 Medical Pay Award - Specialty Doctors - Additional 1% 4 0.006 Virement to Medical Directorate from Mental Health Admin 4 (0.028) Transfer MAT Standards Psychiatrist 0.2 WTE 4 0.029 Primary Care Prescribing Tariff Reduction 4 (0.556) BBV transfer from Public Health 4 0.269 Training Grade Adjustment (Dean Funding) - August 5 0.129 Budget transferred to Capital for INV-3395435821 5 (0.006) Transfer from South - ANP contribution 5 0.030 Primary Care Prescribing Budgets reworked 5 0.130 HD157 3% pay award ADP North 5 0.057 North MDT funding to Arran Medical Group (Virement 11) 5 (0.043) Training Grade Adjustment (Dean Funding) - September 6 0.018 Transfer Methadone LES to East GMS 7 (0.008) Post to Medical records 7 (0.037) GP Prescribing budget adjustment 7 (1.094) ADP MAT Standards Allocation 7 (0.045) ADP ABI to East 7 (0.010) Drug Death Co-ordinator funding returned to PH (retiral - post funding returned) (0.040) BBV funding returned to PH (reduction in hours) 8 (0.008) Training Grade Adjustment (Dean Funding) - December 8 (0.071) Training Grade Rates Adjustment - December 9 0.086 Early Years funding 0.49 WTE Band 4 - MIN Allocat 9 0.020 GP Prescribing budget adjustment 9 (0.365) Training Grade Adjustment (Dean Funding) - January 10 0.019 Junior Doctors Pay Award - additional 0.25% 10 0.008 MAT Standards Adjustment 10 (0.006) 285
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HEALTH Period Permanent or Temporary £'m Training Grade Adjustment (Dean Funding) - February 11 0.004 Band 5 to 6 Upgrades 11 0.023 Medical Discretionary Points 11 0.039 Foxgrove - North share from Flat Cash to Reserves 2025/26 11 (0.086) BBV Transfer Band 8B Pharmacist to Addictions 11 0.013 2025/26 AFC Pay Award additional 0.15% CPI Uplift 11 0.142 Training Grade (Dean Funding) - March 2026 12 0.105 Training Grade Funding Adjustment - March 12 (0.071) Band 5 to 6 Upgrades 12 0.033 MAT Standards North share of Public Health Post funding 12 0.047 ADP Pay Uplift 2025/26 12 0.014 Revenue to Capital transfer North SLT AAC Communication Aid 12 (0.007) Training Bursary funding from HR 12 0.001 Return Chest Heart & Stroke funds to South (see Month 2) 12 (0.001) Balance of North RWW 2025/26 to Flat Cash 12 0.374 Breastfeeding HD107 FYE claimed in error 2024/25 12 (0.006) PDS Dementia HD172 FYE claimed (CY claimed Mth 1) 12 0.000 Reduction to Global Sum HD501 12 (0.005) Virement to Acute AXH359 Breastfeeding Admin 0.6 WTE post 12 (0.016) Whole Systems WSI North HSCP Funding 2025/26 12 0.570 GP Prescribing balanced to zero 12 (0.411) GP Prescribing correct error re £884k 12 0.150 MDT Ringfenced 12 0.400 MHO Ringfenced 12 0.335 CAH Reablement 12 0.403 Protect Capacity Social Care 12 0.231 Roundings (0.001) 173.239 TOTAL COMBINED BUDGET 344.167 Health Budget Reported at Month 12 286
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25-26 IJB Reserves Position Appendix D Balance at 31 March 2025 Area of Reserves Transfers Out 2025- 2026 Transfers In 2025- 2026 Balance at 31 March 2026 Earmarked Funds 353 Alcohol & Drug Partnership (353) 147 147 135 Mental Health Action 15 (135) 0 0 46 Primary Care Improvement Fund (46) 183 183 780 Service Redesign / Challenge Fund (459) 0 321 934 Whole Family Wellbeing Fund (934) 906 906 0 Telecare / community alarms 0 180 180 0 Magic Notes 0 88 88 0 Adult Social Work Restructure resource 0 38 38 36 Breast Feeding Network (36) 0 0 365 MH Recovery and Renewal (365) 0 0 82 LD – Coming Home (82) 212 212 92 Early Intervention in Psychosis (92) 51 51 1 Donation – Police Scotland (1) 0 0 3 GP Premises Improvements - tranches 1 and 2 (3) 0 0 303 Primary Care Improvement Fund (303) 0 0 29 Dental Practice Improvement (29) 0 0 2 Appropriate Adult Scheme (2) 0 0 3,161 Total Earmarked (2,840) 1,805 2,126 0 Unallocated General Fund 0 696 696 3,161 General Fund (2,840) 2,501 2,822 287
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Bank and Agency Costs to Month 12 Appendix E 1) NHS 4863 (Registered) 4864 (Unregistered) 4853 (Registered) 4854 (Unregistered) 4865 (Agency Locum Consultant) TOTAL WARD 1 WOODLANDS VIEW 60,922 280,019 340,941 WARD 2 WOODLANDS VIEW 37,124 393,222 430,346 ACH REDBURN REHAB WARD NRS 28,452 201,176 229,628 ACH DOUGLAS GRANT REHAB WD NRS 40,988 90,818 131,806 WARD 3 WOODLANDS VIEW NURSING 18,331 398,794 417,125 WARD 4 WOODLANDS VIEW NURSING 1,605 47,818 49,423 NEW CLONBEITH NURSING(JURA) 107,350 226,413 333,763 WVIEW THE GLEN ECT 7,557 17,141 24,698 WVIEW WARD 10 ACUTE MH NRS 6,317 279,013 285,330 WVIEW WARD 8 ACUTE MH NRS 28,592 962,429 991,021 WARD 5 WOODLANDS VIEW 13,817 57,428 71,245 WVIEW WARD 7B REHAB MH NRS 7,419 7,419 NEW DUNURE NURSING(CLONBEITH) 47,355 268,025 315,380 MH BED MANAGEMENT 23,103 23,103 TRINDLEMOSS 68,599 365,791 434,390 ARRAN HOSPITAL NURSING 86,743 44,923 131,666 CAMHS MANAGEMENT 4,277 4,277 CAMHS UNSCHEDULED CARE 5,553 5,553 EARLY YRS-C/F TEAM 1 923 923 EARLY YRS-C/F TEAM 3 974 974 IMMUNISATION NURSING 58,197 17,963 76,160 ARRAN HV 310 310 ARRAN DN 14,639 14,639 PACKAGE OF CARE (P) - AMG 132,212 132,212 PACKAGE OF CARE (P) - LMO 879 879 NC POC TEAM 2 1,564 1,564 NC POC TEAM 3 4,118 4,118 THREE TOWNS DN 4,832 4,832 FOXGROVE(NSAIS)ADVANCE RECRUIT 484 31,222 31,705 NORTH AHP MANAGEMENT TEAM 10,427 10,427 IRVINE DN 17,034 17,034 NORTH WEST COAST DN 36,971 36,971 GARNOCK VALLEY DN 58,791 58,791 LADY MARGARET NURSING 11,850 6,641 18,491 PREVENTION + SERVICES SPT TEAM 4,719 4,719 LD HEALTH CHECKS 12,238 12,238 NORTH CLDT 10,607 164 10,771 LDS MANAGEMENT 2,332 2,332 MHANPS MH UNSCHEDULED CARE 46,079 695 46,774 MHS INPATIENT MGT 16,784 496 17,280 CMHT NURSING-NORTH AYRSHIRE 9,362 5,683 15,045 WVIEW WARD 7C FORENSIC REHAB N 11,492 176,046 371 187,909 INTENSIVE COMMUNITY NURSING TEAM 59,112 6,643 65,755 ADULT MENTAL HEALTH LIASION TEAM 1,368 1,368 PCMHT NORTH 4,108 4,108 WVIEW WARD 6 LOW SECURE NRS 68,785 181,082 249,867 WARRIX AVE 140,132 104,622 244,754 ICFN - COMMUNITY PHLEBOTOMY 15,604 15,604 FORENSIC PSYCHOLOGY 6,164 6,164 CHILD HEALTH ADMIN 25,610 1,797 27,407 WVIEW WARD 7A LD A+T NRS 33,772 425,962 1,804 14,532 476,070 WVIEW WARD 9 ACUTE MH NRS 67,128 512,017 441 129 579,715 WVIEW WARD 11 ACUTE MH NRS 467,924 467,924 ADULT EAST 1,131 1,131 OLD AGE 104,562 104,562 ACTION 15 - ADV NURSE PRACT 202 202 1,319,103 5,736,769 2,616 14,661 105,693 7,178,842 2) SOCIAL CARE Mth 12 Spend 379,445 236,558 15,019 69,547 700,569 Mh Acm Ld Acm Agency Montrose House Brodick Unscheduled Care Funding Bank 288
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Appendix F APPENDIX F Lead Partnership Report Background: The Integration Scheme creates various Lead Partnership roles across the three Ayrshire Integration Joint Boards. Each IJB, acting as lead partner, commissions services on behalf of the three Ayrshire IJBs and reclaims the costs involved. This arrangement is treated as an agency arrangement. The projected outturn position for each IJB is adjusted to reflect the impact of Lead Partnership services. The over or underspend in relation to each Lead Partnership services is not fully attributed to that partnership, and a share will be allocated to the other Ayrshire IJBs on an NRAC* basis in line with the agreed risk sharing mechanism. Within the Integration Scheme, as with all delegated budgets, the intention is that services managed under Lead Partnership arrangements should be delivered within budget. Should that not be possible, a financial recovery plan requires to be developed and approved by all three Integration Joint Boards. Should financial recovery plans for Lead Partnership services fail, then all IJBs are required to address any shortfalls which are not related to base line budget issues. There is a requirement for the 3 IJBs to be aware of the position for Lead Partnership services and plans to deliver services from within allocated budget. *NRAC and the percentage information is explained later in the report 289
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1. SUMMARY – Position After Earmarking 1.1 The summary of the financial position month 12 is given in the table below: Further detail by IJB is given below. Allocation of Variance IJB Area of Service Period Covered Budget £’000’s Actual Outturn £’000’s Variance £’000’s North £’000’s South £’000’s East £’000’s North Mental Health Lead Partnership 2025-26 73,233 73,248 (15) (6) (4) (5) North Children Lead Partnership 2025-26 861 802 59 22 18 19 South Community Store 2025-26 1,704 1,695 9 3 3 3 South Family Nurse Partnership 2025-26 2,808 2,817 (9) (3) (3) (3) South Continence Team 2025-26 573 727 (154) (57) (48) (49) East Primary Care (including Dental) 2025-26 144,334 144,449 (115) (42) (36) (37) East Prison and Police Healthcare 2025-26 4,236 4,070 166 61 52 53 East Allied Health Professionals (Lead) 2025-26 5,554 5,285 259 96 81 82 East Other Lead Services 2025-26 2,324 2,394 (70) (26) (22) (22) 2. North Ayrshire: Month 12 2.1 Services managed under Lead Partnership arrangements by North Ayrshire Integration Joint Board are underspent by £0.044m in total. This equates to 0.1% of delegated Lead Partnership budget. 2.2 Allocation of Variance IJB Area of Service Budget £000’s Outturn £000’s Variance £000’s North £000’s South £000’s East £000’s North Mental Health Lead Partnership – pre earmarking 73,233 73,115 118 44 36 38 Earmarking – Early Intervention in Psychosis 133 (133) (51) (39) (43) Outturn post earmarking 73,233 73,248 (15) (7) (3) (5) North Children Lead Partnership 861 802 59 22 18 19 TOTAL 74,094 74,050 44 290
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2.3 • The Lead Partnership for Mental Health is £0.015m overspent (£0.626m favourable) and the main variances are as follows: • Adult Inpatients – overspend by £1.155m (£0.318m favourable) due to very high levels of occupancy, patient mix and complexity and levels of continuous intervention which require additional supplementary staff and enhanced observations (1:1 and 2:1) and use of bank staff. The favourable movement is due to a recharge to another health authority for a patient. • The UNPACS (Unplanned Activities) budget – overspend of £1.018m (£0.085m favourable) based on current placements. UnPACS placements are for individuals with very specific needs that require a higher level of security and/or care from a staff group with a particular skill set/competence. There are no local NHS secure facilities for women, people with a learning disability or people with neurodevelopmental disorder. This can necessitate an UNPACs placement with a specialist provider which can be out-of-area. The nature of mental health UNPACs spend is that it is almost exclusively on medium- or long-term complex secure residential placements which are very expensive so a small change in placements can have a high budgetary impact. Due to the complexity and risk involved, transitions between units or levels of security can take many months. Applications to approve a placement are made to the Associate Medical Director for Mental Health who needs to be satisfied that the placement is appropriate and unavoidable prior to this being agreed. Part of the additional control measures agreed in month 3 was to expand the high-cost care package review group to include all UNPACS placement requests. • Learning Disability Services – overspend of £0.655m (£0.187m adverse). The overspend relates to the delay in achieving the saving from Ward 7A. Whilst the ward closed there are still legacy costs as the staff are still being redeployed and some patients remain within Woodland View. Additionally, the recharges in relation to moving from a health to social care model at Trindlemoss House were higher than projected. • Elderly Inpatients – overspend of £0.153m (£0.050m adverse) due to the use of supplementary staffing. The elderly mental health wards continue to operate at full occupancy with waiting lists, with several patients who are on enhanced observations and bank costs remain high. • Eating Disorders – overspend of £0.136m (£0.001m favourable) due to the staffing level being higher than the funding allocation. This is being considered alongside the overall resource allocation. • Enhanced Mental Health Outcome Framework (EMHOF) – underspend of £0.624m (no movement). There was £0.624m of reserves held for EMHOF and the recovery plan approved the draw down of these reserves. • Psychiatry – is overspent by £0.233m (£0.122m favourable) . The favourable movement is due to receiving additional dean funding. A 291
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wholescale workforce review has been commissioned to determine longer term solutions for sustainability. • MH Pharmacy/Substitute Prescribing – is underspent by £0.260m (£0.041m favourable). The favourable movement is due a further pharmacy rebate. Prior to rebates there was an overspend due to increased demand and cost of medicines, and particularly the cost of Buvidal. This position is after investing £0.510m on a Pan Ayrshire basis (£0.170m per HSCP). • Action 15 – is underspent by of £0.455m (£0.043m favourable). There was £0.487m of reserves held for Action 15 and the recovery plan approved the draw down of these reserves which is the main reason for the underspend. The underspend is after considering the legacy costs from the 2024-25 review of funding. • The turnover target for vacancy savings for the Lead Partnership is held within the Lead Partnership as this is a Pan-Ayrshire target. There is an over recovery of the vacancy savings target of £1.406m (adverse movement of £0.006m) in 2025-26. Further information is included in the table below: Vacancy Savings Target (£1.160m) Projected to March 2026 £2.566m Over/(Under) Achievement £1.406m 2.4 Recovery Plan Action • The Chief Officer and Chief Finance Officer held a rolling programme of one-to- one meetings with individual budget holders across the HSCP to consider opportunities for cost reduction, service change and any spend to save propositions – to support the development of the 2026/27 budget but also to identify further cost reductions for the current financial year. • High-cost care package group – the remit of this group will be expanded to include all UNPACs placement requests. • Seek to improve sickness absence rates through utilisation of Promoting Attendance Policy • Pursue cross-charge for persons admitted from out-of-area following failed placements in Ayrshire and Arran • Continue to progress implementation of Flexible Intervention Guideline to minimise length of time someone requires 1:1 (or higher) support. 292
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2.5 Performance Information • The elderly and adult mental health wards continue to operate at full occupancy and at times with waiting lists, with several patients who are on enhanced observations and bank costs remain high. 3. South Ayrshire: Month 12 3.1 Services managed under Lead Partnership arrangements by South Integration Joint Board are overspent by £0.154m in total. This equates to 1.9% of delegated Lead Partnership budget. 3.2 The table below includes £0.500m earmarked from Operational Improvement Plan funding to improve whole system flow. Allocation of Variance IJB Area of Service Budget £000’s Outturn £000’s Variance £000’s North £000’s South £000’s East £000’s South Community Store 1,704 1,195 509 3 503 3 South Earmarking – OIP Funding 500 (500) (500) Outturn Post Earmarking 1,704 1,695 9 3 3 3 South Family Nurse Partnership 2,808 2,817 (9) (3) (3) (3) South Continence Team 573 727 (154) (57) (48) (49) TOTAL 5,085 5,239 (154) (57) (48) (4) The main variances are as follows: • Community Equipment Store underspend by £9k, favourable movement of £9k from period 9. The planned recovery action to reduce spend on non-fixed costs in line with budgeted monthly budget has maintained spend in line with budget. Budget Pressure of £0.429m approved by all HSCP's and added to Budget 25/26. Operational Improvement Plan £0.500m funding to support whole system flow and improvement outcomes to mitigate pressures and ensure timely discharge from hospital. The full amount will be earmarked by South for use in 2026-27. • Family Nurse Partnership – overspent by £0.009m, favourable movement of £0.020m from period 9, due to vacancies not expected to be filled by the end of year. FNP – overspent by £0.052m, Scottish Government funding based at midpoint of salary, all posts in place at top of scale. Scottish Government have confirmed an additional £0.250m of funding for 2026-27 to expand service to age 20, the service are working on a proposal of how this funding can be optimised to ensure expansion and mitigate cost pressures. School Student Nurses underspent by £0.043, since period 6 there are now 2 Band 6 nurse vacancies, with one projected to be filled at end of May 26. For 2026-27 this budget has now been split into three HSCP areas in line with management structures. 293
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• Continence – overspent by £0.154m. Continence Advisors £0.023m overspend 0.32FTE @ Band 3 additional to establishment £12k, and 1 B6 £10k who is now redeployed. Supplies £0.132mm overspend, increase in costs due to an allocation issue, costs were coded to North in error. Costs now allocated correctly to Pan Ayrshire continence supplies. Financial pressure for 2026-27 now that all Nursing home residents are being coded to the correct code in South Partnership. This years’ outturn included £36k Ontex rebate (£25k 24-25 and £11k 25-26). Therefore, overspend would have been £168k. Remedial action required by service manager to ensure budget can be managed in 2026-27. Work ongoing with provider and DN teams across A&A to reduce spend to look at practice of continence assessments and use of different products 3.3 Recovery Plan Action Community Equipment Store – None required. Family Nurse Partnership- Additional Scottish Government funding to mitigate financial pressure and expand service delivery. Continence Team - Work ongoing with provider and DN teams across A&A to reduce spend to look at practice of continence assessments and use of different products. Action plans to be developed. 3.4 Performance Information To be further developed 4. East Ayrshire: Month 12 4.1 Services managed under Lead Partnership arrangements by East Ayrshire Integration Joint Board draft final outturn position of £0.240m underspend in total. This equates to 0.15% of delegated Lead Partnership budget. 4.2 Allocation of the Variance IJB Area of Service Period Covered Budget £’000’s Actual Outturn £’000’s Varianc e £’000’s North £’000’s South £’000’s East £’000’s East Primary Care (including Dental) 2025-26 144,334 143,083 1,251 141 826 284 East Earmarking Primary Care 2025-26 1,366 (1,366) (183) (862) (321) East Outturn post earmarking 144,334 144,449 (115) (42) (36) (37) East Prison and Police Healthcare 2025-26 4,236 4,070 166 61 52 53 East Allied Health Professionals (Lead) 2025-26 5,544 5,285 259 96 81 82 294
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East Other Lead Services 2025-26 2,324 2,394 (70) (26) (22) (22) EAST TOTAL 156,438 156,198 240 89 75 76 The main variances are as follows: • Allied Health Professions (Lead Partnership) - There is an underspend of £0.259m on AHPs services hosted by East Ayrshire for the current year, which mainly relates to staffing savings. An increase in overall supplies expenditure has seen an adverse movement from month 9 projected underspend £0.378m. • Primary Care and Out of Hours Services (Lead Partnership) - The Primary Care and Out of Hours Services £144.334 budget had an overspend of £0.115m, which is a favourable movement from £1.581m at month 9 • The projected overspend at month 9 included two provisions in relation to backdated Ayrshire Urgent Care Services holiday pay from 1 July 2023 to 30 June 2025 based on 12.8% of total cost paid over that period and five years of backdated Statutory Maternity Pay in GP Practices costing £1.350m and £0.156m retrospectively. However, following discussion with the NHS Ayrshire & Arran Interim Chief Executive and Director of Finance, it had considered prudent to include these provisions within the projected outturn for 2025/26, but following a decision by NHS Board the Ayrshire Urgent Care Service provisions were held centrally. • Underspends within Primary Care Contracting and Support £0.991m. The favourable movement relates to a budget realignment of historic savings following work undertaken to finalise the funding source, partially offset by adverse variances, including new Office 365 licence costs and additional spend related to the GP Sub- Committee and staffing costs. Primary Medical Services had an overspend of £1.978m, largely due to increased pension and sickness cover costs. Primary Medical Services payments also show an overspend due to additional IT costs. These additional costs were partially offset by an underspend of £0.239m (£0.159m at month 9) against Ayrshire Urgent Care Services. Funding had been allocated to partially offset Urgent Care Pathway costs £1.084m (additional £0.260m from month 9) but spent £0.017m over allocation. Funding had also been allocated to Covid-19 Therapeutics of £0.274m, with costs of £0.205m. • The final underspend of £0.581m (£0.505m at month 9) in Dental services that reflects that staffing numbers are running at less than establishment, alongside reduced equipment costs • Prison and Police Healthcare (Lead Partnership) - Underspend of £0.166m (£0.147m underspend month 9) is due to realignment of budget of £0.192m to offset additional prescribing costs. Prison prescribing was highlighted as a budget pressure as part of the 2025/26 budget. Both East Ayrshire and South Ayrshire IJBs had approved additional funding to offset this pressure however North Ayrshire IJB did not provide for this in their approved budget. The additional funding has now been allocated against the prescribing budget at this stage, with North Ayrshire IJB agreeing to allocate additional funding towards Specialist Mental Health Unplanned Activities (UnPACS) (hosted in North Ayrshire) to account for this in the current financial year, 295
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with work to be undertaken to align resources as part of the 2026/27 budget-setting process. • Other Services (Lead Partnership) - The £0.070m overspend (£0.066m overspend month 9) is due to reduced Area Wide Evening Services, with continuing Palliative Care Services cost pressures. • Palliative Care Services budgets continue to be closely monitored and reviewed; however increased costs largely reflect demand for provision of services. This pressure has been considered on a pan-Ayrshire basis and as part of the 2026/27 budget-setting process. • Children’s Services - The £0.179m underspend (£0.112m underspend at month 9) is largely due to reduced staffing costs. 4.3 Recovery Plan Action The East Ayrshire Lead Partnership Draft Final Outturn of £0.238m underspend which is a favourable movement from month 9. Following a decision by NHS Board the Ayrshire Urgent Care Service provisions for holiday pay from 1 July 2023 to 30 June 2025 and five years of backdated Statutory Maternity Pay in GP Practices costing provisions were held centrally. No additional Financial Recovery Plan proposals for East Ayrshire hosted services are included within this report. 4.4 Performance Information To be further developed 5. NRAC 5.1 NRAC is the NHS Scotland Resource Allocation Committee Formula, a method to allocate funding to NHS Scotland Health Boards. Its primary objective is to promote equitable access to healthcare by assessing each board's relative need based on factors like population size, characteristics influencing healthcare needs, and service delivery costs. The formula sets "target shares" for funding distribution, although final allocations may differ to ensure funding stability. 6. Reporting Cycle North: Month 3,4,6,7,9,10 and 12 South: Month 3,6,9,10 and 12 East: Month 2, 4, 6, 9 and 12 296
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Integration Joint Board 18th June 2026 Subject : Eligibility Criteria Implementation Purpose : The purpose of this report is to provide an update on the HSCP’s implementation of the changes to the Eligibility Criteria to critical only:- • Awareness Recommendation : The Integration Joint Board are asked to note the contents of the report and progress to date. Direction Required to Council, Health Board or Both Direction to :- 1. No Direction Required 2. North Ayrshire Council 3. NHS Ayrshire & Arran 4. North Ayrshire Council and NHS Ayrshire & Arran Glossary of Terms NHS AA NHS Ayrshire and Arran HSCP Health and Social Care Partnership ECPB Eligibility Criteria Programme Board ECRIA Equality and Children’s Rights Impact Assessment 1. EXECUTIVE SUMMARY 1.1 This report provides the Integration Joint Board with an update on the implementation of the revised Eligibility Criteria Policy for adult social work and social care services, following the decision taken on 13 March 2026 to move to a Critical Only funding threshold from 1 April 2026. The policy change was agreed as part of the response to the significant and ongoing financial pressures facing the IJB, with the aim of aligning demand for funded adult social care with the resources available while continuing to meet statutory duties in relation to assessment, safeguarding, human rights, unpaid carers and Self-Directed Support. 1.2 Implementation is being overseen through the Eligibility Criteria Programme Board, chaired by the Director of the HSCP. A phased programme of staff engagement, training and support has been undertaken, alongside the development of guidance, communications and supporting materials. A structured programme of assessment and reassessment is now underway, with individuals prioritised through service-based cohorts informed by previous assessment dates, current assessed need, financial implications and risk. The current aim is for all assessments and reassessments to be completed by 31 October 2026. Agenda Item 8 297
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A monitoring framework has been established to track delivery, financial impact and wider strategic and operational consequences, including impacts on unmet need, unpaid carers, Adult Support and Protection activity, complaints, waiting lists, staff wellbeing and demand across services. While early implementation data remains limited, further evidence is expected to emerge over the coming months. Current reporting has been affected by system constraints, particularly the absence of full integration between Eclipse and finance systems; however, process mapping and weekly monitoring arrangements are being progressed to improve reporting and assurance. The report recognises that the move to Critical Only eligibility may have significant implications for individuals, unpaid carers, staff and wider community supports, particularly in the context of North Ayrshire’s existing socio-economic and health inequalities. The IJB is therefore asked to note the progress made to date, the governance and monitoring arrangements in place, and the ongoing work to assess the financial, operational and equality impacts of implementation. 2. BACKGROUND 2.1 At the meeting of the Integration Joint Board of 13th March 2026, the IJB approved the implementation of a revised Eligibility Policy for funded adult social work and social care services, establishing a Critical Only funding threshold for ongoing, commissioned supports. The IJB were asked to approve the policy as a means to balance the IJB budget moving into 2026/27 and to align the demand for social care services to the available resources. The IJB approved that the policy would come into effect from 1 April 2026, with HSCP staff therefore aligning ongoing access to services to the new policy. In practice this means that funded support will be provided when a person’s needs meet the Critical risk descriptor, defined as; • immediate or imminent danger to life or severe deterioration in health; • serious self-neglect where no safe alternative exists; • risk of abuse, exploitation or harm requiring urgent protective action; • breakdown of essential care arrangements leading to unsafe circumstances; • risk of hospital or care home admission avoidable only through urgent support. This would apply to all new assessments from 1 April 2026 and to existing service users at their next scheduled review after that date. Statutory duties to assess need, safeguard individuals, uphold human rights support unpaid carers, and provide Self-Directed Support options remain fully unchanged. 298
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2.2 The IJB continues to face a significant and ongoing challenge in delivering delegated Health and Social Care services within the resources available from partner bodies. While the move the Critical Only was introduced in April 2026, the financial challenge is not limited to 2026/27: the medium-term outlook remains difficult, with projected Social Care budget gaps forecast into future years. This indicates that the Partnership is facing sustained structural financial pressure rather than a one-year budget issue. 2.3 The wider service context is also important and has a compounding impact on delivering health and social care services in North Ayrshire. North Ayrshire faces a combination of demographic decline, entrenched inequality, high health burden, and increasing demand on services. These challenges are interconnected and reinforce one another. • North Ayrshire continues to experience significant health inequalities and poorer outcomes than national averages. • Life expectancy is lower than the Scottish average, and healthy life expectancy is the lowest in Scotland for both men and women. • Residents spend a substantial proportion of their lives in poor health, indicating a widening gap between longevity and quality of life. • These outcomes are closely linked to underlying socioeconomic factors, including deprivation and long-standing inequalities. 2.4 While the financial pressures facing North Ayrshire are not unique and are also being faced and experienced by other Partnerships across Scotland, the socio-economic situation provides an additional challenge. That said, more locally, East Ayrshire HSCP is currently undertaking a period of consultation to determine the measures needed to ensure that they are able to meet their budgetary commitments including a potential move to critical eligibility criteria. In addition, South Ayrshire presented a paper to its Council Cabinet meeting to reconfirm their position that funded adult social care would only be provided to those individuals who meet the critical only eligibility criteria. As such, should East Ayrshire HSCP recommend similar measures, all three Ayrshire HSCPs will be applying a consistent Critical Only policy across adult social care. 2.5 In developing the Critical Only policy, the HSCP undertook extensive public consultation with residents, staff, service users and providers. This consultation sought to address two main principles: firstly to communicate the challenges being faced; and secondly, to understand the views of our colleagues and those within our communities. 2.6 Transitioning to Critical-Only eligibility is expected to have significant consequences for individuals with substantial needs, who may no longer routinely receive funded ongoing support. This could increase risks of social isolation, declining physical and mental health, loss of independence, and greater reliance on unpaid carers. 299
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The proposal to IJB in March was accompanied by a detailed Equality and Children’s Rights Impact Assessment which highlighted a number of areas that the Partnership would monitor as the policy of Critical Only funded social care is implemented. The ECRIA identified stated that monitoring would focus on identifying unintended harm, escalation of risk and disproportionate impacts on protected characteristic groups. 2.7 The HSCP is mindful of the complexities of implementing the Critical Only policy and the wider impacts it is expected to have and has therefore established appropriate governance arrangements. A new Programme Board, chaired by the Director of the HSCP, has been established to provide oversight of the policy’s implementation. With the Programme Board meeting fortnightly since the Policy was approved, the Board is responsible for oversight and planning for a number of areas: • Implementation of the revised eligibility criteria across adult social work and social care services • Assurance that statutory duties (including assessment, safeguarding and Self-Directed Support) continue to be discharged • Workforce readiness, including guidance, training and staff support • Governance arrangements for access, decision-making and resource allocation • Monitoring of demand, risk patterns, unmet need and system impacts • Equality, human rights and children’s rights considerations • Internal and external communications, including with staff, partners, providers and the public • Reporting and escalation to senior governance forums, including the IJB • Monitoring of progress, including that the policy change is meeting the anticipated budget targets. 2.8 Providing support to staff who are implementing the policy has been an early area of focus for the Partnership. Since late March a number of in-person training and development sessions have taken place, specifically designed for the number of different staffing groups who are directly or indirectly impacted by the change to the criteria. These workforce sessions have been broken down into 3 distinct phases: • Phase 1 included 4 face to face sessions undertaken with Adult Services Social Work Staff. Over 200 members of staff were invited and there was an overall attendance rate of 87%. Discussion took place regarding the change of eligibility, the definitions to be applied, the importance of individualised assessment and the impact of the changes in terms of both the management of risk and equity of provision. Senior Leadership were present at all sessions, with frontline staff provided the opportunity to ask questions both as part of a larger group and as part of smaller group discussions. 300
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• Phase 2 included 4 sessions undertaken with wider social work and social care staff, including children’s services and justice services. There was a lower level of take up for these sessions, and 2 mop up sessions are planned to ensure that all social work staff within the organisation have all the necessary information required. • Phase 3 commenced on 1st June 2026 and incorporates engagement with the wider system. Different formats of engagement will be used to ensure the wider workforce and organisation will have the opportunity to hear first-hand the principles behind the change, and the vision going forward. Ongoing engagement will include drop in and hybrid sessions, as well as webinars. The staff sessions have afforded the workforce to request the support they require from the organisation to implement the Policy, staff at the session have been listened to and provided with a detailed information pack, which contains: • Eligibility Criteria Policy • Eligibility Criteria Guidance • SDS Policy • North Ayrshire Directory of Services • Supervision Standards • Your Wellbeing at Work leaflet • Access to Frequently Asked Questions • Standard letter templates 2.9 Staff are also being supported with new technology to support their day to day work through the implementation of Magic Notes, an AI tool which allows social workers the ability to record assessment and/or reassessment meetings with individuals. An initial 8 week pilot of Magic Notes with the Mental Health and Learning Disability Social Work Teams took place over March and April and has highlighted significant benefits among this using the software, including: • Increased productivity, with average identified time savings of 3.5 hours per week per social worker • Improved engagement with service users. • Increased quality of written reports. • Quicker submission of written work: one team confirmed that Magic Notes has more than halved the time it takes to produce assessment documents. • Positive impact to staff wellbeing. Given the significant benefits experienced in the pilot group and the benefits to supporting assessment and reviews the HSCP are now developing a plan to scale up and implement the system across all social work teams in North Ayrshire. A detailed implementation plan will be produced for roll out over the summer. 301
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2.10 The policy is now therefore being implemented and embedded across North Ayrshire. The HSCP must also ensure that existing service users are re-assessed appropriately in line with the new policy guidelines. A programme of assessment and reassessment has therefore commenced, with staff receiving appropriate support to ensure this work is undertaken effectively. Cohorts have been identified to ensure reviews of existing service users are undertaken timeously and in a priority order which supports the safe and sustainable implementation of the Policy. At the commencement of reviews there were 2,479 service users aligned across all 3 cohorts requiring assessment or reassessment against the Critical Only eligibility criteria. This is a risk-based approach with the cohorts being determined with reference to previous assessment dates, financial implications and current assessed need: • Cohort A includes individuals previously identified as falling below the critical threshold, those with no recorded assessment, and those currently on a waiting list. The distinction between personal and non-personal care is also being considered in determining the priority and urgency of reassessment. • Cohort B comprises individuals with stable needs, no current safeguarding concerns, and access to known community-based support. • Cohort C comprises individuals who have previously been assessed as having critical needs and who are known to have fluctuating or complex circumstances. Risk management remains central to all assessments and reassessments, recognising that individual need and safeguarding considerations must remain paramount. Target completion dates have been identified for each cohort; however, these are subject to ongoing monitoring and review to ensure that timescales remain realistic and appropriate. The current aim is for all assessments and reassessments to be completed by 31st October 2026. Current data indicates that assessments and reassessments are taking an average of 15 working days to complete, with a median completion time of 7 working days. These figures should be interpreted with caution, as they may be affected by a small number of outlying assessment timescales. Following consultation with teams and service leads, it is estimated that each social worker will complete between 6 and 8 assessments per month. On this basis, approximately 2,300 assessments are expected to be completed by 31st October 2026, which is slightly below the overall target of 2,479. It should also be highlighted that this requires to be progressed alongside the day to day work and operational demands placed on our front line practitioners. 302
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2.11 All Services discuss the outcomes of reassessments and assessments at existing Allocation Resource Groups (ARGs). These groups provide oversight and allow senior leadership decision making in terms of the appropriateness of funded care packages and to ensure a consistent and equitable approach is taken to decision-making. This has become an essential part of governance in the change to critical only eligibility, with outcomes being reviewed to ensure that the eligibility criteria is being applied consistently. All ARGs are chaired by the Head of Service or an appropriate delegated Senior Manager, with appropriate budget responsibilities. However, where an individuals’ assessed need or the outcome of a review requires a package of care in excess of £40,000 per annum, oversight and decision making is thereafter reserved for the High- Cost Care Packages Group, chaired by the Director of the HSCP To ensure equity in policy deployment across ARGs, a review of each group’s Terms of Reference has been conducted, and new groups have been introduced to address any improvements required to oversight and approval. 2.12 The Partnership is taking a structured and proactive approach to communicating with staff on the new eligibility policy, recognising the scale of change and its impact on frontline practice. A coordinated communication and engagement programme has been developed alongside implementation, including the issue of a comprehensive communication pack with supporting FAQs and policy guidance to ensure consistency of messaging across services. This is being complemented by ongoing staff engagement, training and support activity to build understanding and confidence in applying the revised criteria in practice. Communication is also being reinforced through established governance and programme structures, such as the Eligibility Criteria Programme Board and regular team meetings, providing opportunities for updates, discussion and feedback. Collectively, this approach aims to ensure that staff are well-informed, supported and able to deliver the policy in a clear, transparent and consistent way, while maintaining a focus on fairness and person-centred decision making A new intranet site is being designed specifically for HSCP staff to facilitate communication and the accessibility of guidance materials for staff. This will enable the Partnership to more effectively promote news, information and events to staff and to ensure all staff have access to the most current guidance and support materials. 2.13 A framework has been developed to monitor the progress of the policy. This includes tracking the assessments and re-assessments to provide assurance that delivery remains aligned with agreed budget targets, and monitoring the impact of the policy against a number of strategic indicators. Initial complexities have been identified in producing timely progress reports, primarily as a result of system constraints. Last summer the HSCP moved to a social care case management system called Eclipse, however, some system functionality remains to 303
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be held in Carefirst the legacy care management system. This year, an upgraded finance module will be implemented providing integration between the care management system and finance system. At the moment, this is not the case and manual reconciliation is required to appropriately track staff activity across the systems and report on progress. Plans are being developed to resolve this and therefore it is expected that reporting should be made more simple over the coming weeks. Processes are currently being mapped to ensure that assessments and reviews, system updates, reporting arrangements and financial monitoring are aligned and operating as efficiently as possible. This work will help identify any changes to current processes that may be required to address issues relating to access to information, reporting requirements and system functionality. 2.14 As set out in the report to the IJB and with more detail in the ECRIA, there are a number of strategic and operational indicators that will be monitored to understand the wider impacts of the policy. These range from potential increases in the numbers of unpaid carers, ASP referrals unmet need, to impacts on staff wellbeing and levels of complaints from service users regarding not meeting the criteria in the new policy. Available data from a variety of sources has been grouped together to establish a framework to monitor these indicators. Discussions have taken place with Carers Gateway who will provide important data and information to enable more detailed tracking of the impact on unpaid carers, creating a fuller picture and analysis of any impact to date. Other indicators being monitored include: freedom of Information requests, referrals to Money Smart, waiting lists and service provision statistics. While the policy has been in place for just over two months, few trends have emerged that have highlighted any particular concerns. It is anticipated that further evidence will emerge over the coming months to determine where the impact of the policy is having most impact. It remains too early in the financial year to determine if the outcome from the ongoing reviews is going to deliver at the scale required to fully address the IJB budget gap. 3. PROPOSALS 3.1 It is proposed that the IJB note the contents of the report and the progress made to date. 3.2 Anticipated Outcomes It is anticipated that the work being undertaken in relation to the change to critical only eligibility criteria will address the budget concerns identified. Individuals will be assessed and reassessed by applying this new threshold going forward, with the aim 304
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being, that less adults will be provided funded social care, or adults will receive reduced social care packages. 3.3 Measuring Impact The HSCP is monitoring the impact of this change on an ongoing basis, with further insight and financial information being available for the next IJB meeting on 20th August 2026. 4. IMPLICATIONS 4.1 Financial Should the necessary targets identified to meet the financial position of the HSCP not be met under this programme of work, it will become necessary to revisit service provision, with there being a potential need to implement alternative financial recovery measures. 4.2 Human Resources None. 4.3 Legal None. 4.4 Equality/Socio-Economic The necessary ECRIA documentation was submitted prior to the IJB meeting on 13th March 2026, at which time agreement was reached to implement the changes to eligibility criteria. However, it is recognised that where early intervention services are not available to individuals and communities, there is an increased risk of individuals reaching the threshold for critical need. 4.5 Risk Without a revised eligibility framework, there is a risk that waiting lists would continue to increase at an unsustainable rate, creating significant implications for individuals, services and the wider system. These risks include unmanaged deterioration in need, increased safeguarding concerns, additional moral and ethical pressure on the workforce, greater regulatory scrutiny and escalating longer-term costs. The application of a Critical Only threshold provides a clearer and more consistent basis for prioritising resources, supports financial sustainability and helps ensure that those assessed as being at greatest risk receive priority access to funded support. 4.6 Community Wealth Building None 305
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4.7 Key Priorities The successful delivery of the Eligibility Criteria Policy is important to ensure that social care services are able to be delivered from within the resources available, therefore protecting other areas of service from unplanned reductions, the growing of unmanageable waiting lists and ultimately to protect the ongoing delivery of statutory social work and social care services. 5. CONSULTATION Consultation with staff has been central to the implementation of the revised Eligibility Criteria Policy. As the policy was developed, staff have been actively involved during the engagement phases in December and January. Since late March 2026, the HSCP has delivered a phased programme of in-person engagement, training and development activity for staff directly and indirectly affected by the move to a Critical Only threshold. Feedback from staff has also informed the practical support made available during implementation including frequently asked questions. Consultation with staff will continue as drop-in and hybrid sessions, webinars, regular team discussions, programme updates and new communication sites are organised and developed. Caroline Cameron, Director Author : Stuart MacMillan, Principal Manager, Planning, Performance & Transformation Background Papers IJB – 13 Mar 2026 – Budget consultation & Eligibility Criteria for Social Services 306
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Integration Joint Board 18th June 2026 Subject: Self-directed Support (SDS) Policy Purpose: To seek approval from IJB members to implement and embed the accompanying SDS Policy Recommendation: IJB are asked to: • Approve the SDS Policy • Support the implementation approach • Note the impact of the policy in strengthening consistency, transparency and sustainability in SDS practice Direction Required to Council, Health Board or Both Direction to: - 1. No Direction Required X 2. North Ayrshire Council 3. NHS Ayrshire & Arran 4. North Ayrshire Council and NHS Ayrshire & Arran Glossary of Terms NHS AA NHS Ayrshire and Arran IJB Integration Joint Board HSCP Health and Social Care Partnership SDS Self Directed Support ISF Individual Service Funds 1. EXECUTIVE SUMMARY 1.1 This report seeks approval of the Self-directed Support Policy and implementation approach to continuing to embed SDS to support consistent, lawful and person- centred delivery of social care across North Ayrshire Health & Social Care Partnership (NAHSCP) services. 1.2 The policy strengthens the delivery of SDS in line with statutory duties, it ensures people can have choice, control and involvement in their care and support through the four SDS options and is underpinned by human rights-based principles and values and personalised practice. 1.3 The framework supports implementation within new critical levels whilst promoting proportionate, strengths-based assessment and ensuring all individuals regardless receive good information, advice and relevant signposting to access support to live their lives. 1.4 The policy provides a sound and consistent framework to improve individual outcomes, enhance governance and support sustainable care delivery. Agenda Item 9 307
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2. BACKGROUND 2.1 Self-directed Support (SDS) is the statutory framework for the delivery of social care in Scotland under the Social Care (Self-directed Support) (Scotland) Act 2013 and is central to enabling choice, control and personalisation in care and support arrangements across all adult and children’s services. 2.2 The existing practice guidance has been reviewed. This reflected the need for an overarching policy and ongoing development of new guidance in line with national and local changes. The policy reaffirms NAHSCP’s responsibility to meet statutory duties whilst reflecting: • Updated legislative and national policy requirements, including the SDS Framework of Standards (2024) which highlights what good SDS looks like. • Evolving practice expectations, including strengthening of rights based, person centred and outcomes focused approaches. • Local strategic and practice priorities, including managing increasing demand, changing criteria and complexity in social care services. 2.3 The policy also aligns with NAHSCP’s commitment to uphold: • Human rights and social justice • Personalisation and independent living • Sustainable and where possible, flexible service delivery models 2.4 The policy ensures SDS continues to be the approach and mechanism for delivering personalised care and support and works in tangent with increased eligibility levels to provide clarity on how and when funded services are accessed. 3. PROPOSALS 3.1 The key proposals and priorities of the policy framework and supporting resources are: 1. Strengthening Choice and Control: all eligible individuals must be offered the four SDS options (below) ensuring there is no default model of care and that people are enabled to make informed choices about how their support is directed, managed and delivered. • Option 1 – Direct Payment (most choice and control) • Option 2 – Individual Service Fund (some choice and control) • Option 3 – Arranged Support (least choice and control) • Option 4 – A mix of the above 3 options 2. Embedding Human Rights and Person-Centred Practice: applying SDS principles and values into practice across assessment, support planning and review. This includes better coproduction with people and their carers, building effective relationships with people and ensuring practice is outcomes focused and based on a person’s strengths not deficits. 308
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3. Clear Application of Critical Only Access: the policy provides a clear and transparent approach to eligibility and ensures decisions are proportionate, fair and defensible. 4. Maintaining Support for Those Not Eligible for Funded Support: individuals who do not meet critical thresholds must receive good information, advice and be signposted to community, independent or universal supports, helping them to continue to make informed choices and to prevent escalation of need. 5. Improved Financial Governance and Accountability: there is stronger emphasis on clear, consistent, accountable management around individual budgets. There are explicit expectations around how Direct Payments should be used ensuring they are aligned with individual assessed need and personal outcomes as stated in support plans. The policy details robust monitoring and clearer procedures for the recovery of unspent/ or infrequently misused funds supporting responsible stewardship of public funds. 6. Enhancing Safeguarding and Legal Compliance: The policy ensures full alignment with statutory regulations under the SDS Act. It also advises of clear limits where all options of SDS cannot be offered, especially Option 1 Direct Payment. There are stronger safeguarding measures with new directions under the Protection of Vulnerable Groups scheme for those options with more flexible arrangements. As noted in the policy, SDS works in alignment with other models and approaches and does not supersede existing legal frameworks on capacity, protection and risk. 7. Promoting Consistent Practice and Workforce Development: The framework and supporting resources places a strong emphasis on improving the knowledge, understanding and consistency of how we practice SDS across all service areas. This ensures people and their carers receive more equitable coherent experiences of SDS. It promotes that assessment and support planning approaches should be conversational and relationship-based rooted in understanding each individual’s circumstances and what matters to them most to live their life. It is not fitting people into services. It is encouraging strengths- based practice and positive risk taking to balance independence and safety. The policy also reinforces the need to re-offer SDS options at review as individual circumstances evolve and needs or preferences change. This supports ongoing choice and control and requires systems that provides easier ways to accommodate this. 8. Strengthens Partnership Working and Market Development: With SDS there is opportunity to explore the care market and seek and direct support from a variety of different organisations. The policy supports this route and encourages growth in the wider range of care options. This approach helps move away from reliance of traditional service models and enables often more innovative, personalised, lower cost, responsive care solutions for people. 309
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The framework recognises the critical role of independent advice, advocacy and support services which enable people to make informed choices about their care. In North as part of a pan Ayrshire commitment, we commission the support of Ayrshire Independent Living Network (AILN) who help people make good care choices for their life. Continued investment in these supports is a core component of effective SDS delivery. The policy also places importance on connections with community and third sector supports recognising their part in early intervention and ongoing wellbeing. Integrating the use of these into pre assessment and support planning process again helps people to access a broader range of support beyond statutory services. 3.2 Anticipated Outcomes The intended positive impact of the SDS Policy will be seen at an individual, workforce and systems levels. The framework results in choice, control and involvement for individuals in their care and support by consistently offering the four SDS options and applying person- centred approaches. People will be better supported to shape services round their outcomes leading to improved satisfaction, increased independence and better overall wellbeing. For those who may not meet new levels of criteria the framework ensures continued access to information, advice, signposting and community supports with a focus on prevention. For the workforce the resources highlighted throughout the report will lead to increased knowledge, confidence and consistency with a feeling of being better equipped to carry out strengths-based assessments, have meaningful conversations and apply professional judgement in a fair and equitable way. With the SDS Group we hope to create the space and conditions needed to embed a culture of learning, trust and professional autonomy. At system and service level it is expected to deliver consistency and transparency in decision making with clearer guidance and enhanced monitoring. Financially, increased uptake and effective use of SDS options could support more efficient use of resources whilst maintaining a focus on person centred care. The framework also has potential to contribute to the development of an improved local care market with increased engagement of different and new providers, supporting greater choice and flexibility for individuals. 310
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3.3 Measuring Impact At an operational level, impact can be measured by monitoring the offer of SDS options and their uptake captured in the assessment frameworks for both adults and children, including any shifts away from traditional service models through the number of Option 1 – Direct Payments and Option 2 – Individual Service Funds (ISF). Currently there are 180 people and families managing a Direct Payment and 347 using an ISF. All other people supported by NAHSCP are choosing or being directed through Option 3 - arranged services. Review of care package activity will also demonstrate changes, or whether processes are becoming more consistent or efficient. It will also capture progress of personal outcomes and if people’s needs are being met through increased independence or positive experiences of care, for example. Impact will also be measured through financial monitoring overall across service budgets, but more specifically in relation to Direct Payments to track the use of funds, level of unspent funds etc showing financial compliance, strengthened accountability and best value. Workforce confidence will be measured through training uptake, staff feedback and reflective practice at the SDS Advice and Practice Group. System-wide impact will also be considered through diversity of use of providers, new providers coming onto NAHSCP Framework, more use of community supports and increased engagement with independent information, advice and support services for SDS. Finally regular reporting through governance structures, aligned to the SDS Standards and Framework will allow NAHSCP to identify and respond to areas for improvement with refined practice over time. 4. IMPLICATIONS 4.1 Financial The policy and approach will not create any additional cost pressures in the immediate term. SDS often supports cost savings due to preventative approaches, using community resources and directing individual funds towards personal assistant, third sector or private provision which operate with lower overheads than traditional services. The policy also strengthens the governance and oversight of existing resources, particularly in relation to Option 1 – Direct Payments. It introduces clearer expectations around the use of public funds, monitoring arrangements and accountability, supporting more consistent allocation of resources based on assessed, eligible need. 311
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4.2 Human Resources The policy will require a period of practice development. Social Work staff will be supported through iLearn training, quarterly dedicated sessions commencing in September with national partners Social Work Scotland SDS team and In Control Scotland. There is a specific delivery on SDS as a follow on from the eligibility criteria sessions being developed. A new dedicated SDS website for North Ayrshire staff and public was launched in May and has 362 users so far. We will continue to promote the resource through a Communications Plan across teams and local partners. All learning and resources are to ensure consistent understanding and application of SDS principles, options and support planning approaches. The policy also provides opportunity to enhance professional autonomy, confidence and clearer decision-making around outcomes focused practice and individual budgets. This is hoped to build confidence and improve consistency and quality of practice across teams. 4.3 Legal The new policy framework reinforces the statutory duties that NAHSCP need to continue to meet. It also reflects the wider legislative duties for adults, children and families and unpaid carers ensuring SDS is not applied in isolation but as part of the broader framework governing assessment, eligibility and provision of support. The policy further strengthens compliance with human rights, proportionality and fairness in all Social Work tasks. It incorporates legal safeguards relating to Protection of Vulnerable Adults scheme, Adults with Incapacity and financial governance and monitoring. Overall, the policy reduces legal risk by providing clarity, consistency and transparency for practice. 4.4 Equality/ Socio-Economic The policy has human rights and person-centred approaches at the core which actively seeks to ensure all individuals are treated with dignity, respect and fairness. The emphasis on the SDS principles and values ensure that people are meaningfully involved in their care decisions. In strengthening the use of independent information and advice services this helps reduce inequalities of knowledge, confidence and access to options for support. The policy promotes equity and recognises that resources are allocated based on individual assessed need and not uniformly issued. 312
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4.5 Risk Without approval of the policy NAHSCP would be operating without a robust framework aligned to the Social Care (Self-directed Support) (Scotland) Act 2013 and its regulations within. The risk of non-compliance with statutory duties is increased particularly the offer of four SDS options and supporting informed choice. This leads to inconsistent and inequitable practice across teams and services and variable access for people in their options for support. With ongoing economic pressures and increasing demand, there is a significant financial risk. A lack of uptake of SDS options 1 and 2 means there is a default to traditional/ in-house models of care. While appropriate in many cases this may limit opportunities to deliver more cost effective, flexible, outcome focused packages of support. This in turn leads to a reliance on higher-cost service provision. Without clear guidance practitioners may lack the framework for proportionate, defensible decisions and this could be detrimental to encouraging confident, knowledgeable staff with autonomy to make good choices with and for people. People and their carers would experience reduced clarity on their rights, inconsistent access to choice and control with trust undermined, reduced engagement and less coproduction with people. Personal outcomes would not be identified and met. There is potential for reduced evidence for audit and monitoring of public resources. (Moderate) 4.6 Community Wealth Building The SDS policy supports community wealth building by: • Redirecting individual budgets into local, third sector and community-based services. • Promoting local job creation and skills development particularly through the more flexible options 1 and 2 where people can employ their own personal assistant staff or seek the services of self-employed workforce. • Encouraging preventative models of support and signposting back to communities enables innovative and non-traditional solutions for people and families. • Strengthening community capacity and resilience. 4.7 Key Priorities The key priorities are noted at 3.1. 313
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5. CONSULTATION 5.1 The policy has been informed by internal engagement with practice teams, alignment with national guidance/ standards and best practice frameworks and has been endorsed by Partnership Senior Management Team on 6th June 2026. Caroline Cameron, Director Lead: Scott Hunter – Chief Social Work Officer Prepared by: Kimberley Mroz – Policy Manager SDS/ Unpaid Carers/ ILF Scotland 314
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North Ayrshire Health & Social Care Partnership Self-Directed Support Policy DOCUMENT INFORMATION DOCUMENT NAME/ DESCRIPTION Self-directed Support Policy VERSION NO. V4 AUTHOR SDS/ Carers Manager Practice Standards Team LEAD OFFICER/ MANAGER CSWO & Lead for SDS APPROVAL DATE 6th June 2026 APPROVED BY PSMT REVIEW FREQUENCY 3 yearly (sooner if required) SUMMARY OF CHANGES DATE VERSION UPDATE DESCIPTION OF CHANGE(S) 315
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2 CONTENTS Page Introduction 3 Legal Context 3 Principles & Values 4 Four Options of Self-directed Support 5 Limits to Offering Self-directed Support Options 6 Pathways for Self-directed Support 7 Independent Information, Advice and Support 9 Self-directed Support for Children & their Families 10 Charging Policy for North Ayrshire 11 Option 1 – Direct Payment in Detail 11 Employing Family Under Direct Payment 13 Self-Employed Personal Assistant Services 14 Financial Oversight & Termination of Direct Payment 15 Redundancy of Personal Assistant Staff Under Direct Payment 16 Protecting Vulnerable Groups (PVG) Scheme 17 Supported Decision Making (Power of Attorney/ Guardianship) 18 Complaints Process 19 316
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3 1. Introduction 1.1 This policy relates to Self-directed Support (SDS) within North Ayrshire Health and Social Care Partnership (NAHSCP). 1.2 SDS is Scotland’s legislative framework for delivering social care, across all ages and sectors. It is designed to empower all individuals who access social care supports and their unpaid carers, to have greater choice and control over how their support needs are met. SDS is implemented in accordance with the Social Care (Self-directed Support) (Scotland) Act 2013, herein referred to as the Act, which places statutory duties on all Local Authorities to ensure its effective delivery. 1.3 This policy aims to ensure that all relevant staff, partner agencies and those seeking access to social care supports in North Ayrshire have the information they need to make informed choices about care and support options. 1.4 NAHSCP remains dedicated to the evolving social care needs within its communities, ensuring that delivery of support to the people of North Ayrshire is personalised and fit for purpose (meaningful, responsive and effective) in the current social care market. The ongoing implementation of SDS is key to enabling NAHSCP address the pressures of shifting demographics and rising/ changing demand for support, ensuring services remain. 2. Legal Context 2.1 The legislative and national policy context for good SDS delivery at local level is set out in the following: • Social Care (Self Directed Support) (Scotland) Act 2013 & accompanying Statutory Guidance • The Self-directed Support (Direct Payments) (Scotland) Regulations 2014 • Self-directed Support Framework of Standards 2024 • Self-directed Support Improvement Plan: 2023 - 2027 2.2 The basis for identifying and understanding need remains with the following core legislation: • Social Work (Scotland) Act 1968 – Section 12A • Children (Scotland) Act 1995 – Section 23 • Carers (Scotland) Act 2016 – Section 6 2.3 This policy should also be considered in conjunction with other relevant local mechanisms and frameworks, namely: • The North Ayrshire Ethical Care Framework (in development to accompany) • Supported Self-Assessment Questionnaire/ Action Plan/ Positive Risk/ Review and any accompanying practice guidance • Children’s Plan and any accompanying practice guidance 317
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4 • West of Scotland Adult Support & Protection Guidance • West of Scotland Child Protection Procedures • Adult Carer Support Plan and accompanying eligibility/ guidance • Young Carer Statement and accompanying eligibility/ guidance • Social Care Charging Policy (updated annually) 3. Principles and Values 3.1 Self-directed support is rooted in promoting, supporting and protecting people’s human rights, supports independent living and ensures people can take charge of their lives as active citizens. 3.2 SDS is about working together with people, building relationships and involves supportive and equal conversations to understand people’s unique circumstances through meaningful conversation and support planning. SDS ensures people are fully engaged and helps identify individual need and what matters most to achieve individual outcomes. 3.3 SDS delivery is underpinned by a solid value base which promotes respect, fairness, independence, freedom and safety. The values are embedded into practice by applying and upholding the principles of participation and dignity, involvement, informed choice and collaboration. These guide all aspects of social care decision making and service delivery to ensure consistent best practice. 3.4 NAHSCP must ensure the person’s right to dignity is upheld and their right to belong and feel part of their community is respected. 3.5 People, and those with the legal authority (Parent, guardian, Power of Attorney) to make decisions, must have as much involvement as they wish in identifying and understanding their needs and arranging and directing their support, as per their capacity to contribute. The SDS Handbook produced by Self-directed Support Scotland is a valued resource. 3.6 People must be directed to or provided with assistance to help them explain any views or preferences they have on their options for support, helping them to make informed care choices. NAHSCP will encourage the use of and signpost people to independent information, advice and support agencies. 3.7 NAHSCP must work with people eligible for support to understand their lives and identify their needs. This includes exploring what support could look like through all four options of SDS and the services available to fulfil each option. NAHSCP must explain the nature, distinction and effect of the four SDS options considering each person’s unique circumstances. 3.8 People should be encouraged to shape their own lives with choice and control over the support they receive and how it is managed. Wherever possible, people should be able to use resource flexibly, if agreed that the proposed support plan will meet assessed need and appropriate outcomes for the 318
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5 individual. This enables them to personalise their support in ways that best meets their assessed needs as agreed in their Plan. 3.9 NAHSCP will actively support the development of a diverse and sustainable provider market to ensure people have choice across all SDS options. This includes engagement with community-led services, care agencies, self- employed services and innovative models of support delivery. Providers will be encouraged to co-produce flexible solutions that respond to the evolving needs of people and carers. 3.10 NAHSCP understands that not everyone is able, has the capacity or wishes to take on the responsibility of planning, organising and managing their own support through certain SDS options. In such instances, people will receive support through SDS Option 3 - Arranged Support - but will continue to be as involved as possible. 4. Four Options of Self-directed Support 4.1 In line with the Act, NAHSCP is required to offer four distinct options to adults, children and their families, as well as young and adult carers. The four options must be clearly explained, highlighting the distinctions between each option and ensuring that the level of choice and control each person or family wishes to have over their support arrangements is fully considered. 4.2 The four SDS options are: Option 1: Direct Payment: NAHSCP makes a direct payment to the person/ family for them to choose, arrange, direct, pay for and manage their support to meet their agreed outcomes, flexibly, as set out in their Action Plan/ Child’s Plan. This is the only option where people can become employers of their own Personal Assistant (PA) staff to deliver support, unless option 1 is part of a mixture of support under option 4. NAHSCP should ensure the person is offered independent information, advice and recruitment support where appropriate. Option 2: Individual Service Fund: The person/ family chooses and directs their preferred support to meet their agreed needs and outcomes as noted in their Action Plan/ Childs Plan. NAHSCP arrange and pay for this on behalf of the person/ family. A Three- Way Agreement is drafted for all option 2 arrangements. Option 2 helps to widen choice, is inclusive, and should not exclude types of support or service provision. People can choose service providers or care agencies to seek care staff not on NAHSCP framework although they should remain within the agreed individual budget to ensure care is not compromised for higher rate agencies, outwith the framework. People cannot employ their own PA staff under option 2. Option 3: Arranged Support: NAHSCP chooses, arranges, directs and pays for the support they think is right for the person to meet their needs as noted in their Action Plan/ Childs Plan, 319
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6 with involvement and agreement of the person/ family. The difference between option 2 and option 3 is the person/ family do not choose the service or support provider and do not have direct, ongoing, day to day responsibility for planning and controlling their support under this option. Option 4: A mix of 1, 2 or 3: The person/ family chooses a combination of options 1, 2 or 3 to meet their agreed outcomes in their Action Plan/ Childs Plan. This may suit people who wish to have more control over some aspects of their support than others or give the opportunity to try a particular option i.e. Personal Care delivered by North Ayrshire Care at Home Services under option 3 and the recruitment of a Personal Assistant under option 1 to enjoy leisure activities, attend groups or pursue opportunities to make connections and friendships. 4.3 NAHSCP will not assume or consider any option as a preferred or default option. The person/ family or those caring for loved ones who have the correct legal powers to make these decisions on their behalf can choose the option that works best for them, in accordance with their preferred level of choice and control in the support arrangements. 5. Limits to Offering Self-directed Support Options 5.1 There may be circumstances in which offering all four SDS options is not appropriate or possible. This may include situations of crisis, where a person’s needs are more effectively met through universal or community supports, or where the primary purpose of intervention is immediate protection. 5.2 In accordance with the Self-directed Support (Direct Payments) (Scotland) Regulations 2014, NAHSCP is not required to offer option 1 – direct payment, nor option 4 – a combination where it relates to option 1, in the following circumstances: • NAHSCP has previously terminated a Direct Payment made to the person. • There is evidence that a Direct Payment is likely to put the safety of the person or others at risk. • For those whose needs call for long-term residential/ nursing care. • Certain services which are multiple occupancy or group-tenancy accommodation arrangements (often called Supported Accommodation) may not be suitable due to the potential impact upon the tenancy rights of other tenants and the overall coordination of care, support and safety within the accommodation. • Where the form of service is tied to specific criminal justice orders e.g. Drug Treatment and Testing Order (DTTO). This reflects the fact that the form of service is by its nature prescriptive and controlled. • In relation to support to children and families, if removal of a child to foster care is capable of being support under Section 22, then the foster care itself is 320
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7 something which cannot be purchased by means of a direct payment or converted into a single budget and delivered through another option. 5.3 In all instances where NAHSCP decides that we cannot provide SDS Option 1 - Direct Payment we will explain to the supported person why it is not appropriate at that point. We will explain that the person/ family can consider all options at a future review when the circumstances that gave rise to the initial decision change or improve. NAHSCP will consider the direct payment option alongside the other options provided under the 2013 Act at the point of review. 6. Pathway for Self-directed Support 6.1 For adults, children and families seeking support. 6.2 For unpaid adult and young carers seeking support. Referral to Service Access Initial Contact Conversation (Screening/ Triage) Inform, Advise and Signpost Referral to Money SMART for Income Maximisation Low Level Preventative Support Assessment, Eligibility Positive Risk (if req) Offer SDS Options and Support Plan Individual Budget Approval Support Arranged and Delivered Support Reviewed and SDS Options Reoffered Carer Identified Adult Carer Support Plan/ Young Carer Statement Offered Offer Accepted and Completed Carer Eligibility Criteria Applied Inform, Advise and Signpost Referral to Money SMART for Income Maximisation 4 SDS Options and Support Planning Individual Budget Approved Support Arranged and Delivered Support Reviewed and 4 SDS Options Reoffered 321
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8 6.3 The pathways for adults, children and families, and carers should always provide: • Information, advice, guidance, advocacy and signposting ensuring people are informed and know when and how to access good and correct information from a range of sources within NAHSCP and from our independent partner agencies. • An initial conversation to address the appropriateness to access universal and community resources and supports offered and considered before leading to statutory services. • Full assessment where necessary using relationship-based conversations and person-centred approaches along with application of eligibility frameworks to determine strengths, risks and levels of urgency for support. Eligibility ensures care and support is provided fairly and consistently and the requests for everyone who need support are not simply processed in chronological order. Not everyone will meet the current critical eligibility criteria for a funded service; further information can be found in the Critical Only Access to Funded Adult Social Work and Social Care Services. • Positive risk approaches ensuring people, families and Social Work staff collaborate to balance safety with autonomy and consider potential benefits and not just harm. Transparent, clear, rational and proportionate contingency plans shift the focus from risk avoidance to risk empowerment. • Transparent budget conversations assist with support planning and help informed choice with SDS options encouraging different ways of assessed needs being met. Clarity on resource allocation and individual budgets ensures public funds are distributed equitably based on assessed need rather than arbitrary limits or service-led models. • Support planning tailored to the persons assessed needs, with the aim of enabling them to achieve what matters most. Engaging in a joint, holistic approach with the person by considering all assets (personal, family, community) that contribute to the persons wellbeing and independence, before offering statutory services. • THE OFFER OF FOUR OPTIONS OF SELF-DIRECTED SUPPORT. • Resource is agreed and released and support delivered which aligns with the person’s assessed need and designed to support the achievement of individual outcomes as agreed in the Action Plan/ Childs Plan. • Support is subject to ongoing monitoring to ensure what is being delivered is effective and remains aligned to the persons assessed need. Adjustments to Action Plans/ Childs Plans should be made where necessary to reflect changes in circumstances, needs, outcomes or options for directing support. The process to enable this should be minimal where there is no change to resource or a reduction in resource. The frequency and level of monitoring should be determined on an individual basis taking account of need and comprehensive assessment of risk. 322
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9 • Reviews will be co-produced with the person, where required their carer, and all relevant contributors. The review will again be person-centred, strengths- based and outcome focused with conversations reflecting on progress, enablement, what’s working well and what needs to change, ensuring the relevance and effectiveness of the support in place. During each review, the four options of SDS will be re-offered to ensure informed choice and control in how support is arranged and delivered. 7. Independent Information, Advice and Support 7.1 People and their families have the right to be actively involved in decisions about their care. To support this, independent organisations help people understand their rights and co-produce care that reflects their needs and preferences. 7.2 Accessible, impartial, and well-informed advice, advocacy, and early support must be available throughout the support journey, with consideration given to any potential barriers. People in North Ayrshire have access to multiple national and local organisations. 7.3 NAHSCP commissions Ayrshire Independent Living Network (AILN) to provide the public and social work professionals with free independent advice and guidance and Personal Assistant (PA) recruitment support. AILN can help with: - The four SDS options and their application - Employing PA staff; including all aspects of recruitment and compliance with employment responsibilities - Signposting to additional resources - Support from people with lived experience of disability and SDS - Opportunities for peer support, mentoring, or shared learning - Training, awareness raising, or practice development input to help staff understand good SDS practice In addition to commissioned services, AILN offers payroll and third-party banking services to support the management of direct payments, including invoicing and payment of staff. AILN works in partnership with NAHSCP Finance to support the monitoring of direct payment use, while maintaining independence from statutory decision-making. 8. Self-directed Support for Children & their Families 8.1 NAHSCP apply Getting it Right for Every Child (GIRFEC) policy frameworks and Signs of Safety (SoS) approaches to assess the safety and wellbeing of children and to determine the provision of support. 323
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10 8.2 SDS applies to children, young people and families, including those transitioning to adulthood. It aligns with both GIRFEC ensuring support is personalised, outcomes-focused and co-produced with families and SoS enhancing its strengths-based, inclusive principles. Together these approaches ensure children and families are empowered, protected and actively involved in shaping their support. SDS offers the mechanism for children and families to access options, choice and control aligned with personal outcomes. 8.3 In some cases, the four SDS options may not be suitable—particularly where safety concerns exist. Direct Payments (Option 1) may be refused under Regulation 11 if they pose a risk to the child. Also refer to Section 5 which details all limits to offering SDS options. 8.4 NAHSCP will support young people and their families through the transition from children to adult services by initiating early planning and multi-agency collaboration. SDS will be used to promote continuity of support and enable young people to shape their future. The principles of GIRFEC and tools developed by ARC Scotland underpin good transition planning, ensuring that young people are empowered to lead their support journey. Standard 10 of the SDS Framework offers further guidance on planning and decision making through different phases of life. 8.5 ARC Scotland provides best practice frameworks and the Compass tool to support young people with additional needs (ages 14–25) through life transitions. 9. Charging Policy for North Ayrshire 9.1 Free personal and nursing care is available to all adults assessed by NAHSCP as requiring this as set out in Scottish Government Circular CCD3/ 2018. 9.2 Parents or carers are not charged for any children’s social care support (either personal or non-personal) up to the point that they transition to adult social work services. 9.3 The Carers (Waiving of Charges for Support) (Scotland) Regulations 2014 require NAHSCP to waive charges in relation to support for unpaid carers of any age. Carer support needs to be clearly stated in an Adult Carer Support Plan, Young Carer Statement or as part of the Action Plan/ Child’s Plan to indicate to budget holders and Finance staff that charges should be waived. 9.4 The Self-directed Support (Direct Payments) (Scotland) Regulations 2014 prevents NAHSCP from means testing or requiring a contribution from a carer where carer support is being delivered by Option 1 Direct Payment. 9.5 NAHSCP local Social Care Charging Policy is updated annually and any revisions approved by North Ayrshire Council Cabinet. The policy details how 324
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11 contributions are considered and calculated for adults for residential and non- residential support. 10. Option 1 – Direct Payment in Detail 10.1 NAHSCP must ensure the right processes, capacities and systems are in place to enable choice, control and flexibility. Resource allocation should be fair, equitable, sufficient and transparent. SDS statutory guidance states that people should be involved in the development of their budget and have flexibility to use this in a way which meets their agreed assessed outcomes as stated in their Action Plan/ Childs plan. 10.2 Social work practitioners should have ability to exercise professional autonomy to plan support and set/ alter budgets within NAHSCP agreed local parameters in line with Self-directed Support Statutory Guidance Section 7: Budgeting, Charging, Commissioning and Procurement and Social Work Scotland SDS Framework of Standards (Standard 8: Worker Autonomy). 10.3 Individual budgets are not a benefit or gift and should be used to meet the needs and outcomes as assessed and agreed in each person’s Action Plan/ Child’s Plan. The budget can be used in any way provided it will secure the support agreed with the Social Worker and meets the outcomes detailed in the Plan. The budget cannot be used in the following ways: - Tobacco, e-cigarettes, alcohol - Gambling including scratch cards, bingo, slot machines or online - Anything illegal - General transport costs: taxi’s, trains, petrol if the person is in receipt of DLA or PIP mobility payments. Where transport is an agreed part of social support or alternative to residential building-based respite to meet personal outcomes this will be stated clearly in the Action Plan/ Childs Plan and agreed by the relevant service Senior Manager/ Resource Group. - Rewards or gifts for carers - Any service or equipment that can be provided by NHS or another public body i.e. Housing - Service user/ personal contributions for care - Permanent or long term (more than 4 weeks) residential or nursing care - Routine weekly food shopping or general clothing (exceptions may be considered for urgent and/or respite situations) - Household expenditure such as rent, mortgage, utility bills, furniture - Paying off accrued debts - Employing family members or friends who have welfare or financial guardianship or power of attorney - Personal, car, household, holiday or pet insurances 325
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12 - Legal costs associated with power of attorney or guardianship - Anything that has not been identified and agreed with the Social Worker through the assessment and Action Plan/ Child’s Plan. 10.4 Housing support refers to non-care services that enable people to establish or maintain their tenancy and live independently. Where such support is deemed to fall under critical levels and within the scope of community care services, the provisions of the Act apply, and the supported person must be offered the full range of SDS options. 10.5 Housing adaptations are structural changes to a property that promote independent living. Direct Payments may be used for larger-scale adaptations however this must be assessed by the appropriate public body to ensure the support qualifies as community care. Direct Payments are intended to meet social care needs and are not a substitute for housing improvement grants. 10.6 Where NAHSCP services agree to the purchase of a piece of equipment under Direct Payment, consideration should first be given to the potential of local loan arrangements, or if the equipment can be acquired/ is the responsibility of another public body to provide or fund. Direct Payments may be used to fund equipment and adaptations that meet assessed needs and outcomes, provided they are lawful, agreed and recorded within the Action Plan/ Childs Plan. Responsibility for ownership and maintenance and any associated costs typically rests with the supported person, unless otherwise agreed and documented. 10.7 NAHSCP require the supported person to maintain records and receipts for direct payment monies spent. They must submit monthly monitoring reports and bank statements to NAC Finance which will enable NAHSCP to ensure that the Direct Payment is being managed in accordance with the Financial Procedures for Direct Payment and is meeting the agreed outcomes. 11. Employing Family Under Direct Payment 11.1 The Self-directed Support (Direct Payment) (Scotland) Regulations 2014 set out that the direct payment recipient/ carer can employ a family member in the role of Personal Assistant for the provision of care and support in line with the individual Action Plan/ Childs Plan. 11.2 Employment of a family member can only occur if all parties (direct payment recipient, family member and NAHSCP Service) agree it is the most suitable option and the family member can meet the direct payment recipient’s needs as outlined in their Action Plan/ Child’s Plan. The following factors need to be taken into consideration before agreeing to this arrangement: 326
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13 - Is there a limited choice of service providers available who could meet the needs of the person. - Does the person have specific communication needs meaning it is difficult to source a provider to meet the needs. - Can the family member provide care at times that is required that service providers would not reasonably be able to. - The intimate nature of the support required means the person would prefer this support to be provided by a family member. - Does the person have religious, cultural beliefs which make it more appropriate to be delivered by a family member. - Does the person have palliative care needs. - Does the person require the care in an emergency or for only a short period of time. - Any other factors that NAHSCP find it appropriate in the person’s individual circumstances, for the family member to provide support. 11.3 A family member cannot provide care and support as a paid/ employed Personal Assistant in the following circumstances: - Where NAHSCP determines the family member or the person in receipt of the direct payment to be under pressure to agree to the family member becoming the Personal Assistant. - Where the family member has legal guardianship, or active welfare or financial attorney powers of decision making regarding the support, welfare and life decisions of the person in receipt of the direct payment. - Where the arrangement could impact adversely on an unpaid young or adult carer role/ relationship. - Where NAHSCP deems the family member unable to provide the assessed level of care due to other reasons uncovered and explained throughout the assessment process. 11.4 For clarity ‘family member’ according to this regulation means: - The spouse, civil partner or someone living with the person as if their partner of the person in receipt of the direct payment. - The parent, child, brother, sister, aunt, uncle, niece, nephew, grandchild, grandparent or cousin of the person in receipt of the direct payment. - Any spouse or partner or someone living with those persons listed above as if their partner. 327
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14 12. Self-Employed Personal Assistant Services 12.1 Under Option 1 - Direct Payment, people can seek and use the services of a self-employed Personal Assistant. This is different to an employed Personal Assistant who receives a contract of employment and their status is confirmed in the employment status checks by HM Revenue & Customs (HMRC). 12.2 The self-employed Personal Assistant provides care but has their own business. They set their own terms and conditions and offer an agreed set of services for an agreed fee or rate. 12.3 There are several checks and balances that must take place before a self- employed Personal Assistant agreement will be authorised by NAHSCP services. The Personal Assistant must: - Provide a quote for the cost of the services they offer and formal invoice for receipt of payment. - Confirm when, how or where they are willing to work in a written agreement and bring their own equipment if and where required. - Organise and pay for their own training and provide suitable agreed cover when they cannot deliver care and support due to sickness or holidays. - Arrange their own tax and National insurance contributions and any pensions would be organised personally. - Provide the person with the results of an employment status check to ensure they are registered correctly with HMRC. A ‘worker’ must tell HMRC if they think they are or have become self-employed. 12.4 A Personal Assistant’s employment status is not a matter of choice; it depends on the individual circumstances. There are a wide range of tasks PA’s carry out to help people to live independently, and each person is unique in their needs and the way they want to live their life. It should also be considered that the support may change over time if a person’s needs change. 328
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15 Resources, Contacts & Helpful Links Resources … there is lots of help locally in North Ayrshire and nationally to become an employer or a PA/ Self-employed PA and to check employment status. • Self-Directed Support & Information Service - Ayrshire | AILN • Home - Personal Assistant Network Scotland (panetworkscotland.org.uk) • Self-directed support | Partners in Personalisation CIC | Scotland • Self -directed Support Scotland (SDSS) - Self Directed Support Scotland (sdsscotland.org.uk) • Welcome - The PA & PA Employer HandbookThe PA & PA Employer Handbook • SDS Forum - Inclusive, knowledgeable and accessible (sdsscotland.org.uk) • Employment status: Employee - GOV.UK (www.gov.uk) • Check employment status for tax - GOV.UK (www.gov.uk) • Acas | Making working life better for everyone in Britain • The Community Brokerage Network | Your Path To Personalised Support OR Telephone: • Ayrshire Independent Living Network (AILN) on 01294 475685/6 • Partners in Personalisation (PIP) on 07712 703733 • Community Brokerage Network (CBN) on 07769 698 606 • Personal Assistants Network Scotland 01563 522551 • HMRC on 0300 123 2326 • Pension Regulator Helpline on 0345 600 1011 • ACAS helpline on 0300 123 1100 13. Financial Oversight & Termination of Direct Payment 13.1 NAHSCP Finance Team applies the CIPFA Guidance: Self-directed Support – Resource Implications (Part II) in the robust monitoring of Option 1 Direct Payments. This ensures accountability in the use of public funds, promotes transparency, and supports consistency in financial oversight. 13.2 Unspent and accrued public funds held within the Direct Payment account will be reviewed on a quarterly basis by the NAHSCP Direct Payment Finance Team. NAHSCP will request the return of surplus funds, providing sufficient notice to the direct payment recipient. 13.3 NAHSCP reserves the right to pause future Direct Payment transfers where requested reclaim amounts are not returned. Scheduled Payments will resume once the account balance has been reduced to a level retaining the equivalent of 4-weeks payment, any planned respite funds and any contingency amount agreed and stated within the Direct Payment Request Form. A significant accrual of unspent funds will trigger a review of the individual’s care and support needs. 329
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16 13.4 Where misuse of public funds is identified through the financial monitoring process, the individual will be required to repay the full amount to NAHSCP. Failure to comply with repayment requests will result in the initiation of formal debt recovery proceedings. 13.5 In accordance with the Self-directed Support (Direct Payment) (Scotland) Regulations 2014, NAHSCP reserves the right to terminate an Option 1 Direct Payment under the following circumstances: • The individual is no longer eligible to receive a Direct Payment (refer to Regulation 6). • Funds have been used for purposes other than those agreed in the Action Plan or Childs Plan (i.e. misappropriation). • The individual is unable to manage the Direct Payment, despite reasonable support and guidance. • The individual has breached criminal or civil law in relation to the support funded by the Direct Payment. • A family member has been paid to provide care and support without prior agreement from the relevant Social Work team. • The Direct Payment is not meeting the assessed needs and outcomes as outlined in the Action Plan or Childs Plan. • The use of the Direct Payment poses a risk to the safety of the individual or others. 13.6 Before terminating a Direct Payment, NAHSCP will consider any existing employment contracts held by the Direct Payment recipient, as well as the time required to arrange alternative care and support. It is recognised that replacement arrangements will not replicate the support previously delivered under the Direct Payment. 13.7 Where a Direct Payment is terminated or the person is no longer eligible to receive their support under Option 1 but continues to have assessed needs and outcomes, NAHSCP will offer the opportunity to choose from the remaining three SDS options. It will not be presumed that Option 3 is the default alternative in these circumstances. 14. Redundancy of Personal Assistant Staff Under Direct Payment 14.1 If a Personal Assistant employed under Option 1 - Direct Payment is made redundant, the Direct Payment employer - or legally appointed Financial Guardian or Power of Attorney - is responsible for ensuring that the PA receives final payment for all hours worked, any statutory notice period and accrued annual leave entitlements, in accordance with employment legislation. 330
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17 14.2 NAHSCP has no statutory requirement to fund a redundancy claim. This is the responsibility of the Direct Payment employer no matter the circumstances leading to the redundancy, including due to the death of the Direct Payment employer. 14.3 Where the employer is in receipt of an Independent Living Fund (ILF) budget in addition to Self-directed Support, ILF Scotland can consider making a contribution towards the cost of redundancy, if required and at its discretion, in respect of the amount of support hours funded by ILF only. Please see link Employer Support Information Note. 14.4 All other redundancy claims must be directed through the Employer’s Liability Insurance provider. Most Employer’s Liability Insurance will require an additional ‘add-on’ policy in respect of redundancy payments, and we encourage PA employers to acquire this cover. Where insurance coverage is insufficient, PA’s can apply for support through the Statutory Redundancy Scheme. Further information is available via mygov.scot – Help if you're made redundant. 14.5 Any unspent funds associated with the Direct Payment and employment arrangement must be returned to the relevant funding bodies, including NAHSCP and, where applicable, Independent Living Fund Scotland. Returns must be completed in accordance with each organisation’s financial reconciliation procedures. 15. Protecting Vulnerable Groups (PVG) Scheme 15.1 Under Option 1 Direct Payments, individuals who employ Personal Assistants (PAs) must now adhere to updated safeguarding requirements. PAs are formally recognised as occupying regulated roles, which brings new responsibilities for employers and NAHSCP. 15.2 Direct Payment employers are required to confirm that their PA holds membership with the Protecting Vulnerable Groups (PVG) Scheme either prior to or at the commencement of employment. Employers are not legally liable for ensuring PVG membership but they are expected to follow safe employment practices in line with national guidance. 15.3 Exceptions to PVG membership apply only in specific circumstances - namely, when care is provided within a family relationship (such as by a parent, sibling, or household member), or when care is delivered as part of a personal relationship without any commercial gain. 331
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18 15.4 The new requirements came into force on 1 April 2025, and a transition period concluded on 1 July 2025. From this date forward, it is a criminal offence to work in or offer work for a regulated role without PVG membership. 15.5 The associated costs are £59 for new members and £18 for updated memberships which are included within NAHSCP Direct Payment budgets. Looking ahead, PVG membership will require renewal every five years, beginning in April 2026. 15.6 The application process for PVG membership is managed through MyGov. Scot. Direct Payment employers may seek support from local accredited umbrella bodies to pursue applications; however, these organisations do not share vetting outcomes with employers and application fees may vary depending on the provider. 15.7 Local authorities, including NAHSCP have a duty to ensure that service users employing PAs are fully informed of PVG requirements. They must actively promote the use of Disclosure Scotland’s guidance and tools, maintain internal protocols that reflect current legislation, and respond appropriately to concerns regarding PA conduct—including making referrals to Disclosure Scotland when necessary. 15.8 It is important to note NAHSCP will not have access to PA PVG records; this is only for the direct employer. 15.9 While Direct Payments cannot be refused solely due to the absence of PVG confirmation, they may be withheld if there are identified safety risks, in accordance with the Direct Payment Regulations 2014. 15.10 For further support, SDS Statutory Guidance and Disclosure Scotland’s online tools are available to help clarify the definition of regulated roles. Tailored advice can also be obtained by contacting Disclosure Scotland’s Customer Engagement Team at: DisclosureAct@disclosurescotland.gov.scot 16. Supported Decision Making – Power of Attorney/ Guardianship 16.1 SDS must be delivered in accordance with the principles of informed choice, dignity and participation. 16.2 Where a person is aged 16 years and has limited or fluctuating capacity to make decisions about their support, NAHSCP will ensure that supported decision-making is facilitated in line with the Adults with Incapacity (Scotland) Act 2000. 332
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19 16.3 Advocacy services, communication supports and enabling approaches will be offered to ensure participation in SDS processes. This includes ensuring information is provided in accessible formats and sufficient time is given for decision-making. Every effort should be made to uphold the individual’s right to express preferences and exercise choice and control. 16.4 NAHSCP staff should exercise professional judgement in line with the principles of least restriction, benefit to the adult, and respect for rights and preferences. This includes evaluating whether the person can understand, retain, and weigh relevant information to make decisions, and whether they can communicate their choices effectively. Social Workers must also consider the impact of mental disorder, cognitive impairment, trauma or communication barriers, and ensure that all practicable support has been provided to enable decision-making before concluding incapacity. 16.5 Where an individual lacks capacity to make specific decisions, NAHSCP must establish whether there is a valid Welfare Power of Attorney in place. Where this is in place and powers have been activated, they have authority to make decisions about care and support on behalf of the adult. 16.6 In relation to SDS Welfare Attorneys should be fully involved in assessment, support planning and review processes. Thery should be supported to act in accordance with the principles of the Adults with Incapacity (Scotland) Act 2000. Their role is to reflect the adults wishes and ensure decisions are made in the best interests. NAHSCP must verify the scope of powers granted within the PoA and ensure decisions fall within those powers. 16.7 Where there is no Power of Attorney and the adult lacks capacity, a Welfare Guardianship Order may be in place. This is appointed by the Court and has legal authority to make decisions about the adults personal welfare including care arrangements and SDS options. In these circumstances the guardian must be involved in SDS decision- making and should act in line with the principles of benefit, least restriction and participation. The adult should continue to be involved as far as possible even where there is a guardian in place. 17. Complaints 17.1 Children and families, adults and their carers who experience difficulties with services provided or commissioned by NAHSCP should first seek resolution through informal discussion with their allocated Social Worker and relevant Team Managers. Local support organisations may assist by offering advocacy and helping clarify the situation. 17.2 If informal resolution is unsuccessful, people can escalate their concerns through the NAHSCP’s formal complaints procedure, which follows a two-stage process: 333
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20 • Stage 1 – Frontline Resolution: Staff aim to resolve complaints within 5 working days. • Stage 2 – Investigation: For more serious or complex issues, complaints are formally investigated, with a response provided within 20 working days, unless exceptional circumstances apply. 17.3 Complaints may relate to any action, decision, or perceived failing by NAHSCP. If all internal processes have been exhausted and the person remains dissatisfied, they can refer the matter to the Scottish Public Services Ombudsman (SPSO). 17.4 However, complaints about services procured independently via SDS Option 1 (Direct Payments) such as those involving PAs or independent providers should be directed to the relevant service provider or addressed directly with the employee. 17.5 Complaints regarding any registered care service may also be submitted to the Care Inspectorate, which oversees regulatory standards across Scotland’s care sector. 17.6 Additionally, people can share feedback publicly via Care Opinion, an independent platform supported by NAHSCP. 334
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Integration Joint Board 18th June 2026 Subject : Ayrshire Transformation Board – Right Care, Right Place Purpose : The purpose of this report is to update the IJB on the Ayrshire Transformation Board (ATB), specifically in relation to the Right Care, Right Place programme of work. Recommendation : The Integration Joint Board is asked to: • Note the update on progressing plans under the Right Care, Right Place workstream including developing plans to shift the balance of care and resource, focussed on improving outcomes and utilising resources more effectively • Approve delegated authority to the Chief Officer to progress operational plans, subject to the conditions detailed in the report being met as set out in section 2.12. • Note that a full update on the plan will be presented to the IJB after the summer recess. Direction Required to Council, Health Board or Both Direction to :- 1. No Direction Required X 2. North Ayrshire Council 3. NHS Ayrshire & Arran 4. North Ayrshire Council and NHS Ayrshire & Arran Glossary of Terms NHS AA NHS Ayrshire and Arran HSCP Health and Social Care Partnership ATB Ayrshire Transformation Board DWD Discharge without Delay CfSD Centre for Sustainable Delivery 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. The IJB endorsed involvement in the ATB at the meeting in April, noting that the accountability for delivery and decision making remains with the relevant organisations including North Ayrshire IJB through existing governance structures. Agenda Item 10 335
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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. 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. 1.3 The report provides an update on progress for the Right Care, Right Place programme which is focused on improving hospital occupancy and flow. This work has also been supported by NHS Ayrshire and Arran establishing a Flow Assurance Board. 1.4 The IJB received an update in November 2025 in relation to Unscheduled Care Improvement Plans in North Ayrshire, this included our delayed discharge performance, and an update to the funding and pan-Ayrshire plans at that time and highlighted the risks associated with the non-recurring nature of funding. 1.5 Scottish Government have advised on funding available for 2026/27 across Scotland for the Operational Improvement Plan, this being a lower quantum of funding overall and targeted at both planned and unplanned care. Through the Ayrshire Transformation Board and NHS Ayrshire and Arran’s Flow Assurance Board plans have been in development since April 2026 to progress proposals to support acute hospital flow and occupancy and to effectively shift resource into the community including for social care services. The plans remain at the final stages of development and require to go through formal governance for approval, however given the immediacy of need to address quality and safety issues in the hospitals, to improve performance both for the Health Board and the HSCPs and to address financial challenges there is a requirement to seek agreement to implement a plan which can be enacted prior to the winter period. For this reason and due to the recess period the IJBs are being asked to endorse the principal of a draft plan and delegate authority to the Chief Officer to operationalise the plan subject to conditions being met in relation to financial risk and the requirement to improve patient and service user outcomes. 2. BACKGROUND 2.1 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. All three Councils, Integration Joint Boards and NHS Ayrshire and Arran are operating within extremely challenging financial circumstances, and both community and acute services are experiencing growing waiting lists for assessment and treatment. Given these pressures, it is essential for Ayrshire to take greater collective control and to work more closely and consistently than we have before. To 336
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support this, we are proposing the following revised arrangements to strengthen integrated working and improve our 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. Ayrshire Transformation Board & NHS AA Flow Assurance Board 2.2 The ATB has five 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. This report provides an update on the plans for 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. Health and Social Care services across Scotland continue to face real pressures, including demographics, growing demand, healthcare needs, and increasing financial pressures. Unscheduled care performance, and in particular delayed discharge performance, is utilised as one of the key indicators to measure the efficiency and effectiveness of our health and care system. 2.3 A Flow Assurance Board has been stepped up within NHS AA, the Board is chaired by the NHS AA Chief Executive with membership from across Directorates including the Chief Officers, there are also external stakeholder representatives from example the national DWD collaborative and CfSD. The Board is structured to oversee – progress on: • Discharge Without Delay • Virtual Capacity • Adults with Incapacity (AWI) • Integrated Discharge Hub • Performance & Digital • SAFER • General Medicine Target Model • ED Operations Improvement • Mental Health Flow 337
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Unscheduled Care Plans 2.4 The Scottish Government confirmed £10.079m for NHS Ayrshire & Arran (June 2025) for the Operational Improvement Plan aligned to Unscheduled Care, with £1.081m ring-fenced for North Ayrshire to enhance hospital-based MDT capacity (£746k) and Mental Health Officer (MHO) capacity (£335k). During 2025/26 plans were further progressed to develop initiatives in alignment with the Discharge without Delay (DwD) programme, NHS Renewal Framework, and Hospital at Home expansion, aiming to reduce hospital occupancy, improve patient flow, and shift care closer to home. North Ayrshire HSCP is actively participating in this whole-system transformation. Appropriate representatives are members of both National and Ayrshire and Arran workstreams. The Partnership has committed to implementing DwD principles and achieving the whole system outcomes through enhanced hospital-based assessment teams, expansion of Care at Home capacity, and the development of discharge-to assess pathways. These actions are supported by targeted investment from the NHS Renewal funding, enabling North Ayrshire to strengthen its multi-disciplinary response and reduce delayed discharges, particularly for frail older people and those requiring complex social care interventions. There were significant concerns in utilising the funding, which was at that time non- recurring, when the solutions required a recurring commitment for investment. This led to during 2025/26 a significant level of overall slippage in funding on a Pan Ayrshire basis for which short term capacity options were funded for each Partnership and acute services, including for example the purchase of interim care home placements, SDS care package options and additional temporary staff and overtime. 2.5 Investment through Phase 1 of the plan enacted in 2025/26 has not delivered operational performance improvement at the scale and level required to release recurring resource nor impact significantly on the quality and safety issues in the hospital settings in acute settings in Ayrshire and Arran. Furthermore, the levels of delayed discharge across NHS AA have increased to resource constraints for IJBs and social care services. As noted in the update to the IJB in November 2025 the level of recurring investment estimated at that time was over £23million on a pan-Ayrshire basis. 2.6 The NHS AA Flow Assurance Board has sought to update the business case ask for investment, with further work in this area indicating the requirement for a similar level of investment to fully address hospital flow, unmet need and levels of delayed discharge. This is not a scale of investment at this time which is deemed to be feasible. There remain significant safety concerns in the acute hospitals in NHS AA with additional unfunded wards remaining open, full capacity bed areas and excessive front 338
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door waits for admission. NHS AA through the Flow Assurance Board have asked the HSCPs to support a reduced occupancy footprint in the acute hospitals by 115 spaces with a request that plans are identified to step up alternative community pathways and supports to collectively deliver on this. 2.7 This Phase 2 Short Term Flow Improvement plan which is targeting the 115 bed space and wait reduction across the two acute sites seeks a total investment of circa £4.5m overall on an annual basis. This could from a business case perspective be funded from the reduction in costs in the acute sites assuming the bed reductions can be sustained. The North Ayrshire request in the plan focusses on social care capacity including: • Care Home beds – with the ability to move patients awaiting funding for admission from hospital • Care at Home Reablement – linking with the MDT team in the hospital and a discharge to assess (D2A) ethos • Step Down beds – in-house beds in our dementia respite facility which would be stepped up as part of the D2A pathway in North Ayrshire The plans are focussed on areas which will provide short term, more immediate support to the sites reflecting the resources which could be accessed and stepped up in each HSCP area but also aspects of sustainability, for example how we not only achieve a reduction in delayed discharges but also continue to support the hospital front door pressures. 2.8 The Short Team Flow Improvement Plan does not address the systemic issues and resource challenges on a whole system basis but would be a positive step forward in starting to shift the balance of care and the realignment of resources into community services. The HSCP will continue to pursue the funding and resources required to address all areas of the pathway and gaps in capacity to fully address flow and unmet need. Governance 2.9 The governance structure previously shared 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 and 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. 2.10 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, 339
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emphasising the collaborative governance required for integrated service delivery across Ayrshire. The Phase 2 Flow Improvement Plan requires to be presented to the Ayrshire Transformation Board on 19th June for consideration and endorsement, therefore has not yet been formally endorsed to progress. The ATB will make recommendations to partner organisations with any decisions requiring formal approval will continue to be progressed through existing North Ayrshire IJB governance routes. 2.11 There are significant risks in any plans being unable to progress due to the upcoming summer recess period, with some elements of the plans having lead in times of 3-4 months. The expectation is that NHS Ayrshire and Arran make significant progress to improve performance in advance of the winter period. Therefore, it is recommended that the IJB endorses the direction of travel subject to a full update report being presented after the summer recess. It should also be noted that there remains a commitment to pursue the full investment plan, alongside any focus on immediate and short term improvement. 2.12 The IJB are asked to delegate authority to the Chief Officer to progress with operationally implementing agreed plans subject to the following conditions being met: 1. The Plan has Pan Ayrshire and system wide support and is formally endorsed at a meeting of the Ayrshire Transformation Board 2. Funding requires to be provided on a recurring basis, and an assurance is provided that this is formally underwritten by NHS Ayrshire and Arran or Scottish Government – i.e. there is zero financial risk or liability to the IJB 3. The HSCP are assured that plans will target improving performance and patient outcomes in areas of priority for the IJB, including delayed transfers of care and unmet need 4. A full business case is finalised to be brought back to the IJBs after the summer recess 3. PROPOSALS 3.1 North Ayrshire IJB is asked to: • Note the update on progressing plans under the Right Care, Right Place workstream including developing plans to shift the balance of care and resource, focussed on improving outcomes and utilising resources more effectively • Approve delegated authority to the Chief Officer to progress operational plans, subject to the conditions detailed in the report being met as set out in section 2.12. • Note that a full update on the plan will be presented to the IJB after the summer recess. 340
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3.2 Anticipated Outcomes Anticipated benefits include: • Improved system-wide planning and decision-making. • Reduced variation in service delivery across Ayrshire. • Improved flow through acute and community settings. • More timely and consistent AWI processes. • Enhanced use of shared digital infrastructure and data. • Clearer and more consistent communication with staff, partners and communities. 3.3 Measuring Impact Impact will be monitored through the improvement trajectories and targets set on a Pan Ayrshire basis as part of the Right Care, Right Plan plans and will be monitored through: • Plan-specific delivery plans and milestones. • Existing IJB performance and assurance frameworks. • Regular reporting through agreed ATB governance routes. • Use of quantitative and qualitative measures, including flow metrics, delayed discharge data and financial performance. North Ayrshire IJB will retain responsibility for evidencing impact and performance within its statutory and local governance arrangements. 4. IMPLICATIONS 4.1 Financial Participation in system-level transformation activity may requires targeted investment, the plans in development would be a step towards shifting the balance of care with resources being released from acute hospital settings and investment in community pathways and capacity. The investment plan for IJBs in includes additional spend in delegated community health and social care services sitting across NHS AA and the Council. As highlighted the requirement is for recurring funding, to support sustainable and successful recruitment and the sustainability of any investment, before progressing this assurance alongside a formal underwriting from NHS AA or Scottish Government will be required to minimise the financial risk to the IJB. 4.2 Human Resources Overall all ATB 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. Investment plans will see an investment in community based capacity and workforce. 341
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4.3 Legal 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. 4.4 Equality/Socio-Economic Initial Quality Impact Assessments have been undertaken at programme level. 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. 4.5 Risk Key risks include: • Inconsistent implementation across partner organisations. • Service disruption during transformation. • Workforce capacity and wellbeing impacts. • Financial sustainability risks. Risks will be managed through programme-level risk registers, established assurance routes, and appropriate escalation arrangements. There remains an inherent risk of plans requiring agreement on a Pan Ayrshire basis from a range of partners. There is a risk of plans not being able to progress if sufficient assurances over funding are not secured. 4.6 Community Wealth Building There are no direct Community Wealth Building (CWB) implications arising from this report. However, governance arrangements should ensure that the CWB principles of local procurement, workforce wellbeing, and community empowerment are considered as part of transformation activity. 4.7 Key Priorities Shifting the balance of care and operationalising the acute set aside remains a priority for IJBs across Scotland to ensure acute hospital resources are planned and allocated within integrated health and social care with an objective of shifting care closer to home and reducing hospital reliance. It is central to strategic commissioning plans for urgent and unscheduled care. The plans being developed demonstrate important progress in Ayrshire and Arran towards operationalising these plans at a local level meeting the key local objectives of reducing hospital occupancy, redesigning models of care and working towards financial balance across the system. 342
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5. CONSULTATION Senior officers from North Ayrshire Council, North Ayrshire IJB and NHS Ayrshire and Arran have been involved in the development of the proposals aligned to the ATB. HSCP representatives are involved in ongoing development of plans Pan Ayrshire including discussion and oversight at NHS AA Flow Assurance Boards. Ongoing engagement with staff, partners, communities and service users will be progressed through the Communications programme and formal consultation will be undertaken where required. Caroline Cameron, Director Previous IJB Report: IJB November 2025 - Unscheduled Care Improvement Plan Update 343
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Integration Joint Board 18th June 2026 Subject : Trindlemoss Court Purpose : The purpose of this report is to update the IJB and seek approval for the proposal for the future delivery of care provision in Trindlemoss Court Supported Accommodation in Irvine. Recommendation : The IJB is asked to: • Approve the proposal to develop a single care provider model within Trindlemoss Court • Approve the commencement of procurement processes associated with the change in delivery model • Note the potential impact on NAC, external care provider and Personal Assistant staff groups Direction Required to Council, Health Board or Both Direction to :- 1. No Direction Required 2. North Ayrshire Council X 3. NHS Ayrshire & Arran 4. North Ayrshire Council and NHS Ayrshire & Arran Glossary of Terms NHS AA NHS Ayrshire and Arran HSCP Health and Social Care Partnership CAH Care at Home PBS Positive Behaviour Support LD Learning Disability SDP Service Delivery Priority SDS Self Directed Support 1. EXECUTIVE SUMMARY 1.1 Since the early 2020s, North Ayrshire Health and Social Care Partnership has facilitated the development of 6 Supported Accommodation services, including one at Trindlemoss Court, in Irvine which mainly supports adults who have a Learning Disability. Trindlemoss Court is part of the wider Trindlemoss service which also includes Trindlemoss Day Opportunities and Trindlemoss House Care Home. Trindlemoss Court is made up of 20 North Ayrshire Council Housing tenancies. 1.2 Across the majority of the Supported Accommodation sites, a single commissioned model of care delivery is in place. Agenda Item 11 344
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The model of care provision within Trindlemoss Court is a mixed model – comprising of a core support model provided by the HSCP’s inhouse Care at Home service, who provide support to the majority of residents alongside providing the 24 hour responder service for Trindlemoss Court. In addition to the core Care at Home service, around 50% of individuals also receive support through other Self Directed Support arrangements, predominantly via external providers. At the moment there are 4 external care providers who are commissioned to deliver care within Trindlemoss Court alongside some Personal Assistant arrangements (Direct Payment via SDS Option 1). 1.3 The involvement of multiple providers reflects arrangements in place prior to individuals moving into Trindlemoss Court, supporting continuity and minimising disruption during their transition. Trindlemoss Court opened in 2020 at a time when services were focussed on the pandemic response, and the imperative was to open the service using the skills and expertise of existing care providers to move residents into their new homes. Over time, variation in approach has been observed within the current mixed model. This reflects a range of factors influencing service delivery, including different models of care delivery and different and distinct organisational structures and oversight arrangements. The care delivery spans across Learning Disability and Health and Community Care services rather than being the responsibility of one service area. Variation is also influenced by differences in governance and oversight arrangements across services and there are differences in the routine involvement of the Learning Disability Management Team across elements of provision. These dynamics are not evident in other supported accommodation developments, where a single commissioned provider delivers care. Financial modelling indicates these models also operate at a lower overall cost, as duplication of effort is minimised. 1.4 The current model reflects earlier decisions to prioritise stability and continuity for individuals. However current transformation activity has provided an opportunity to review and refine the current model of care which aligns with priorities in providing safe and effective care, whilst enabling the most effective use of resources. This option also affords an opportunity for commissioned care providers to tender for the service in a timescale in alignment with the ongoing reviews of community-based adult supports. Approval is therefore sought to move to a single externally commissioned provider model, consistent with other developments in North Ayrshire. This would also be in alignment with the IJB budget planning assumptions where a saving from moving to a single provider model has been included in the budget. It is anticipated that a full year annual saving of circa £460k can be delivered following a successful procurement exercise. 2. BACKGROUND 345
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2.1 North Ayrshire Health and Social Care Partnership Learning Disability services in collaboration with North Ayrshire housing services embarked on a major programme of strategic supported accommodation development in 2016 in alignment with the North Ayrshire learning disability and HSCP strategic plan to address a significant gap in the choice and range of housing options for adults with learning disabilities, mental health needs and physical disabilities. This strategic programme resulted in the development of 6 Supported Accommodation services across North Ayrshire, including one at Trindlemoss Court, in Irvine which mainly supports adults who have a Learning Disability. Trindlemoss Court which opened in 2020 is part of the wider Trindlemoss service site which also includes Trindlemoss Day Opportunities and Trindlemoss House Care Home. Trindlemoss Court is made up of 20 North Ayrshire Council Housing tenancies. Supported Accommodation options across localities in North Ayrshire cater to various needs including for adults with Learning Disabilities, Physical Disabilities and Mental Health difficulties. The services are modern, purpose-built facilities offering independent living combined with onsite 24/7 personalised care and assistive technology. The services are managed in partnership with the HSCP and North Ayrshire Council Housing colleagues, with the matching of tenancies and the responsibility for any voids remaining with the HSCP. Our supported accommodation developments are consistently fully utilised with the HSCP managing the waiting list and matching new residents to housing and care needs as and when any vacancies arise. This strategic approach and subsequent developments are also aligned with the national Coming Home agenda, which is clear that people with learning disabilities and complex care needs should be supported to live in their own homes and communities, close to family, friends and local networks, with models of care that are rights-based, sustainable and able to prevent unnecessary institutional or fragmented arrangements. In this context, the proposed move toward a more coherent single- provider model reflects not only local service learning, but also the need to ensure that Trindlemoss Court continues to develop in line with national expectations for consistent, community-based and person-centred support. Many of the individuals who moved into Trindlemoss Court already had existing community support packages. The move to a core and cluster model within Trindlemoss Court, where daily living and overnight support could be provided from a dedicated team on-site Care at Home team, allowed the residents to enhance their independence and dignity while still providing a safe reassuring environment. Tenants of Trindlemoss Court were also able to retain continuity of support arrangements which provided comfort to them and their families while minimising disruption during their transition into a new home. Within Trindlemoss Court, external providers were able to support with many crucial aspects of daily living such as housing support, social support and opportunities to access the local community. Alongside this the Care at Home service, based on site 346
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24/7, provided a response service to alarm and telecare activations alongside support with daily living activities such as personal care, meal preparation and medication management. 2.2 Over time, the service has evolved, with changes in tenancy occupation and ongoing involvement from several care providers. Feedback and evaluation has highlighted challenges commonly associated with multi-provider models, including: • Variation in how support is delivered across teams • A higher number of staff interactions within individuals’ homes • Challenges in consistent application of support plans • Increased complexity in communication and coordination • Constraints on flexibility within the current model • Practical operational differences arising from organisational policies • Inefficient use of resources through duplication of effort These challenges reflect system-wide complexities rather than the performance of any single service. The current arrangements do not always fully support shared objectives of consistency, integration, and simplified care pathways. 2.3 Care at Home and community support services are a critical component of the care and support landscape across North Ayrshire. The whole system continues to experience increased demand for services, and increasingly complex care and support needs in what is a changing and fragile market. These factors highlight the importance of ensuring resources are optimally aligned to best support individuals in achieving outcomes whilst maintaining sustainability. Similarly, there is greater fragility within the external Provider economy than ideal, which will be compounded by the need to review and possibly reduce packages, as a result of the changes to eligibility criteria. Both sets of concerns highlight the need to ensure that resource is directed appropriately, in the interests of individuals first and foremost, but also of the broader health and social care landscape. 2.4 Financial modelling of the current model of care delivery within Trindlemoss Court, and comparison of this with delivery by a single external provider, highlights opportunities to improve value and offer financial savings. • Current model: £1,701m • Single provider model: £1,233m • Indicative saving: £0.467m This suggests opportunities to improve overall value and sustainability while maintaining quality of care. The indicative saving is based on the current average care hours of existing residents and it is anticipated that this may reduce further. 347
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2.5 Individual service users will continue to have their needs met, with a social work assessment in place for each service user setting out their individual support needs. This will continue to be complimented by 24/7 on-site support and assistive technology. This proposal will see the service at Trindlemoss Court be brought into line with the service models at all other supported accommodation services across North Ayrshire. 3. PROPOSALS 3.1 Building on the strengths of current services and recognising the contribution of all partners, the North Ayrshire IJB is asked to: • Approve the proposal to develop a single care provider model within Trindlemoss Court • Approve the commencement of procurement processes associated with the change in delivery model • Note the potential impact on NAC, external care provider and Personal Assistant staff groups A proposed timetable is included in Appendix 1, this would see a new contract commence by 1st July 2027. 3.2 Anticipated Outcomes A single provider model is expected to support: • Greater consistency of care through a stable staff team • Improved alignment of care plans with partner input • Enhanced understanding of individuals across the team • Reduced complexity in communication • Increased flexibility and responsiveness • Opportunities for improved social connection and shared activities • Financial sustainability • Strengthened collaboration with LD services and partners Fundamentally, this model is expected to support improved outcomes for supported individuals. 3.3 Measuring Impact Individual outcomes would be recorded on an ongoing basis as part of delivering care within Trindlemoss Court. Expected processes surrounding the summative reporting of these would be incorporated into a collaborative monitoring framework, established as part of the service specification tied to delivery. A key element of this would be an expectation that the voices of residents themselves would be a critical part of reporting, and would collectively shape the ongoing delivery of support on site. 348
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Working in line with the Charter for Involvement would be an expected part of delivery and would be incorporated into the service specification (reflecting NAHSCP’s position as a signatory to the Charter). Built into the specification would be an expectation regarding pro-active collaboration with third sector and other partners both locally and across North Ayrshire as a whole (and elsewhere), in the interests of creating novel, inclusive opportunities for residents. 4. IMPLICATIONS 4.1 Financial Financial information identifies a current total cost of the delivery of care within Trindlemoss Court as being £1,701,397. The estimated costs for a single provider model of care are £1,233,433. This represents a potential indicative saving of £467,954. This is based on an average of 42.2 care hours per person per week plus the provision of overnight responder services. Support costs associated with other Supported Accommodation developments, where single commissioned provider arrangements are in place, are illustrated below: Bute Walk, Largs: £1,012,935 Caley Gardens, Stevenston: £834,898 Castlecraigs, Ardrossan: £745,300 Bessie Dunlop Court, Dalry: £717,096 The current supported accommodation contracts align with the hourly rate for commissioned providers as part of the adult community support framework, providing equity with the commissioning of other community-based supports. The block contract nature of supported accommodation contracts provides greater stability for care providers and in previous tender exercises a high level of interest from the market is experienced due to the static workforce and guaranteed commissioned care hours. 4.2 Human Resources Currently there are workforce posts across the inhouse Care at Home service, external care providers and Personal Assistant(s) arrangements which would be affected by the proposed change in model of care delivery. This is inclusive of 37 North Ayrshire Council positions. Following a procurement exercise, and as part of contract mobilisation, appropriate TUPE transfer arrangements would be considered for affected staff. All staff would be supported through this process, with access to organisational and employment support, including engagement with HR and Trade Unions. 4.3 Legal Any changes in provision would occur in line with relevant employment and contract law. 349
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4.4 Equality/Socio-Economic A full ECRIA has been completed and is attached as Appendix 2. This highlights positive impacts including: • by simplifying care provision to a single provider, this is expected to improve communication and consistency of support for residents • single provider model should reduce communication breakdowns and improve seamless support • will provide consistent support that respects individual rights and promotes safe community involvement • potential negative impacts relate to current staff groups delivering in-house and commissioned care, which will be addressed during implementation 4.5 Risk Key risks include: • Potential disruption to established relationships • Staff retention challenges during transition • Potential reliance on specialist models rather than mainstream integration These risks are considered manageable and proportionate within the Partnership Risk Appetite. 4.6 Community Wealth Building Increased investment in local provider market Economic benefit to North Ayrshire Opportunities for local employment 4.7 Key Priorities The proposal will support prevention activity through ensuring effective and consistent communication regarding every resident’s care, and pro-active collaboration with primary care and other partners. All too often, failures in communication are highlighted in national learning documents as contributing to missed opportunities, and negative outcomes. It will support Community Based Services, through better enabling individuals to stay well in their own homes as a result of more flexible, better integrated care. It will support a Life Stages approach, through the establishment of a consistent team, supporting the individual holistically, and adapting around them as they age and their needs change. 350
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It will prioritise a Whole Person Approach, attending to social context and the connection between peers and others, just as much as individual wellbeing. As described in previous sections, a key aim of this proposal is that it will enable greater collaboration with the Learning Disability service, and others. Mutual learning, consistently evidenced through reporting and activity, will be an expected part of delivery. This also reflects the national Coming Home agenda by supporting rights-based, community-based care that enables people to live well in their own homes with consistent and coordinated support. The proposal aligns with ensuring that the IJB makes the best use of available resources by addressing a historic model of care which is inconsistent with other services and is an inefficient use of resources. 5. CONSULTATION The Learning Disability Transformation Board have discussed the detail of the proposal and the ongoing complexities associated with the mixed model of care with a recommendation to proceed. The HSCP engaged the IJB through the Finance Working Group between November 2025 and March 2026 with the IJB approving a saving as part of the 2026/27 budget aligned to “Moving from a mixed model (in-house and purchased) to a purchased model” of care at Trindlemoss. North Ayrshire Council Elected Members were briefed as part of HSCP budget engagement in December 2025 and January 2026. Staff, trade union, provider and service user communications have commenced in advance of the proposal being presented to the IJB for approval. Thelma Bowers, Head of Service (Mental Health) Appendices Appendix 1 – Tender Timetable Appendix 2 – Equality & Children’s Rights Impact Assessment 351
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OFFICIAL INFORMATION OFFICIAL INFORMATION Appendix 1 TENDER TIMETABLE TRINDLEMOSS ACCOMODATION CARE & SUPPORT PROJECT May 2026 v1 NAHSCP Contracts & Commissioning Team Action Timeline By when Establish steering group 1-31 May By end May Draft tender timetable & Key dates 1-31 May By end May Circulate tender timetable 1-31 May By end May Confirm Interim Budget for an RPA 8 – 12 June (1 wk) By 12 June Agree MEAT Q/C Weighting Complete and issue RPA for approvals 15-19 June (1 wk) By 19 June Complete IG & EIA requirements 15-19 June (1 wk) By 19 June Submit RPA to CPU 19 June By 19 June Draft & circulate project plan & Risk register 22 – 26 June (1 wk) By 26 June Confirm project plan 29 June By 29 June Confirm risk register 29 June By 29 June Complete pretender internal TUPE activity 1 May – 31 July By 31 July Confirm final TUPE position 31 July By 31 July Review & Analysis (Volume & Cluster Model) Review hours & ceiling level of need to determine procurement budget 1 – 31 July By 31 July Scope model – Volume & Cluster model incl. base costs & bidder responsibilities 1 – 31 July By 31 July Confirm final budget & distinct budget for transferring contract TUPE costs 1 – 31 July By 31 July Agree requirement scope 1 – 31 July By 31 July Complete CPU Contract Strategy 1 – 31 July By 31 July Draft comms strategy 1 – 31 July By 31 July Agree comms strategy 1 – 31 July By 31 July Summary project outline paper to PSMT with TUPE related project cost pressures August PSMT By end August Action recommendations from PSMT if required August By end August Draft specification 1 July – 31 August By end August Agree pricing/contract model i.e. block 1 July – 31 August By end August Finalise draft Specification 1 July – 31 August By end August Draft and agree method statements 1 July – 31 August By end August User engagement 1 July – 31 August By end August Provider engagement X 4 meetings 1 July – 31 August By end August Letter to Service Users 1 July – 31 August By end August Agree User input to tender 1 July – 31 August By end August 352
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OFFICIAL INFORMATION OFFICIAL INFORMATION Confirm support for users in tender process 1 July – 31 August By end August Draft contract 1 July – 31 August By end August CPU formal Request anon TUPE Info from current providers ahead of tender publish 1 – 30 Sept By end Sept HCC & HR to confirm internal applicable TUPE staff requirements & provide anon ELI info template ahead of tender publish 1 – 30 Sept By end Sept Tender training for users 1 – 30 Sept in person with CPU By end Sept Tender training for evaluation panel 1-30 Sept Panel to complete CPU online training guidance By end Sept Issue PIN 1 – 25 Sept By 25 Sept Review PIN responses & take action if required 28 Sept – 2 Oct By 2 Oct Finalise tender docs 28 Sept – 2 Oct By 2 Oct Publish Tender 5 Oct - 3 Nov Out for 30 days By 3 Nov Bidders questions 5 – 23 Oct By 23 Oct Tender return deadline Closes 3 Nov By 3 Nov Procurement checks 3 - 10 Nov By 10 Nov Tender evaluations 11 – 13 Nov Allow 3 days By 13 Nov Award moderation 16 - 17 Nov Allow 2 days By 17 Nov Tender Outcome Report 18 Nov – 4 Dec By 4 Dec Issue standstill letters 7 – 8 Dec Allow 2 days By 8 Dec Standstill 8 – 17 Dec 10 days By 17 Dec Issue Formal award 18 Dec By 18 Dec XMAS Break Establish and action contract mobilisation 1 Jan – 30 June 2027 By 30 June 2027 Contract start 1 July 2027 353
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Version: 7.0 Appendix 2 North Ayrshire Council Equality & Children’s Rights Impact Assessment (Full Form) Please Note: Before you begin, is this version the most up to date? You can download the most recent version on Connects. Screenings and ECRIAs should be included with relevant Committee Reports and may be published on our website. Introduction This form will assist in carrying out an Equality Impact Assessment and where appropriate, Socio-Economic, Children’s Rights, Island Communities and Consumer Duty Impacts of new, revised and existing policies and practices. Guidance on how to complete assessments is given in the Council’s Equality and Children’s Rights Impact Assessment Toolkit. The form is mandatory and must be published on the Council website once the policy or practice has been approved. 1. General Details 1.1 Directorate/Service: HSCP: Section: Mental Health and Learning Disabilities 1.2 Name of Policy, Practice of Proposal being assessed: Trindlemoss Supported Accommodation Please delete whichever statements are not applicable from the highlighted text below: This is a budget proposal. Please insert Budget Reference number (if applicable) Click or tap here to enter text. 1.3 List of participants in the assessment Members of the Learning Disability Transformation Board have discussed high level implications of the proposal and agreed to proceed. 1.4 Manager responsible for the impact assessment Name: Nicola Fraser Designation: Project Manager independent Living services 1.5 Timetable (should be started during the development phase of the proposal) Date Assessment Started: February 2026 354
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Version: 7.0 Appendix 2 Interim Review Date: TBC Final sign off by Head of Service at the end of the form. 2. Aims and Relevance 2.1 What is the purpose of the policy practice or proposal? Look to move towards a single care provider for all of the residents in Trindlemoss supported accommodation and away from the current mix of inhouse care at home staff and a number of other third sector care providers. 3. Equality and Diversity 3.1 What evidence were you able to access about the relevant needs of protected groups as outlined in section 3.3 below (Please include your sources – links to equality providers and evidence can be found in both the toolkit and the Promoting Equality Page on Connects). Information on existing models of similar type and complexity Brief Evaluation of Trindlemoss Court Tenancies and Support, September 2020. The Charter for Involvement, the National Involvement Network, 2019. National Health and Wellbeing Outcomes, The Scottish Government, February 2015. North Ayrshire Health and Social Care Partnership Strategic Commissioning Plan, “Caring Together 2022/30”. North Ayrshire Council Plan 2023/28. European Convention on Human Rights (ECHR). United Nations Convention on the Rights of Persons with Disabilities (UNCRPD). North Ayrshire Health and Social Care Partnership Strategic Needs Assessment, Jan 2022. Public Health Scotland Strategic Plan 2022/25, December 2022. The Fairer Scotland Duty -Guidance for Public Bodies, The Scottish Government, October 2021. National Health and Wellbeing Outcomes, The Scottish Government, February 2015. Poverty and Inequality Commission reports. Poverty and Income Inequality in Scotland 2020/23, published March 24. 355
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Version: 7.0 Appendix 2 3.2 Are there any gaps in your evidence or areas of uncertainty? No 3.3 From the list of protected characteristic groups identified in section 3.3, please identify any potential positive and negative impacts on any of these protected characteristics. Protected Characteristic Impact on the Protected Characteristic? (yes, no, not applicable) Please Explain (Positive or Negative or Neutral) Age - Older people, children and young people – please identify which categories will be affected Not applicable The service is delivered to working age adults Disability - Physical and Learning Yes All of the residents in the complex are known to have a learning disability or Physical Disability. The change is expected to be positive as the service will be more seamless rather the current situation where there may be multiple providers leading to communication breakdown etc Gender reassignment - When a person is living in a gender other than their birth gender. No It not anticipated that those with this protected characteristic will be adversely impacted. Pregnancy and Maternity No It not anticipated that those with this protected characteristic will be adversely impacted. Race, ethnicity, colour, nationality or national origins (including gypsy/ travellers, refugees and asylum seekers) No It not anticipated that those with this protected characteristic will be adversely impacted. 356
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Version: 7.0 Appendix 2 Protected Characteristic Impact on the Protected Characteristic? (yes, no, not applicable) Please Explain (Positive or Negative or Neutral) Religion or belief (includes religious and philosophical beliefs, including no belief) No It not anticipated that those with this protected characteristic will be adversely impacted. Sex - Women and Men No It not anticipated that those with this protected characteristic will be adversely impacted. Sexual Orientation – such as lesbian, gay and bisexual people. No It not anticipated that those with this protected characteristic will be adversely impacted. Marriage and Civil Partnership - this includes same sex couples Not applicable It not anticipated that those with this protected characteristic will be adversely impacted. Human Rights Yes The Human Rights Act 1998 was introduced to ensure that people are treated with dignity and respect. Respect for the rights of individuals or groups is fundamental to their quality of life. The Human Rights Act has at its core the principles of fairness, respect, equality, dignity and autonomy. The Equality Act 2010 has as a purpose to tackle disadvantage and discrimination. The Equality Act provides a legal framework to protect the rights of individuals and advance equality of opportunity for all.The Hate Crime and Public Order (Scotland) Act 2021 will provide greater protection for those who are targeted by hate crime.The service will have a positive impact on Human Rights. 357
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Version: 7.0 Appendix 2 Protected Characteristic Impact on the Protected Characteristic? (yes, no, not applicable) Please Explain (Positive or Negative or Neutral) Care Experienced - This term refers to anyone who is currently in care or has been for any length of time regardless of their age and includes Kinship Care (other family members); Looked After at Home (with support from social work); Residential Care; Foster Care; Secure Care; Adoption. Yes The Fairer Scotland Duty, part 1 of the Equality Act 2010 places a legal responsibility on public bodies in Scotland to pay regard to how they can reduce inequalities of outcomes caused by socio-economic disadvantage when making strategic decisions. Certain equality groups are a higher risk of being in poverty, these include, people from an ethnic background and people living in a household with a disabled person. Health is one of the drivers of poverty:- Physical health/disability-impacts on, for example, education and employment; and Mental health, wellbeing and stress -impact on work, family and interaction with services. The service will have a positive impact on those within this protected characteristic. Other - Homelessness, ex-offenders, carers, part-time workers Not applicable It not anticipated that those with this protected characteristic will be adversely impacted. 3.4 Describe any consultation or engagement undertaken, including details of the groups involved and the methods used. Evaluation work carried out in the early days of the establishment of Trindlemoss Court highlighted perceived issues with the mixed care arrangement, from the perspective of other partners involved in the support of residents. At that time, the support arrangements within Trindlemoss Court were compared with those in place within other North Ayrshire Supported Accommodation developments, where support came from a single Provider. Feedback within that exercise highlighted the flexibility that was possible in supports through working with a single Provider, as well as changes around establishing consistent support across the mix of Providers and CAH within Trindlemoss Court. Reflections of practitioners over the subsequent years 358
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Version: 7.0 Appendix 2 have continued to highlight the challenges created by the mix of supports on site Questions 3.5 to 3.7 refer to the ‘Three Key needs (or aims) of the Equality Duty’ 3.5 Which aspects of the policy eliminate unlawful discrimination, harassment and victimisation? The more consistent support that would be enabled by a move to a single provider of care to residents would be a key means of realising individuals rights and safe involvement within communities, as a result of easier establishment of a shared understanding of individuals, their strengths, and their support needs. 359
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Version: 7.0 Appendix 2 3.6 Which aspects of the policy advance equality of opportunity between people who share a relevant protected characteristic and those who do not? Through the integration of supported accommodation and the support service there will be a positive impact on the Fairer Scotland duty to reduce socio-economic impact of policies, strategies and budget decisions. The service will deliver outcomes for individuals/tenants which include: • Being included in the service and community and offered support in relation to physical, intellectual, emotional and social needs/outcomes; and • Individuals will be empowered to reach their potential. Achievement of these outcomes may lead to individuals progressing to, or being able to maintain their participation in, further education, training or employment. This in turn would further improve their socio economic standing. Individuals may also be able to progress to volunteering which may in itself provide the confidence and skills to enter into employment again improving socio economic standing. 3.7 Which aspects of the policy foster good relations between people who share a protected characteristic and those who do not? (Does it tackle prejudice and promote a better understanding of equality issues). A more consistent focus on involvement within the community would be enabled by the involvement of a single staff group. 3.8 If you have identified any negative impacts of your proposal how will you mitigate these? Any negative impacts relate to current staff groups. This will have an impact on the current care at home staff group who deliver the inhouse support to the residents, as well as the various external Providers involved in the support of residents. 3.9 Is the policy or practice intended to promote equality by permitting positive action or lead to positive outcomes for people based on a protected characteristic? All individuals with a tenancy will receive income maximisation support from North Ayrshire Councils. This will ensure that all receive their maximum benefit entitlement. Other outcomes relate to promoting inclusion in the local community and developing social networks. This has benefits for individuals as well as the local community and economy. There are an estimated 16 million disabled people in the UK. The combined spending power of households with at least one disabled person-known as the purple pound- is worth approximately £274 billion per year to the UK economy (19 March 2024). 360
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Version: 7.0 Appendix 2 4. Section 4 – The Fairer Scotland Duty The Fairer Scotland Duty (‘the Duty’), Part 1 of the Equality Act 2010 places a legal responsibility on the Council to actively consider (‘pay due regard to’) how we can reduce inequalities of outcome caused by socio-economic disadvantage when making decisions. 4.1 Does the proposal have the potential to have a significant impact on inequalities of outcome caused by socio-economic disadvantage? (Consider low income; low wealth; material deprivation; area deprivation; communities of place or interest, socio-economic background). Please delete whichever statement is not applicable from the highlighted text below: No, the proposal does not have the potential to have a significant impact on inequalities of outcome caused by socio-economic disadvantage. If No, please go to Section 5. If Yes please provide more information under any of the below headings (4.2 to 4.6) which are relevant, highlighting any evidence and sources of evidence used to inform your information. 4.2 Low Income/Income Poverty: Cannot afford to maintain regular payments such as bills, food and clothing Click or tap here to enter text. 4.3 Low/and or no wealth: Having enough money to meet basic living costs and pay bills but have no savings to pay for any unexpected spends and no provision for the future. Click or tap here to enter text. 4.4 Material Deprivation: Being unable to access basic goods and services, i.e. financial products like life insurance, repair/replace broken electrical goods, warm home, leisure/hobbies Click or tap here to enter text. 4.5 Area Deprivation: Where you live (rural areas), where you work (accessibility of transport. Click or tap here to enter text. 4.6 If impacts have been identified how will these be mitigated or explored in more detail? (please outline below) Click or tap here to enter text. 361
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Version: 7.0 Appendix 2 5. Section 5 – Children’s Rights When considering the Children’s Right’s Impact process, some of the key considerations include any evidence, research and consultation (specifically including any consultation or engagement with young people). 5.1 Are any Children’s Rights impacted by this proposal? (please refer to Appendix 1 of this document, where the Children’s Rights Articles have been matched against the Getting It Right For Every Child (GIRFEC) wellbeing indicators. This is solely to make it easier to identify which rights might be impacted on; the Rights are the key element of this section). Please delete whichever statement is not applicable from the highlighted text below: No, there are no Children’s Rights impacted by this proposal. 5.2 Please indicate, if possible, how many children and young people (nearest estimate) are likely to be affected by the policy or measure? Not applicable 5.3 Are some children and young people more likely to be affected than others? Please delete whichever statement is not applicable from the highlighted text below: No, some children and young people are not more likely to be affected than others. If, Yes what groups? (Consider protected characteristics – for example disabled young people, LGBT etc.) Click or tap here to enter text. 5.4 What Children’s Rights are likely to be affected by the policy/proposal? Please refer to Table 2 (Appendix 1) ‘Links between Wellbeing Indicators and Articles of the UNCRC’ and insert the relevant rights and indicators in the table below. Wellbeing indicator (for example, safe, healthy etc.) Children’s Right (for example, 22 – refugee children) Not applicable Not applicable 362
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Version: 7.0 Appendix 2 5.5 What likely impact will the policy/proposal have on Children’s Rights and Wellbeing? Either Positive, Negative or Neutral. Children Rights Not applicable Other Protected Characteristics Nor applicable 5.6 Describe any consultation or engagement that has taken place with young people? Not applicable 5.7 If negative impacts are identified how will these be mitigated either fully or in part? Not applicable 363
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Version: 7.0 Appendix 2 6. Section 6 – Island Communities Impact (or Island Proofing) Island Proofing is about considering the particular needs and circumstances of island communities when public sector organisations exercise their functions and make decisions. This has been added to the process of assessing the Council Plan and includes a range of issues such as access to services, digital connectivity, employment and access to education, transport and access to goods and services. 6.1 Do the intended outcomes of the proposal potentially differ or have a different impact for our Island Communities? Please delete whichever statement is not applicable from the highlighted text below: No, the intended outcomes of the proposal do not potentially differ or have a different impact for our Island Communities. 6.2 Please describe the potential impacts for our Island Communities. Not applicable 6.3 Please explain if the impacts are different for communities on different islands? Not applicable 6.4 What consultation or engagement has taken place with our Island Communities? Not applicable 6.5 How will you address any potential barriers or wider impacts for our Island Communities as identified through this assessment? Not applicable 364
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Version: 7.0 Appendix 2 7. Section 7 – The Consumer Duty The Consumer Duty is about the impact of Council proposals on consumers in Scotland. A Consumer is an individual or a small business that purchases, uses or receives goods or services in Scotland, that are supplied either by a business or a public body – please see What is the Consumer Duty. 7.1 Will your proposal impact on consumers? Please delete whichever statement is not applicable from the highlighted text below: Yes, the proposal will impact on consumers. If no, please request then complete the ‘Assessment not required’ by emailing equalities@north-ayrshire.gov.uk. 7.2 What are the impacts, if any, on consumers in general? Is it likely that consumers will experience harm because of this proposal? The proposal will be beneficial to consumers, in that it will improve consistency of support and enable the development of more sustained relationships with residents. Both of these will contribute to better outcomes for individuals (informed by the individuals needs and choices), as well as creating greater scope for them to have clear routes for contributing to collectively shaping service activity (as described within the Charter for Involvement). 7.3 Describe the impacts if any, on consumers in vulnerable circumstances. Is it likely that consumers in vulnerable circumstances* will experience harm because of this proposal? (please include any relevant evidence or engagement with consumers) *Vulnerable circumstances may be temporary in nature and may or may not arise as a resulted of a consumer’s protected characteristics. For more information, please see page 31 of Consumer Scotland’s draft guidance on the consumer duty. People with learning disabilities are generally considered a vulnerable population. The degree of this will vary, and it should not obscure recognition of their strengths and potential. As outlined above, the proposal will impact on residents in a positive way, through contributing to improved outcomes, as a result of factors such as more consistent practice, better relationships enabled by a smaller and more consistent staff group, and easier communication between staff. 7.4 Describe any consultation and engagement that has taken place with consumers around your proposal. Consumers were involved in early evaluation work undertaken regarding support in Trindlemoss Court. This involved interviews with residents, facilitated by 365
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Version: 7.0 Appendix 2 members of staff from the Integrated Learning Disability Team who were familiar to them. 7.5 What alternative proposals could improve outcomes for consumers and/or reduce harm to consumers? How do these compare to the original proposal? Moving to provision of care by a single Provider represents the most relevant and effective response to the issues associated with the existing provision. 366
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Version: 7.0 Appendix 2 8. Section 8 – Crosscutting Impacts 8.1 Have any cross-cutting impacts been identified from other Council Services or Partner Agencies (multiple discrimination or accumulated effects on a protected characteristic group through multiple proposals or existing decisions)? No 8.2 If Crosscutting issues have been identified with other Services, what discussion/interaction has taken place to mitigate any potential negative impacts of accumulated proposals? Not applicable. 9. Section 9 – Outcome of the Assessment 9.1 Please detail the outcome of the assessment: Please delete whichever outcomes are not applicable from the highlighted text below: a) No major alterations to the policy assessed: the Impact Assessment demonstrates the policy is robust and there is no possible discrimination or adverse impact. All opportunities to minimise negative impacts and enhance positive outcomes have been taken. 9.2 For Outcome 2. in section 9.1 above - please detail recommendations, including any action required to address negative impacts identified or to better promote equality. Not applicable 9.3 If Outcome 3 is chosen from section 9.1 above, please outline the justifications for continuing the policy/procedure. Not applicable 9.4 Please state the key issues, recommendations and future actions arising from the Integrated Impact Assessment. Not applicable 367
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Version: 7.0 Appendix 2 10. Section 10 – Monitoring 10.1 Describe how you will monitor the impact of this policy for example, performance indicators, actions, other monitoring arrangements, who will monitor progress, criteria used to measure if outcomes are achieved, timescales including any future reviews of the impact of the proposal and where this will be recorded. Individual outcomes would be recorded on an ongoing basis as part of delivering care within Trindlemoss Court. Expected processes surrounding the summative reporting of these would be incorporated into a collaborative monitoring framework, established as part of the service specification tied to delivery. A key element of this would be an expectation that the voices of residents themselves would be a critical part of reporting, and would collectively shape the ongoing delivery of support on site. Working in line with the Charter for Involvement would be an expected part of delivery and would be incorporated into the service specification (reflecting NAHSCP’s position as a signatory to the Charter). Built into the specification would be an expectation regarding pro-active collaboration with third sector and other partners both locally and across North Ayrshire as a whole (and elsewhere), in the interests of creating novel, inclusive opportunities for residents. 11. Section 11 – Sign Off 11.1 Head of Service approval of the impact assessment. Name: Thelma Bowers Title: Head of Service (Mental Health) Date: 5.06.26 12. Section 12 – Publication 12.1 Following approval by Head of Service, completed Impact Assessments are published on our Council’s External Website. Please email: equalities@north-ayrshire.gov.uk 368
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Version: 7.0 Appendix 1 - GIRFEC Wellbeing Indicators and Children’s Rights Table 1 - GIRFEC Wellbeing Indicators Indicator Description Safe Protected from abuse, neglect and harm Healthy Having the best possible standards of physical and mental health; support to make healthy, safe choices Achieving Accomplishing goals and thereby boosting skills, confidence and self-esteem; ‘being all they can be’. Nurtured Having a loving and stimulating place to live and grow Active Having opportunities to take part in a wide range of activities Respected Being enabled to understand their world, being given a voice, being listened to, and being involved in the decisions that affect their wellbeing. Responsible Taking an active role within their home, school and community. Included Being a full member of the communities in which they live and learn; receiving help and guidance to overcome inequalities. 369
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Version: 7.0 Articles of the UNCRC matched against the GIRFEC indicators Summary of the UNCRC Articles from 1 – 54 (UNICEF) Table 2 - Links between Wellbeing Indicators and Articles of the UNCRC *Please note in general the use of the term Governments, includes public sector organisations such as the Council, some articles will have stronger relevance for the work of the Council than others. Wellbeing Indicator – Safe There are 12 relevant articles of the UNCRC (Rights of the Child) linked to the Safe indicator. Article 9 – Separation from parents Children must not be separated from their parents against their will unless it is in their best interests (for example, if a parent is hurting or neglecting a child). Children whose parents have separated have the right to stay in contact with both parents, unless this could cause them harm. Article 10 – Family reunification Governments must respond quickly and sympathetically if a child or their parents apply to live together in the same country. If a child’s parents live apart in different countries, the child has the right to visit and keep in contact with both of them. Article 11 - Abduction and non-return of children Governments must do everything they can to stop children being taken out of their own country illegally by their parents or other relatives or being prevented from returning home. Article 19 - Protection from violence, abuse and neglect Governments must do all they can to ensure that children are protected from all forms of violence, abuse, neglect and bad treatment by their parents or anyone else who looks after them. Children and Young People have the right to be kept safe from harm. They must be given proper care by those looking after them. Article 22 - Refugee children If a child is seeking refuge or has refugee status, governments must provide them with appropriate protection and assistance to help them enjoy all the rights in the Convention. Governments must help refugee children who are separated from their parents to be reunited with them. Children and Young People have the right to special help and be allowed to live somewhere that is safe if they are a refugee. 370
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Version: 7.0 Article 32 - Child labour Governments must protect children from economic exploitation and work that is dangerous or might harm their health, development or education. Governments must set a minimum age for children to work and ensure that work conditions are safe and appropriate. If they are under 16 there are laws about where, when and for how long they can work. Article 33 - Drug abuse Governments must protect children from the illegal use of drugs and from being involved in the production or distribution of drugs. Article 34 - Sexual exploitation Governments must protect children from all forms of sexual abuse and exploitation. Children and Young People have the right to never be pressurised or forced into doing anything sexual. They have the right to be protected from it. Article 35 - Abduction, sale and trafficking Governments must protect children from being abducted, sold or moved illegally to a different place in or outside their country for the purpose of exploitation. People should never make them do anything against their will, like marry someone for instance. Article 36 - Other forms of exploitation Governments must protect children from all other forms of exploitation, for example the exploitation of children for political activities, by the media or for medical research. Children and Young People have the right to be protected from being taken advantage of in any way. Article 37 - Inhumane treatment and detention Children and Young People have the right to be treated with respect. If they have committed a crime children should be arrested, detained or imprisoned only as a last resort and for the shortest time possible. They must be treated with respect and care and be able to keep in contact with their family. Children must not be put in prison with adults. They should not be imprisoned unless it is absolutely necessary and they will get legal help. Article 38 - War and armed conflicts Governments must not allow children under the age of 15 to take part in war or join the armed forces. Governments must do everything they can to protect and care for children affected by war and armed conflicts. In Scotland, they have to be 16 to join the armed forces and are not normally allowed to fight until they are 18. 371
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Version: 7.0 Wellbeing Indicator – Healthy There are four relevant articles of the UNCRC (Rights of the Child) linked to the Healthy indicator. Article 3 – Best interests of the child The best interests of the child must be a top priority in all decisions and actions that affect children. Children and Young People have the right to have their interests considered if a decision is being made by any person about them. What is best for them is what matters. Article 6 – Life, survival and development Every child has the right to life. Governments must do all they can to ensure that children survive and develop to their full potential. Children and Young People have the right to be kept safe from harm, they have the right to be alive, survive and develop through life. Article 24 - Health and health services Every child has the right to the best possible health. Governments must provide good quality health care, clean water, nutritious food, and a clean environment and education on health and well-being so that children can stay healthy. Children and Young People have the right to be given good healthcare (if they are ill) so they can get well again. They have the right to live in a safe, healthy environment with good food and clean drinking water. Article 39 - Recovery and rehabilitation of child victims Children who have experienced neglect, abuse, exploitation, torture or who are victims of war must receive special support to help them recover their health, dignity, self-respect and social life. 372
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Version: 7.0 Wellbeing Indicator – Achieving There are four relevant articles of the UNCRC (Rights of the Child) linked to the Achieving indicator. Article 4 – Implementation of the Convention Governments must do all they can to make sure every child can enjoy their rights by creating systems and passing laws that promote and protect Children’s Rights. Children and Young People have the right to have their rights protected and an environment where they can grow up safe. Article 18 - Parental responsibilities and state assistance Both parents share responsibility for bringing up their child and should always consider what is best for the child. Governments must support parents by creating support services for children and giving parents the help they need to raise their children. Article 28 - Right to education Every child has the right to an education. Primary education must be free and different forms of secondary education must be available to every child. Discipline in schools must respect children’s dignity and their rights. Richer countries must help poorer countries achieve this. In Scotland education is free and children three years old+ are entitled to a free nursery place. Some 2 year olds may be eligible for free care depending on family circumstances, such as level of income. Article 29 - Goals of education Education must develop every child’s personality, talents and abilities to the full. It must encourage the child’s respect for human rights, as well as respect for their parents, their own and other cultures, and the environment. It must help to prepare them for adult life. 373
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Version: 7.0 Wellbeing Indicator – Nurtured There are eight relevant articles of the UNCRC (Rights of the Child) linked to the Nurtured indicator. Article 4 – Implementation of the Convention Governments must do all they can to make sure every child can enjoy their rights by creating systems and passing laws that promote and protect children’s rights Children and Young People have the right to have their rights protected and an environment where they can grow up safe. Article 5 - Parental guidance and a child’s evolving capacities Every child has the right to be registered at birth, to have a name and nationality, and, as far as possible, to know and be cared for by their parents. Children and Young People have the right to their parents being responsible to guide them through their childhood and help them learn how to use their rights. Article 9 – Separation from parents Children must not be separated from their parents against their will unless it is in their best interests (for example, if a parent is hurting or neglecting a child). Children whose parents have separated have the right to stay in contact with both parents, unless this could cause them harm. Article 10 – Family reunification Governments must respond quickly and sympathetically if a child or their parents apply to live together in the same country. If a child’s parents live apart in different countries, the child has the right to visit and keep in contact with both of them. Article 18 - Parental responsibilities and state assistance Both parents share responsibility for bringing up their child and should always consider what is best for the child. Governments must support parents by creating support services for children and giving parents the help they need to raise their children. Article 20 - Children deprived of a family If a child cannot be looked after by their immediate family, the government must give them special protection and assistance. This includes making sure the child is provided with alternative care that is continuous and respects the child’s culture, language and religion. Children and Young People have the right to special care if they can’t live with their parents. They may be looked after by other members of their family or by a different family. 374
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Version: 7.0 Article 21 - Adoption Governments must oversee the process of adoption to make sure it is safe, lawful and that it prioritises children’s best interests. Children should only be adopted outside of their country if they cannot be placed with a family in their own country. Article 25 - Review of treatment in care If a child has been placed away from home for the purpose of care or protection (for example, with a foster family, in hospital, a care home or somewhere else away from home), they have the right to a regular review of their treatment, the way they are cared for and their wider circumstances to help make sure they are still getting what’s best for them. Article 27 - Adequate standard of living Every child has the right to a standard of living that is good enough to meet their physical and social needs and support their development. Governments must help families who cannot afford to provide this. Children and Young People have the right to a safe place to live, food, clothing and to take part in things they enjoy. 375
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Version: 7.0 Wellbeing Indicator – Active There are eight relevant articles of the UNCRC (Rights of the Child) linked to the Nurtured indicator. Article 3 - Best interests of the child The best interests of the child must be a top priority in all decisions and actions that affect children. Children and Young People have the right to have their interests considered if a decision is being made by any person about them. What is best for them is what matters. Article 23 - Children with disabilities A child with a disability has the right to live a full and decent life with dignity and, as far as possible, independence and to play an active part in the community. Governments must do all they can to support children with a disability and their families. Children and Young People have the right to have special help to make sure they can join in with things if they have any form of disability. Article 31 - Leisure, play and culture Children and Young People have the right to rest, play and have the chance to join a wide range of artistic and cultural activities. It is really important to they have a balance in their life. 376
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Version: 7.0 Wellbeing Indicator – Respected There are 12 relevant articles of the UNCRC (Rights of the Child) linked to the Nurtured indicator. Article 2 - Non-discrimination The convention that applies to everyone under the age of 18, regardless of circumstances. Article 3 - Best interests of the child The best interests of the child must be a top priority in all decisions and actions that affect children. Children and Young People have the right to have their interests considered if a decision is being made by any person about them. What is best for them is what matters. Article 4 – Implementation of the Convention Governments must do all they can to make sure every child can enjoy their rights by creating systems and passing laws that promote and protect children’s rights. Children and Young People have the right to have their rights protected and an environment where they can grow up safe. Article 5 - Parental guidance and a child’s evolving capacities Every child has the right to be registered at birth, to have a name and nationality, and, as far as possible, to know and be cared for by their parents. Children and Young People have the right to their parents being responsible to guide them through their childhood and help them learn how to use their rights. Article 8 - Protection and preservation of identity Every child has the right to an identity. Governments must respect and protect that right, and prevent the child’s name, nationality or family relationships from being changed unlawfully. Children and Young People have the right to know who they are – official records should be kept. If they are over 16 years old and adopted, they can try to find out who their birth parents are. Article 12 - Respect for the views of the child Every child has the right to express their views, feelings and wishes in all matters affecting them, and to have their views considered and taken seriously. This right applies at all times, for example during immigration proceedings, housing decisions or the child’s day-to-day home life. Children and Young People have the right to speak up and have their opinions listened to and be taken seriously by adults on things that affect them. 377
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Version: 7.0 Article 13 - Freedom of expression Every child must be free to express their thoughts and opinions and to access all kinds of information, as long as it is within the law. Children and Young People have the right to say whatever they believe as long as it does not harm or offend other people. They also have the responsibility to respect the rights and freedom of others. Article 14 - Freedom of thought, belief and religion Every child has the right to think and believe what they choose and also to practise their religion, as long as they are not stopping other people from enjoying their rights. Governments must respect the rights and responsibilities of parents to guide their child as they grow up. Children and Young People have the right to choose their own religion and beliefs. Their parents should help them think about this. Article 16 - Right to privacy Every child has the right to privacy. The law should protect the child’s private, family and home life, including protecting children from unlawful attacks that harm their reputation. They shouldn’t have their personal letters opened or anyone listening in to their personal phone calls. Article 17 - Access to information; mass media Every child has the right to reliable information from a variety of sources, and Governments should encourage the media to provide information that children can understand. Governments must help protect children from materials that could harm them. Children and Young People have the right to access information which is important to their wellbeing. Adults should help them find information they are looking for and make sure it’s not harmful. Article 18 - Parental responsibilities and state assistance Both parents share responsibility for bringing up their child and should always consider what is best for the child. Governments must support parents by creating support services for children and giving parents the help they need to raise their children. Article 30 - The right to learn and use the language, customs and religion of their family Every child has the right to learn and use the language, customs and religion of their family, whether or not these are shared by the majority of the people in the country where they live. 378
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Version: 7.0 Wellbeing Indicator – Responsible There are five relevant articles of the UNCRC (Rights of the Child) linked to the Responsible indicator. Article 3 - Best interests of the child The best interests of the child must be a top priority in all decisions and actions that affect children. Children and Young People have the right to have their interests considered if a decision is being made by any person about them. What is best for them is what matters. Article 12 - Respect for the views of the child Every child has the right to express their views, feelings and wishes in all matters affecting them, and to have their views considered and taken seriously. This right applies at all times, for example during immigration proceedings, housing decisions or the child’s day-to-day home life. Children and Young People have the right to speak up and have their opinions listened to and be taken seriously by adults on things that affect them. Article 14 - Freedom of thought, conscience and religion Every child has the right to think and believe what they choose and also to practise their religion, as long as they are not stopping other people from enjoying their rights. Governments must respect the rights and responsibilities of parents to guide their child as they grow up. Children and Young People have the right to choose their own religion and beliefs. Their parents should help them think about this. Article 15 - Freedom of association Every child has the right to meet with other children and to join groups and organisations, as long as this does not stop other people from enjoying their rights. Article 40 - Juvenile justice A child accused or guilty of breaking the law must be treated with dignity and respect. They have the right to legal assistance and a fair trial that takes account of their age. Governments must set a minimum age for children to be tried in a criminal court and manage a justice system that enables children who have been in conflict with the law to reintegrate into society. Children and Young People have the right to be given legal assistance if they have committed a crime. The Convention also states that they should only be sent to prison if they have committed a serious crime. 379
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Version: 7.0 Wellbeing Indicator – Included There are five relevant articles of the UNCRC (Rights of the Child) linked to the Included indicator. Article 3 - Best interests of the child The best interests of the child must be a top priority in all decisions and actions that affect children. Children and Young People have the right to have their interests considered if a decision is being made by any person about them. What is best for them is what matters. Article 6 - Life, survival and development Every child has the right to life. Governments must do all they can to ensure that children survive and develop to their full potential. Children and Young People have the right to be kept safe from harm, they have the right to be alive, survive and develop through life. Article 18 - Parental responsibilities and state assistance Both parents share responsibility for bringing up their child and should always consider what is best for the child. Governments must support parents by creating support services for children and giving parents the help they need to raise their children. Article 23 - Children with disabilities A child with a disability has the right to live a full and decent life with dignity and, as far as possible, independence and to play an active part in the community. Governments must do all they can to support children with a disability and their families. Children and Young People have the right to have special help to make sure they can join in with things if they have any form of disability. Article 26 - Social security Every child has the right to benefit from social security. Governments must provide social security, including financial support and other benefits, to families in need of assistance. Article 27 - Adequate standard of living Every child has the right to a standard of living that is good enough to meet their physical and social needs and support their development. Governments must help families who cannot afford to provide this. Children and Young People have the right to a safe place to live, food, clothing and to take part in things they enjoy. 380
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Integration Joint Board 18th June 2026 Subject : Ward 7A Options Appraisal Purpose : • Awareness • Approval Recommendation : IJB is asked to approve the outcome of the Option Appraisal process and the commencement of next steps towards delivery. Direction Required to Council, Health Board or Both Direction to :- 1. No Direction Required 2. North Ayrshire Council 3. NHS Ayrshire & Arran X 4. North Ayrshire Council and NHS Ayrshire & Arran Glossary of Terms NHS AA NHS Ayrshire and Arran HSCP Health and Social Care Partnership LD Learning Disabilities DSR Dynamic Support Register SHRC Scottish Human Rights Commission IST Intensive Support Team CRPD Convention on the Rights of Persons with Disabilities OA Options Appraisal MWC Mental Welfare Commission 1. EXECUTIVE SUMMARY 1.1 Ward 7A opened in early 2020 with a view to providing in-patient assessment and treatment to adults with learning disabilities whose needs could not be safely met within the community. Ongoing issues regarding the environment and staffing, combined with significant issues around discharge of individuals to appropriate supports and accommodation, led to a situation in early 2025 when all 6 individuals within the ward were significantly delayed discharge extending to a period of years. 1.2 Reflecting the profound challenges this presented for patients, staff, and families, the difficult decision was taken in May 2025 to temporarily close the ward. An Options Appraisal process was subsequently initiated, with a view to identifying a preferred route for future development. Agenda Item 12 381
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1.3 As a result of engagement with and involvement of staff, clients, and families, establishment of a pan-Ayrshire Intensive Support Team (with support in each locality) emerged as the preferred option, accompanied by the permanent closure of Ward 7A as a learning disability assessment and treatment facility. 2. BACKGROUND 2.1 At times, the support needs of people with learning disabilities (LD) can exceed that which can safely be provided by their existing supports. Often, this is linked to mental health or related issues, such as: • Self-injurious behaviour, this being on some occasions, noted as extreme. • Violent or aggressive behaviour towards others • Suicidal ideation. • Paranoia and auditory or visual hallucinations • Destructive behaviour • Severe anxiety/distress • Self-neglect. In such circumstances, a period of admission to an in-patient Assessment and Treatment facility may be sought, if the individual’s needs can’t be safely managed within a community setting. 2.2 Such admissions come with a risk of the individual remaining in hospital for longer than necessary. National discussions in relation to delayed discharge and inappropriate institutionalisation of people with learning disabilities has been ongoing for some time. The Coming Home report, published in 2018, outlined an ambition to address this through means such as the provision of specific funding from Government, and the pursuit of alternative means of providing support, such as community based Intensive Support Teams. 2.3 Intensive Support Teams are a relatively familiar model of delivery across the UK. They enable the provision of a support at higher levels to individuals within the community, in order to prevent avoidable hospital admissions, reduce overall risk, and support improved clinical outcomes. The existing evidence base suggests that, among other outcomes, they can reduce hospital admissions; reduce out of area placements; reduce the use of restraint; increase family satisfaction; improve quality of life for individuals; and generate financial savings. 2.4 Despite the recommendations of the Coming Home report, and the existing evidence base around other solutions, delayed discharge remains a significant issue. The ‘Tick Tock’ (2025) report from the Scottish Human Rights Commission (SHRC), along with the ‘Hospital is not Home’ (2025) report from the Mental Welfare Commission (MWC), both highlighted a lack of progress in relation to long stays in institutions across Scotland. 382
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2.5 In early 2020, Ward 7A (Woodland View) opened as the new location of the Ayrshire Learning Disabilities Assessment and Treatment (A&T) Unit (previously at Arrol Park). It opened with the capacity to accommodate 10 individuals, however, reflecting an awareness of the impact of the existing space and environment on patients and staff, this was reduced in 2023 to 7. In the latter stages of its operation, 6 individuals were being supported within the ward. The reduction in capacity was one response to ongoing issues within the ward, linked in no small way to challenges in discharging people, including: • Difficulty in finding care providers with skills and capacity to support people. • Difficulty in finding appropriate homes within the community The consequences of this for the individuals themselves, their families, and staff were significant. Some individuals were admitted to the ward for considerably longer than intended, past the point that was clinically necessary, and with negative consequences for their wellbeing and that of others on the ward. The resulting care environment also had negative consequences for staff, resulting in low morale, high levels of sickness, and high usage of bank staff. 2.6 Reflecting the extremity of the situation in Ward 7A, the difficult decision was taken in mid-2025 to temporarily close the ward. The closure was instigated first and foremost in the interests of patients and staff themselves, but also with a view to creating the space to explore options for the future provision of alternative support within Ayrshire and Arran. 2.7 A variety of review and information gathering was undertaken to inform consideration of future provision. Summary of this work is included in the Background Document prepared for the Option Appraisal (Appendix 1). The Options considered were: • Status Quo: reopening of Ward 7A as it was prior to closure • Option 1: Specialist Learning Disability Assessment and Treatment Inpatient with 3 beds • Option 2: Assessment and Treatment Inpatient within an alternative environment (e.g. mainstream adult mental health ward) • Option 3: An Intensive Support Model in all three HSCPs (potentially including out of hours support) with access to LD beds hosted within a mainstream MH ward Some key points to note are: • A Benchmarking exercise of In-patient assessment and treatment services for people with learning disabilities across Scotland clearly indicated that the issues experienced within Ward 7A were not unique to it. 8 of the 9 areas which indicated that they had an inpatient LD unit noted that there were issues with the environment, in addition to areas also highlighting issues around staffing. 383
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• A review of past admissions to Ward 7A noted that approximately a third of admissions could potentially have been avoided. Possible contributors to this avoidance were varied but included earlier intervention within the community. • A learning review of the work of the North Ayrshire Intensive Support Service (a small team of Nurses, with some Psychology and Occupational Therapy input) was undertaken in mid-2025. The team (established in late 2023) is intended to provide support at a higher level of intensity than is possible within the core community team, in order to prevent placement breakdown, or to support individuals being brought back into North Ayrshire. The learning review clearly indicated positive outcomes associated with the skills of the team and the additional time they were able to spend with individuals, carers, and providers, as a result of their smaller caseload and specific focus. 2.8 The Option Appraisal process which was initiated in relation to identifying a future direction is described in further detail under section 5 (Consultation). It involved a wide range of participants, including people with learning disabilities and family carers, and was supported by a range of partners, particularly In Control Scotland. Planning, analysis and reporting was supported by NHS Ayrshire Arran Health Economics staff, with prior experience of supporting Option Appraisals. The process followed aligned with formal guidance regarding the completion of Option Appraisals. Health Economics colleagues combined the non-financial and financial information gathered within the Option Appraisal in order to identify a preferred Option. Option 3 was identified as a result of this analysis, i.e. ‘Woodland View Ward 7A does not re- open as a specialist learning disability inpatient unit and existing Ward 7A resources are re-purposed as an intensive community team within each locality supported by mainstream mental health wards at Woodland View’. 3. PROPOSALS 3.1 The IJB is asked to endorse the following actions: • Families, services, and others potentially affected to be notified of the outcome of the Option Appraisal process, and the resultant direction of travel. • Ward 7A to be permanently closed as an Assessment and Treatment inpatient facility for adults with learning disabilities. • Work to commence on the development of a full business case and delivery plan for a pan-Ayrshire Intensive Support Team. Proposed timeline for that work as below: 384
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Finalise detailed staffing model July 2026 Establish and schedule regular meetings of delivery/implementation group July 2026 – July 2027 Leadership Recruitment programme August – October 2026 Full recruitment programme October – February 2026 Service launch April 2027 3.2 Anticipated Outcomes Investment in community infrastructure will ensure that wherever possible, adults with learning disabilities presenting with significant mental health or other issues are supported to remain in their own home. This will prevent the disintegration of community supports which has in the past often resulted from admission to an inpatient environment, and prioritise supporting the capacity of existing care networks, as well as the individual themselves. In this way, the proposed changes will significantly improve the scope for the creation of real-world solutions in partnership with individuals and their support networks, which are informed by and benefit from a direct consideration of their home and community environment. The proposed changes will significantly reduce the risk of extended inpatient stays, and the trauma for individuals and families which can be linked to these. It will significantly enhance the capacity of the HSCPs and NHS Ayrshire and Arran to respect and promote the human rights of individuals. Admission to a hospital setting is a form of institutionalisation, and the Convention on the Rights of People with Disabilities Committee has set out clear actions as to what is required to end institutionalisation, including: - Prioritising the development of high quality, individualised support, and inclusive services in the community - Prohibiting investment in institutions and directing funding to community support The changes will also directly address a number of the actions within the recent Coming Home Action Plan (2026), specifically those in relation to the need to shift resources from hospitals to communities (Action 3.3); the need to strengthen community services and ensure staff have the skills needed to support people with complex needs to live well there (Strategic Aim 6); and the need to create the conditions for people to thrive within their community (Strategic Aim 13). Changes will also address recommendations within a recent Position Statement regarding ISTs 385
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(2026), published by the National IST Network, including addressing the commissioning of ISTs as a matter of priority. It is essential to note that investment in the establishment of a pan-Ayrshire Intensive Support Team will not remove the option of admission to an in-patient environment, where this is clearly identified by all involved as the most appropriate way to prioritise the safety and wellbeing of the individual. Admission will be possible to mainstream mental health wards: as far as possible, this will be to an identified space within Woodland View (Ward 11), which will be ear marked as having a speciality in relation to learning disability, in much the same way as other wards on the site have other designated specialities. In addition, the proposed changes will involve the establishment of a small specialist learning disability in-patient workforce; this in turn will be supported by in-reach from the Intensive Support Team. In this way, the relationships which may be established by an individual with the IST while in the community, can be sustained and used to enhance any subsequent in-patient admission. 3.3 Measuring Impact Implementation of the pan-Ayrshire Intensive Support Team will be accompanied by an ongoing process of learning and review. This will be shaped with reference to the description of Best Practice outlined within the National Position Statement on ISTs (as recommended within that report). As one part of this, the work of the team will be closely aligned to the use of the Dynamic Support Register (DSR) within each HSCP. The DSR was a national development recommended by the original Coming Home report, which is used to track and enhance the visibility of individuals admitted to hospital settings, or whose community supports are at risk of breakdown. Individuals on the DSR are categorised using a RAG system: changes in that category will be used as one means of evidencing impact of the Intensive Support Team. The SHRC report includes within it a set of Human Rights indicators which were used to structure the work linked to it. Those indicators are also recommended for use to guide duty bearers in ending institutionalisation. On this basis, they will be used alongside other mechanisms to evidence the rights-based work of the Intensive Support Team, and associated local services. The need for accountability was clearly voiced in feedback from family carers as part of the Options Appraisal. Reflecting this, delivery partners will seek to include family carers and clients in the design and ongoing delivery of the Intensive Support Team. As part of this, we will seek to maintain our positive working relationship with In Control Scotland, to help shape that involvement, and ensure the voices of family carers and clients form a core element of impact measurement. 386
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4. IMPLICATIONS 4.1 Financial A saving of £0.341m was approved as part of the 2025/26 budget with the presumption that an alternative model of care would deliver financial efficiencies together with an improvement in outcomes for supported people. This takes the available financial envelope for the delivery of an LD Assessment and Treatment service is £1.325 million. This is significantly less than the costs previously associated with the delivery of Ward 7A. High level costing of Option 3 undertaken as part of the Option Appraisal process indicated that it would come within the available envelope. It is important to reiterate that the implementation of Option 3 would evidence the shift in resource from hospital to community settings which is required by the national Coming Home Action Plan (2026), as well as being an overarching ambition for the public sector for a number of years. 4.2 Human Resources The staff group linked to Ward 7A was redeployed to support patients relocated to other wards as a result of the temporary closure in 2025. Since then, some staff have moved on to other posts, including within the Ayrshire LD Community Teams. The recruitment programme which would be linked to the establishment of the pan- Ayrshire IST (and associated in-patient workforce) would prioritise involvement of those staff, as well as those staff already working within the North Ayrshire Intensive Support Service. Support from Human Resources colleagues will be ongoing to ensure that this happens in line with NHS HR policies. 4.3 Legal None. 4.4 Equality/Socio-Economic Shifting resource from investment in hospital settings to community will create a more flexible care infrastructure, with greater capacity to work equitably across communities. It is important to note that people with learning disabilities remain a population that routinely experiences inequity across communities and services. This inequity fundamentally shapes the actions of the Learning Disability Service, and its collaboration with partners. 4.5 Risk It is important to note that the initial closure of Ward 7A, and the subsequent Option Appraisal, were themselves linked to risks associated with the existing model. Establishing a pan-Ayrshire Intensive Support Team will mitigate many of those risks, but also brings some of its own: • The absence of a dedicated learning disability inpatient unit, and demand already seen within mainstream mental health wards in Woodland View, creates some risk that beds may not be available when required. Mitigating 387
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this will be an intent to protect capacity within Ward 11, and flexibility to consider other Wards within Woodland View when appropriate. • Establishing the Intensive Support Team, and the small associated in-patient workforce, will require recruitment. Even with the opportunity to open recruitment to existing staff teams (linked to Ward 7A and North Ayrshire Intensive Support Service), the challenging recruitment landscape (particularly with regard to Learning Disability Nursing) may create some delays. Planned timescales for the development reflect this concern. • Establishing a new team, at a pan-Ayrshire level, will require strong professional leadership, particularly in relation to Learning Disability Nursing. The existing provision of Senior Learning Disability Nurse roles across Ayrshire is currently only 2-days a week. Learning Disability Nursing is a critical component of a pan-Ayrshire Intensive Support Team, and in the absence of consistent professional leadership, there is a risk that the potential of the Nursing role within the team’s intended multi-disciplinary context will be diminished. • Making use of space within a mainstream ward will make it even more necessary to ensure that every admission is completely necessary, with no safe alternative possible. This will require the consistent application of a clear process, involving clients, families, and professionals, in order to ensure the appropriateness of admission. In the absence of this, there is a risk that resources will become unavailable. Positive steps to mitigating against this are already seen in the current admission scrutiny process which has been established. • Resource availability may become all the more pressing an issue in the context of changes in eligibility criteria. A shift to funding critical care only in North Ayrshire has the potential to contribute to the creation of crisis, with the scope for increased pressure on the IST and its associated resources. • This in turn highlights another potential risk: that the creation of a pan-Ayrshire IST is taken as sufficient in terms of community infrastructure, capable of providing support in relation to complex needs. Complex needs are always present across the learning disability population, and there is an ongoing need to ensure capacity within specialist, but also mainstream services, to meet those needs. Establishing a pan-Ayrshire IST needs to be considered as only a part of a broader system response, with development as necessary in other parts of that system. This should include (but is not limited to) Primary Care. • It should also be noted that variance in the resource and community landscape across the 3 Ayrshire localities (e.g. in the availability of respite facilities) will present risks for a pan-Ayrshire service such as the IST. While it will be able to manage consistency in its practice to a considerable degree, there will be 388
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some limitations on this, imposed by the surrounding infrastructure. Flexibility in the practice of the IST, and creative collaboration with all partners relevant to an individual’s care, will be key to successful delivery within such variance. It should also be noted that the pan-Ayrshire aspect of the IST will afford a fresh lens through which to view locality variance as a source of learning, and a means of highlighting gaps/opportunities. Taken together, these risks are considered manageable and proportionate when assessed against the Partnership’s Risk Appetite Statement, approved by the IJB in April 2026, which recognises that delivery of health and social care services requires a balanced approach to risk across the key domains of service, quality, people and finance. The proposed shift from an inpatient model to a community-based intensive support model involves an acceptable level of managed risk in pursuit of improved outcomes, reduced institutional harm, better use of available resources and a more sustainable model of care. On that basis, the overall risk associated with the preferred option is considered to be consistent with the HSCP’s agreed risk appetite. 4.6 Community Wealth Building By supporting individuals to remain within and connected to their communities, the pan-Ayrshire IST will contribute to a flourishing independent and voluntary sector across Ayrshire. Its work in relation to training within care providers will also support the ongoing growth of a robust and highly skilled provider market across Ayrshire. 4.7 Key Priorities The implementation of the pan-Ayrshire IST will address a range of priorities within the new HSCP strategic plan: It will enable intensive support at an earlier point, preventing escalation of issues and supporting the development of resilience within the individual and their support network (SP1: Prevention) It will realise a significant shift in investment from hospital into community based services, and increase the likelihood of people being able to remain within their own home, alongside their existing supports (SP2; Community Based Services). It will enable more flexible working with other services linked to an individual’s age and stage (SP3: Life Stages). It will support a greater holistic focus on the individual and their network, working in partnership with them to identify the outcomes they see as important, and recognising the assets and experience that already exist within them (SP4: Whole Person Approach). Working directly with individuals in their homes and other settings, and having the flexibility to spend time and build valued care relationships, will ensure the IST’s practice is deeply informed by an awareness of individual needs and abilities (SP5: Accessibility and Communication). 389
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5. CONSULTATION The Option Appraisal (OA) which led to identification of a preferred option was initiated in the second half of 2025. The format of the process reflected guidance from Healthcare Improvement Scotland, and was also shaped by good practice from other areas across Scotland. In particular, conversations with Dumfries and Galloway colleagues regarding their delivery of an OA process, and sharing of the materials linked to this, proved particularly valuable. Given the publicity surrounding Ward 7A, and the national conversation regarding such services, efforts were made to draw in external partners to support the local OA process. Of those approached, In Control Scotland provided the most support (mainly in relation to engagement with family carers), with some support also coming from the Scottish Commission for People with Learning Disabilities. The SHRC and Healthcare Improvement Scotland were also approached, but were unable to provide assistance. Steps followed within the OA process were as follows: Establishment of a long list of options An initial list of 6 options (including the Status Quo) was developed on the basis of the preliminary information gathering (e.g. national benchmarking; review of past admissions, review of North Ayrshire ISS). Other work undertaken to inform the development of the long list included: • An engagement event involving approximately 50 participants from across health and social care and the third sector • Interviews with 4 clients who had been admitted to Ward 7A (facilitated by clinicians from the Community Learning Disability Teams) • Interviews with 5 families, whose family members had experienced 7A or similar inpatient environments (facilitated by the Director of In Control Scotland) While the number of clients and families involved may appear small, it is necessary to bear in mind that the population of people admitted to 7A is itself relatively small (admissions for 35 individuals were reviewed for this work). Establishment of a short list of options Following review by the pan-Ayrshire stakeholder group overseeing the OA process, 2 options were removed from the long list. This resulted in a short list of 4 options being taken forward for consideration, these being: • Status Quo: reopening of Ward 7A as it was prior to closure 390
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• Option 1: Specialist Learning Disability Assessment and Treatment Inpatient with 3 beds • Option 2: Assessment and Treatment Inpatient within an alternative environment (e.g. mainstream adult mental health ward) • Option 3: An Intensive Support Model in all three HSCPs (potentially including out of hours support) with access to LD beds hosted within a mainstream MH ward The Status Quo was included in order to provide a baseline for comparison of the other options, but was not itself considered as a viable Option for future delivery. Establishment of criteria for non-financial benefits scoring A brief set of scoring criteria were established, based around principles, values, and practice identified as important across the various strands of engagement activity. The 6 criteria were finalised with the input of the pan-Ayrshire stakeholder group, and were: Safe; Sustainable; Person-centred; Flexible; Integrated; Effective Non-financial benefits scoring In line with the expected OA process, scoring of non-financial benefits linked to the Options involved 3 groups of individuals: • Group 1: Individuals who receive the service or their representatives (family carers and related organisations) • Group 2: Ground level staff involved in delivering the service • Group 3: Senior managers with overall responsibility for services Representatives of the Independent and Voluntary sector (Provider organisations) were also invited to take part (within Group 2), reflecting their critical role in the support of people within communities. Scoring events took place in January and February 2026, with that from Group 1 (primarily family carers, and representative organisations) taking place separately. That event was co-facilitated by In Control Scotland, and all scoring events were supported by Health Economics colleagues from the NHS Ayrshire and Arran Transformation Team. All participants in the scoring events received 2 documents in advance of the scoring sessions: one describing the background to the process; and the other outlining the Options and scoring Criteria. Both documents are embedded in Appendix A. Scoring events involved participants individually weighting each of the criteria, in terms of the importance of each; and then scoring each Option in relation to these criteria. 391
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Financial assessment of the Options In partnership with finance colleagues, high level indicative costs for the options were developed. These costs were not intended to be precise, given the nature of the process, but were intended to be sufficiently accurate to enable consideration of potential cost alongside the outcomes of the non-financial benefits scoring. As the 7A assessment and treatment services are delivered Pan Ayrshire and by North Ayrshire on behalf of East and South Ayrshire HSCPs. Learning Disability Services and leads in East and South Ayrshire have been actively involved in the options appraisal process and consultation has taken place with the Chief Officers to seek support for the recommendation re future service delivery. Caroline Cameron, Director Thelma Bowers, Head of Service (Mental Health Services) 392
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DIRECTION Reference No. 260618-09 From North Ayrshire Integration Joint Board/Caroline Cameron To NHS Ayrshire Arran x Name/Contact Details Kirstin Dickson Local Authority x Name/Contact Details Craig Hatton, Chief Executive Both Name/Contact Details 1. IJB Report Reference No. 260618-09 2. Date Direction Issued/Approved by IJB 18 June 2026 3. Report Author/Contact Details 4. Date Direction takes effect 18 June 2026 5. Does this direction supercede, amend or revoke a previous direction – if yes, include the reference numbers(s) Yes No x 6. Description of services/functions covered by the direction • Learning Disability Assessment and Treatment (A&T) services across Ayrshire • Inpatient learning disability provision (Ward 7A, Woodland View) • Community-based intensive support provision • Associated integrated health and social care functions relating to: • Mental health support • Community care and prevention services • Hospital admission avoidance and discharge pathways This reflects a change in model of care from inpatient provision to community-based intensive support 7. Full text of direction The Integration Joint Board directs NHS Ayrshire & Arran to: • Permanently close Ward 7A, Woodland View, as an inpatient learning disability assessment and treatment facility • Cease provision of inpatient A&T services within this dedicated ward model • Develop and implement a pan-Ayrshire Intensive Support Team (IST) model to support individuals with learning disabilities in community settings • Repurpose existing Ward 7A resources to support community-based service delivery [IJB Report...submitted | Word] 393
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• Ensure access to inpatient care, where necessary, via: o Mainstream mental health wards (including identified provision within Woodland View) o A small specialist LD inpatient workforce supported by IST in-reach • Progress development and implementation of the IST in line with the following key milestones: o Staffing model finalised – July 2026 o Implementation group established – July 2026 onwards o Leadership recruitment – August to October 2026 o Full recruitment – October 2026 to February (as per report timeline) o Service launch – April 2027 • Ensure delivery aligns with: o Human rights-based approaches o National policy direction toward community-based care and avoidance of institutionalisation 8. Specification of those impacted by direction. • Adults with learning disabilities requiring assessment and treatment • Families and carers • NHS staff (Ward 7A and wider LD/mental health workforce) • HSCP staff and community services • Independent and voluntary sector providers • Local communities (Reflects requirement to identify those impacted by service change) 9. Budget allocated by Integration Joint Board to carry out direction • Total available financial envelope: £1.325 million • Delivery to be achieved within this resource • Resource shift from inpatient provision to community-based model (Direction includes financial resource as required by statutory guidance) 10. Outcomes/Link to Strategic Priorities The direction supports: • Shift from hospital to community-based care • Reduction in inappropriate hospital admissions and delayed discharge • Improved outcomes and quality of life for individuals • Delivery of HSCP Strategic Plan priorities including: o Prevention 394
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o Community-based services o Whole-person approach o Accessibility and person-centred care 11. Timescales/Review/Monitoring Arrangements • Delivery milestones as outlined in Section 7 • Ongoing monitoring through: o Dynamic Support Register (DSR) outcomes tracking o Human rights indicators (SHRC framework) o Engagement with families and service users • Formal review aligned with service implementation and reporting cycles (Aligned with requirement for measurable outcomes and monitoring) 12. Lead Partnership Arrangements • Lead delivery: NHS Ayrshire & Arran • Working in partnership with: o North Ayrshire HSCP o Community and voluntary sector providers • Pan-Ayrshire delivery model with multi-agency collaboration 395
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Learning Disabilities Assessment & Treatment: An Options Appraisal Report 396
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Executive Summary: Woodland View (Ward 7A) opened early 2020 to provide short-term focused periods of assessment and treatment to adults with learning disabilities (LD A&T) whose needs could not be safely met within the community. However, following a series of significant challenges and re-configurations, Woodland View (Ward 7A) was temporarily closed in mid-July 2025 as part of a systematic review of LD A&T. As part of the systematic review of LD A&T, the options appraisal (OA) process was used to identify a preferred value for money option which reflects the needs, objectives, and perspectives of all stakeholders. The stages of the OA process thus permitted deliberation and quantification of costs/benefits associated with competing options to identify a A&T LD preferred value for money option. Overall, the preferred value for money option was identified as Option 3: ‘Woodland View Ward 7A does not re-open as a specialist learning disability inpatient unit and existing Ward 7A resources are re-purposed as an intensive community team within each locality supported by mainstream mental health wards at Woodland View’ The value for money of Option 3 was robust to variations in cost, benefit, time-horizon, and stakeholder subgrouping parameters. 397
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Contents: 1. Context & Rationale ........................................................................................... 1 1.1: Challenges with Woodland View (Ward 7A) ............................................. 1 2. Options Appraisal Framework ............................................................................ 2 2.1: Non-Technical Summary ......................................................................... 2 2.2: Options Appraisal Survey Methods .......................................................... 2 2.3: Options Appraisal Investment Horizon & Net Present Costs ....................... 2 2.4: Options Appraisal Decision Rule ............................................................. 3 2.5: Options Appraisal Advantages ................................................................. 3 2.2: Options Appraisal Engagement, Participants, & Stages ............................. 3 3. Defining Investment Criteria (Stage 1) ................................................................. 4 4. Generating Options and Short-listing Options (Stages 2&3) .................................. 6 5. Quantifying Benefits (Stage 4) ............................................................................. 7 6. Quantifying Costs (Stage 5) ................................................................................ 9 6.1: Net Present Costs & Investment Time-Horizon .......................................... 9 7. Base Case Investment Appraisal (Stage 6) .......................................................... 10 7.1: The Base Case Preferred Option ............................................................. 10 8. Sensitivity Analysis (Stage 7) ............................................................................. 11 8.1: Cost Variations ...................................................................................... 11 8.2: Weighted Benefit Score Variations .......................................................... 12 8.3: Time-Horizon Variations ......................................................................... 13 8.3: Sub-Group WBS Variations ..................................................................... 14 9. Conclusion ...................................................................................................... 15 10. Authors and Acknowledgements ..................................................................... 15 11. References ..................................................................................................... 15 12. Supporting Documents ................................................................................... 16 13. Appendix 1: Option Appraisal Participants ........................................................ 17 Appendix 2: Options Shortlisting ..................................................................... 18 398
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List of Tables: Table 1: Options Appraisal Stages 1-7 ..................................................................... 4 Table 2: Definition of Investment Criteria ................................................................ 5 Table 3: Shortlisted Options ................................................................................... 6 Table 4: Summary Stats Criteria Weighting .............................................................. 7 Table 5: Option Scores & Weighted Benefit Scores Per Option .................................. 8 Table 6: Net Present Costs Per Option .................................................................... 9 Table 7: Base Case Investment Appraisal ............................................................... 10 Table 8: Sensitivity Analysis: Identifying Maximal Cost for Option 3 .......................... 11 Table 9: Sensitivity Analysis: Identifying Minimal WBS for Option 3 ........................... 12 Table 10: Sensitivity Analysis: Long-term Investment Appraisal ............................... 13 Table 11: Sensitivity Analysis: WBS Across OAG Subgroups ..................................... 14 List of Abbreviations: 1. Cost Group (CG) 2. Health Economics (HE) 3. Learning Disabilities Assessment & Treatment (LD A&T) 4. Net Present Costs (NPC) 5. Options Appraisal (OA) 6. Options Appraisal Group (OAG) 7. Social Time Preference Rate (STPR) 8. Pan-Ayrshire Multi-Disciplinary LD A&T Transformation Group (TG) 9. Weighted Benefit Scores (WBS) 10. Willingness To Pay (WTP) 399
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1 1. Context and Rationale: Woodland View (Ward 7A) opened early 2020 to provide short-term focused periods of assessment and treatment to adults with learning disabilities (LD A&T) whose needs could not be safely met within the community. However, following a series of significant challenges and re-configurations, Woodland View (Ward 7A) was temporarily closed in mid-July 2025 as part of a systematic review of LD A&T. As part of the systematic review of LD A&T, the options appraisal (OA) process was used to identify a preferred value for money option which reflects the needs, objectives, and perspectives of all stakeholders. 1.1. Challenges with Woodland View Ward 7A: Temporary closure of Woodland View (Ward 7A) in mid-July 2025 was precipitated by a series of significant challenges and re-configurations, leading to a systematic review of LD A&T services. For example, a key issue with Woodland View (Ward 7A) was the environment. With an initial configuration of 10 individuals (2020-2022), Woodland View (Ward 7A) did not provide sufficient space to comfortably support individuals with complex presentations. Therefore, in 2022, Woodland View (Ward 7A) was reconfigured with spaces attenuated from 10-7. However, despite recognisable change to individuals and staff, issues still remained with the environment itself. Furthermore, without accommodation and appropriately skilled external agencies with capacity to support discharge, by 2024 many of the now-6 individuals residing in Woodland View (Ward 7A) had no clinical reason to be there. Significantly delayed discharge had consequences for individuals, families, staff, and the cost burden of the resulting care environment, such as increased bank staff costs due to high levels of staff absence. The culmination of these challenges and the requirement to improve and re-design the service initiated the OA process for evaluating options that reflect needs and objectives of all stakeholders. 400
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2 2. The Options Appraisal Framework: 2.1. Non-Technical Summary: Options Appraisal (OA) is an investment evaluation framework used across the public sector to assess value for money of competing options from the perspective of all stakeholders. Stakeholder expertise plays a central role in quantifying benefits associated with competing options, and then with each option adjusted for cost, value for money can be derived, comparatively. The OA framework is thus designed to identify a preferred option where incremental benefits cost less-than or equal-to the legacy model/alternatives, to ensure value for money. 2.2. Option Appraisal Survey Methods: To quantify benefits, stakeholders complete two surveys: • Criteria weighting survey. Stakeholders rank/weight investment criteria (e.g. ranking sustainability versus person-centredness) using an ordinal scale. • Option scoring survey. For each option, stakeholders assign points per criteria (e.g. score how sustainable an option is). Thereafter, to ensure the completed surveys are representative of stakeholders, criteria weights and option scores are averaged. The product is expressed as the ‘weighted benefit score (WBS) per option.’ 2.3. Options Appraisal Investment Horizon and Net Present Costs: Public sector investment often has a long time-horizon (e.g. a health service provision may last 10-30 years). As a Green Book (2026) requirement, future investment costs are transformed into ‘net present’ terms. Transforming future costs into net present terms means discounting costs that are further away by weighting parameters such as risk, real income growth, and evolving consumption preferences through time. 401
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3 The OA process thus uses Green Book (2026, Section 6.54) guidance on discounting at 3.5% to ensure costs (such as revenue costs) are expressed in net present terms during the investment appraisal. 2.4. Options Appraisal Decision Rule: The OA framework uses incremental analysis to determine value for money. Options are expressed in term of incremental net present costs per benefit point and compared to the legacy model and alternatives. The preferred option should thus satisfy a decision rule whereby costs per incremental benefit are less-than or equal-to those the service is already willing to pay (WTP) for the legacy model/alternative options. 2.5. Options Appraisal Advantages: The OA framework has several advantages suitable for ensuring a high standard of public sector investment, including: • Inclusivity. Benefits are quantified using the expertise and experience of all relevant stakeholders. • Transparency. All stages of an OA are well-documented and subject to the scrutiny of stakeholders. • Consistency. OA is a consistent methodology undertaken in accordance with well-defined stages and rules, rather than project specific. 2.6. Options Appraisal Engagement, Participants, & Stages: The OA framework was informed by multiple engagement activities with individuals, families, and patient representatives, as a part of the pan-Ayrshire Multi-Disciplinary LD A&T Transformation Group (TG). Other stakeholders include, an Options Appraisal Group (OAG), a Cost Group (CG), and Health Economics (HE). Appendix 1 provides a complete list of all participants, their designation, and stakeholder groupings, while Table 2 presented below provides a summary of stages and stakeholders per stage. 402
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4 Table 1: Options Appraisal Stages 1-7 Stages Description Participants Defining Investment Criteria Investment criteria are defined to reflect all potential needs and objectives of the service. TG Generating Options A comprehensive set of options is considered to reflect all potential needs and objectives of the service. TG Options Shortlisting Financially infeasible and inactionable options are excluded from the finalised shortlist. Status Quo remains as a willingness to pay baseline comparator. TG Quantifying Benefits Using information presented in an LD A&T Evidence Pack, stakeholders complete criteria weighting and options scoring surveys instrumental for quantifying weighted benefits per option. OAG, HE Quantifying Costs Revenue (running) costs and capital (investment) costs are exponentially discounted at the Social Time Preference Rate of 3.5% (Green Book, 2026) over the investment time-horizon to obtain net present costs. CG, HE Base Case Appraisal Discounted costs and weighted benefits are incrementalised to identify the preferred value for money option relative to willingness to pay threshold of Status Quo/alternatives options. HE Sensitivity Analysis The robustness of base case analysis is tested by accounting for uncertainty around cost/benefit parameters. HE 403
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5 3. Investment Criteria (Stage 1): Presented in Table 2 below, the TG established a total of six criteria characterising a series of professional, clinical, and individual-based objectives for LD A&T investment options. Table 2: Definition of Investment Criteria Criterion Definition Safe The service should be safe for all patients, carers, visitors, and staff. It should also be able to balance safety with choice/independence. Sustainable The service should meet the needs of the current population, but also have the potential to learn and respond to changing population needs. Person- Centred The service should be able to adapt around an individual’s needs and circumstances to provide support that reflects their wishes, interests/aspirations, and the concerns of those who know them best. Flexible The service should be able to provide support in places and at times that enables preventative care, as well as effective to responding to crises. Integrated The service should promote and enable integration and collaboration, not just with other NHS, social care, and provider services, but with the individuals, families, and the third sector. Effective The service should have available or be able to readily access the mix of skills and professions that will enable it to respond to diverse or complex needs. 404
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6 4. Generating Options & Shortlisting Options (Stages 2 & 3): The TG regularly met late 2025/early 2026 to establish a potential set of options informed by stakeholder expertise, further supported by various engagement events with third sector partners, individuals, and families. The process identified a total of 5 potential options (in addition to Status Quo). The full list of potential was reduced to 3 options (in addition to Status Quo). Appendix 2 presents elimination process, whereas Table 3 provides the finalised shortlist. Table 3: Shortlisted Options Option Definition Status Quo A specialist learning disability assessment and treatment inpatient unit with 6 beds at Woodland View (Ward 7A), re-opening the existing site with no workforce or environmental changes. Option 1 A specialist learning disability assessment and treatment inpatient unit with 3 beds at Woodland View (Ward 7A), re-opening the existing site with a reduced number of beds and scope to redesign the ward for comfort and therapeutic spaces. Option 2 Woodland View Ward 7A does not re-open as a specialist learning disability inpatient unit. Instead, admissions are supported to a host ward (Ward 11) within mainstream mental health wards, or other wards subject to client mix, bed availability, and individual needs. A specialist LD staff group would be available to support this. Option 3 Woodland View Ward 7A does not re-open as a specialist learning disability inpatient unit, and existing Ward 7A resources are re- purposed as an intensive community team within each locality supported by mainstream mental health wards at Woodland View. 405
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7 5. Quantifying Benefits (Stage 4): OAG members (n = 28) met across two events, in January 2026 at Saltcoats Town Hall and February 2026 at Cunningham House Irvine to complete criteria weighting and options scoring surveys by consulting information on criteria and options presented in an evidence pack. The criteria weighting exercise involved OAG members using a total of 60 points to freely weight the importance of each criterion’s characteristics. From the summary stats presented in Table 4., we can observe distributional properties of the criteria weighting exercise. For example, from Table 4, person-centredness is associated with the highest average score (11.82) and the lowest variance (2.16). Hence, person-centredness is characterised by a stable high mean score. By comparison, sustainability has the lowest mean (7.07) and low variance (2.70), implying sustainability has a stable low mean score. Furthermore, despite OAG participants permitted to mark a single criterion a maximum of 60, Table 4 shows that the criteria weighting exercise is not characterised by extremes. Instead, the mode (common frequency) is predominantly uniform across each six criteria (with exception of sustainability), and min/max is bounded by [0-25]. Table 4: Summary Statistics – Criteria Weighting Min. Max. Median Mode SD Mean Safe 5 15 11 10 2.68 11.39 Sustainable 0 11 6.5 5 2.70 7.07 Person-Centred 10 17 11 10 2.16 11.82 Flexible 0 15 10 10 2.96 9.57 Integrated 4 15 9 10 3.14 8.78 Effective 5 25 10 10 3.53 11.14 N = 28 406
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8 OAG participants also scored options subject to each criterion during the January and February 2026 sessions. OAG participants were permitted to assign each criterion a maximum of 10 points subject to information presented in the evidence pack. Table 5 summarises that the OAG scored Option 3 higher across all six criteria on average. Hence, when the average criteria weights (taken from Table 4 above) are used to scale the average option scores, weighted benefit scores for each criterion per option are generated. The sum of the weighted benefit scores per option is given by the total weighted benefit score (WBS) per option. Therefore, Table 5 shows that Option 3 has the highest WBS (384.75). Table 5: Option Scores & Weighted Benefit Scores Per Option Safe Sustain- able Person- centred Flexible Integrate d Effective Averaged Option Scores Stat. Quo 1.28 1.35 2.75 1.03 1.71 2.67 Option 1 4.07 2.28 4.24 2.25 2.78 4 Option 2 4.28 3.14 3.64 2.75 2.96 3.75 Option 3 5.57 5.67 7.14 6.89 6.67 6.46 Averaged Criteria Weights 11.39 7.07 11.82 9.57 8.78 11.14 Weighted Benefit Scores Stat. Quo 14.64 9.09 32.50 9.91 15.06 29.84 Option 1 46.38 16.16 49.81 21.53 24.47 44.57 Option 2 48.82 22.22 43.03 26.32 26.04 41.78 Option 3 63.47 40.15 84.4 65.97 58.67 72.03 Total WBS Stat. Quo 111.07 Option 1 202.94 Option 2 208.26 Option 3 384.75 N = 28 407
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9 6. Quantifying Costs (Stage 5): The CG provided a set of nominal revenue (running) costs and capital (investment) per option following detailed discussion to ensure all potential options were accurately costed. Year 2023-2024 of Woodland View (Ward 7A) was taken to be a stable baseline representation of the revenue costs. Therefore, revenue costs were scaled per option using the 2023-2024 baseline. For example, revenue costs were scaled according to expected quantities of nursing staff, MDT staff, bank staff, bed use, emergency respite access, and depreciation/damages, per option. By comparison, only Option 1 was subject to capital investment cost estimates due to significant infrastructure works required converting Woodland View (Ward 7A) into suitable 3-bed environment. 6.1. Net Present Costs & Investment Time-Horizon: Annual nominal costs were transformed into net present costs (NPC) using a medium- term investment time-horizon of 10 years. Firstly, nominal costs are converted into real terms (Green Book, 2026, Section 6.56), and then discounted in real terms at the Social Time Preference Rate (STPR) of 3.5% (ibid, Section 6.54). Table 6: Net Present Cost Per Option Status Quo Option 1 Option 2 Option 3 Year 1 Cost £2,301,730 £2,741,589 £1,211,644 £1,530,572 10-year NPC £21,787,619 £25,981,306 £11,491,661 £14,448,953 STPR = 3.5% 408
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10 7. Base-Case Investment Appraisal (Stage 6): Incremental analysis was conducted using WBS and NPCs to identify the preferred option. The preferred option satisfies a decision rule that costs per incremental benefit that are less-than or equal-to those the service is already willing to pay for Status Quo/lowest cost alternative options. 7.1. The Base Case Preferred Option: From Table 7 below, the preferred option is identified sequentially: • Status Quo (WTP = £196, 161) is used as the baseline WTP comparator. • Among all options, Option 1 is eliminated immediately given it is more expensive/less beneficial than Option 2 and Option 3. • Furthermore, Option 2 (WTP = £55,179) and Option 3 (WTP = £37,554), both have WTP less than Status Quo (WTP = £196, 161). • Therefore, Status Quo is eliminated, and the remaining lowest cost alternative (Option 2) becomes the new baseline WTP comparator. • Since Option 3 has an incremental cost per benefit point of £16,756 < £55,179, Option 3 is considered the preferred option versus Option 2’s new WTP baseline. • Option 3 is identified as the value for money option versus Option 2, and versus Status Quo, Option 3 offers annual potential annual savings of £771,158 (Table 6). Table 7: Base-Case Investment Appraisal Option Total WBS 10-year NPC Cost per Benefit Point (WTP threshold) Inc. Cost Inc. Benefit Points Inc. Cost Per Benefit Point 3 384.75 £14,448,953 £37,554 £2,957,292 176.49 £16,756* 2 208.26 £11,491,961 £55,179 1 202.94 £25,981,306 £128,024 Stat. Quo 111.07 £21,787,619 £196,161 409
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11 8. Sensitivity Analysis (Stage 7): In the spirit of base case analysis presented in Section 7.1, Option 2 remains the baseline WTP comparator for sensitivity analysis. Therefore, to ensure Option 3 remains a robust value for money option, sensitivity checks were carried out to stress test variations in cost, benefits, and time horizon, and stakeholder subgroup WBS. 8.1. Cost-Variations: Base case analysis in Table 7 identified that the incremental cost per benefit point of Option 3 was less than the WTP for Option 2 (£16,756 < £55,179), implying that Option 3 is the preferred option. However, it is important to stress test the base case result to ensure robustness to any cost uncertainties. This requires that we identify the maximal locus where Option 3 remains value for money. • From Table 8 we see Option 2: WTP = £11,491,661/208.26 = £55,179. • This implies that the maximal NPC locus for Option 3 must satisfy that the WTP and incremental cost per benefit point < Option 2. • Hence, the maximal NPC locus = £55,178 * 384.75 = £21,229,735. • Over a 10-year horizon, the base case result remains robust to a ~46% maximal increase in NPC over a 10-year horizon (£14,448,953 to £21,229,735). Table 8: Identifying Maximal Cost for Option 3 Option Total WBS 10-year NPC Cost per Benefit Point (WTP threshold) Inc. Cost Inc. Benefit Points Inc. Cost Per Benefit Point 3 384.75 £21,229,735 £55,178 £9,738,074 176.49 £55,177* 2 208.26 £11,491,961 £55,179 1 202.94 £25,981,306 £128,024 Stat. Quo 111.07 £21,787,619 £196,161 410
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12 8.2. Weighted Benefit Score Variations: Holding all else equal, (base case costs and WBS for other options), Table 9 below identifies the minimal WBS locus for Option 3 to remain a robust value for money option versus Option 2 WTP. • Again, from Table 9 we see Option 2: WTP = £11,491,661/208.26 = £55,179. • This implies that minimal WBS locus for Option 3 must satisfy that the WTP and incremental cost per benefit point < Option 2. • Hence, the minimal WBS locus = £14,448,953/£55,178 = 261.86. • Therefore, Table 9 identifies that a >32% decrease (384.75 – 261.86) would be required in Option 3’s WBS to make Option 2 the preferred option, all else equal. • Overall, this suggests WBS of Option 3 remains robust. Table 9: Identifying Minimal Benefit for Option 3 Option Total WBS 10-year NPC Cost per Benefit Point (WTP threshold) Inc. Cost Inc. Benefit Points Inc. Cost Per Benefit Point 3 261.86 £14,448,953 £55,178 £2,957,292 53.6 £55,173* 2 208.26 £11,491,961 £55,179 1 202.94 £25,981,306 £128,024 Stat. 2Quo 111.07 £21,787,619 £196,161 411
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13 8.3. Time-Horizon Variations: Base case analysis assumed a medium-term investment horizon of 10 years given services evolve over the long run. However, to ensure Option 3 is robust over the long run, Table 10 below shows analysis over a 30-year horizon, with Option 2 as baseline WTP. • Over the long-term horizon, Status Quo and Option 1 are immediately eliminated given they are dominated by Option 2 and Option 3 (i.e. Option 2 and 3 are less expensive/have more benefit). • Therefore, Option 3 is evaluated versus Option 2 as the baseline WTP comparator (£148,946 per benefit point). • However, since Option 3 has an incremental cost per benefit point of £43,137 < £148,946, Option 3 is considered the preferred option. • Option 3 is identified as the preferred value for money option vs Option 2, and Option 3 vs Status Quo over the long run. Table 10: Long-Term Investment Appraisal Option Total WBS 30-year NPC Cost per Benefit Point (WTP threshold) Inc. Cost Inc. Benefit Points Inc. Cost Per Benefit Point 3 384.75 £38,363,766 £100,410 £7,613,259 176.49 £43,137* 2 208.26 £31,019,506 £148,946 1 202.94 £70,005,107 £344,954 Stat. Quo 111.07 £58,589,447 £527,320 • Minimal WBS locus/maximal NPC locus can be identified over the long run too following methods above, such that Option 3 WBS is robust to a ~33% decrease before Option 2 becomes the favoured option, and Option 3 remains a robust option unless to <48% increase in NPC. 412
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14 8.4. Sub-Group WBS Variations: The OAG (n = 28) had a staff sub-group (n= 19), and a sub-group with patient representatives and families (n = 9). To ensure Option 3 is the preferred option across both sub-groups, sensitivity analysis is conducted on sub-group WBS. Overall, Table 11 below highlights Option 3 WBS remains a robust preferred option across both OAG subgroupings, with sufficient incremental benefits versus Option 2 for Option 3 to remain value for money. Table 11: WBS Across OAG Subgroups Safe Sustain- able Person- centred Flexible Integrated Effective Subgroup 1: OAG Staff Weighted Benefit Scores (n = 19) Stat. Quo 21.66 12.99 44.88 14.54 21.09 41.82 Option 1 58.61 19.11 60.43 25.57 26.92 52.75 Option 2 60.52 24.36 50.26 30.08 29.16 48.16 Option 3 69.44 43.19 82.57 66.18 58.87 71.10 Subgroup 2: OAG Patient Rep/Families Weighted Benefit Scores (n = 9) Stat. Quo 1.19 1.48 2.83 0 1.03 3.88 Option 1 24.17 10.37 24.13 12.88 18.66 25.92 Option 2 27.46 17.77 25.55 18.25 18.66 27.22 Option 3 51.64 34.07 88.02 65.51 58.07 73.88 Criteria Weights for each OAG Sub-Group Subgroup 1 12.10 7.26 11.36 9.52 8.52 10.89 Subgroup 2 9.88 6.66 12.77 9.66 9.33 11.66 Subgroup 1 Total WBS Subgroup 2 Total WBS Stat. Quo 156.45 11.44 Option 1 243.40 116.16 Option 2 242.67 134.95 Option 3 391.28 371.22 413
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15 9. Conclusion: Temporary closure of Woodland View (Ward 7A) in mid-July 2025 was precipitated by a series of significant challenges and re-configurations, leading to a systematic review of LD A&T services. Stages 1-7 of the OA process identified a robust value for money option which reflects the needs, objectives, and perspectives of all LD A&T stakeholders. Overall, the preferred value for money option was identified as Option 3: ‘Woodland View Ward 7A does not re-open as a specialist learning disability inpatient unit and existing Ward 7A resources are re-purposed as an intensive community team within each locality supported by mainstream mental health wards at Woodland View’ Option 3 remains a robust value for money option subject to variations in cost, benefit, time-horizon, and OAG subgrouping parameters. 10. Authors and Acknowledgements: The Report was written by the Health Economics Team at NHS Ayrshire & Arran, Andrew Coyle (Health Economist) and Moray Baylis (Senior Health Economist). Enormous credit is given to secondary authors including Nicola Fraser (Planning Manager Mental Health, N. Ayrshire HSCP) and Dominic Jarrett (LD Development Manager, N. Ayrshire HSCP) for supporting documentation, consultation, and assistance. Further thanks are given to all stakeholders involved in the OA, with special thanks to families and patient representatives for their invaluable time and input. 414
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16 11. References: H.M Treasury (2026) The Green Book: UK Government Guidance on Appraisal [online] available at: https://assets.publishing.service.gov.uk/media/698dbcd17da91680ad7f4308/The_Gree n_Book_2026.pdf 12. Supporting Documents: A series of LD A&T supporting documents are available on request, including evidence pack and background documents. • Background Information for Learning Disability Assessment and Treatment Options Appraisal (2026) • Initial Learning from the Activity of the North Ayrshire Intensive Support Service (2025) • Learning From Past Admissions to Ward 7A (2025) • Learning Disability Assessment and Treatment Provision Across Scotland – Summary of Benchmarking Work (2025) • Summary of Client Feedback Regarding Experiences of Ward 7A (2025) • Summary of Carer Feedback Regarding Experiences of Ward 7A (and other inpatient environments) (2025) • Summary of Outputs from Engagement Event with Staff and Other Stakeholders (2025) • Ward 7A – Summary of Activity (2022) 415
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17 13. Appendix: Appendix 1: Option Appraisal Participants Name Title Membership Moray Baylis Senior Health Economist NHSA&A HE Thelma Bowers Head of Mental Health & Learning Disabilities N. Ayrshire HSCP TG, OAG, CG Debbie Browne Deputy Medical Director TG Tony Clapham Team Lead – South CLDT OAG Andrew Coyle Health Economist NHSA&A HE Eleanor Currie Principal Finance Manager, N. Ayrshire HSCP CG John Dalrymple Radical Visions OAG Marianne Dolan HR Manager NHSA&A OAG Paul Donnelly Senior Manager, S. Ayrshire HSCP TG Gillian Duffy Service Manager, Learning Disabilities N. Ayrshire HSCP TG, OAG, CG Nicola Fraser Planning Manager Mental Health, N. Ayrshire HSCP TG, OAG, CG Darren Fullarton Associate Nurse Director MH Services & Lead N. Ayrshire HSCP TG Brian Gilmour Management Accountant, NHSA&A CG Ashley Gorman Support & Development Manager OAG Karen Gribben Senior Nurse LD, NHSA&A TG Mairi Gribben Senior Manager NHSA&A TG Sharon Hackney AHP Senior Manager NHSA&A TG, OAG Claire Hughes Consultant Psychiatrist/Clinical Director LD TG, OAG Dominic Jarrett LD Development Manager, N. Ayrshire HSCP TG, OAG, CG Maria Lavery SLT Service Manager N. Ayrshire HSCP OAG Pauline Lunn Director, In Control Scotland OAG William Lauder Senior Manager Inpatient MH & Forensic Services, NHSA&A TG, OAG, CG Ken McMahon Head of Psychological Speciality TG, OAG Tricia McGuiness Bed Manager NHSA&A OAG Michelle McInroy Team Lead E. Ayrshire HSCP OAG Sharon McLeod Chief Executive of Ayrshire Independent Living Network OAG Jaynie Mitchell Coalition for Carers in Scotland OAG Janet Millar Team Lead Occupational Therapy NHSAA OAG Kaye Robertson Operations Manager, Community Brokerage Network OAG Shaun Ryan Service Manager LD, E. Ayrshire HSCP TG, OAG Kelly Shepherd Senior Charge Nurse LD, NHSAA TG Jan Thomson Senior Manager LD, N. Ayrshire HSCP TG, OAG, CG Laura Watters Senior Principal Clinical Psychologist, NHSAA OAG Steve Wright Senior Nurse LD, NHSA&A TG, OAG Unnamed N = 5 family carers OAG Unnamed Multiple individuals, family carers, and patient representatives Engagement activities 416
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18 Appendix 2: Options Shortlisting Option Description Y/N Reason Stat.Quo A specialist learning disability assessment and treatment inpatient unit with 6 beds at Woodland View (Ward 7A), re-opening the existing site with no workforce changes. Y Inclusion subject to Treasury Guidelines. 1 A specialist learning disability assessment and treatment inpatient unit with 3 beds at Woodland View (Ward 7A), re-opening the existing site with a reduced number of beds and scope to redesign the ward for comfort and therapeutic spaces. Y Agreed by TG and OAG to match inclusion criteria. 2 Woodland View Ward 7A does not re-open as a specialist learning disability inpatient unit. Instead, admissions are supported to a host ward (Ward 11) within mainstream mental health wards, or other wards subject to client mix, bed availability, and individual needs. Y Agreed by TG and OAG to match inclusion criteria. 3 Woodland View Ward 7A does not re-open as a specialist learning disability inpatient unit. Instead, existing Ward 7A resources are re- purposes as an intensive community team within each locality supported by mainstream mental health wards at Woodland View. Y Agreed by TG and OAG to match inclusion criteria. 4 Specialist learning disability assessment and treatment inpatient service with 6 beds N Agreed by TG and OAG to be inactionable given the environment is suitable only for 3 beds. 5 A well-resourced community-based intensive support model within each HSCP with pan- Ayrshire leadership/management combined with a limited number of beds in a specialist LD facility N Agreed by the TG and OAG to be inactionable given resource demands. 417
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Background Information for Learning Disability Intensive Assessment and Treatment Options Appraisal January 2026 418
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419
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Preface This document has been written to support the Options Appraisal process regarding future intensive Assessment and Treatment services for adults with learning disabilities in Ayrshire. It provides background information relevant to the process, including national context, data from services, and feedback from clients, carers, and staff. It is accompanied by a separate document which outlines the steps taken within the Options Appraisal process, as well as information on the Options being considered. The team supporting this process hope that splitting the information in this way will help to keep things manageable for participants. If you have any questions in relation to either document, or this process, please contact: Nicola Fraser, North Ayrshire HSCP Planning Manager nicolafraser@north-ayrshire.gov.uk or Dominic Jarrett, North Ayrshire Learning Disabilities Development Manager Dominic.jarrett@aapct.scot.nhs.uk Tel (for both) 01294 322473 Acknowledgements Everyone involved in planning this work is immensely humbled by and grateful to the clients, carers, and staff, who have shared their experiences and ideas, and to the internal and external colleagues who have supported this. Particular thanks are extended to Pauline Lunn (Director, In Control Scotland) for supporting the engagement with family carers, and doing so with great passion, credibility, and respect. 420
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Turning To One Another (Margaret Wheatley, 2002) There is no greater power than a community discovering what it cares about. Ask, "what's possible?" not "what's wrong?" Keep asking. Notice what you care about. Assume that many others share your dreams. Be brave enough to start a conversation that matters. Talk to people you know. Talk to people you don't know. Talk to people you never talk to. Be intrigued by the differences you hear. Expect to be surprised. Treasure curiosity more than certainty. Invite in everybody who cares to work on what's possible. Acknowledge that everyone is an expert about something. Know that creative solutions come from new connections. Remember, you don't fear people whose story you know. Real listening always brings people closer together. Trust that meaningful conversations can change your world. Rely on human goodness. Stay together. 421
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Contents Introduction ............................................................................................. 1 The national context ............................................................................... 2 The local context: Ward 7A ..................................................................... 4 The experience of Ward 7A: Feedback from clients ............................. 6 The experience of Ward 7A: Feedback from family carers .................. 8 The experience of Ward 7A: Feedback from staff ............................. 10 Intensive Support Teams ...................................................................... 12 Closing comments ................................................................................ 15 422
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Introduction 1 At times, the support needs of people with learning disabilities can exceed that which can safely be provided by their existing supports. Often, this is linked to mental health or related issues, such as: • Self-injurious behaviour, this being on some occasions, noted as extreme. • Violent or aggressive behaviour towards others • Suicidal ideation. • Paranoia and auditory or visual hallucinations • Destructive behaviour • Severe anxiety/distress • Self-neglect. In such circumstances, a period of admission to an in-patient Assessment and Treatment facility may be sought, if the individual’s needs can’t be safely managed within a community setting. In early 2020, Ward 7A (Woodland View) opened as the new location of the Ayrshire Learning Disabilities Assessment and Treatment (A&T) Unit (previously at Arrol Park). It opened with the capacity to accommodate 10 individuals, however, reflecting an awareness of the impact of the existing space and environment on patients and staff, this was reduced in 2023 to 7. In the latter stages of its operation, 6 individuals were being supported within the ward. The reduction in capacity was one response to ongoing issues within the ward, linked in no small way to challenges in discharging people, including: • Difficulty in finding care providers with skills and capacity to support people. • Difficulty in finding appropriate homes within the community The consequences of this for the individuals themselves, their families, and staff were significant. Some individuals were admitted to the ward for considerably longer than intended, past the point that was clinically necessary, and with negative consequences for their wellbeing and that of others on the ward. The resulting care environment also had negative consequences for staff, resulting in low morale, high levels of sickness, and high usage of bank staff. Reflecting the extremity of the situation, the difficult decision was taken in mid-2025 to temporarily close the ward. The closure was instigated first and foremost in the interests of patients and staff themselves, but also with a view to creating the space to explore options for the future provision of alternative support within Ayrshire and Arran. 423
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The National Context 2 The issues experienced within Ward 7A were in no way unique to it. This situation has been reflected within a variety of national documents and resources: Coming Home (Scottish Government, 2018), and the Coming Home Implementation Plan (Scottish Government, 2022) The Coming Home report described significant issues across Scotland in relation to individuals being placed out of their home area, frequently in response to a crisis. In addition, it described significant issues around delayed discharge (people staying in hospital past the point when there is a clinical need for it). Its recommendations included the strengthening of community services in order to enable better responding to crisis, and greater support for the family carers of people with complex needs. The Implementation report, published in 2022 provided, an update on progress since the original report, noting that much remained to be done, and making further recommendations, including the national implementation of a Dynamic Support Register for maintaining oversight of people admitted to or at risk of being admitted to inpatient settings. Tick Tock: A human rights assessment of progress from institutionalisation to independent living in Scotland (Scottish Human Rights Commission, 2025) This report explored the impact of the Coming Home report, and the funding provided across Scotland to realise its aims. The general finding was that significant gaps remained in the realisation of the Coming Home Implementation Plan, and the meaningful realisation of a human-rights based approach linked to this. Hospital is not home: The circumstances of people with learning disability and complex needs who have been in hospital for 10 years or more (Mental Welfare Commission for Scotland, 2025) This report examined the circumstances of 55 people with a learning disability, who had been living in hospitals for over 10 years. Linked to this, the authors found inconsistent interpretation of the use of the Dynamic Support Register; and reluctance to discharge some individuals, due to concerns around the capacity of community services to meet their needs. 424
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The National Context 3 The State of Our Rights (Scottish Commission for People with Learning Disabilities, 2023) This explored the experiences of people with learning disabilities from a Human Rights perspective. Its findings highlighted the ongoing stigma and discrimination, within institutions and communities, that remains the experience for many people. The experience of delayed discharge within institutions, and the restrictions on liberty which this represents, was one of the many challenges highlighted. Benchmarking of inpatient facilities for people with learning disabilities across Scotland NHS Ayrshire and Arran and North Ayrshire HSCP staff sought information on in- patient units for adults with learning disabilities across Scotland. They were interested in seeing how Ward 7A compared to similar services, in terms of things like staffing, number of beds, and extent of delayed discharges. Key findings were: • Of the 14 NHS Health Boards across Scotland, 9 reported that they had specialist inpatient beds for people with learning disabilities. • There did not appear to be a consistent pattern regarding the number of beds that areas had, linked to the size of their local population. • Similarly, there was a good deal of variability regarding the size (and to a lesser degree, the skill mix) of the workforce linked to these specialist beds. • All areas with specialist learning disability beds reported that they had individuals who were described as delayed discharge. This ranged from 2 areas were all admitted clients were delayed discharge, to one where approximately a quarter were. • 8 of the 9 areas reported that they had issues with their in-patient environment. 425
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The local context: Ward 7A 4 The Learning Disability Service across Ayrshire supports adults (16 years and up). Similarly, it is an adult population that Ward 7A was intended to support. Work undertaken as part of exploring the implementation of Annual Health Checks (linked to the new Scottish Government specification) indicated that there are 2006 identified adults with a learning disability across Ayrshire. This represents 0.65% of the adult population across Ayrshire 309,864, based on mid-year estimates for 2024). The number within each locality is shown in the table below. East North South Total Mid-year estimates 2024 101,196 113,113 95,555 309,864 No adults with learning disability as indicated through Health Checks activity 771 646 589 2006 Identified adult LD population as a percentage of overall locality population 0.76% 0.57% 0.62% 0.65% In reviewing individuals admitted to Ward 7A since it opened, information on 35 individuals was examined. This represents a little under 2% of the 2006 identified adults with learning disabilities. It’s important to remember that people with learning disabilities always have the option to be admitted to mainstream mental health wards, if that is seen as appropriate (or indeed, if there was no space within Ward 7A). The graph below shows the number of adults with learning disabilities admitted to Woodland View wards other than 7A. Overall, it can be seen that a low number of individuals were admitted, with the increase in 2024/25 being linked to lack of capacity within, followed by closure of, Ward 7A. 0 2 4 6 8 10 12 14 16 18 Jan-Jun 2020 Jul-Dec 2020 Jan-Jun 2021 Jul-Dec 2021 Jan-Jun 2022 Jul-Dec 2022 Jan-Jun 2023 Jul-Dec 2023 Jan-Jun 2024 Jul-Dec 2024 Jan-Jun 2025 Jul-Sep 2025 Total ward movements in (Jan 2020 to Sep 2025) 7A Other wards 426
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The local context: Ward 7A 5 Some caution is needed in looking at any figures regarding identified adults with learning disabilities. However, there is a clear indication that most adults with learning disabilities are successfully supported by themselves, family, communities and services without the need for an inpatient admission. Admissions to Ward 7A were not split evenly across the 3 Ayrshire localities. It could be assumed that most individuals would come from East Ayrshire, as it has the largest identified population of adults with learning disabilities. However, nearly half of those admitted to Ward 7A came from (or were placed within) North Ayrshire. The figures for North and East Ayrshire both include individuals from other areas, who were placed in those localities. Outside of this, it could be speculated that the placement of Ward 7A within North Ayrshire had some impact on who was using it. This is, potentially, something to be kept in mind when thinking about future options. As has been highlighted already, many individuals admitted to Ward 7A stayed there longer than intended. This is made clear in the information below, which provides some overall information regarding lengths of admission, compared to admissions to non-learning disability wards over the same period (1/3/20-10/3/25): LD Non-LD Wards Median1 length of stay: 1514 46 Maximum length of stay: 1808 264 Minimum length of stay: 3 19 1 The median indicates the value which sits in the middle of a range of values. It is less affected by extreme values than the average. 427
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The experience of Ward 7A: Feedback from clients 6 Clients, family carers, and others were asked for their feedback regarding experiences of Ward 7A. It is hoped that doing so has provided learning and reflection which will inform the results of this Options Appraisal process. Listening to the experiences of people admitted to Ward 7A was an essential part of this process. 4 clients provided feedback on their time: the number of clients involved reflects a variety of factors, mainly • People’s availability • Whether they wanted to or were able to take part Conversations took place between clients and members of staff from the local Community Learning Disability Team who were familiar to them. Notes of those conversations were taken by those staff, and provide the basis of the following observations. Staff: some clients were very positive and described the staff as ‘nice’ or ‘good at listening’. Most clients commented on lack of availability of staff, mentioning things like staff being busy on ‘constants’, their being busy with ‘less able’ patients, or the need for someone to be ‘on the floor’. Because of this, people didn’t always get the input they were seeking, had to wait for help, or were restricted in their ability to get out for a walk or do other things. Another client was noted as feeling that their complaints were not taken seriously. Feeling safe: Some clients did say that they felt safe, with one noting that family visiting and staff input helped with this. One client described negative interactions with other patients, including being hit by one when staff were not around, which they did not tell anyone about. Activities: One client noted that they enjoyed joining activities which were relevant to them. Another said they had input from Occupational Therapy, which they would have liked more of. But for the most part, people described a lack of activities. One individual said they were often bored, and another said that they just stayed in their room. Noise in the ward was also highlighted in relation to this. Able to see friends and family: Most clients commented on this, and said they were able to see people. One noted that they saw family in the café, rather than the ward; another was aware of their visitor being worried about them being on the ward. 428
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The experience of Ward 7A: Feedback from clients 7 Being included and making choices: Most clients remembered attending meetings, such as CPA meetings, and being involved in those. One noted that there were no meetings to discuss ward issues, while another would have liked more regular meetings with ward and community staff. Bedrooms: half of the clients spoken to were happy with these spaces, with one commenting that they felt safe there. The others were less positive, noting challenges such as noise from other service users; blankets not being warm enough; no TVs; and poor mobile reception. One client commented that being in their room made them ‘stress’. Garden: 2 clients commented on this being a nice place to sit, but they also said they had only used it once. Another noted that they had planted something in the garden, which was subsequently damaged by someone else. Other spaces: The beehive was commented on positively, as a space for playing pool. Accessing it could be a challenge due to staff availability. Regarding the group room and sensory room, for the most part these were either not available1, not used for the intended purpose, or the individual was not aware of them being there. Many of the problems people highlighted are ones which staff and others were very much aware of, including the availability of staff themselves. Similarly, there has been a long-standing awareness of the unsuitability of the environment, as well as the scope for improving the range of activities within the Ward. Staff availability is obviously a factor in relation to this, as it is in relation to enabling people to make use of the spaces that are available. The feedback from clients highlights important things to bear in mind regarding any potential in-patient environment: • The need for comfortable, safe spaces, that enable independence, but do not isolate • The need for sufficient staff to allow for all to be responded to appropriately • The need for people to shape not only their care, but life on the ward generally • The need for ‘wellness’ to be prioritised as much as ‘health’ • The need for people to be listened to and any concerns acted on 429
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The experience of Ward 7A: Feedback from family carers 8 Family carers linked to individuals admitted to Ward 7A were invited by staff from the Community Learning Disability Teams to provide feedback. Interviews were carried out and reported by a member of staff from In Control Scotland. 5 families participated in these conversations. A summary of the themes from that work is available. It provides a clear picture of the ways in which Ward 7A did not work as intended. But there is also recognition of positives within the support provided. All of that feedback has to be respected in taking forward this Options Appraisal process. Of immediate relevance to this document are the feedback around structural essentials, and essential elements of a future model which came from those conversations. Structural essentials: • a single, named point of contact • rapid, skilled crisis support • respite • opportunities for family training • strong community support to avoid admission • inpatient care only when absolutely necessary, and in the right environment Essential elements of a future model: A) Do Not Reopen Like-For-Like Families’ accounts strongly indicate that an inpatient model like Ward 7A was not suited for their loved ones’ needs; in several cases, time in hospital worsened behaviours and trauma. If any inpatient capacity is retained, it must be small, autism- informed, sensory-adapted, and operate to rehabilitation and relational standards, not containment. B) Build a Community-First Intensive Support Model This must include: 1. Named family liaison (‘single front door’) + 24/7 helpline so families never feel they are in “no man’s land.” 2. Rapid-response respite (hours–days) and in-home crisis support using low- arousal techniques. 3. Make training, advice, and support available to families proactively. 430
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The experience of Ward 7A: Feedback from family carers 9 4. Autism-informed MDT outreach (SALT, OT, psychology) that can deploy to homes/supported living rapidly. 5. Access to meaningful, enjoyable, daily activities (sensory spaces, movement, time outdoors) because boredom itself can be a source of distress. C) If Inpatient Care Is Needed, It Must Look Different This must include: 1. Short stays for clear clinical purpose, with discharge planning beginning immediately on admission. 2. Environment: quiet zones, sensory rooms, predictable routines, outdoor access; with consideration given to mixed-gender arrangements. 3. Relational practice: protected family time; no bans without transparent risk review and appeal; family as partners in plans. 4. Safeguarding: greater transparency when concerns are raised; thoughtful planning documented using least restrictive practices. 5. Medication governance: closer medication reviews during acute phases; thoughtful plans to reduce medication dependence over time. 6. Activity and purpose: daily structured engagement; stop the cycles of boredom and containment. D) Culture, leadership, and accountability Across the consultation, families described moments of genuine kindness from individual nurses and auxiliary staff, but they also described a wider culture that too often felt defensive, inconsistent, or closed off to challenge. Several families felt that concerns were minimised or reframed, incidents were misrepresented, and complaints rarely resulted in meaningful change. In some cases, families felt that raising concerns positioned them as adversaries, rather than as essential partners and experts in their loved one’s care. Ultimately, what families called for was not perfection but integrity, a culture where mistakes are acknowledged, learning is shared, and partnership is genuine. They want leaders who listen, staff who feel supported to provide compassionate care, and a system where honesty and openness are embedded. A rights-based culture is not just one element of their vision of a future model; it is the foundation on which everything else must be built. 431
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The experience of Ward 7A: Feedback from staff 10 Over the summer of 2025, staff from 7A, the 3 Ayrshire Community Learning Disability Teams, and Providers, were involved in a reflective review of past admissions to Ward 7A. This was done primarily with a view to thinking about which could, potentially, have been avoided, and what would have allowed this to happen. A full report on that work is available: key themes from it are summarised here: • Approximately a third of admissions were suggested as being avoidable, by either the 7A Senior Charge Nurse; LD Teams; or both. • The role of the person’s home environment (both physical and social) was identified as key: where these were not right, individuals would ‘fight’ against them. Linked to this, the potential of (and a push towards) core-and-cluster arrangements was noted; however, there was a need for this to balanced by proper consideration of the social context within them. • A range of partners were identified as potentially contributing to the pressure to admit someone, for understandable reasons. These included: parents; Providers, Emergency Services; and Police. • Acting in a timely manner was key to avoiding admission, both in terms of help being provided promptly when sought, and in terms of help being sought in advance of crisis occurring. • Getting transitions right was critical. This included transitions from child to adult services. Failure to appropriately plan at that stage was recognised as contributing to the admission journey for some individuals. • Admission to general Mental Health wards had occurred with some success, but was seen as a best fit for individuals with a mild learning disability. Skills gaps were at times evident in those settings, in relation to the support of people with complex learning disabilities. • Availability of respite options (including emergency respite) across the 3 areas was variable, and it’s lack could contribute to the likelihood of admission. • Good relationships existed between LD teams and some Providers. There was a clear need for respectful, trusting relationships between partners, which enabled best use of all resources each had available (including specialist roles, such as PBS leads, within Providers). 432
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The experience of Ward 7A: Feedback from staff 11 • Trauma was a significant antecedent of many admissions, and potentially a defining characteristic of one cohort of individuals. Reflecting this, there was a need for a shared realisation of trauma informed practice across all partners, enabled by trauma informed/relationship aware commissioning practices, which prioritised the person. The discussions highlighted a complex diversity of factors which could feed into an eventual admission. Some of these factors were within the gift of care teams and local services to influence; others were arguably aspects of the broader systemic, cultural, and community landscape. The following table suggests a variety of valued aspects of a potential intensive assessment and treatment response. Other aspects which could be considered desirable (or indeed, necessary) aspects of the broader context are described alongside this in the full report describing this review exercise. Creating the right response: • Has capacity to respond rapidly, and with autonomy. • Has the capacity to provide a fresh, safe context (possibly a physical space) for an individual, within which it is possible to get an accurate understanding of the root causes of critical issues. • Has the capacity and relationships to act as a valued partner of Mental Health inpatient services where this is identified as appropriate for someone. • Can provide sustained support in an equitable manner to all those active to it, without disadvantaging others. • Founded on trauma informed practice (and what this looks like in a practical sense, day to day), as well as PBS. • Has the scope to both act creatively itself, and support others to think and act creatively. • Has the scope and skillset to inform commissioning conversations at the level of individuals, but also at a collective level (observing and learning from overarching patterns of activity). • Can feed into capacity for informed and consistent responding across mainstream partners. • Health, social care, and commissioning are fundamentally relationship-focused: not just about being person-centred, but about being relationship/network aware, and enabling stable responses to complex trauma. 433
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Intensive Support Teams 12 Among the recommendations within the Coming Home report was the need to increase the capacity of community services to respond to people with particularly complex needs. That suggestion reflected existing good practice in Scotland and elsewhere regarding the use of Intensive Support Services/Teams. Such teams are intended to provide more intensive support within the home than is routinely available within existing community learning disability teams, in relation to individuals who presented with significant complexity, in relation to (for example) behaviours perceived as challenging, or mental health issues. The intention behind providing intensive support within an individual’s own home would be to avoid consequences such as placement breakdown, admission to an inpatient facility, or withdrawal of a Care Provider. The type of input required to provide appropriate preventative support in such circumstances could comprise (for example) daily visits, each for an extended period. While the existing community Learning Disability Teams have under exceptional circumstances provided such support, it is not something which is possible with any degree of frequency. Commonly, Intensive Support Services/Teams are based around a Positive Behaviour Support (PBS) approach. PBS is a person-centred approach to care which intends to understand challenging behaviours in terms of what they may be achieving for the person, and then support them in developing alternative skills which meet the same purpose. Nursing and Psychology may have lead roles in relation to PBS within a team, but it is a model which very much lends itself to the multi-disciplinary activity commonly seen in support to people with learning disabilities. Existing Intensive Support (or related) models in Ayrshire North and South Ayrshire both have small teams which deliver intensive support: North Ayrshire Intensive Support Service (ISS): The ISS has been established since late 2023. At the current time, it comprises 2 full time Learning Disability Nurses, and one part time Psychologist. The team has previously had a part-time Occupational Therapist, and full-time Nursing Support Worker within it, but those posts are currently unfilled. The original intention for the team included the recruitment of a full-time Social Worker, and part-time Speech and Language Therapist. It was designed with the intention of carrying small caseloads, having greater flexibility with regard to time to spend with individuals, and intervening over a maximum of 12- weeks. A learning summary shared in September regarding the work of the team outlined the following findings: 434
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Intensive Support Teams 13 • As of September 2025, 26 individuals had been supported by the team, of whom nearly 2 thirds were male. 62% of involvements had been longer than 12-weeks. • Activity data clearly evidenced that a greater proportion of contacts by the ISS were return/review home visits, in comparison to the core Integrated Learning Disability Team (43% vs. 20%). In addition, there was also evidence of contacts tending to be longer. • Risk Assessment at the point of admission to the ISS indicated that along with risk of harm to self and others, occupation of time and support network were also frequently identified risks. • The range of activity undertaken by the ISS, and outcomes achieved, was diverse. Key to these were the capacity for relationship building and fresh assessment which the ISS was able to realise. • Feedback from the Integrated Learning Disability Team was very positive. As noted above, a key distinction in the way the ISS works was the time available to it. Feedback from carers and a client was also positive. Quality of relationships was key to this. South Ayrshire Flexible Assessment and Support Team (FAST): The FAST team is a small social care service that provides support for people with learning disabilities who are in crisis. It has two social care support workers and one health care assistant. The limited resource impacts the on the amount of work the team can do, and as a result it can’t really be seen as an intensive support service in the true sense. Another way it differs from the ISS is in having a flat associated with. This flat is intended to provide short term accommodation in a different environment, where that is identified as a necessary aspect of a response to an individual. It should be noted that at times, the flat has become unavailable for use, as a result of individuals staying within it longer than intended. This echoes the challenges seen at times within Ward 7A (and elsewhere in Scotland), in terms of creating the right solution within the community to allow someone to move on from a ward environment. It also highlights the benefit of providing support, as far as possible, within an individual’s own home, and with the involvement of their existing supports. 435
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Intensive Support Teams 14 Key learning from the ISS and FAST • Time and effective relationship building are always important elements of effective care. The experience of the ISS in particular clearly illustrates the value of having the capacity to spend time with individuals and their care teams. • Feedback from the ISS clearly indicated the value of being able to support care teams within an individual’s own home, and using that as an opportunity to model different ways of providing support. This is not unfamiliar work for any learning disability service, but it is work that can be all too readily constrained by other demands. • Feedback from the ISS also highlights the importance of managing potential transitions effectively, between services and professions. Services can routinely evidence a tendency to ‘push’ individuals on to new sources of support, rather than ‘pulling in’ additional support to enhance that already involved. A focus on pulling in support places an emphasis on sustaining and building on existing care relationships and networks. • The work of the ISS has highlighted the value of an awareness of opportunities within local communities. This reflects the frequency with which occupation of time and support networks were highlighted as risks for individuals referred. • The leadership of the ISS was integrated into an existing management role. Feedback from the ISS indicated that were the team to be developed in any way (particularly if it were to become a pan-Ayrshire model), then dedicated leadership should be available. • The 2 teams evidence differing approaches to skill mix. The North team emphasised a clinical and practical response to individuals, while that of the FAST evidenced a clearer social care focus. The skill mix of the ISS provides a more direct analogue of that available within a ward environment. Since being established, the work of both the ISS and FAST have stimulated discussion around the potential for such approaches to be available uniformly across Ayrshire. The reflective review of past admissions provided some further opportunity to explore their actual and potential impact: the North team clearly indicated that they felt the ISS had been instrumental in avoiding inpatient admissions for some individuals; while the East team reflected on the absence of such a support within their locality (while also recognising that the existing community team acted, at times, in a similar manner to the ISS). 436
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Closing comments 15 This document has provided a summary of a variety of local and national work, undertaken for or relevant to this Options Appraisal process. Hopefully, it has provided some useful information regarding the activity within and experiences of Ward 7A, as well as illustrating the potential of complementary approaches, such as Intensive Support Teams. Further information in relation to these and other topics is available within the full reports from which some of this information was drawn, which are listed below: • Learning Disability Assessment and Treatment Provision Across Scotland – Summary of Benchmarking Work (2025) • Summary of Client Feedback Regarding Experiences of Ward 7A (2025) • Summary of Carer Feedback Regarding Experiences of Ward 7A (and other inpatient environments) (2025) • Summary of Outputs from Engagement Event with Staff and Other Stakeholders (2025) Should you like to see any of these reports, please contact Nicola Fraser, North Ayrshire HSCP Planning Manager nicolafraser@north-ayrshire.gov.uk or Dominic Jarrett, North Ayrshire Learning Disabilities Development Manager Dominic.jarrett@aapct.scot.nhs.uk 437
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Assessment and Treatment Options Appraisal: Process, Options for consideration, and Scoring Criteria January 2026 438
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Preface This document has been written to support the Options Appraisal process regarding future intensive Assessment and Treatment services for adults with learning disabilities in Ayrshire. It provides information on what an Options Appraisal process is, the steps to be undertaken within it, and the Options being considered. relevant to the process, including national context, data from services, and feedback from clients, carers, and staff. It is accompanied by a separate document which provides background information relevant to the process, including national context, data from services, and feedback from clients, carers, and staff. The team supporting this process hope that splitting the information in this way will help to keep things manageable for participants. If you have any questions in relation to either document, or this process, please contact: Nicola Fraser, North Ayrshire HSCP Planning Manager nicolafraser@north-ayrshire.gov.uk or Dominic Jarrett, North Ayrshire Learning Disabilities Development Manager Dominic.jarrett@aapct.scot.nhs.uk Tel (for both) 01294 322473 Acknowledgements Everyone involved in planning this work is immensely humbled by and grateful to the clients, carers, and staff, who have shared their experiences and ideas, and to the internal and external colleagues who have supported this. Particular thanks are extended to Pauline Lunn (Director, In Control Scotland) for supporting the engagement with family carers, and doing so with great passion, credibility, and respect. 439
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Contents Introduction ............................................................................................. 1 Exploring future possibilities .................................................................. 2 What are the steps in an Options Appraisal? ..................................................... 2 What has been done so far? ..................................................................................... 3 How were the options developed? ........................................................................ 3 What are the Options being considered? .............................................. 4 Discounted Options ...................................................................................................... 5 The Status Quo (Legacy Model) ............................................................................... 6 Option 1 ............................................................................................................................. 8 Option 2 ........................................................................................................................... 10 Option 3 ........................................................................................................................... 13 Scoring and analysis of the Options ................................................... 16 The criteria for scoring the Options ..................................................................... 16 Weighting of the criteria ........................................................................................... 17 Scoring the Options .................................................................................................... 17 Sharing the results of the scoring exercise ....................................................... 18 Next steps .............................................................................................. 18 Financial assessment .................................................................................................. 18 Wider consultation ...................................................................................................... 18 Final reporting and decision making ................................................................... 18 Appendix A. Principles from engagement activity underpinning the scoring criteria ...................................................................................... 19 440
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Introduction 1 Ward 7A Woodland View has been providing in-patient assessment and treatment to adults with learning disabilities since early 2020. It opened as the pandemic started, which presented significant challenges for the Ward from the outset. Over the following years, it became increasingly obvious that a variety of factors were working against the intended purpose of the ward, that being To deliver short-term, focused periods of assessment and treatment to adults with learning disabilities whose needs could not safely be met within the community. A key issue for the ward was the environment. It was designed to accommodate 10 individuals, and in that configuration, it did not provide sufficient space to comfortably support people with complex presentations. In late 2022, evidence was drawn together and used to request a reduction in the spaces within the ward, from 10 to 7. At that time, it was intended to repurpose the space created as sensory or activity rooms. The reduction was agreed, and while this brought benefits to people living and working within the ward, significant issues remained, including an awareness that even in the new configuration, the environment remained an issue. Further challenges were created by the lack of appropriate accommodation to discharge individuals to, along with the lack of capacity within appropriately skilled Provider agencies to support them there. These were issues out-with the control of Ward 7A staff, and which led to a situation late in 2024 where all individuals admitted to the ward no longer had a clinical need to be there. The consequences of this were significant for clients, families, and staff: For clients, improvements achieved over the initial stages of their admission, along with skills they had prior to being admitted, could be lost, and challenges develop between individuals within the ward. For families, seeing the deterioration in loved ones and the trauma linked to this could be profoundly distressing, and the apparent inability of the broader system to arrive at effective solutions, immensely frustrating. For staff, seeing the benefits of the care they delivered diminish, having to respond to new challenges arising from this, and recognising the frustration of clients and families, was demoralising and damaging. For these reasons, the ward was temporarily closed in mid July 2025, with a view to exploring possible alternative provision or fundamental improvements. 441
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Exploring future possibilities 2 Large changes within the public sector are expected to follow a process called Options Appraisal. This is intended to support good decision making. It is used to identify the different ways in which we can ensure the options proposed follow a rigorous and robust service change process to achieve the right outcome. The process enables participants to consider the information/evidence provided and objectively score ‘non-financial benefits’ of the option based on that information. Participants are encouraged to ask questions if they wish clarification or further information. The process helps ensure decisions taken are based on a clear justification. Through options appraisal this is achieved by examining all the important non-financial benefits before taking a decision about implementing a new way of working. A separate financial assessment of the options is also done. The Options Appraisal process involves the development and scoring of a short list of options. Work relevant to this Options Appraisal started prior to the closure of Ward 7A. That work, along with other relevant information, is described in a background document which accompanies this one. This document explains a bit more about the Options Appraisal process; describes the options being considered; and outlines the next steps in the process. What are the steps in an Options Appraisal? There is an established process to be followed for an Options Appraisal. It involves: • Defining the intended outcome • Establishing the evidence base • Creating a long list of possible options • Refining this to a short list of options • Scoring the short list options in relation to those benefits which cannot be valued in cost (non-financial benefits) • Undertaking a financial assessment of each of the short list options • Taking the results of the non-financial benefit scoring and financial assessments to a public consultation • Presenting the combined outcomes of the all the above along with the identified preferred option for a final decision to relevant Boards/committees. 442
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What has been done so far? 3 Below are some of the key activities completed to get to this point: • A benchmarking exercise was completed, looking at what in-patient assessment and treatment units for people with learning disabilities are like across Scotland. • A review of past admissions to Ward 7A was completed with staff and Providers, with a view to exploring whether any admissions were avoidable, and how they could have been. • An engagement event took place with staff and other stakeholders, to gather their views and ideas about future options. • Interviews with family carers were undertaken, to gather their reflections on Ward 7A, and their hopes for future options. • Interviews with clients who had been through 7A were completed, to hear their views on it and highlight what needed to be different. That work is described in the Background Document, which accompanies this one. Working with all these people has led to a short list of 3 options, in addition to one describing what things would look like if no changes were made (the Status Quo). How were the options developed? Some initial ideas for options were developed through discussions with health and social care colleagues across Ayrshire. These were informed by experiences to date within Ward 7A (and historically within Arrol Park); relevant other pieces of local and national activity, such as the development of Intensive Support Teams; local evidence gathering such as that listed above; and an awareness of the broader evidence base regarding inpatient services for people with learning disabilities. These options were then developed further in partnership with staff and other stakeholders at an engagement event, at which approximately 50 people from various disciplines and sectors participated. The contribution of carers and clients to shaping the options was also critical. Recognising the potential sensitivity of those conversations, this engagement was done separately from that with staff, and the feedback used to affirm or adapt the draft options. 443
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What are the Options being considered? 4 The following pages describe the 3 options (in addition to the Status Quo) to be considered as part of the financial and non-financial benefits options appraisal process. Before describing these, it is important to note some overarching context: • Even while Ward 7A was open, there was always the option for individuals with learning disabilities to be admitted to adult mental health wards (as opposed to a specialist learning disability ward). This could be as a result of such an environment being identified as most appropriate for the individual. But it has also happened due to lack of availability of space within Ward 7A. Whatever option is identified for a specialist learning disability assessment and treatment response, access to beds within mainstream adult mental health wards could always be considered, where appropriate (or necessary). • Any in-patient option will have to be accompanied by the consistent implementation of access criteria. In addition to this, any admission would be informed by a comprehensive discussion prior to admission, involving the individual, family, care providers, and other relevant partners. This would be with the intention of ensuring the appropriateness of an admission, and a consensus regarding the intended purpose and goals. Similarly, early discharge planning involving all relevant partners would have to be a consistent feature of any in- patient option. • All options require pro-active and ongoing involvement with existing provider teams supporting individuals. They also require good ongoing communication between those teams and local services, such that help is sought early, and with the scope to prevent further deterioration. • Any inpatient admission which involves individuals placed in Ayrshire by Authorities elsewhere has the potential to become complex and lengthy. In the future, it will be essential to ensure that any such situations are explored in a productive manner from the outset, with clear commitment on all sides to working in the individual’s best interests. • Recruitment of staff to specialist roles within Learning Disability Services is broadly challenging at the moment. The redeployment of 7A staff to other settings will also contribute to potential challenges in the recruitment of a skilled workforce to support any of the Options • Within the options, AHPs is used as an abbreviation of Allied Health Professionals. This grouping includes Occupational Therapy, Physiotherapy, Dietetics, and Speech and Language Therapy. 444
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What are the Options being considered? 5 Discounted Options Along with the 3 Options described on the following pages, 2 other options were also considered as part of this process. Brief details of these and why they were discounted are provided below. • Discounted Option: Specialist Learning Disability Assessment and Treatment Inpatient Unit with 6 beds The existing site at Woodland View is re-opened. While the number of beds and associated workforce would remain unchanged, significant work would be undertaken on the environment. This would reflect the fact that experience since opening Ward 7A has made it clear that the existing environment is unsuitable: it doesn’t provide any flexibility to adapt around the needs of individuals, as well as providing limited or inappropriate space for training; activities; and meetings with families. Reasons for discounting: Exploratory work undertaken so far regarding potential changes to the Ward 7A environment made it clear that there wasn’t sufficient space within the Ward to allow for 6 beds in addition to the other necessary modifications. • Discounted Option: A specialist learning disability in-patient environment with a limited number of spaces (3) in addition to a community based Intensive Support Team in all three HSCPs Each locality would have access to an Intensive Support Team. In addition to this, the team would have access to a small in-patient environment, specifically designed to meet the needs of people with learning disabilities and complex needs. A small core team would be linked to this ward, with additional support for any admissions coming from members of the relevant Intensive Support Team. However, the need to resource the development of and maintain such an environment may limit the extent of the possible workforce within each Intensive Support Team Reasons for discounting: This option represents a merging of what are now Options 1 and 3. In seeking to realise aspects of both of these options (development of a specialist inpatient environment, and of locality Intensive Support Teams), there was significant concern that the efficacy and quality of both would be fundamentally compromised as a result of the resource available to realise an Option. The following pages describe the Status Quo, and the 3 Options to be considered as alternatives to this. 445
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The Status Quo (Legacy Model) 6 Status Quo (Legacy Model) Specialist Learning Disability Assessment and Treatment Inpatient Unit with 6 beds The existing site at Woodland View is re-opened in its current configuration (6-beds) and with no changes to the associated workforce. Resource Workforce As previously, a specialist Learning Disability workforce would provide support within the ward (Nursing Assistants, Registered Nurses, Psychiatry, Psychology). Recruitment would be required, as a result of the existing staff team being redeployed/moving on while the ward was closed. Some additional input to the Ward would be provided by professionals from the Community Learning Disability Teams, as part of them remaining involved with individuals admitted to the Ward while under their care. This option would not involve investment in any new community resources. Infrastructure No changes would be made to the building or other infrastructure. Benefits of model • Access to a specialist Learning Disability workforce within an environment which has some capacity to accommodate people with learning disabilities, including those with potentially complex issues. • Location of Woodland View at Ayrshire Central Hospital enables ready access to other wards, for drawing in additional support when required, and a central location for input from Community Learning Disability Teams. • No additional investment would be required to realise this model. 446
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The Status Quo (Legacy Model) 7 Risks • The existing physical environment has already proven to be inadequate in meeting the needs of clients admitted. • Returning to a legacy model which has already presented significant issues for staff, clients, and their families, could create challenges with regard to drawing back previous staff, or recruiting new ones. • A reliance on in-patient provision without accompanying community or other investment may lead to individuals remaining in Ward 7A for longer than intended, as well as opportunities being missed for preventative action. • Admission to an in-patient space has the potential to remove individuals from beneficial community connections which could be part of their recovery. • An intense ward environment has the potential to create challenges not only for the individuals admitted, but also for the staff on the ward. As such, it carries the risk of high staff turnover and sickness/absence. • Bank staff may be used to fill gaps, but those staff may not be familiar to the clients, or have a background in working with people with learning disabilities. • There is a risk of unplanned changes to existing supports while an individual is admitted, which may contribute to them being admitted for longer than necessary. • In the event of all beds being in use, there is a risk of increased pressure on mainstream adult mental health wards to admit individuals. • Location near to North team could create over reliance on it specifically, as well as presenting challenges for colleagues from East and South teams linking into the ward (travel time etc.). • Excessive financial burden linked to need to draw in additional staff as necessary. 447
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Option 1 8 Option 1: Specialist Learning Disability Assessment and Treatment Inpatient Unit at Woodland View, with 3 beds Ward 7A is re-opened, but with a reduced number of beds (3), with admissions taking place when agreed as clinically required. This creates scope for redesign of the ward environment, with the potential to explore the creation of comfortable and therapeutic spaces. Resource Workforce A specialist Learning Disability workforce would provide support within the ward (Nursing Assistants, Registered Nurses, Psychiatry, Psychology, Occupational Therapy, and Speech and Language Therapy). Some additional input to the Ward would be provided by professionals from the Community Learning Disability Teams, as part of them remaining involved with individuals admitted to the Ward while under their care. This option would not involve investment in any new community resources. Infrastructure Adaptation would be required to convert the ward environment to more therapeutic spaces, with the extent of this reflecting the agreed accommodation format. Benefits of model • Access to a specialist Learning Disability workforce within an environment which is specifically designed to work best for people with learning disabilities and potentially complex issues. • Location of Woodland View at Ayrshire Central Hospital enables ready access to other wards, for drawing in additional support when required, and a central location for input from Community Learning Disability Teams. • A redesigned ward environment could create a more therapeutic space, as well as an improved working environment for staff, leading to better outcomes for all. • A reduced number of individuals admitted would improve therapeutic environment and create a better working environment, contributing to better outcomes for individuals and staff reduced turnover and sickness/absence, and consequently, less reliance on bank staff. 448
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Option 1 9 Risks • A reliance on in-patient provision without accompanying community or other investment may lead to individuals remaining in Ward 7A for longer than intended, as well as opportunities being missed for preventative action. • Admission to an in-patient space has the potential to remove individuals from beneficial community connections which could be part of their recovery. • An intense ward environment has the potential to create challenges not only for the individuals admitted, but also for the staff on the ward. As such, it carries the risk of high staff turnover and sickness/absence. • Bank staff may be used to fill gaps, but those staff may not be familiar to the clients, or have a background in working with people with learning disabilities. • There is a risk of unplanned changes to existing supports while an individual is admitted, which may contribute to them being admitted for longer than necessary. • In the event of all beds being in use, there is a risk of increased pressure on mainstream adult mental health wards to admit individuals. • Location near to North team could create over reliance on it specifically, as well as presenting challenges for colleagues from East and South teams linking into the ward (travel time etc.).A reduced number of beds could further increase the likelihood of pressure on adult mental health wards, and on other community resources. • The extent of redesign possible within the Ward may be limited by the overall shape of the space. • The extent to which the multi-disciplinary workforce described above could be realised would be very much dependent on identifying the financial resources to make this possible, as AHP input has not in recent years been included in the budget for Ward 7A. 449
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Option 2 10 Option 2: Admission to mainstream Mental Health wards at Woodland View, but with the support of a specialist Learning Disability Workforce Ward 7A does not reopen as a specialist learning disability inpatient unit. Instead, admissions are supported to a base ward (Ward 11) within the mainstream Mental Health wards, when they are clinically required. Use of other wards within Woodland View may be explored as required in addition to this, for reasons such as client mix, bed availability, or finding the appropriate environment for an individual. Resource Workforce Staff within the ward would be a mix of mainstream Mental Health and Learning Disability staff. Learning Disability Nurses and Nursing Assistants would be a key focus for recruitment, but with the intention to also recruit AHPs (particularly Occupational Therapy and Speech and Language Therapy). Dedicated Learning Disability Psychiatry and Psychology input would also be linked to the ward. This option would not involve investment in any new community resources. Infrastructure Some adaptation of the Ward 11 environment may be undertaken (e.g. of existing High Care Environments within the ward) in order to maximise its suitability for people with learning disabilities. Benefits of model • A specialist workforce supporting a smaller patient group could work in favour of both patients and staff. • Being based alongside Mental Health staff could provide an additional source of support for learning disability staff, as well as opportunities for Mental Health staff to learn from them (and vice-versa). • There would be scope to tap into better designed spaces. • The focus on bringing additionality to an existing resource (Ward 11) could create scope for better use of finances available. 450
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Option 2 11 Risks • A reliance on in-patient provision without accompanying community or other investment may lead to individuals remaining admitted for longer than intended, as well as opportunities being missed for preventative action. • Admission to an in-patient space has the potential to remove individuals from beneficial community connections which could be part of their recovery. • An intense ward environment has the potential to create challenges not only for the individuals admitted, but also for the staff on the ward. As such, it carries the risk of high staff turnover and sickness/absence. • Bank staff may be used to fill gaps, but those staff may not be familiar to the clients, or not have a background in working with people with learning disabilities. • There is a risk of unplanned changes to existing supports while an individual is admitted, which may contribute to them being admitted for longer than necessary. • In the event of all beds being in use, there is a risk of increased pressure on community resources and other mainstream adult mental health wards to admit individuals. • Location near to North team could create over reliance on it specifically, as well as presenting challenges for colleagues from East and South teams linking into the ward (travel time etc.). • There is potential for activity within the learning disability beds to impact on that within the surrounding Mental Health ward. • The potential mix of patients with and without learning disabilities may create the need for additional consideration and caution regarding admissions. • There is scope for staff linked to the learning disability beds to be drawn away to support activity within the surrounding ward when capacity to do this exists. Potentially, this may lead to situations where it is difficult to draw individuals back to their core purpose i.e. supporting admissions of people with learning disabilities. • The Learning Disability workforce would have to be sufficiently skilled in relation to general mental health care as to be able to work effectively in relation to that staff group, where able/required. • Spaces available may not ideally reflect the requirements of people with learning disabilities and particularly complex needs, potentially creating a need to seek admission elsewhere. 451
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Option 2 12 • Supporting individuals with a larger staff group with a mixed skills set could create some inconsistency in the nature of support provided to individuals. • The extent to which the multi-disciplinary workforce described above could be realised would be very much dependent on identifying the financial resources to make this possible, as AHP input has not in recent years been included in the budget for Ward 7A. 452
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Option 3 13 Option 3: Intensive Support Team within each locality supported by access to mainstream Mental Health wards at Woodland View The existing resource linked to Ward 7A is repurposed to provide a multi-disciplinary Intensive Support Team within the community (one for each Ayrshire locality) and a small number of LD staff to enhance LD expertise in a host Mental Health ward (to a more limited degree than described in Option 2). The Intensive Support team would have extended (and flexible) working hours and would be in addition to the existing Community Learning Disability Teams. It would have the capacity to provide intensive support within people’s homes, with the intention of reducing the likelihood of the need for an admission. The only admission options would be into mainstream adult mental health wards. However, individuals would be supported to some degree while admitted by staff from the Intensive Support Team, alongside the small LD workforce within the host Mental Health Ward. Resource Workforce Each Intensive Support Team would primarily consist of Nursing Assistants and Registered Nurses, but would also have an AHP presence (particularly Occupational Therapy), and potentially social care staff. Some dedicated Psychology and Psychiatry time would also be required to support the team, and any admissions to wards. Professions not represented within the team would be draw in from the local Integrated Learning Disability Team as required and where possible. The small workforce associated with the Mental Health wards would consist of Nurses and Nursing Assistants. Infrastructure Each Intensive Support Team would have access to a base with the scope for undertaking assessment and providing training. As far as possible, this would provide a homely environment, to allow for comfortable interactions within environments with real world relevance (as opposed to environments with only clinical relevance). 453
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Option 3 14 Benefits of model • Prioritises supporting individuals within their existing environment • Locality presence enables a good understanding of local service/third sector context and active collaboration with local partners including Providers • Front loading the community could create capacity within/reduce demand on other locality services • Provision of local assessment spaces minimises scope for disruption and provides opportunity for more ‘real world’ understanding of individuals, if assessment spaces reflect living spaces in a meaningful way • Capacity to follow individuals into an inpatient admission allows for the sustaining of relationships established within the community • Greater capacity for pro-active support to family and paid carers, to sustain them in their caring role • Retains capacity for specialist support from LD staff in relation to inpatient admission • Reduced reliance on a static body of staff to sustain a ward (reduced scope for bank staff reliance) • Scope for clearer collaborative planning with families and Providers in advance of admission (when this is required), with potential to reduce scope for unanticipated changes to existing supports • Scope to build on existing developments within South and North Ayrshire (FAST and ISS) Risks • No dedicated learning disability inpatient provision – spaces available may not ideally reflect the requirements of people with learning disabilities and complex needs. In addition, there is the risk of beds being unavailable when needed. • Input may not provide immediate relief in instances where family/carers are under significant stress. • Reliance on the team may contribute to unplanned changes to other supports, which lead to a need for the team to stay involved for longer than intended. This would subsequently reduce its capacity to respond to others. 454
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Option 3 15 • The inpatient Learning Disability workforce would have to be sufficiently skilled in relation to general mental health care as to be able to work effectively in relation to that staff group, where able/required. • The extent to which the multi-disciplinary workforce described above could be realised would be very much dependent on identifying the financial resources to make this possible, as AHP input has not in recent years been included in the budget for Ward 7A. • Identifying a relevant base for each team to access (whether within NHS or social care premises) will be dependent on availability within each locality. Excluding the Status Quo, one of the main differences between the 3 Options is the extent to which they prioritise activity within an in-patient environment, or activity within the community: • Options 1 and 2 prioritise investment in an in-patient environment only • Option 3 mainly prioritises investment in activity within the community, but also includes some investment in an in-patient environment This is represented roughly in the graphic below: Option 1 Option 2 Option 3 = investment in in-patient environment = investment in community activity 455
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Scoring and analysis of the Options 16 The criteria for scoring the Options 6 criteria will be used to score the non-financial benefits relating to the above options. The criteria include standard elements frequently seen in Options Appraisals, but have also been shaped by the engagement with clients, families, and staff, to reflect the things which they saw as important elements of a successful service. A set of principles was identified within this work that has informed the criteria: those are outlined in Appendix A. The criteria to be used in scoring the Options are described below: Safe The option should be safe for all patients, carers, visitors and staff. It should also be able to balance safety with choice and independence, and be risk aware, as well as risk enabling. Sustainable The option should meet the needs of the current population, but also have the potential to learn and respond to changing population needs. Person-centred The option should be able to adapt around an individual’s needs and circumstances, to provide support that reflects their wishes, interests and aspirations, and the concerns of those who know them best. Flexible The option should be able to provide support in places and at times that enable preventative care, as well as effective responding to crisis. Integrated The option should promote and enable integration and collaboration, not just with other NHS, social care, and provider services, but with the individual themselves, their families, and the whole range of Third Sector partners. Effective The option should have within it or be able to readily access the mix of skills and professions that will enable it to respond to diverse and potentially complex needs. 456
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Scoring and analysis of the Options 17 Weighting of the criteria As part of the scoring process, a weighting will be assigned to each of the criteria. The weighting will be determined with the involvement of all those who take part in the scoring. This weighting will reflect the relative importance of each criteria, as determined by the overall participant group. To do this, participants will be asked to individually distribute 60 points across 6 criteria, with the number of points they allocate to each reflecting its degree of importance for them. This will be done as an initial activity within the scoring sessions. The responses of all participants will be drawn together, and used to form a ranked list which will create a weighting score for each criterion. Scoring the Options As noted earlier, the scoring part of an Options Appraisal usually involves 3 groups of people, with an equal number (ideally) in each group. The 3 groups are: • Group 1: Individuals who receive the service or their representatives • Group 2: Ground level staff involved in delivering the service • Group 3: Senior managers with overall responsibility for services For the purposes of this Options Appraisal, we are also involving representatives from the Independent and Voluntary sector, as part of the Ground level staff group. They are critical partners in supporting people to live well within communities, as well as in working with people, families, and services where issues arise. This Options Appraisal process will involve 2 scoring sessions: • One will involve Group 1 participants. • The other will involve Groups 2 and 3. We have taken a similar approach here to that used in the preceding engagement work. In doing so, we have tried to create comfortable spaces for people to participate fully, and free of any potential power imbalances. Both sessions will be supported by colleagues from North Ayrshire HSCP, as well as Health Economics colleagues from the NHS Ayrshire and Arran Transformation and Sustainability Directorate. The scoring session for Group 1 will take place on the 10th of February The scoring session for Groups 2 and 3 will take place on the 28th of January 457
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Next steps 18 Sharing the results of the scoring exercise Initial results will be shared back to all participants following completion of the scoring exercise. Part of the analysis of the scoring results will include a sensitivity analysis. This is a process which will allow everyone to understand the impact different groups had on the scoring. It will show, for example, whether the responding of Senior Managers differed from that of ground level staff or carers and client representatives. The results of the sensitivity analysis will be included in the final report of the non-financial benefits scoring, which all participants will receive a copy of. Financial assessment As noted earlier, alongside the scoring of the non-financial benefits, a separate financial appraisal of the Options will be undertaken. Wider consultation The results of the financial assessment and non-financial benefits scoring will be shared more broadly as part of a public consultation. Key to this process will be exploring the extent to which people not involved in earlier elements of the Options Appraisal process agree with the outcomes achieved. Approximately 1-month will be used to undertake this wider consultation. Within it, we will seek to engage with a broader spectrum of clients and carers, as well as other service and Third Sector partners. Final reporting and decision making The outcomes of the non-financial benefits scoring and financial assessment, along with the feedback from the public consultation, will be drawn together in a final report along with detail around the identified preferred Option. This will then be presented for approval to the necessary local bodies. Given the fact that this service is a pan-Ayrshire one, and will impact on 3 Health and Social Care Partnerships as well as NHS Ayrshire and Arran, approval will have to be sought from the 3 Integration Joint Boards linked to the Health and Social Care Partnerships, as well as from the NHS Ayrshire and Arran CMT (Clinical Management Team?). Everyone involved in planning this process recognises that it is a complex one, but that it is very much a necessary one. The decision being taken is of profound significance, and the involvement of all who take part is immensely appreciated. 458
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19 Appendix A. Principles from engagement activity underpinning the scoring criteria 1. Proactive and Preventative – Act early to prevent issues rather than react to crises. 2. Caring and Compassionate – Show empathy and kindness in all interactions. 3. Respectful and Dignified – Treat people with dignity and respect in everyday care. 4. Empowering and Partnership-Oriented – Work in genuine partnership with families and empower individuals. 5. Honest, Transparent, and Accountable – Communicate openly and take responsibility for actions. 6. Risk Aware but Risk Enabling – Balance safety with enabling choice and independence. 7. Trauma-Informed – Understand and respond appropriately to trauma. 8. Skilled and Autism-Informed – Ensure staff have the right skills and knowledge for diverse needs. 9. Independent and Fair Complaints Process – Provide transparency and independence in handling concerns. 459
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Version: 7.0 North Ayrshire Council Equality & Children’s Rights Impact Assessment (Full Form) Please Note: Before you begin, is this version the most up to date? You can download the most recent version on Connects. Screenings and ECRIAs should be included with relevant Committee Reports and may be published on our website. Introduction This form will assist in carrying out an Equality Impact Assessment and where appropriate, Socio-Economic, Children’s Rights, Island Communities and Consumer Duty Impacts of new, revised and existing policies and practices. Guidance on how to complete assessments is given in the Council’s Equality and Children’s Rights Impact Assessment Toolkit. The form is mandatory and must be published on the Council website once the policy or practice has been approved. 1. General Details 1.1 Directorate/Service: HSCP: Section: Mental Health – Learning Disabilities 1.2 Name of Policy, Practice of Proposal being assessed: Closure of Ward 7A Assessment and Treatment Unit and establishment of a pan-Ayrshire Intensive Support Team (IST). Please delete whichever statements are not applicable from the highlighted text below: This is a new proposal. Please insert Budget Reference number (if applicable) Click or tap here to enter text. 1.3 List of participants in the assessment Thelma Bowers, Head of Service (Mental Health); Jan Thomson, Senior Manager (Learning Disabilities); Nicola Fraser, Project Manager (Independent Living Services); Dominic Jarrett, Learning Disabilities Development Manager 1.4 Manager responsible for the impact assessment Name: Jan Thomson Designation: Senior Manager (Learning Disabilities) 1.5 Timetable (should be started during the development phase of the proposal) 460
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Version: 7.0 Date Assessment Started: 26/05/2026 Interim Review Date: Click or tap here to enter text. Final sign off by Head of Service at the end of the form. 2. Aims and Relevance 2.1 What is the purpose of the policy practice or proposal? To formally close Ward 7A Learning Disabilities Assessment and Treatment Inpatient Service. To establish, in its place, a pan-Ayrshire Intensive Support Team, with the option to admit individuals to a mainstream mental health ward (with the support of specialist Learning Disability staff). Central to the IST’s role will be a focus on pro-active intervention while people are still in the community, with the aim of removing the need for subsequent inpatient admission. 3. Equality and Diversity 3.1 What evidence were you able to access about the relevant needs of protected groups as outlined in section 3.3 below (Please include your sources – links to equality providers and evidence can be found in both the toolkit and the Promoting Equality Page on Connects). The proposal has been informed by a range of evidence gathering, including analysis of presenting needs of clients, and review of past admissions to Ward 7A. Benchmarking of similar services across Scotland also took place. A learning evaluation of an existing local Intensive Support Service also shaped the proposal, as well as engagement with clients and family carers with experience of admission to Ward 7A or similar in-patient environments. Past activity reporting in relation to Ward 7A, as well as the broader evidence base in relation learning disability inpatient services, were also considered. 3.2 Are there any gaps in your evidence or areas of uncertainty? The information gathered offers a comprehensive basis upon which the proposal has been developed. It has also been informed by a robust Option Appraisal process, involving a broad range of participants from within services, third sector partners, and service users/carers. As with any service, there remains a need to embed an ongoing process of learning based on actual delivery. 3.3 From the list of protected characteristic groups identified in section 3.3, please identify any potential positive and negative impacts on any of these protected characteristics. 461
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Version: 7.0 Protected Characteristic Impact on the Protected Characteristic? (yes, no, not applicable) Please Explain (Positive or Negative or Neutral) Age - Older people, children and young people – please identify which categories will be affected Yes Positive impact. Review of past admissions to Ward 7A highlighted the ways in which poorly planned transitions between child and adult services had contributed to negative outcomes, the deterioration of wellbeing, and the eventual need for an inpatient admission. Establishing a pan-Ayrshire, community based Intensive Support Team will create opportunity for more flexible delivery and networking within the Ayrshire localities, including collaboration in relation to transitions. Disability - Physical and Learning Yes Positive impact. Work undertaken as part of the Option Appraisal process, as well as national activity linked to the Coming Home report, has highlighted the potential negative impact of periods of inpatient admission for people with learning disabilities, and their families. A critical aspect of this is the removal of existing networks of support, and the reduced involvement of those who know the individual best. The establishment of the IST will enable a more genuinely relationship focused way of working, which involves close partnership with existing supports, and prioritises ways of working that are centred around the individual, and their place within the community. Gender reassignment - When a person is living in a gender other than their birth gender. Yes Positive impact. This has not been a specific issue within the work undertaken to inform the proposal. However, it would be anticipated that the shift to a more community 462
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Version: 7.0 Protected Characteristic Impact on the Protected Characteristic? (yes, no, not applicable) Please Explain (Positive or Negative or Neutral) focused, individualised way of working will bring benefits for those experiencing potential adversity linked to inequitable ways of working in other contexts. Pregnancy and Maternity Yes Positive impact. This has not been a specific issue within the work undertaken to inform the proposal. However, it would be anticipated that the shift to a more community focused, individualised way of working will bring benefits for those experiencing potential adversity linked to inequitable ways of working in other contexts. The anticipated low caseload and capacity for intensive involvement which will be core aspects of the work of the IST will be of direct relevance in such circumstances. Existing research in relation to the experiences of parents with learning disabilities clearly indicates the importance of intensive, flexible involvement, and positive relationships. The anticipated practice model of the IST will very much support such interventions. Race, ethnicity, colour, nationality or national origins (including gypsy/ travellers, refugees and asylum seekers) Yes Positive impact. This has not been a specific issue within the work undertaken to inform the proposal. However, it would be anticipated that the shift to a more community focused, individualised way of working will bring benefits for those experiencing potential adversity linked to inequitable ways of working in other contexts. This would include greater capacity to adapt around the community lives of individuals. 463
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Version: 7.0 Protected Characteristic Impact on the Protected Characteristic? (yes, no, not applicable) Please Explain (Positive or Negative or Neutral) Religion or belief (includes religious and philosophical beliefs, including no belief) No Neutral impact Sex - Women and Men No Neutral impact. Sexual Orientation – such as lesbian, gay and bisexual people. Yes Positive impact. This has not been a specific issue within the work undertaken to inform the proposal. However, it would be anticipated that the shift to a more community focused, individualised way of working will bring benefits for those experiencing potential adversity linked to inequitable ways of working in other contexts. Marriage and Civil Partnership - this includes same sex couples Yes Positive impact. This has not been a specific issue within the work undertaken to inform the proposal. However, it would be anticipated that the shift to a more community focused, individualised way of working will bring benefits for those experiencing potential adversity linked to inequitable ways of working in other contexts. Human Rights Yes Positive impact. The work of the Scottish Human Rights Commission and Mental Welfare Commission, as well as local engagement with carers as part of the Option Appraisal, has made it clear that inpatient admissions for people with learning disabilities can undermine the human rights of individuals. Conversations with local carers 464
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Version: 7.0 Protected Characteristic Impact on the Protected Characteristic? (yes, no, not applicable) Please Explain (Positive or Negative or Neutral) highlighted that gaps in relation to early, accessible, skilled support undermine the right to independent living; the right to family life; the right to the highest attainable standard of health; and the right to early help and intervention. Establishing the pan- Ayrshire IST will be a direct response to such issues. Fundamentally, this will be tied to its capacity to work intensively with individuals in their own home, or other appropriate settings within the community, in collaboration with the individual and their existing support networks. Care Experienced - This term refers to anyone who is currently in care or has been for any length of time regardless of their age and includes Kinship Care (other family members); Looked After at Home (with support from social work); Residential Care; Foster Care; Secure Care; Adoption. Yes Positive impact. This has not been a specific issue within the work undertaken to inform the proposal. However, it would be anticipated that the shift to a more community focused, individualised way of working will bring benefits for those experiencing potential adversity linked to inequitable ways of working in other contexts. This would be of particular relevance for care experienced individuals, for whom institutional settings may hold negative associations. 465
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Version: 7.0 Protected Characteristic Impact on the Protected Characteristic? (yes, no, not applicable) Please Explain (Positive or Negative or Neutral) Other - Homelessness, ex-offenders, carers, part-time workers Yes Engagement work carried out for the Option Appraisal linked to this proposal clearly highlighted carers’ wishes in relation to early, pro-active support, which recognises and values their experience and insight. Working with carers to enhance their capacity to support a family member, as well as to support their own wellbeing, will be key elements of the work of the IST. 3.4 Describe any consultation or engagement undertaken, including details of the groups involved and the methods used. The Option Appraisal which led to identification of an IST as a preferred option was initiated in the second half of 2025. The format of the process reflected guidance from Healthcare Improvement Scotland, and was also shaped by good practice from other areas across Scotland. In particular, conversations with Dumfries and Galloway colleagues regarding their delivery of an OA process, and sharing of the materials linked to this, proved particularly valuable. Given the publicity surrounding Ward 7A, and the national conversation regarding such services, efforts were made to draw in external partners to support the local OA process. Of those approached, In Control Scotland provided the most support (mainly in relation to engagement with family carers), with some support also coming from the Scottish Commission for People with Learning Disabilities. Steps followed within the OA process were as follows: Establishment of a long list of options An initial list of 6 options (including the Status Quo) was developed on the basis of the preliminary information gathering (e.g. national benchmarking; review of past admissions, review of North Ayrshire ISS). Other work undertaken to inform the development of the long list included: • An engagement event involving approximately 50 participants from across health and social care and the third sector • Interviews with 4 clients who had been admitted to Ward 7A (facilitated by clinicians from the Community Learning Disability Teams) 466
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Version: 7.0 • Interviews with 5 families, whose family members had experienced 7A or similar inpatient environments (facilitated by the Director of In Control Scotland) While the number of clients and families involved may appear small, it is necessary to bear in mind that the population of people admitted to 7A is itself relatively small (admissions for 35 individuals were reviewed for this work). Establishment of a short list of options Following review by the pan-Ayrshire stakeholder group overseeing the OA process, 2 options were removed from the long list. This resulted in a short list of 4 options being taken forward for consideration, these being: • Status Quo: reopening of Ward 7A as it was prior to closure • Option 1: Specialist Learning Disability Assessment and Treatment Inpatient with 3 beds • Option 2: Assessment and Treatment Inpatient within an alternative environment (e.g. mainstream adult mental health ward) • Option 3: An Intensive Support Model in all three HSCPs (potentially including out of hours support) with access to LD beds hosted within a mainstream MH ward The Status Quo was included in order to provide a baseline for comparison of the other options, but was not itself considered as an Option for future delivery. Establishment of criteria for non-financial benefits scoring A brief set of scoring criteria were established, based around principles, values, and practice identified as important across the various strands of engagement activity. The 6 criteria were finalised with the input of the pan-Ayrshire stakeholder group, and were: Safe; Sustainable; Person-centred; Flexible; Integrated; Effective Non-financial benefits scoring In line with the expected OA process, scoring of non-financial benefits linked to the Options involved 3 groups of individuals: • Group 1: Individuals who receive the service or their representatives (family carers and related organisations) • Group 2: Ground level staff involved in delivering the service • Group 3: Senior managers with overall responsibility for services Representatives of the Independent and Voluntary sector (Provider organisations) were also invited to take part (within Group 2), reflecting their critical role in the support of people within communities. 467
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Version: 7.0 Scoring events took place in January and February 2026, with that from Group 1 (primarily family carers, and representative organisations) taking place separately. That event was co-facilitated by In Control Scotland, and all scoring events were supported by Health Economics colleagues from the NHS Ayrshire and Arran Transformation Team. All participants in the scoring events received 2 documents in advance of the scoring sessions: one describing the background to the process; and the other outlining the Options and scoring Criteria. Both documents are embedded in Appendix A. Scoring events involved participants individually weighting each of the criteria, in terms of the importance of each; and then scoring each Option in relation to these criteria. Questions 3.5 to 3.7 refer to the ‘Three Key needs (or aims) of the Equality Duty’ 3.5 Which aspects of the policy eliminate unlawful discrimination, harassment and victimisation? The Scottish Human Rights Commission ‘Tick Tock’ report described a lack of progress in relation to effectively addressing the human rights agenda referenced within the Coming Home work. This includes failings in relation to realising non-discrimination. The most recent Coming Home Action Plan (2026) recommended the shifting of resources from hospital to community settings, in order to deliver meaningful change. The establishment of the pan- Ayrshire IST represents such a shift, and a meaningful commitment to the avoidance to unnecessary hospital admissions. 468
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Version: 7.0 3.6 Which aspects of the policy advance equality of opportunity between people who share a relevant protected characteristic and those who do not? In line with the intended improvements in pro-active, holistic and community based care which will be enabled by the IST, it is hoped that individuals will be better supported to remain in connection with, or establish connection with, opportunities within the broader community which are open to all. 3.7 Which aspects of the policy foster good relations between people who share a protected characteristic and those who do not? (Does it tackle prejudice and promote a better understanding of equality issues). The work of the IST will be very much focused on responding to the immediate needs of individuals. There will be circumstances were consideration of the individual’s connection to their broader community, and activities within it, will be a necessary aspect of this support. In such circumstances, appropriate planning as to how the individual can be supported to establish good relations with the broader community will need to be undertaken. This may include considering how the individual can be prepared for such activities; how their sensory needs can be effectively met within such settings; and how support can be delivered and scaled (up or down) in order to realise community integration. 3.8 If you have identified any negative impacts of your proposal how will you mitigate these? Not applicable. 3.9 Is the policy or practice intended to promote equality by permitting positive action or lead to positive outcomes for people based on a protected characteristic? The proposal is intended to promote equitable and proportionate care and improved outcomes for individuals. Most significantly, this is linked to the intention to deliver care within the individuals own home or community, as opposed to admitting them to a hospital setting. 4. Section 4 – The Fairer Scotland Duty The Fairer Scotland Duty (‘the Duty’), Part 1 of the Equality Act 2010 places a legal responsibility on the Council to actively consider (‘pay due regard to’) how we can reduce inequalities of outcome caused by socio-economic disadvantage when making decisions. 4.1 Does the proposal have the potential to have a significant impact on inequalities of outcome caused by socio-economic disadvantage? (Consider low income; low wealth; material deprivation; area deprivation; communities of place or interest, socio-economic background). Please delete whichever statement is not applicable from the highlighted text below: 469
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Version: 7.0 Yes, the proposal does have the potential to have a significant impact on inequalities of outcome caused by socio-economic disadvantage. If No, please go to Section 5. If Yes please provide more information under any of the below headings (4.2 to 4.6) which are relevant, highlighting any evidence and sources of evidence used to inform your information. 4.2 Low Income/Income Poverty: Cannot afford to maintain regular payments such as bills, food and clothing By prioritising working intensively with people in their own homes, and engaging with their broader support network, the IST will have the opportunity to develop a deep understanding of the issues impacting on an individuals wellbeing. While their actions will predominantly be related to mental health, behaviours perceived as challenging, or related issues, making appropriate connections to allow other potential stressors to be addressed (such as low income) will be a legitimate aspect of their activity, and enabled by their having a strong focus on collaboration with local services and other partners. 4.3 Low/and or no wealth: Having enough money to meet basic living costs and pay bills but have no savings to pay for any unexpected spends and no provision for the future. As above. 4.4 Material Deprivation: Being unable to access basic goods and services, i.e. financial products like life insurance, repair/replace broken electrical goods, warm home, leisure/hobbies As above. 4.5 Area Deprivation: Where you live (rural areas), where you work (accessibility of transport). As above. 4.6 If impacts have been identified how will these be mitigated or explored in more detail? (please outline below) The impact of the IST with regard to the above inequalities will be positive. 5. Section 5 – Children’s Rights When considering the Children’s Right’s Impact process, some of the key considerations include any evidence, research and consultation (specifically including any consultation or engagement with young people). 5.1 Are any Children’s Rights impacted by this proposal? (please refer to Appendix 1 of this document, where the Children’s Rights Articles have been matched against the Getting It Right For Every Child (GIRFEC) 470
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Version: 7.0 wellbeing indicators. This is solely to make it easier to identify which rights might be impacted on; the Rights are the key element of this section). Please delete whichever statement is not applicable from the highlighted text below: Yes, there are Children’s Rights impacted by this proposal. 5.2 Please indicate, if possible, how many children and young people (nearest estimate) are likely to be affected by the policy or measure? Currently not possible to estimate number of children anticipated as being affected. 5.3 Are some children and young people more likely to be affected than others? Please delete whichever statement is not applicable from the highlighted text below: Yes, some children and young people are more likely to be affected than others. If, Yes what groups? (Consider protected characteristics – for example disabled young people, LGBT etc.) Children with learning disabilities. 5.4 What Children’s Rights are likely to be affected by the policy/proposal? Please refer to Table 2 (Appendix 1) ‘Links between Wellbeing Indicators and Articles of the UNCRC’ and insert the relevant rights and indicators in the table below. Wellbeing indicator (for example, safe, healthy etc.) Children’s Right (for example, 22 – refugee children) Healthy 2 - best interest of the child 6 – life, survival and development 24 – health and health services Nurtured 18 – parental responsibilities and state assistance 27 – adequate standard of living 471
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Version: 7.0 Wellbeing indicator (for example, safe, healthy etc.) Children’s Right (for example, 22 – refugee children) Active 3- best interests of the child 23 – children with disabilities 31 – leisure, play and culture Respected 3- best interests of the child 12 – respect for the views of the child Responsible 3- best interests of the child 12 – respect for the views of the child Included 3- best interests of the child 6 – life, survival and development 18 – parental responsibilities and state assistance 23 – children with disabilities 26 – social security 27 – adequate standard of living 5.5 What likely impact will the policy/proposal have on Children’s Rights and Wellbeing? Either Positive, Negative or Neutral. Children Rights Positive Other Protected Characteristics Positive 5.6 Describe any consultation or engagement that has taken place with young people? It was not possible to engage with children and young people as part of developing this proposal. 472
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Version: 7.0 5.7 If negative impacts are identified how will these be mitigated either fully or in part? Click or tap here to enter text. 473
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Version: 7.0 6. Section 6 – Island Communities Impact (or Island Proofing) Island Proofing is about considering the particular needs and circumstances of island communities when public sector organisations exercise their functions and make decisions. This has been added to the process of assessing the Council Plan and includes a range of issues such as access to services, digital connectivity, employment and access to education, transport and access to goods and services. 6.1 Do the intended outcomes of the proposal potentially differ or have a different impact for our Island Communities? Please delete whichever statement is not applicable from the highlighted text below: No, the intended outcomes of the proposal do not potentially differ or have a different impact for our Island Communities. 6.2 Please describe the potential impacts for our Island Communities. Not applicable(?) 6.3 Please explain if the impacts are different for communities on different islands? Not applicable. 6.4 What consultation or engagement has taken place with our Island Communities? Not applicable. 6.5 How will you address any potential barriers or wider impacts for our Island Communities as identified through this assessment? Not applicable. 474
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Version: 7.0 7. Section 7 – The Consumer Duty The Consumer Duty is about the impact of Council proposals on consumers in Scotland. A Consumer is an individual or a small business that purchases, uses or receives goods or services in Scotland, that are supplied either by a business or a public body – please see What is the Consumer Duty. 7.1 Will your proposal impact on consumers? Please delete whichever statement is not applicable from the highlighted text below: Yes, the proposal will impact on consumers. If no, please request then complete the ‘Assessment not required’ by emailing equalities@north-ayrshire.gov.uk. 7.2 What are the impacts, if any, on consumers in general? Is it likely that consumers will experience harm because of this proposal? There will be a positive impact on consumers. The work of the North Ayrshire Intensive Support Service (which shares a focus and purpose with the proposed pan-Ayrshire IST, and will be replaced by it) has already demonstrated the positive difference that intensive, flexible support can make to individuals, family carers, and care teams experiencing complex challenges. The quality of the relationships which will be enabled by that way working, as well as the aim of supporting people (and their networks) within the community, will ensure the creation of practical, impactful change. As noted previously, this will always be the possibility of admission to an inpatient setting, should that be what is required under the circumstances. But the focus on community working will bring with it the benefits of close collaboration with a broad range of service and other partners, within the locality. The intended small caseload, as well as close collaboration with core Community Learning Disability Teams in each locality, will ensure equitable access to the support of the IST. 7.3 Describe the impacts if any, on consumers in vulnerable circumstances. Is it likely that consumers in vulnerable circumstances* will experience harm because of this proposal? (please include any relevant evidence or engagement with consumers) *Vulnerable circumstances may be temporary in nature and may or may not arise as a resulted of a consumer’s protected characteristics. For more information, please see page 31 of Consumer Scotland’s draft guidance on the consumer duty. All of those supported by the IST will be in vulnerable circumstances. For the most part, they will be individuals who are either within hospital settings, or for whom there is a risk of their community supports breaking down. Severe mental ill health will be a common feature across the intended client group, as will severe 475
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Version: 7.0 behaviour that is perceived as challenging. The design of the IST has been (and will continue to be) very much informed by what could work best for individuals in such positions of vulnerability. Basing the practice of the team around Positive Behaviour Support will ensure that the individual’s communication is never lost sight of within a support situation; multi-disciplinary support and collaboration across services will ensure that (as far as possible) the relevant skills are made available to an individual; and close partnership working with family carers, and paid carers, will ensure that their knowledge and experience informs all actions, and that their own wellbeing is also considered as part of the support provided. 7.4 Describe any consultation and engagement that has taken place with consumers around your proposal. See Section 3.4 for a description of the consultation work undertaken to inform this proposal. 7.5 What alternative proposals could improve outcomes for consumers and/or reduce harm to consumers? How do these compare to the original proposal? Within the Option Appraisal process, 3 Options (in addition to the Status Quo) were explored. Alongside establishment of a pan-Ayrshire IST, consideration was also given to the establishment of a specialist Learning Disability Inpatient Unit (based around a heavily re-developed Ward 7A); and placing a large specialist learning disability workforce within mainstream mental health wards, in order to support admissions there. While both were seen to have some benefits (e.g. the former would ensure a specialist workforce and environment designed specifically around the needs of people with learning disabilities, and the latter would enable integration alongside and support from a larger mainstream workforce), neither offered the community focused, preventative action that the pan-Ayrshire IST would. Ultimately, it was advantages such as this which played a significant part if identifying the proposed direction as the preferred one. 476
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Version: 7.0 8. Section 8 – Crosscutting Impacts 8.1 Have any cross-cutting impacts been identified from other Council Services or Partner Agencies (multiple discrimination or accumulated effects on a protected characteristic group through multiple proposals or existing decisions)? The decision of the HSCP in recent months to fund critical care only impacts on all service discussions. It can be anticipated that that decision could well prove to be an antecedent in some of the situations which the IST would become involved with. 8.2 If Crosscutting issues have been identified with other Services, what discussion/interaction has taken place to mitigate any potential negative impacts of accumulated proposals? The intended function of the IST is in many ways a response to the risk created by the move to critical only funding. Through investing in community based responses, as opposed to hospital based ones, capacity will be created to support crises within the community earlier and at a greater intensity than might otherwise be possible. 9. Section 9 – Outcome of the Assessment 9.1 Please detail the outcome of the assessment: Please delete whichever outcomes are not applicable from the highlighted text below: a) No major alterations to the policy assessed: the Impact Assessment demonstrates the policy is robust and there is no possible discrimination or adverse impact. All opportunities to minimise negative impacts and enhance positive outcomes have been taken. 9.2 For Outcome 2. in section 9.1 above - please detail recommendations, including any action required to address negative impacts identified or to better promote equality. Not applicable 9.3 If Outcome 3 is chosen from section 9.1 above, please outline the justifications for continuing the policy/procedure. Not applicable 9.4 Please state the key issues, recommendations and future actions arising from the Integrated Impact Assessment. No significant issues have been identified as a result of the Impact Assessment. 477
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Version: 7.0 10. Section 10 – Monitoring 10.1 Describe how you will monitor the impact of this policy for example, performance indicators, actions, other monitoring arrangements, who will monitor progress, criteria used to measure if outcomes are achieved, timescales including any future reviews of the impact of the proposal and where this will be recorded. Implementation of the pan-Ayrshire Intensive Support Team will be accompanied by an ongoing process of learning and review. This will be shaped with reference to the description of Best Practice outlined within the National Position Statement on ISTs (as recommended within that report). As one part of this, the work of the team will be closely aligned to the use of the Dynamic Support Register (DSR) within each HSCP. The DSR was a national development recommended by the original Coming Home report, which is used to track and enhance the visibility of individuals admitted to hospital settings, or whose community supports are at risk of breakdown. Individuals on the DSR are categorised using a RAG system: changes in that category will be used as one means of evidencing impact of the Intensive Support Team. The SHRC report includes within it a set of Human Rights indicators which were used to structure the work linked to it. Those indicators are also recommended for use to guide duty bearers in ending institutionalisation. On this basis, they will be used alongside other mechanisms to evidence the rights-based work of the Intensive Support Team, and associated local services. The need for accountability was clearly voiced in feedback from family carers as part of the Options Appraisal. Reflecting this, delivery partners will seek to include family carers and clients in the design and ongoing delivery of the Intensive Support Team. As part of this, we will seek to maintain our positive working relationship with In Control Scotland, to help shape that involvement, and ensure the voices of family carers and clients form a core element of impact measurement. 11. Section 11 – Sign Off 11.1 Head of Service approval of the impact assessment. Name: Thelma Bowers Title: Head of Service (Mental Health) Date: 5.06.26 12. Section 12 – Publication 12.1 Following approval by Head of Service, completed Impact Assessments are published on our Council’s External Website. Please email: equalities@north-ayrshire.gov.uk 478
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Version: 7.0 Appendix 1 - GIRFEC Wellbeing Indicators and Children’s Rights Table 1 - GIRFEC Wellbeing Indicators Indicator Description Safe Protected from abuse, neglect and harm Healthy Having the best possible standards of physical and mental health; support to make healthy, safe choices Achieving Accomplishing goals and thereby boosting skills, confidence and self-esteem; ‘being all they can be’. Nurtured Having a loving and stimulating place to live and grow Active Having opportunities to take part in a wide range of activities Respected Being enabled to understand their world, being given a voice, being listened to, and being involved in the decisions that affect their wellbeing. Responsible Taking an active role within their home, school and community. Included Being a full member of the communities in which they live and learn; receiving help and guidance to overcome inequalities. 479
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Version: 7.0 Articles of the UNCRC matched against the GIRFEC indicators Summary of the UNCRC Articles from 1 – 54 (UNICEF) Table 2 - Links between Wellbeing Indicators and Articles of the UNCRC *Please note in general the use of the term Governments, includes public sector organisations such as the Council, some articles will have stronger relevance for the work of the Council than others. Wellbeing Indicator – Safe There are 12 relevant articles of the UNCRC (Rights of the Child) linked to the Safe indicator. Article 9 – Separation from parents Children must not be separated from their parents against their will unless it is in their best interests (for example, if a parent is hurting or neglecting a child). Children whose parents have separated have the right to stay in contact with both parents, unless this could cause them harm. Article 10 – Family reunification Governments must respond quickly and sympathetically if a child or their parents apply to live together in the same country. If a child’s parents live apart in different countries, the child has the right to visit and keep in contact with both of them. Article 11 - Abduction and non-return of children Governments must do everything they can to stop children being taken out of their own country illegally by their parents or other relatives or being prevented from returning home. Article 19 - Protection from violence, abuse and neglect Governments must do all they can to ensure that children are protected from all forms of violence, abuse, neglect and bad treatment by their parents or anyone else who looks after them. Children and Young People have the right to be kept safe from harm. They must be given proper care by those looking after them. Article 22 - Refugee children If a child is seeking refuge or has refugee status, governments must provide them with appropriate protection and assistance to help them enjoy all the rights in the Convention. Governments must help refugee children who are separated from their parents to be reunited with them. Children and Young People have the right to special help and be allowed to live somewhere that is safe if they are a refugee. 480
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Version: 7.0 Article 32 - Child labour Governments must protect children from economic exploitation and work that is dangerous or might harm their health, development or education. Governments must set a minimum age for children to work and ensure that work conditions are safe and appropriate. If they are under 16 there are laws about where, when and for how long they can work. Article 33 - Drug abuse Governments must protect children from the illegal use of drugs and from being involved in the production or distribution of drugs. Article 34 - Sexual exploitation Governments must protect children from all forms of sexual abuse and exploitation. Children and Young People have the right to never be pressurised or forced into doing anything sexual. They have the right to be protected from it. Article 35 - Abduction, sale and trafficking Governments must protect children from being abducted, sold or moved illegally to a different place in or outside their country for the purpose of exploitation. People should never make them do anything against their will, like marry someone for instance. Article 36 - Other forms of exploitation Governments must protect children from all other forms of exploitation, for example the exploitation of children for political activities, by the media or for medical research. Children and Young People have the right to be protected from being taken advantage of in any way. Article 37 - Inhumane treatment and detention Children and Young People have the right to be treated with respect. If they have committed a crime children should be arrested, detained or imprisoned only as a last resort and for the shortest time possible. They must be treated with respect and care and be able to keep in contact with their family. Children must not be put in prison with adults. They should not be imprisoned unless it is absolutely necessary and they will get legal help. Article 38 - War and armed conflicts Governments must not allow children under the age of 15 to take part in war or join the armed forces. Governments must do everything they can to protect and care for children affected by war and armed conflicts. In Scotland, they have to be 16 to join the armed forces and are not normally allowed to fight until they are 18. 481
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Version: 7.0 Wellbeing Indicator – Healthy There are four relevant articles of the UNCRC (Rights of the Child) linked to the Healthy indicator. Article 3 – Best interests of the child The best interests of the child must be a top priority in all decisions and actions that affect children. Children and Young People have the right to have their interests considered if a decision is being made by any person about them. What is best for them is what matters. Article 6 – Life, survival and development Every child has the right to life. Governments must do all they can to ensure that children survive and develop to their full potential. Children and Young People have the right to be kept safe from harm, they have the right to be alive, survive and develop through life. Article 24 - Health and health services Every child has the right to the best possible health. Governments must provide good quality health care, clean water, nutritious food, and a clean environment and education on health and well-being so that children can stay healthy. Children and Young People have the right to be given good healthcare (if they are ill) so they can get well again. They have the right to live in a safe, healthy environment with good food and clean drinking water. Article 39 - Recovery and rehabilitation of child victims Children who have experienced neglect, abuse, exploitation, torture or who are victims of war must receive special support to help them recover their health, dignity, self-respect and social life. 482
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Version: 7.0 Wellbeing Indicator – Achieving There are four relevant articles of the UNCRC (Rights of the Child) linked to the Achieving indicator. Article 4 – Implementation of the Convention Governments must do all they can to make sure every child can enjoy their rights by creating systems and passing laws that promote and protect Children’s Rights. Children and Young People have the right to have their rights protected and an environment where they can grow up safe. Article 18 - Parental responsibilities and state assistance Both parents share responsibility for bringing up their child and should always consider what is best for the child. Governments must support parents by creating support services for children and giving parents the help they need to raise their children. Article 28 - Right to education Every child has the right to an education. Primary education must be free and different forms of secondary education must be available to every child. Discipline in schools must respect children’s dignity and their rights. Richer countries must help poorer countries achieve this. In Scotland education is free and children three years old+ are entitled to a free nursery place. Some 2 year olds may be eligible for free care depending on family circumstances, such as level of income. Article 29 - Goals of education Education must develop every child’s personality, talents and abilities to the full. It must encourage the child’s respect for human rights, as well as respect for their parents, their own and other cultures, and the environment. It must help to prepare them for adult life. 483
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Version: 7.0 Wellbeing Indicator – Nurtured There are eight relevant articles of the UNCRC (Rights of the Child) linked to the Nurtured indicator. Article 4 – Implementation of the Convention Governments must do all they can to make sure every child can enjoy their rights by creating systems and passing laws that promote and protect children’s rights Children and Young People have the right to have their rights protected and an environment where they can grow up safe. Article 5 - Parental guidance and a child’s evolving capacities Every child has the right to be registered at birth, to have a name and nationality, and, as far as possible, to know and be cared for by their parents. Children and Young People have the right to their parents being responsible to guide them through their childhood and help them learn how to use their rights. Article 9 – Separation from parents Children must not be separated from their parents against their will unless it is in their best interests (for example, if a parent is hurting or neglecting a child). Children whose parents have separated have the right to stay in contact with both parents, unless this could cause them harm. Article 10 – Family reunification Governments must respond quickly and sympathetically if a child or their parents apply to live together in the same country. If a child’s parents live apart in different countries, the child has the right to visit and keep in contact with both of them. Article 18 - Parental responsibilities and state assistance Both parents share responsibility for bringing up their child and should always consider what is best for the child. Governments must support parents by creating support services for children and giving parents the help they need to raise their children. Article 20 - Children deprived of a family If a child cannot be looked after by their immediate family, the government must give them special protection and assistance. This includes making sure the child is provided with alternative care that is continuous and respects the child’s culture, language and religion. Children and Young People have the right to special care if they can’t live with their parents. They may be looked after by other members of their family or by a different family. 484
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Version: 7.0 Article 21 - Adoption Governments must oversee the process of adoption to make sure it is safe, lawful and that it prioritises children’s best interests. Children should only be adopted outside of their country if they cannot be placed with a family in their own country. Article 25 - Review of treatment in care If a child has been placed away from home for the purpose of care or protection (for example, with a foster family, in hospital, a care home or somewhere else away from home), they have the right to a regular review of their treatment, the way they are cared for and their wider circumstances to help make sure they are still getting what’s best for them. Article 27 - Adequate standard of living Every child has the right to a standard of living that is good enough to meet their physical and social needs and support their development. Governments must help families who cannot afford to provide this. Children and Young People have the right to a safe place to live, food, clothing and to take part in things they enjoy. 485
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Version: 7.0 Wellbeing Indicator – Active There are eight relevant articles of the UNCRC (Rights of the Child) linked to the Nurtured indicator. Article 3 - Best interests of the child The best interests of the child must be a top priority in all decisions and actions that affect children. Children and Young People have the right to have their interests considered if a decision is being made by any person about them. What is best for them is what matters. Article 23 - Children with disabilities A child with a disability has the right to live a full and decent life with dignity and, as far as possible, independence and to play an active part in the community. Governments must do all they can to support children with a disability and their families. Children and Young People have the right to have special help to make sure they can join in with things if they have any form of disability. Article 31 - Leisure, play and culture Children and Young People have the right to rest, play and have the chance to join a wide range of artistic and cultural activities. It is really important to they have a balance in their life. 486
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Version: 7.0 Wellbeing Indicator – Respected There are 12 relevant articles of the UNCRC (Rights of the Child) linked to the Nurtured indicator. Article 2 - Non-discrimination The convention that applies to everyone under the age of 18, regardless of circumstances. Article 3 - Best interests of the child The best interests of the child must be a top priority in all decisions and actions that affect children. Children and Young People have the right to have their interests considered if a decision is being made by any person about them. What is best for them is what matters. Article 4 – Implementation of the Convention Governments must do all they can to make sure every child can enjoy their rights by creating systems and passing laws that promote and protect children’s rights. Children and Young People have the right to have their rights protected and an environment where they can grow up safe. Article 5 - Parental guidance and a child’s evolving capacities Every child has the right to be registered at birth, to have a name and nationality, and, as far as possible, to know and be cared for by their parents. Children and Young People have the right to their parents being responsible to guide them through their childhood and help them learn how to use their rights. Article 8 - Protection and preservation of identity Every child has the right to an identity. Governments must respect and protect that right, and prevent the child’s name, nationality or family relationships from being changed unlawfully. Children and Young People have the right to know who they are – official records should be kept. If they are over 16 years old and adopted, they can try to find out who their birth parents are. Article 12 - Respect for the views of the child Every child has the right to express their views, feelings and wishes in all matters affecting them, and to have their views considered and taken seriously. This right applies at all times, for example during immigration proceedings, housing decisions or the child’s day-to-day home life. Children and Young People have the right to speak up and have their opinions listened to and be taken seriously by adults on things that affect them. 487
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Version: 7.0 Article 13 - Freedom of expression Every child must be free to express their thoughts and opinions and to access all kinds of information, as long as it is within the law. Children and Young People have the right to say whatever they believe as long as it does not harm or offend other people. They also have the responsibility to respect the rights and freedom of others. Article 14 - Freedom of thought, belief and religion Every child has the right to think and believe what they choose and also to practise their religion, as long as they are not stopping other people from enjoying their rights. Governments must respect the rights and responsibilities of parents to guide their child as they grow up. Children and Young People have the right to choose their own religion and beliefs. Their parents should help them think about this. Article 16 - Right to privacy Every child has the right to privacy. The law should protect the child’s private, family and home life, including protecting children from unlawful attacks that harm their reputation. They shouldn’t have their personal letters opened or anyone listening in to their personal phone calls. Article 17 - Access to information; mass media Every child has the right to reliable information from a variety of sources, and Governments should encourage the media to provide information that children can understand. Governments must help protect children from materials that could harm them. Children and Young People have the right to access information which is important to their wellbeing. Adults should help them find information they are looking for and make sure it’s not harmful. Article 18 - Parental responsibilities and state assistance Both parents share responsibility for bringing up their child and should always consider what is best for the child. Governments must support parents by creating support services for children and giving parents the help they need to raise their children. Article 30 - The right to learn and use the language, customs and religion of their family Every child has the right to learn and use the language, customs and religion of their family, whether or not these are shared by the majority of the people in the country where they live. 488
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Version: 7.0 Wellbeing Indicator – Responsible There are five relevant articles of the UNCRC (Rights of the Child) linked to the Responsible indicator. Article 3 - Best interests of the child The best interests of the child must be a top priority in all decisions and actions that affect children. Children and Young People have the right to have their interests considered if a decision is being made by any person about them. What is best for them is what matters. Article 12 - Respect for the views of the child Every child has the right to express their views, feelings and wishes in all matters affecting them, and to have their views considered and taken seriously. This right applies at all times, for example during immigration proceedings, housing decisions or the child’s day-to-day home life. Children and Young People have the right to speak up and have their opinions listened to and be taken seriously by adults on things that affect them. Article 14 - Freedom of thought, conscience and religion Every child has the right to think and believe what they choose and also to practise their religion, as long as they are not stopping other people from enjoying their rights. Governments must respect the rights and responsibilities of parents to guide their child as they grow up. Children and Young People have the right to choose their own religion and beliefs. Their parents should help them think about this. Article 15 - Freedom of association Every child has the right to meet with other children and to join groups and organisations, as long as this does not stop other people from enjoying their rights. Article 40 - Juvenile justice A child accused or guilty of breaking the law must be treated with dignity and respect. They have the right to legal assistance and a fair trial that takes account of their age. Governments must set a minimum age for children to be tried in a criminal court and manage a justice system that enables children who have been in conflict with the law to reintegrate into society. Children and Young People have the right to be given legal assistance if they have committed a crime. The Convention also states that they should only be sent to prison if they have committed a serious crime. 489
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Version: 7.0 Wellbeing Indicator – Included There are five relevant articles of the UNCRC (Rights of the Child) linked to the Included indicator. Article 3 - Best interests of the child The best interests of the child must be a top priority in all decisions and actions that affect children. Children and Young People have the right to have their interests considered if a decision is being made by any person about them. What is best for them is what matters. Article 6 - Life, survival and development Every child has the right to life. Governments must do all they can to ensure that children survive and develop to their full potential. Children and Young People have the right to be kept safe from harm, they have the right to be alive, survive and develop through life. Article 18 - Parental responsibilities and state assistance Both parents share responsibility for bringing up their child and should always consider what is best for the child. Governments must support parents by creating support services for children and giving parents the help they need to raise their children. Article 23 - Children with disabilities A child with a disability has the right to live a full and decent life with dignity and, as far as possible, independence and to play an active part in the community. Governments must do all they can to support children with a disability and their families. Children and Young People have the right to have special help to make sure they can join in with things if they have any form of disability. Article 26 - Social security Every child has the right to benefit from social security. Governments must provide social security, including financial support and other benefits, to families in need of assistance. Article 27 - Adequate standard of living Every child has the right to a standard of living that is good enough to meet their physical and social needs and support their development. Governments must help families who cannot afford to provide this. Children and Young People have the right to a safe place to live, food, clothing and to take part in things they enjoy. 490
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1 of 7 Paper 19 NHS Ayrshire & Arran Meeting: Ayrshire & Arran NHS Board Meeting date: Tuesday 7 April 2026 Title: Whistleblowing Report – Quarter 3, October – December 2025 Responsible Director: Jennifer Wilson, Nurse Director Report Author: Karen Callaghan, Whistleblowing Coordinator Shona McCulloch, Head of Corporate Governance 1. Purpose This is presented to Committee for: • Discussion This paper relates to: • Government policy/directive This aligns to the following NHSScotland quality ambition(s): • Safe • Effective • Person Centred This supports the following Corporate Objectives: • Better Workplace – Creating a great place for us to work • Better Care – Improving your experience of care A strong delivery of the National Whistleblowing Standards supports NHS Ayrshire & Arran’s Better Care and Better Workplace objectives by enabling staff to safely raise concerns that highlight risks, drive learning, and improve the quality and safety of care. A clear, fair and supportive whistleblowing process also strengthens trust, psychological safety and organisational culture, helping to create a better workplace for all staff. 2. Report summary 2.1 Situation The National Whistleblowing Standards and Once for Scotland Whistleblowing policy (the Standards) were introduced on 1 April 2021. Board members are asked to discuss the report on organisational activity in relation to Whistleblowing concerns raised in 2025/26 Quarter 3 (1 October – 31 December 2025). Agenda Item 13 491
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2 of 7 2.2 Background The Standards set out how the Independent National Whistleblowing Officer (INWO) expects all NHS Boards to manage, record and report whistleblowing concerns. It is a requirement of the Standards that whistleblowing data is reported quarterly to the NHS Board. The Standards also require that Boards publish an annual report setting out performance in handling whistleblowing concerns. The annual report will report performance against the requirements of the Standards, Key Performance Indicators (KPIs), the issues that have been raised and the actions that have been or will be taken to improve services as a result of concerns. This report will summarise and build on the quarterly reports produced by the Board In NHS Ayrshire & Arran, the agreed governance route for reporting on whistleblowing is to the Staff Governance Committee and then to the NHS Board. The NHS Board report will be shared with Integration Joint Boards following the NHS Board meeting. 2.3 Assessment 2.3.a Two concerns were received in quarter 3 (Q3). • Not whistleblowing: An individual (A) contacted the SpeakUp mailbox seeking information, guidance, and support on how to progress a concern they had received confidentially from a third party (C) regarding potential racist behaviours. The third party chose to remain anonymous and did not wish to come forward. The Whistleblowing Coordinator engaged directly with (A) to discuss the matter and agree an appropriate way forward. Following this discussion, and given that the concern was anonymous, the matter was referred to HR colleagues to be taken forward by the area manager with HR support. • Whistleblowing Stage 2: The second concern was received by email to the SpeakUp mailbox. The complainant provided detailed information and requested that it be progressed through the whistleblowing route. The concern relates to service culture, leadership behaviour, clinical practice, confidentiality, and staff wellbeing, and its impact within North Ayrshire Health & Social Care Partnership (NAHSCP). The Whistleblowing Decision Team agreed that it should proceed under Stage 2 of the whistleblowing process. A Lead Investigator has been appointed, and the Commissioning Director has been informed and has met with the investigator. The Terms of Reference have been agreed, and the investigation is now underway. HR support has been requested and is in place due to the nature and complexity of the issues raised. Quarter 3 Theme Division Service Stage 2 Concern • service culture, • leadership behaviour, • clinical practice, • confidentiality, and • staff wellbeing NAHSCP District Nursing Team 492
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3 of 7 No immediate risk was identified to patient safety in the concerns received in Q3, with no action required 2.3.b Ongoing Case update: At the end of quarter 3 (December 2025) four investigations were in progress, including the concern received in quarter 3. Table 1 provides an update on the three ongoing cases carried forward from previous quarters. These investigations are complex in nature and have required extensions to the standard 20‑day response timeframe. All extensions were agreed with the complainants in advance. Engagement with complainants has continued throughout, and regular updates have been provided for each case. Table 1 – ongoing cases previous quarters Case Stage Division Status Theme Update Q4 2024/25 Stage 2 NAHSCP Community Mental Health Team (CMHT) Open – Investigation ongoing Concerns under review: Patient‑care issues Poor practice Unsafe working conditions Potential abuse of authority The Lead Investigator continues to progress the investigation, with HR providing support throughout. Regular updates are being provided to the complainant. Q2 2025/26 Stage 2 NAHSCP Child and Adolescent Mental Health services (CAMHS) Open – Investigation ongoing Concerns under review: Workplace culture Patient-care issues Poor practice Unsafe working conditions Abusing authority Lead Investigators are continuing to progress the investigation. They have met with senior managers and have received the requested documentation from HR colleagues. The investigation is being supported by HR throughout. Q2 2025/26 Stage 2 NAHSCP Woodland View, Ayrshire Central Hospital Open – Investigation ongoing Concerns under review: Patient-safety issues Patient-care issues Poor practice Unsafe working conditions Lead Investigators are continuing to progress the investigation and have met with the complainant. The Terms of Reference for the investigation have been agreed, and the Commissioning Director has been informed. The investigation is being supported by HR, and regular progress updates are being provided. 2.3.c Improvement plans: one open improvement plan linked to a case raised in 2024/25. The investigation concluded in May 2025. The investigation report and the improvement plan were approved by the Commissioning Director by early 493
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4 of 7 August. Progress of the improvement plan being monitored through the Acute Services Governance Group, with oversight provided by the Corporate Governance Coordinator and reporting on completion to the Whistleblowing Oversight Group. 2.3.d Training update: Monthly reports are produced to monitor completion of the Turas Whistleblowing eLearning modules. Table 2 shows the position for Q3 2025/26. Table 2 – Completion of Turas e-Learning Programme Nos Completed Increase Total No of Staff % staff completed 01/10/2025 31/12/2025 An overview (Staff) 5107 5459 352 11951 45.6% For Line Managers 338 377 39 997 87.1% For Senior Managers 486 492 6 Table 2 The data shows a limited increase over the quarter, however, there are numbers “in progress” for each programme and there will be focus in our communications to remind and encourage those who have started the programmes to complete them. In progress at 31/12/2025 Whistleblowing: An overview Whistleblowing: For senior managers Whistleblowing: For Line managers 374 172 109 The whistleblowing training provided through Turas Learn has three programmes: • staff who need an overview of the Standards – 1 hour • staff who are line managers or work in a similar role, who are likely to receive concerns from colleagues in their day-to-day work – around 2 hours • senior managers who are involved with not only receiving concerns, but also investigating, responding to, and reporting on whistleblowing concerns to the board – 3 hours. The e-learning modules for line managers and senior managers are mandatory. The learning programmes are available on Turas Learn https://learn.nes.nhs.scot/40284 2.3.e Independent National Whistleblowing Officer (INWO): A clear indicator of the satisfaction of those who raise concerns can be derived from the number of concerns that are escalated to the Independent INWO. At this current time, there have been no referrals to the INWO from completed cases. 2.3.f Speak Up Week: took place from 29 September to 3 October 2025. The theme for 2025, “Listen, Act, Build Trust,” reflected INWO’s continued focus on developing a culture where staff feel safe and supported to raise concerns. The theme highlighted three core components of an effective speak‑up system: o Listening to concerns with openness and respect o Acting promptly and transparently o Building trust through consistent, fair, and accountable processes This year’s programme built on learning from previous years and incorporated participant feedback to ensure the initiative remained relevant and responsive to organisational needs. 494
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5 of 7 Due to resource constraints, Speak Up Week 2025 was delivered through digital engagement and communication channels. This approach enabled broad participation while maintaining accessibility. Activities included INWO online events and targeted communications designed to support ongoing improvement in speak‑up culture. 2.3.1 Quality Procedures for raising concerns should provide good-quality outcomes through a thorough but proportionate investigation. The approach to handling whistleblowing concerns ensures that learning and improvement is progressed for upheld whistleblowing concerns and are shared across all relevant services. 2.3.2 Workforce The Standards support our ambition for an open and honest organisational culture where staff have the confidence to speak up and all voices are heard. This is focused through our organisational Values of ‘Caring, Safe and Respectful’ and promoting a culture of psychological safety. 2.3.3 Financial There is no financial impact. 2.3.4 Risk assessment/management If staff do not have confidence in the fairness of the procedures through which their concerns are raised, or do not feel assured that concerns raised will be acted upon, there is a risk that they will not raise valid concerns about quality, safety or malpractice. The opportunity to investigate and address these concerns will have been lost, with potentially adverse impact on quality, safety and effectiveness of services. There is also a wider risk to organisational integrity and reputation if staff do not believe they will be listened to and do not feel senior leaders in NHS Ayrshire & Arran are fulfilling the organisation’s Values of ‘Caring, Safe and Respectful’ and promoting a culture of psychological safety. 2.3.5 Equality and diversity, including health inequalities A local Equality Impact Assessment (EQIA) for the Standards is in place and published on our public facing web. This assesses the impact of the Whistleblowing Standards on staff and those who provide services on behalf of the NHS with protected characteristics. 2.3.6 Best value This paper support Best Value across the themes of; • Governance and accountability • Performance management The delivery of an effective process for whistleblowing concerns will support the Board’s commitment to safe, effective and person-centred care. Effective handling of concerns supports the delivery of the Healthcare Quality Strategy 2.3.7 Other impacts There are no other relevant impacts. 495
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6 of 7 2.3.8 Communication, involvement, engagement and consultation There is no requirement for formal engagement with external stakeholders in relation to the formulation of this paper. There has been wide communication of the Standards across the organisation. 2.3.9 Route to the meeting This has been previously considered by the following groups as part of its development. The groups have either supported the content, or their feedback has informed the development of the content presented in this report. • Whistleblowing Oversight Group on 29 January 2026 (Virtual) • Staff Governance Committee on 17 February 2026 2.4 Recommendation For discussion: Board members are asked to discuss the performance for Quarter 3 (October - 31 December 2025). 496
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7 of 7 Appendix 1: 497
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NORTH AYRSHIRE Health and Social Care Partnership Delivering care together OFFICIAL INFORMATION OFFICIAL INFORMATION Minutes of North Ayrshire Strategic Planning Group Meeting Held on Wednesday 26 November 2025, 10:00am Microsoft Teams Present: (tbc) Councillor Chloe Robertson, Chair Joyce White, Vice Chair Alison Mcallister, Library & Information Services Manager, NAC Billy Brotherston, Independent Chair, NA ADP Darren Fullarton, Associate Nurse Director, NAHSCP Fiona Comrie, KA Leisure Jennifer McGee, Policy & Community Planning Officer, NAC John Eden, NHS Education for Scotland Katie Bell, Team Manager, Housing, NAC Laura Barrie, KA Leisure Lisa Davidson, Assistant Director Public Health, NHS AA Michelle Sutherland, Senior Manager, Primary Care & Communities NAHSCP Morag Blackley, Unity Carers Gateway Holly Tait, Unity Carers Gateway Seony Ross, Team Manager, Strategic Planning & Equalities, NAHSCP Sharon Hackney, AHP Lead, NAHSCP Stuart MacMillan, Principal Manager, Planning, Performance, Transformation, NAHSCP Vicky Yuill, Chief Executive, Arran CVS Wendy Van Riet, Director of Psychological Services, NAHSCP Apologies Received: Betty Saunders, Senior Manager Contracts and Commissioning, NAHSCP Caroline Cameron, Director, NAHSCP Elizabeth Stewart, Head of Service Children, Families & Justice, NAHSCP Iain Jamieson, Clinical Director, North Ayrshire HSCP Kerry Logan, Head of Service, Health & Community Care, NAHSCP Michael McLennan, Lead Officer ADP, NAHSCP Nicola Teager, Communication & Engagement Officer, NAHSCP Rebecca Black, Partnership Engagement Officer, NAHSCP Roseanne Burns, Senior Manager Justice & Intervention, NAHSCP Scott Hunter, Chief Social Work Officer Thelma Bowers, Head of Service Mantal Health, NAHSCP Agenda Item 14 498
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NORTH AYRSHIRE Health and Social Care Partnership Delivering care together OFFICIAL INFORMATION OFFICIAL INFORMATION Item Item Action 1. Welcome and Introductions 2. Update from Chair Councillor Chloe Robertson introduced the meeting 3. Minutes of Meeting held June 2025 The minutes of the meeting held September 2025 were agreed as an accurate reflection of discussion. Service/Partner Updates 4. Carers Gateway Update and Engagement Work Holly Tait and Morag Blackley attended from the Carers Gateway to provide the group with an update on recent developments in the service related to Engagement and Health Services. They provided a Presentation. Holly Tait is the Engagement Officer at Carers Gateway and provided an overview of her role. The Engagement officer carries out community engagement to build strong connections with unpaid carers across North Ayrshire, delivering outreach events and roadshows to raise awareness of support available. Her role ensures engagement is inclusive and aims to reach under-represented groups. The role involves communication and promotion of the Carers Gateway service to carers, such as supporting the promotion of the Carers Gateway Digital Platform, Bridgit https://carers.bridgit.care/app/cgna/live, and the Carer Newsletter. Holly also shares information on services, rights, events and opportunities for carers. Including helping to identify carers and connect them to the right support at the right time, working closely with local support officers and young carer services, and signposting to wellbeing activities, advice, breaks, and online resources. The Engagement officer works alongside the Health & Social Care Partnership and community partners and helps shape services based on carer feedback and lived experience. She is currently working on the development of a Carers Information Pack 2026 via the Champions Board, and in 2025, there were 12 projects funded via the Carers Community Fund. The role also includes listening to carers, helping to tailor and shape how the service is delivered. Morag Blackley is the Case Support Officer for Health at Carers Gateway. The Service launched in early July across Woodland View, Douglas Grant, and Redburn units. Referral pathways have been established for Lady 499
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NORTH AYRSHIRE Health and Social Care Partnership Delivering care together OFFICIAL INFORMATION OFFICIAL INFORMATION Margaret and Arran War Memorial Hospitals. A collaborative approach has been implemented, using the Triangle of Care model to support timely and effective discharges. Initial engagement was carried out through pop-up information stalls across all hospital areas. Introductions were completed with ward staff and HSCP teams, providing carers’ rights information to strengthen recognition, inclusion, and value of unpaid carers. The Service provides enhanced communication between families and healthcare teams. Staff value the service as it allows them to focus on patient care while ensuring carers receive dedicated support. There has been significant increase in referrals across Mental Health, Palliative Care, Elderly, Neurology, and Stroke wards. There is active participation in MDT meetings, providing advocacy for families and advisory input for healthcare teams. Morag is collaborating with the Mental Health Engagement Officer to develop and facilitate the Mental Health Carers Forum. Service visibility and referral rates continue to grow, strengthening overall engagement. The service ensures carers’ voices are being heard, with improved support and inclusion in care planning and decision-making. Collaborative partnerships extend support beyond hospital settings, ensuring continuity of care. Timely and successful discharges are increasing, reducing delays and improving patient outcomes. Next Steps: Introduce drop-in visitor sessions to provide accessible, on-the- spot support for carers. Maintain continuous staff engagement and training, reinforcing best practice and carer inclusion. Contact details: Holly Tait (Engagement), holly.tait@unity-enterprise.com Morag Blackley (Health Services), Morag.Blackley@unity-enterprise.com https://www.CarersGateway.org.uk 5. National Induction Framework for Adult Social Care John Eden from NES provided a presentation with some information on a national resource, an induction framework for adult social care, and to tell us a bit about the benefits that it could bring to North Ayrshire. Current induction challenges in social care • 25% turnover year on year (SSSC workforce data) • Repetition of the same or similar induction learning for workers • Workers feeling overwhelmed and under confident, leading to early exit from the sector • Additional expenditure of resources for employers • Slower onboarding of staff • Harder to build a stable team of experienced staff 500
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NORTH AYRSHIRE Health and Social Care Partnership Delivering care together OFFICIAL INFORMATION OFFICIAL INFORMATION • Challenging for small and medium sized providers to build and maintain comprehensive induction programs • No common standard for induction • Variability in the quality of learning materials and therefore of worker knowledge The National Induction Framework: Social Care is the result of a collaborative project between NHS Education for Scotland (NES) Social Care & Communities Directorate and the Scottish Social Services Council (SSSC). It’s a programme of learning for all workers across adult social care in Scotland who are taking up a new support worker or practitioner role. It provides learners with a foundation of knowledge that is relevant to their role, through accessible eLearning courses and learning materials which will be completed flexibly during their induction period. A record of learning is automatically populated on the learner’s SSSC MyLearning App. Should the learner switch roles, the record of learning can be provided as evidence of completed learning. This will allow time to be freed up to, for example, provide direct care. The main aim of the National Induction is to ensure that all workers in adult social care in Scotland have access to high quality learning, but also aims to reduce duplication of induction learning for workers and employers, reduce worker turnover, improve the standard of induction across social care and improve access to quality assured learning resources. The Framework was commissioned by Scottish Government and launched on 14th May 2025. It is 30 hours of quality assured induction learning for adult social care staff with additional learning resources to support further staff development. Early Evaluation results Highly positive feedback with 88% recommending the framework and 89% of workers said the NIF positively influence their practice. Over 80% of workers reported increased knowledge and workers commented they had enjoyed their learning experience. The average score for induction topics 4.6/5 82% of workers said the module length was about right and over 80% found Turas and MyLearning platforms easy or satisfactory to use. The benefit to employers: • Reduce the resources needed to develop and maintain induction programs. • Reduce the learning and development resources employers expend in providing repeat induction. • Improve the consistency and standard of induction across the social care sector by aligning induction with the National Occupational Standards and SSSC Continuous Professional Learning framework. 501
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NORTH AYRSHIRE Health and Social Care Partnership Delivering care together OFFICIAL INFORMATION OFFICIAL INFORMATION • Faster onboarding of staff who have completed all or part of the National Induction. The benefit to staff: • Reduce the requirement for workers to repeat core induction learning when changing role. • Increase workers’ knowledge and confidence for their role. • Improve access to high quality learning resources. • Access to additional learning resources that support continuous professional learning. NES would like to amplify the benefits of the NIF by working with North Ayrshire HSCP to develop a strategic approach to the adoption of the NIF across public, independent and third sectors. Strategic Planning 6. Final Strategic Plan 2026-2030 The draft plan was presented to the group in September for agreement prior to going to consultation The final Priorities are: Strategic Priorities: 1. Supporting the Improvement of Population Health 2. Addressing the Changing Needs of an Ageing Population 3. Tackling the Root Causes of Health and Care Inequality Service delivery priorities: 1. Prevention 2. Community Based Services 3. Life Stages 4. Whole Person Approach 5. Accessibility and Communication 6. Evidence and Performance Online consultation on the plan was open from the 29th September to the 9th of November. It was only made available online because there was a requirement to have read the plan or at least have access to it in order to participate in the survey. The survey and a copy of the draft was hosted on the community planning partnership website, and it was advertised through our website and social media, through partners and partnership lists, and through staff newsletters. 502
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NORTH AYRSHIRE Health and Social Care Partnership Delivering care together OFFICIAL INFORMATION OFFICIAL INFORMATION 30 people took the survey, a positive result for consultation on a draft, we were aiming for a minimum of 20 since people are more interested in providing feedback that either ask general questions at the engagement stage, or give feedback on specific services but there is often little interest in consultation on high-level strategies such as this. 77% agreed with the approach to have both strategic priorities for future service delivery and service delivery priorities for immediate delivery. There was a minimum of 80% agreement across all priorities, but the 2 most popular in terms of agreement were for strategic priority 2: addressing the changing needs of an ageing population, and service delivery priority 2 community based services, both with 93% agreement. There were a number of changes made as a result of the consultation including some edits for clarity, the addition of a specific reference to dementia, further clarification of what is in the scope of the HSCP to deliver, particularly in relation to the strategic priorities, and some edits to the delivery activities. The Group was asked to choose a vision for the strategy based on the feedback received during the consultation. The vision has been in place since the very first strategic plan and the inception of the health and social care partnership, ca 10 years. 63% did feel as though the vision was an accurate reflection, 23% said they were unsure and 13% said it wasn’t an accurate reflection. Suggestions for the group were: 1. People in North Ayrshire are able to have a safe, healthy and active life (the current vision) 2. People in North Ayrshire have safe, healthy and active lives (simplified current vision) 3. People in North Ayrshire have safe, healthy and active lives with health and care services that meet their needs (considers comments re service delivery) 4. People in North Ayrshire have equal and fair access to sustainable health and care services within their own communities (incorporating suggested words) 5. North Ayrshire Health and Social Care Partnership works with our communities to ensure equity, access and care closer to home (incorporates partnership working) Other suggestions included inclusion, empowerment, participation, equal access to services, sustainability of services, individuality. Following discussion, the group chose the vision to be: “To empower people in North Ayrshire to live safe, healthy and active lives with fair and equal access to sustainable health and care services” 503
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NORTH AYRSHIRE Health and Social Care Partnership Delivering care together OFFICIAL INFORMATION OFFICIAL INFORMATION The Group was then asked to choose Values for the strategy/ HSCP based on consultation feedback. The current values are Care, Empathy and Respect. 60% said the they were an accurate reflection, 30% saying they were unsure and 10% saying they weren’t. Suggestions included equity and sustainability, in addition to existing values. Following discussion, the group chose the values to be: ‘Caring, Compassionate, Respectful, Inclusive’ Adjectives were chosen to allow for ‘we will be..’ statements. The Group agreed that once the vision and values were amended, they were in support of the Final Draft, which would be presented for approval to the IJB on the 11th December 2025. 7. Strategic Plan Delivery Plan 2026-2030 Seony Ross presented an early draft of the delivery plan to the group in order to seek feedback on its uses and what could strengthen it before a final copy would be brought to the group in February 2026. The strategic plan itself is a strategy; it outlines the demonstration of need as well as our priorities for delivery to meet those needs. So essentially the strategic plan outlines the what we need to do and the why we need to do it. The delivery plan is intended to be the how. The Strategic Plan outlines short- and medium-term activity to be achieved between 2026 and 2030. The delivery plan takes these activities and outlines the actions and teams that will support their delivery over the course of the plan. Not only is the delivery plan intended to outline our delivery over the next few years, it is intended to be a public document, which means we’re hoping to improve transparency with our communities and partners, by showing our intended activity, but it should also increase transparency among our staff. Many teams working across the HSCP won’t have an awareness of these more high-level goals, or even what is happening across different services, so it is hoped that the delivery plan can be made available across teams so there is increased awareness of all of the activity happening to deliver our strategic goals which may increase staff awareness of what's going on across the partnership. The other key purpose of the delivery plan is to guide the monitoring of the plan, both within the annual performance report, and within the Strategic Planning Group itself. Most of the meetings this year have been focussed on updates about the development of the refreshed strategic plan. The goal of having a delivery plan in place by February means that we as a group can also focus on the delivery of the plan and help guide our agendas and priorities as well. 504
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NORTH AYRSHIRE Health and Social Care Partnership Delivering care together OFFICIAL INFORMATION OFFICIAL INFORMATION The goal for having a complete suite of strategies and plans in place to really show our priorities and activities is the strategic plan to be in place for April, and the various enabling plans sitting underneath this that are either in place or to be updated, including the transformation plan, workforce plan, digital and data plan and the participation and engagement strategy. Then the delivery plan should encompass activity from all of these plans, outlining how they will be achieved. And then finally, we hope to be able to develop service plans which will outline more detail about the activity across the services. The Draft Delivery Plan has been to each of service for review. It is requested that the group also review the actions and think about where there is information missing from partners that could be included or referenced within the plan to help develop the full picture of delivery activity. The plan is to bring the final Delivery Plan back to Strategic Planning Group in February; however the Delivery Plan is intended to be a live document, unlike the strategic plan which is only reviewed every few years. Although a final version will be ready for February, it is imagined that we will have a review schedule, perhaps annual, to ensure the delivery plan is accurate and reflective of any budgetary or other changes. 8. Strategic Plan Draft Performance Indicators 2026-2030 Seony provided an overview of performance of the Strategic Plan, and a list of draft indicators were provided to the group. Performance monitoring is carried out quarterly to the performance and audit committee. This monitors the strategic priorities as set out in the 2022 to 2030 Strategic Plan against the National Outcomes. It monitors a set of strategic indicators and highlights where over the quarter there has been a decline or improvement, particular indicators that may need additional monitoring, and indicators that are consistently missing target. The rationale behind the quarterly reporting is to give the committee the opportunity to scrutinise performance and possibly highlight if there needs to be a review of resource or a service where performance is regularly low. We then have our Annual Performance Report which is a monitoring requirement of the Strategic Plan, to show how well the Strategic Plan is achieving what it set out to in relation to the national health and wellbeing outcomes, and an assessment of performance in relation to the strategic plan, as well as financial information, best value information and performance information in terms of localities. These are just our high-level reporting mechanisms, across our services we also have a number of national returns, often with overlapping reporting requirements. We have a number of Boards where performance is reported, such as for children’s services, child protection and justice. And we also 505
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NORTH AYRSHIRE Health and Social Care Partnership Delivering care together OFFICIAL INFORMATION OFFICIAL INFORMATION have a number of internal mechanisms for monitoring things like unmet need or other things that are reported through the services. We currently have an existing set of performance indicators that are mapped to the existing priorities outlined in the Caring Together Strategic Plan from 2022. The Strategic Planning team worked with the Performance team to realign these existing performance indicators to our new priorities, which is forming the starting point for developing a new set of indicators that will measure the priorities of the updated Strategic Plan. The services are currently reviewing the indicators measured across their service, either for national or internal reporting purposes, to consider what may be better measures. We are aiming to work with the services to develop a new set of indicators in the new year and will bring the final list of Performance Indicators, along with baseline information, aims and targets to the February Strategic Planning Group meeting and they will be in place for the delivery of the new Strategic Plan on the 1st of April 2026. This means the first Quarter to use the new indicators will be from April to June 2026, and the first APR aligned to the new indicators will be the following year in summer 2027. The goal over the course of the new strategic plan is to develop a wider Performance Management Framework which more centralises our performance monitoring. In the new year, we intend to develop locality plans and we will identify locality indicators for each plan, aligned to the priorities identified for each area. Following that, we plan to develop a new workforce plan, and with it a set of workforce indicators which will allow us to monitor resources across the partnership, and finally we want to develop service plans, and with that have more visible service indicators. The aim is to achieve this within the life of the refreshed strategic plan. 9. HSCP Draft Participation and Engagement Strategy 2026-2030 The Participation and Engagement strategy has been led by Rebecca Black from the strategic planning and equalities team, however Rebecca was unwell and so the paper was introduced by Seony Ross. The previous Participation and Engagement Strategy was in place from 2022 to 2025 and was aligned to the strategic priorities of Caring Together. It set out principles for engagement and some high-level actions to achieve over the course of the plan. To refresh the Strategy, a review of engagement policies and resources was carried out in order to align the strategy to the national guidance such as the standards of community engagement, Planning with People, and UNCRC, as well as the Community Planning Partnerships existing engagement framework. 506
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NORTH AYRSHIRE Health and Social Care Partnership Delivering care together OFFICIAL INFORMATION OFFICIAL INFORMATION The engagement reviewed as part of the Strategic Plan analysis was reviewed for gaps, strengths and opportunities, and was used to develop the action plan. The intention behind the new Participation and Engagement Strategy is that it supports the delivery of the refreshed Strategic Plan, ensuring we are monitoring who we are engaging with and targeted seldom heard or priority groups for delivering the Strategic Plan. Because our engagement resource is limited and there is rich engagement happening across the services already, the strategy is aligned to our 3 strategic Priorities and the action plan reflects the need for engagement focussed on these priorities. The strategy sets out our new principles of engagement which are • Build a Culture of Engagement • Strengthen Inclusive Engagement • Improve Communication and Feedback Loops • Enhance Locality-Based Engagement – • Increase Accessibility and Flexibility • Monitor, Evaluate and Improve The strategy contains an action plan aligned to these principles for 2026- 2030, which matches the life of the Strategic Plan. This strategy has been round services and is pending some edits, so we’re now also looking for any comments from Strategic Planning Group. The aim is to have the completed strategy ready for the February IJB to be in place for delivery in the new year, alongside the rest of the documents brought forward today. 10. Proposed Date of Meetings 2026 A survey was carried out at the end of 2024 to find the best time for the meetings to be held so the proposed dates are still in line with that, which is a Wednesday morning 4 times a year with 2 being held online, so the following dates are being proposed: • 25th Feb 2026 in person • 10th June 2026 online • 2nd September 2026 in person • 25th November 2026 online These were agreed so Laura will get them in the diary for next year. AOCB 11. - There was no other business to be discussed and the meeting was closed. Note from the chair that the next meeting will take place Wednesday 25th February, 10am – 12pm; in-person 507
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NORTH AYRSHIRE Health and Social Care Partnership Delivering care together Minutes of North Ayrshire Strategic Planning Group Meeting Held on Wednesday 25 February 2026, at 10am Via MS Teams Present: Councillor Chloe Robertson, Chair Joyce White, Vice Chair Alison Mcallister, Library & Information Services Manager, NAC Billy Brotherston, Independent Chair, NA ADP Fiona Comrie, KA Leisure Jennifer McGee, Policy & Community Planning Officer, NAC Katie Bell, Team Manager, Housing, NAC Lisa Davidson, Assistant Director Public Health, NHS AA Seony Ross, Team Manager, Strategic Planning & Equalities, NAHSCP Sharon Hackney, AHP Lead, NAHSCP Stuart MacMillan, Principal Manager, Planning, Performance, Transformation, NAHSCP Vicky Yuill, Chief Executive, Arran CVS Elizabeth Stewart, Head of Service Children, Families & Justice, NAHSCP Wendy Van Riet, Director of Psychological Services, NAHSCP Kerry Logan, Head of Service, Health & Community Care, NAHSCP Michael McLennan, Lead Officer ADP, NAHSCP Rebecca Black, Partnership Engagement Officer, NAHSCP Scott Hunter, Chief Social Work Officer Apologies Received: Betty Saunders, Senior Manager Contracts and Commissioning, NAHSCP Caroline Cameron, Director, NAHSCP Iain Jamieson, Clinical Director, North Ayrshire HSCP Nicola Teager, Communication & Engagement Officer, NAHSCP Roseanne Burns, Senior Manager Justice & Intervention, NAHSCP Thelma Bowers, Head of Service Mantal Health, NAHSCP Julie Barrett, Associate Nurse Director, NAHSCP Michelle Sutherland, Senior Manager, Primary Care & Communities NAHSCP 509
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NORTH AYRSHIRE Health and Social Care Partnership Delivering care together Item Item Action 1. Welcome and Introductions Councillor Chloe Robertson welcomed everyone to the meeting and apologies were noted as above. 2. Update from the Chair Councillor Chloe Robertson introduced the meeting and noted some key points of interest and ongoing activity for the group’s awareness, including: - Council budget is being set today which will determine the HSCP Budget for 26/27. The integration joint board must balance the 25/26 budget by 13th March. - NHSAA is going in front of a public audit committee - Caroline Cameron has arranged meetings with public ministers to request more funding for NAHSCP. - We are about to enter the pre-election period. 3. Minutes of the meeting held on 26th November 2025 The minutes of the meeting held on the 26th of November 2025 were agreed as an accurate reflection of discussion. Strategic Planning 4. Strategic Plan Delivery and Monitoring Plan 2026-2030 Seony tabled the paper for the group’s information and noted the refreshed Strategic Plan was agreed by the IJB on the 11th of December 2025, with the updated priorities and actions in place from the 1st of April 2025. The Delivery Plan will be made publicly available alongside the Strategic Plan with the aim of increasing transparency about the work of the HSCP, and how services will be delivered. There are 3 new strategic priorities which will form workstreams aiming to understand how the HSCP may need to change its services based on changing demand, and will be delivered through 2026/27: 1. Supporting the Improvement of Population Health 2. Addressing the Changing Needs of an Ageing Population 3. Tackling the Root Causes of Health and Care Inequality The Strategic Planning and Equalities team will work with Public Health Scotland LIST analysts to develop and deliver these workstreams. The data collected via this process will inform the next iteration of the Transformation Plan. The Delivery Plan details how the HSCP will achieve the noted delivery activity, which corresponds to each of the 6 priorities: 1. Prevention 2. Community-based services 510
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NORTH AYRSHIRE Health and Social Care Partnership Delivering care together 3. Life stages 4. Whole person approach 5. Accessibility and communication 6. Evidence and performance The group noted the paper and agreed to approve the Delivery and Monitoring Plan and agreed to support further development and delivery of this. 5. Housing Contribution Statement and Shared outcomes with Housing Seony tabled the paper for the group’s information and noted this presents the Housing Contribution Statement (HCS) which accompanies the Strategic Plan for 2026-2030 and will be published on the HSCP website alongside the Strategic Plan. The HCS outlines key challenges for particular client groups and outlines housing for particular needs, including: - Older people - Physical disabilities - Children and young people - Homelessness - Refugees - Gypsy/ traveller - Justice - Dementia - Mental health Some key achievements were also noted, for example: - Through the Brighter Pathways group, housing has redrafted the “Housing and Care Leaver Protocol”. From April 2024 to end March 2025, 14 tenancies were allocated to individuals who are in receipt of continued care through the Local Authority. - North Ayrshire Council has established the Arran Housing Task Force to quantify demand for affordable housing on Arran and to assess the future housing need and demand of our island residents, workers, and key workers. - A number of Sheltered Housing units have been refurbished in recent years, including Barnett Court in Saltcoats and Cheviot Court in Irvine. Refurbishment will continue in 2026 in Vineburgh Court in Irvine and Laigh Court in Beith. It was noted that the shared outcomes were agreed by the IJB on the 11th December 2025, via the refreshed Strategic Plan. 511
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NORTH AYRSHIRE Health and Social Care Partnership Delivering care together The group were happy to agree the HCS and will continue to support and monitor this going forward. 6. Developing Locality Plans Rebecca delivered a presentation and noted work is planned to develop 6 locality plans by the end of the 2026/27 year. A pilot locality plan will be developed in one area which will allow for the approach to be tested, ensure the resources are sufficient, and enable the SPG and partners to influence how the plan is developed before it is replicated in the other localities. Data from 2024 will be updated to identify key challenges for the Three Towns, with a single data update document produced. Learning will be summarised from the Locality Conversations and other engagement activity, and a short policy review will be carried out to ensure relevant plans for the area are reflected. Services available within the locality will then be mapped, including HSCP, partner organisations and community partners, and the team will meet with locality service managers to understand key operational issues and insights relating to service delivery. The team will then produce a draft outline of priorities for each service area, with a locality forum engagement session held to gather feedback, identify any final insights and support the development of actions. Under the new proposed arrangements, locality leads would continue to represent their localities but as members of the CPP Locality Partnership, as opposed to the previous model of Locality Planning Review Groups. The SPG will retain oversight and continue to receive updates on progress. Locality Planning Presentation 25 Feb 2 Group Planning 7. Draft Terms of Reference The Strategic Planning Group Terms of Reference (2026-2030) was agreed by the group. 8. Discussion regarding plan for year The Strategic Planning Group plan for the year was noted and agreed by the group. Suggestions for future agenda items include: - Children’s Services Plan - Homecare Strategy RB to invite reps to present 512
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NORTH AYRSHIRE Health and Social Care Partnership Delivering care together - Pan-Ayrshire Palliative Strategic Group - Update on CHES - Child Poverty Plan It was noted that the SPG is for more than just providing updates to members, but allowing them the opportunities to contribute. September’s agenda includes: - Biannual Locality Planning Update - ADP Strategy - Carer’s Strategy Close 9. Date of meetings – 2026 The dates for the 2026 meetings were agreed by the group: - 10th June 2026 (in person) - 2nd September 2026 (in person) - 25th November 2025 (online) 10. AOB Hazel Brown will replace Vicki Yuill to represent the TSI. Invite Hazel to future SPG meetings 513